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HomeMy WebLinkAboutBuilding Permit #166-14 - 219 FRENCH FARM ROAD 8/21/2013 Ar tORT1► BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINAT iL 1 ra^ Permit NO:*k Date Received 21 1 " 4,'�:�a ,+ Too Date Issued: (J �sSACNus IMPORTANT: Applicant must complete all items on this page LOCATION21 q FP-eJVCH F4zm -b -t- Print __ ! PROPERTY OWNERUSTIIJ 9 A\I&S Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesnn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two or more family 0 Industrial ❑Alteration No. of units: ❑ Commercial )(Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: JVST/tJ NAIES Phone: Address: 20 q F1?L-Aio4 IG'A104 RD Ai- Am-D vcp, CONTRACTOR Name: DISQZeAJ HA4ThV4 Phone: q*18 — qQZ-316 Address: 4ll ADD/JcW A & EXT. 06T#Uek)1tY1A 0/141y Supervisors Construction License: Exp. Date: 0-45--15- Home -s1 15-Home Improvement License: ay Exp. Date: q--1 y — 3 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. Total Project Cost: $ ��� 6 Q O FEE. $ L[ Check No.: Receipt No.: NOTE: Persons co racdng with unregistered contractors do not have acc th guar my fund `gnature of Agent/Owner Signature of contra r i Location �"1y No. - JV Date i • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� t I i Foundation Permit Fee $ Other Permit Fee $ TOTAL . $ I Check# � i. i r � r r" 6 7 v 4 Building Inspector Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF-SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ 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 COMMENTS HEALTH Reviewed on -Signature �I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes p Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tocho Engineer: Signature: Located 384 Osgood Street EIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Mair, Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of dieter location, mast or service drop requires approval of i 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 ® Notified for pickup - Date Doc.Building Permit Revised 2010 J - Building Department i The following is-a list of the required forms to be filled out for the appropriate permit to be obtained. Roofirg, 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 ❑ 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) ❑ Mass 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) ❑ 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 In 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 apuaal 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 Doc: Doc.Buhding Permit Revised 2012 . Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 345600.00 m $ - $ 415.20 Plumbing Fee $ 51.90 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 51.90 Total fees collected $ 619.00 219 French Farm Road 166-14 on 8/21/13 Bathroom Remodel NORTH Town o '� ndover O "� . to No. _ to wI Z o - h , ver, Mass, 1 coc"Ic Nl WIck �i4 A�R'1TE0 S S U BOARD OF HEALTH Food/Kitchen PERMIT .T L D Septic System THIS CERTIFIES THAT ..... ! +,............ ............ .. .. ... .......................................... BUILDING INSPECTOR Foundation has permission to erect .. ........... .......... buildings on ..��. ........ L....Rrr.%,..J2ok * ....................................................................... Rough to be occupied as ........ .... .... ........ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 qjr% PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC T S Rough Service ............ .... ..... ................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/MassageBody Art ❑ Well ❑ 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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date Y- COMMENTS ClIx The Commonwealth of Massachuseth 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 Legibly Name (Business/Organization/Individual): DAMEAt MARS11A) - Address: 4Y A`j DI Soo Av6- ii��a City/State/Zip: ft_T�040v, /Y,'- 6 f tf Phone#: lor6 f 5---36-3"7 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 2.X I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp. insurance.: 9. E]Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑Other employees. [No workers' 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 state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: -'� Phone 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 Person: Phone#: Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor .License: CS-066342 DARREN MARTI o �� 1 44 ADDISON AVE EX7T ry METHUEN MA 81844 Expiration Commissioner 08/15/2015 ofriceTo*onsumer A airs&BVines� aho HOME IMPROVEMENT CONTRACTOR Registration: ;,,124961 Type: Expiration: :9/17/2013 Individual TMEN Darren MARTINO ', 7-: 44 ADDISON AVE.EXT ' METHUEN,MA 01844-.."-,' Undersecretarye DM Construction Building with the QUALITY and Character of yesteryear. 