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Home My WebLink AboutBuilding Permit #404-2011 - 2189 SALEM STREET 11/12/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: D a�/ Date Received �, d Date Issued: IMPORTANT: Applicant must complete all items on this page C , LOCATION 21 ? Print PROPERTY OWNER ( (�'� lal Print MAP NOb�(1, O PARCEL:0 `� ZONING DISTRICT: Historic District yes of Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition _ 11Two or more family ❑ Industrial w ❑Alteration No. of units: ' ❑ Commercial @,Kepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i ® ept`ca ®.Wella n F?lodp 1®�Wetl nds;, 13 shemsttf, �,.. -,�� DESCRIPTION OF WORK TO BE PERFORMED: Q AA b entificaf n Plea OWNER: Name: se Type or Print Clearly) Lf 3�? . i � � Phone(970 Address: 7 CONTRACTOR Name: C Phone: l ��---��f 3 3 3 ; Address: 4AMP Supervisor's Construction License: L► 1> Exp. Date: Home Improvement License: ( 692-7S- Exp. Date: 2— ARCH ITECT/ENGI NEER ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. j Total Project Cost: $ "7 (0 oo . 6-6 FEE: $ Check No.: aZ2 Receipt No.: NOTE: Persons contracting tivith unregistered contractors do not have ace to the guaranty f d Signature�ofAgent/Owner" I nature_gfcontractor .. . 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [Well YPE OF SEWERAGE DISPOSAL ublic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ``Conservation Decision: Comments ' I Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 1 FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street " ' Fire Department signature/date p COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: - ELECTRICAL. Movement of Meter location mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use i I El Notified for pickup - Date Doc:.Building Permit Revised 2008 . i Building Department The following is a list of the required forms to be filled out for theappropriate ermit to be obtained. p Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy'of Contract ❑ - Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application '❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ` ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Muss check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) a '❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Yn all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe: Doc.Building Permit Revised 2008mi Location a ��! No. 7 �1— lD// Date �ORTM TOWN OF NORTH ANDOVER 3? • O O L F � 9 Certificate of Occupancy $ MuBuilding /Frame/Frame Permit Fee $ s,ksE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - Check # 236b8 /4 Z, ,Vuilding Inspector 4 Massachusetts Rome ImpY'ovement Sample Contract This form satisfies all basic requirements of the state's Home Impmvement Contractor Law(MGL chapter 142A),but does not Include standard language to protect homeowners. Seek Legal advice if necessary. Any person plarming]tome improvements should first obtain a copy of"a Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8767 or 1488-283-3757. Homeowner Information Contractor Information Name ompany Name Street Address(do not use a Post Office Box address) Contrrctorl Salesperson/Owner Name C C ity /town State nZip Code / usiness Address(must include a street address) Th_ PC— AVytime Pbope Evening Phone 1,grFovrn State Zip Code 7, ,( - z -Irsn A'� 4 D2 SZ Mailing Address at different from above) Business Pbon - ederal EmployerM or S.S.Number Law requnres that mon home un- Home provemenlContractor seg.Number Expiration due prawmeut eomnetors have a Gd 'I I avicomtia.,ber The Contractor agrees to do th'e"following work for the Homeo ner:(besZ � V . m e m a r o comp e e specifying e e, r , j �e o m n s o e e on ece s ve {.n c �iLA CLS 41�. SVS; Required.Permits-The following.4uilding permits are required Proposed Start and Completion'Schedule-The following schedule will and vyill be secured by the contractor as the bomeownees agent, be.adhered to unless circumstances beyond the contractot s control arise (Ovtlners who secure their own permits will be exclilded from•the Guaranty Fund provisions of 10 I Date when contractor will begin contracted work MGL chapter 142A.)' Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule ' The Contractor agrees-to perform the work,fiirnish the material and labor specified above for the total sum of (*) Paynienits will be made according to the following schedule: S upon signing contract(riot to exceed 1/3 of the'total contract price or the cost of'special order items,whichever is greater) $22�6� by /�/� orupon compledonrof S2" Eoa by —/_/_"or upon completion of IF upon completion of the contract. (Law forbids demanding full-payment until contract is completed-to-both,party's satisfaction)— The following material/equipment must be special $ '— to be paid for t— ordered before the contracted work'begins in order S to be paid for to meet the completion schedule.(**) NOTES:(*)Including all finance charges(**)Law requires that any depositor down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered-in advance to meet the completion schedule; Express Warrant Is an express warrnryty beine Provided by the cuntractor? No Yesfall terms of the warranty must be attached to the contract] Subebutractors-The-contractor agrees to be solely responsible for coutpletion of the work described regardless of the actions of any third paity(&ubcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • ' fvlake sure the contractor has a valid Home Improvement Contractor R.et+istr'etion The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Inforinatioln on the reverse side of this form and gets copy of the Consumer Guide to the Home.Improvement Contractor Law. You may cancel this agreement if it has been signed at a platie otiiier than the contractor's.normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following.the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IP T11ERE ARE ANY BLANK SPACES!!! Two identical copies of thc-contract must be completed and signed One copy should go to. 'hofneowner.The other copy should be kept b the contractor. ;t s Homeowner's Signa re Contractor's Signature Date tl Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with-the right to initiate an arbitration action(as an . alternative to.coun action)if they have a dispute"with a contract contractor,however. The contractor would have.to resolve any or. The same right is not automatically afforde� to a' dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as�is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in'the event the contractor has a dispute, concerning this-contract,the contractor may submit the dispute to a private arbitration firm which has been apprpved,by the Secretary,of the•Executive Office.of Consumer Affairs and Business Regulation and the consumer all.be required to submit to such arbitration-as provided In Massachusetts General Law hapter 142A. Homeowner`s Signa re Contractor's Sign re NOTICE: The si a s of the parties above apply only to the agreement of the parties.to alternative dispute resolution initiated by the con ctor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights ; A homeowner's rights under the Home Improvement'Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A).may not be waived in any way,.even by agreement* homeowners may be excluded from certain rights if the contractor'they choose is not properly registered as prescribed by law, Homeowners who secure their own building permits are automatically,excluded from all Guaranty-Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled'to other specific regal rights:if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties pro tees the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose,' An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the term's of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions!about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract ,. The contract must be executed in du licate doe' and should not;be signed until.a copy of all exhibits and referenced ments have been.attached. Parties are-also advised not to sign the document until all'blank sections have been filled in or marked as'yoid, deleted,or not applicable. One original signed copy of the contract with attachments'is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be nt writing p and agreed to by both arties. Contracted work may not begin until both parties have received a fully executed co v of the contract,.and the three day recission period has expired. p_ Accelerated Payments contractor may not demand'payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him herself to be financially insecure. However,•in instances where a contractor deems hhn i:erself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work, Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or of consumer rights,or#f you wish to obtain a free copy of "A Consumer Guide.to the Home Improvement Contraetorr Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business'Regulatioa .10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787or 1-(888)2833757 Ifyou want to verify the registration of a contractor or if you hate questions or Ile about the contractor registration component of.the Home-Improvement Contractor ed additional information specifically tractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards ! One-Ashburton Place, Room.1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes,or tole register formal complaints against a business,call: Consumer Complaint Section Office of the,&ttorney General ; (617) 727-8400 AND/OR -Better Business Bureau (508)652-4800 .