44 Addison Ave Ext. Methuen, MA 01844 (978) 685-3037 Estimate Submitted To: Construction Supervisors License 66342 Justin&Jody Hayes Home Improvement Registration 124961 219 French Farm Rd. N.Andover,MA We hereby purpose to furnish the materials indicated and perform the labor necessary for the completion of: Renovation of master bathroom (See specifications sheet& drawings) All material is guaranteed to be as specified,and the above work to be performed in accordance -with the drawings and specifications submitted for above work and completion in a substantial workmanlike manner in the sum of. Thirty-four thousand six hundred dollars- $34,600.00 Payments to be made as follows: $1,000.00 Upon execution of the contract. $5,000.00 When work begins Remaining payments as work progresses. Respectfully submitted: Darren Martino Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon accidents,or delays beyond our control. Note-This proposal may be withdrawn if not accepted within 10 days. Proposal Date 07/23/13 ACCEPTANCE OF PROPOSAL The above prices, specifications,and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date: Signature:_ Qi1i�-C Date: Signature: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 1JILDING DEPT. CQP S. 1 HA YES RESIDENCE Specifications Sheet Scope of work:Renovation of master bathroom. PERMITTING DMConstruction is responsible for obtaining the following permits required: building, plumbing, electrical, and debris removal. The cost of all permits necessary is not included in this estimate and will be billed separately. DEBRIS REMOVAL DMConstruction is responsible for all debris generated. A container will be placed on site to ensure a clean work site. The container is for debris generated by DMConstruction only; it is not intended for homeowner use. SITE PREP In an effort to limit the dust generated from the renovation process. Doorways and openings to other areas of the house will be sealed off within reason with plastic or drop clothes. Drop clothes will be used to protect floor surfaces. DEMOLITION The existing master bathroom will be completely gutted to the studs including: fixtures, drywall, insulation,flooring, with the exception of the one exterior wall. The drywall, insulation, heating element, window, and window trim on this wall will remain as is. FRAMING Framing to take place according to submitted drawings. Framing for a new custom shower. Installation of blocking for cabinetry and accessories. INSULATION Insulation will be installed between bathrooms for soundproofing purposes. The insulation in the exterior wall and ceilings will remain as is. DRYWALL The ceiling and all the walls will have %Z"blue board installed with a plaster skim coat. Ceiling will receive a smooth finish. Patch in and plaster areas in master closet that were removed to dry out walls. FINISH WORK Installation of two new doors on the bathroom and master closet w/casing to match the new window casing detail. Installation of baseboard trim. Installation of 3 %"crown molding in the bathroom. PAINTING The ceiling and all the walls will receive a primer and two coats of finish. All new trim will receive a primer and two coats of finish. All paint colors to be determined. Paint will be Benjamin Moore or an equivalent. HVAC DMConstruction will provide proper venting for the exhaust fan. HA YES RESIDENCE Specifications Sheet CABINETR Y INSTALLA TION DM Construction will install all cabinetry, vanities, and their associated moldings and hardware. The cost of the cabinets, moldings, vanities, and their associated hardware is covered under the bathroom fixtures allowance. TILE SETTING DM Construction will install the/marble on the floor in the bathroom. Dura-rock subflooring will be installed under the tile. DM Construction will install the/marble on the shower walls and shower floor. The shower floor will beset in cement. The shower walls will receive %"dense shield wall board, with all joints receiving a waterproof membrane. This contract includes standard the installation. If any patterns, designs, or feature strips are involved, this may incur extra costs. The cost of the the/marble, grout, corner shelves, seats, niches, and any enhancers or sealers is covered under the TilelMarble allowance. PLUMBING Provisions for drain lines, water lines, and vents for the following futures: one toilet(at its existing location), one sink(on the same wall as existing), and one custom shower. The new shower valve will be installed on the opposite side as current. The custom shower will have a copper pan, a built in seat, one main shower head, and one hand shower. All drains and vents will be in pvc. All water lines will be done in copper. All plumbing fixtures including: toilets, sinks,faucets, shower valves, copper pans, shower heads, shower enclosures, etc. are covered under the bathroom fixtures allowance. ELECTRICAL Demolition of existing wiring and futures as necessary. Installation of new switches, receptacles, and wiring as necessary. Provide and install one recess light in the shower and one recess light over the toilet. Install/vent one exhaust fan. Relocate switch for exterior spot light. Provisions for one or two vanity lights. (Vanity lights to be purchased and provided by the homeowner.) CUSTOM SHOWER A curb and seat or just a seat will be framed for a custom shower according to the submitted drawings. Dense shield wall board will be installed on the walls of the custom shower. A copper pan will be installed as the shower base. All dense shield seams, corners, seat, and the curb will have a waterproofing membrane applied ACCESSORIES DM Construction will install all accessories (robe hooks, towel bars, etc.),provided that the homeowner supplies them before the project is complete. If accessories are selected before drywall is installed, solid blocking will be installed to ensure proper fastening. HA YES RESIDENCE ALLOWANCES The following allowances are included in this estimate. The allowances exist to cover the purchase to materials only, unless otherwise specified. Any amount in excess of an allowance will incur extra cost. Any amount less than the allowance