(508)755-2548 (413)734-3114 ORTH TONM of OAndover No. 70 � O COCKICMEWICK LAKE O � dower, 1Vlass., / 0 �� 7,9 Ad RATED `SS BOARD OF HEALTH Food/Kitchen Septic System .PERM IT T BUILDING INSPECTOR THIS CERTIFIES THAT.... .....Sll.l..:1 '.......................................................................................................... Foundation n g � ....3. 6 o' ...5�............................... Rough has permission to erect.........:.............................. buildings ,,,��.......yl�'. �.c. C e to be occupied as...........:......................S /!i��.. .... '..1.� 1?. ............................................................................ himn y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations'Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ............ ........................ B DING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor D Wall To Be Done � FIRE DEPARTMENT _. Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. I'tassachusetts- Department of Public Safet� Board of Building Reaulations and Standards Construction Supervisor License License: CS 84391 MICHAEL MCDUFFEE fo. .63 WALDEN ST WINTHROP, MA 02152 -- ` Expiration: 11/17/2012 Commissioner Tr#: 4699 w All COMMERCIAL & RESIDENTIAL T T ROOFING SPECIALISTS COROLLACustomer Satisfaction Is Our First P ority ROOFING ]5 BATES . MA 1'H. (617)561-1333 WINTHROPMA 02152 FAx;(617)561-4726 wWW.COROLLAROOFINO.COM SALE54PCOROLLAR00FINO-COM Proposal Submitted to. Ed Stunner April 22,2010 2189 Salem Street North Andover,MA, 01845 Work To Be Performed At: (same) We hereby propose to furnish all the materials and perform all the labor necessary for the completion of 1. At the main roof and the teat sun porch roof-Strip and remove the existing shingles& flashings down to wood deck. Remove 6 box vents and install plywood in the openings. 2. Replace any damaged or rotted wood deck at a unit cost of$3.50 per foot Re-secure any loose deck boards. 3. Install new 8"white aluminum drip edge at all outside perimeters. 4. Install Ice&Water Shield at the eaves, and along the side wall.Install new 15 lb. underlayment over the remainder of the wood deck. 5. Install new 30-year architectural-style shingles,and flash the chimney and vent pipe_ Install new ridge vent at the peak. Install a new bathroom vent at the rear section. 6. Clean and remove all debris caused by the above work from the property. 7. Proposal includes contractor's 5-year warranty on workmanship and a 30-year warranty on shingles. Price includes obtaining building permit from the Town 1,10. All materials are guaranteed to be as specified and the above work to be completed in a workmanlike manner for the sum of, $7,600.00 (Seven thousand six hundred dollars) With payments to be made as follows: 113—When work begins 1/3—when work is half complete 1/3—when 100%complete NOTE--ke-roofing operation may cause dust/debris to fall into attic space and precautions should be taken. Respectfully Submitted: Robert J.Corolla Jr.,President Note-This Proposal may be withdraws,by us if not accepted within 30-days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date: Signature_ `Lrel.-r}C- 116-d 10/10'd ZOZ-1 51E016E1811 8004 051140-A04:1 ZZ:80 01-1Z-d3S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Lel4ibly C� t14 Name (Business/Organization/Individual): Address: [ (3 A Ve- City/State/Zip: /Q ®ZC S�,phone#: (6-17 i Are yo n employer?Check'the appropriate box: Type of project(required): l. am a employer with s� 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t EJ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g. E]Building addition [No workers' comp.insurance 5• El We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.EJ Plumbing repairs or additions myself t o workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs y t employees.[No workers' insurance required.] 13.❑Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. I r Insurance Company Name:. Y-►�✓l4–ll yIMC►A / l f'r— TASl/rLtUlCp Expiration Date: Policy#or Self-ins.Lic.#._ ( DO p Job Site Address: ( SA > c JVD ' City/State/Zip: 1�{/r 01 D, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb c rtify under the ai s nd pen 'es of erjury that the information provided above is true and correct. _t e:-- > Dat Si nature: 44 Phone#: J� Official use only. Do not write in this area,to be..completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other- Contact therContact Person: Phone#: r�S•rchuscttx_ �,p Board 01'Buildin., Partin cnt ref Public$atiq, Construction gRc�;ulation•�: Stan Lice Pervisor + d dar'd.� nse: CS 84391 License MICHAEL MCD 63 WALDEN ST UFFEE ^� WINTHROP, MA 0 2152 Conn,Z011cr _ EXPiration. 1171.g Tr#. 4699 �`�_ 11/09/2010 TUE 12:30 FAX 617 561 4726 Corolla Contracting Inc 2003/004 2010/11./09 12 :19 : 53 2 /3 ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYM/J ra 11/0912010 PRODUCER (800)666-0200 FAX (781)261-1111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Croup LLC - Main ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 77 Accord Park Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. unit B1 Norwell, MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED Corolla Contracting, Inc INsuHtNA: Max Special ty .Insurance Co 15 Bates Avenue IN;URFR B- Commerce Insurance Company 3_4_754 Winthrop, MA 02152 INSURCR c. National Union Fire Ins Co PA' INSURER D: - INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR D'L TYPE OF INSURANCE POLICYNUMBER DPOLICY F=FFmwr-ATE MMM GATE Wbb 71'OlJ LIMITS LTR NSR GENERAL LIAMLrrY MAX2GL0000791 06109/2010 0610912012 CACII OCCURRCNCE $ 1,000,006 DA>vwGt r61e FE $ S0,00 X COMMERCIAL GENERAL,LIA13II.ITY PREMISES EOCcurrenco CLAIMS MADE FX-1 OCCUR MED EXP(Any one person) $ 5,00C A PERSONAL R ADV INJURY $ 1,000,00f --------._., --._ GEN)'kAI-a.GGRFCaTE $ 2,000,00 GENT,AGGREGATE LIMIT APPLIES PER. PRODUCTS-COME'/OP AGG 5 2,000,00( POLICYFX7 PELT M LOC AUTOMOBILE LIABILITY 10XMBCMHJD 0512712010 0512712022 - COMBINED SINGLE LIMIT $ ANY AUTO (Ea ecci&nL) 2,000,000 ALL OWNED AUT06 BODILY INJURY 3 X 'SCHEDULED AUTOS (Pr,pa'YOn) 8 X HIRED AUTOS DODILY INJURY $ X NON-OWNED AUTOS IPcr dccidcrd) PROPMTY DAMAGE $ /Per occident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AITO tA,ACC OTHER THAN AUTO ONLY: PSCC $ EXCE913IUM6RE1-1-ALIAAlLTrV MAX24CL0000791XL 0610912010 06/0912011 EACH OCCURRENCE S 51000,00 --k]OCCUR CLAIMS MADE AGGREGATE $ 5,000,006 A $ DrDUCTIDLC $ X RETENTION $ 10,00 $ WORKERS COMPENSATION W0006893966 01 18/2020 02 18/2013 Xjurl AND EMPLOYERS'LIABILITY Y/N TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E L rAC1 I ACCIDENT $ 50000 C OFFICCRJMEMBER EXCLUDED? -- -- (Mandatory In NHL E.L.DISEASE-PA EMPLOYEE $ 50000 It yes.describe undLv — SPECIAL PROVISION$nalo E.L.DISCASC-POLICY LIMB I S 50000 07HER DESCRIPTION OF aPERATIONS 1 LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SP ECTAL PROVISIONS oofing at 2189 Salem St., North Andover, MA Ed Skinner is named as Additional Insured as respects to General Liability as required y written contract- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCROED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 . DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,IT9 AGENTS OR Ed Skinner REPRESENTATIVES. 2289 Salem St. AUTHORIZED REPRESENTATNE North Andover, MA 01845 Ronald Cleaves/SEW2 ACORD 25(2009/01) O 1988-2009 ACORD CORPORATION. All rights reserved. I The ACORD name and logo are registered marks of ACORD 11/09/2010 TUE 12:30 FAX 617 5614726 Corolla Contracting Inc 002/004 Office of Consumer Affairs-and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachpsetts 02116 Home improvement (f, :.,4ptor Registration Registration: 109275 Type: Private Corporation ✓_ 'r —`"� 9/8/2012 Tr# 202738 I "' ,^ (�.�• Expiration; COROLLA CONTRACTING, INC. Robert Corolla, Jr. ! i•.; 15 BATES AVE i'I WINTHROP, MA 02152 ,) 9P • fir;, :�,._� /W� .. Update Address and return card.Mark reason for 62 �•--�' DPS-CAI 0 SOM-04104-0Address [] Renewal ( j Employment U Los 1,0{1219 c)[fice�l Co mer i`a`ersli7sin � euia`f o License or registration valid for individul use only NOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ,,x09275 Type: Office of Consumer Affairs and Business Regulation Expiration: _Qjk/ 12 Private Corporation 10 Park Plaza_Suite 5170 Boston MA 02116 k!S;6'jLLA CONTR.# Al ::1N ��'i Robert Corolla,jr;' 15 BATES AVE ti WINTHROP,MA 021 - i,_%"� Undersecretary Not valid without signature I I I I I