will warrant a credit. Upon completion of the project any extra cost or credits will be issued. Bathroom Fixtures-$12,500.00 This allowance covers the cost of all bathroom fixtures including, but not limited to: faucets, toilets,pedestal sinks, bathroom sinks, bathroom faucets, matching shutoffs, copper pans, tubs, valves, shower enclosures, vanities, linen cabinets, built ins, countertops, steam generators, accessories, etc. Tile/Marble-$2,500.00 This allowance covers the cost of all tile, marble, thresholds, corner shelves, grout, enhancers, sealers, slab for bench, etc. MISCELLANEOUS Note: Due to the nature of wood and plastic and the drastic temperature and humidity changes in our region,you may notice the movement and shrinking of the interior and exterior trim. This is typical of the region and is not due to defective installation. Change Orders Any changes from the existing plans or increased scope of work involving extra costs will become an extra charge over and above the contract price Change order agreements must be signed before any work commences The following schedule will be adhered to, unless circumstances beyond our control arise: Time frame for completion:From the date demolition begins to project completion 5-7 weeks* *Contingent upon lead time of shower enclosure. All work to be done Monday-Friday between the hours of 7:00 am-6:00 pm. If deemed necessary to work any other times, the homeowner will be consulted first. MEMBER OF THE BETTER BUSINESS BUREAU HOME IMPROVEMENT CONTRACTOR: 124961* CONSTRUCTIONSUPERVISOR LICENSE: CS 066342 *All home improvement contractors and subcontractors shall be registered Any inquiries about a contractor or subcontractor relating to registration shall be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Boston,MA 02113 Phone: (617) 973-8700 mc:i M� UD-) L9?)- I I DMCODStrucaon Building with the QUALITY and Character of yesteryear. 44 Addison Ave Ext. Methuen, MA 01844 (978) 685-3037 NOTICE OF CANCELLATION 07/23/13 You may cancel this transaction,without any penalty or obligation,within three business days from the above date. If you cancel,any property traded in,any payments made by you under the agreement,and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice,and any security interest arising out of the transaction will be cancelled If you cancel,you must make available to the seller at your residence, in substantially as good condition as when received,any goods delivered to you under this agreement;or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller,or if you agree to return the goods to the seller and fail to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice to: NAME OF SELLER: DARRENMARTINO ADDRESS: 44 ADDISONAVE EXT METHUEN,MA 01844 NOT LATER THANMIDNIGHT OF: April 2, 2012 1 HEREBY CANCEL THIS TRANSCA TION Date.- Buyer's ate:Buyer's Signature: I I(we each)acknowledge receipt of two copies of this form. Buyer: _ �u rv� ��(( Buyer: I�� DM Construction Building with the QUALITY and Character of yesteryear. 44 Addison Ave Ext. Methuen, MA 01844 (978) 685-3037 CONTRACTOR ARBTTRATAION AGREEMENT The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor however. The contractor would have to resolve any 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(Darren Martino)and the Homeowner(Justin & Jody Hayes) 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 approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A. Homeowner's Signatu Co actors Signature Homeowner's Signature ITx,MN D+ '. rte' 2 ■ e■ M ON M momil MEMO ON M MEN millilm IMME ME IN ONE 1IIIMMMENEM mmoom MEMO ME ME No INNINOME III No MEN ommomm ON No M M ME No CME ONMEMENNEENEEM M No pMEMMEM M No III No :i . vim 8ON MMMEEN ME M mom No No n■r■MME■■Mmiwm�iii C 0 0 0 o O0 0 0 0 0 L- LL= I 1 0 0 Note:This drawing is an artistic Designed: 8/5 interpretation of the general recO ioGiEs L, Printed: 8/7/2 appearance of the design. It is not meant to be an exact rendition. Jody Hayes Master Bath 5.kit All Drawin Client#:968806 DARREMAR2 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/13/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(fes)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: Ginger MarSZalek USI Insurance Services SLC-SCI. ,800-403-4159413-733.7722 ac No PO Box 406 AD"AIL ginger.marsZalek@usi.biz Portland,ME 04112-0406 INSURER(S)AFFORDING COVERAGE NAIC s INSURERA:Nautilus Insurance Company 17370 INSURED INSURER 8: Darren Martino dba D M Construction INSURER C: 44 Adison Ave Ext INSURER D: Methuen,MA 01844 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UB POLICY EFF POLICY P LIMITS LTR INS POLICY NUMBER MMI IC MM/DO A GENERAL LIABILITY NN26O323 9/21/2012 09/21/201 -EACH ppOEECCURRRRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurr0enoe $100,000 CLAIMS-MADE �OCCUR MED EXP(An one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY jRa 0 LOC $ AUTOMOBILE LIABILITY FOMB deMSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per acadeM) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acc dent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ T WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LJABILnYDRYFR ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS be EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more apace is required) CERTIFICATE HOLDER CANCELLATION Justin Hayes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 219 French Farm Road ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #SI06O4553/M9718273 VAMCX