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Home My WebLink AboutBuilding Permit #Exception - 22 HARKAWAY ROAD 5/1/2018 (3) i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ' Date Issued: IMPORTANT: Applicant must complete all items on this page • LOCATION � x Print PROPERTY OWNER NJc>1C-Gy en-e— / Print _ 100 Year Old Structure yes no MAP NO: 9/,<LPARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT. PROPOSED USE i Residential Non- Residential ❑ New Building ❑ One family (Addition C"Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer 1 DESCRIPTION OF WORK TO BE PERFORMED: x 1�� MUD Identification Please Type or Print Clearly) OWNER: Name: 60,1 — j Phone: - �? —x'35 Address: 22 ktac k c vju R�> CONTRACTOR 'Name: N 1 6C. Phone: q-1 ? l01 U Address: PD NX 132- ' _ Su ervisors Construction License: / Supervisor's �Z-u11� Exp. Date: �-- Home Improvement License:===Q55`4 Exp. Date: ( ARCHITECT GINEER �I�p�V ,�" >�sut_�ihi� Phone: 9_12) 3ZZt Address: 1 L qS'T 4 0fX Nq(.,L &A-efhueA_) MOI Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 10, 3 20`� FEE: $ Check No.: Receipt No.: NOTE: .Persons contracting with unregister d contractors do not have access to the guarantyfund Situreof Agent/Owner �> >�t ure of contractor gna — i Plans Submitted Plans Waived EY Certified Plot Plan ❑ Stampe Plans ❑ r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF;.:SEWER-A DiSP_OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. =permanent Diunpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATEAPPR-OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature 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 Water & Sewer Connection lSignature Date Driveway Permit DPW Tmv;� Engineer: Signature: Located 384 Osgood Street FIRE DEPARTKENT. --Temp Dumpster on site yes no Located-at 124,Mair, Street:-. Fire Departme► t.sigr+ature/date-, :` COMMENTS_ ' ._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 DANGERZONE LITERATURE: Yes No MGL-Chapter 166.Section 21A-F and G min.$10041000fine NOTES and DATA— (For department use ® Notified for pickup - Date 3 Doc.Building Permit Revised 2010 Building Department The fol'lowing'is"a list of the required=forms to be-filled outfor:the appropriate.permit to-.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ B,ailding 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apn•�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Euiljing permit Revised 2012 °F NORTH y� Zoning Bylaw Denial ~ Town Of North Andover Building Department 400 Osgood St. North Andover, MA. 01845 �q3•+nn•r��.5 Phone 978-688-9545 Fax 978-688-9542 Street: r Ma /Lot: Applicant: Request: ba Date: Please be advise that fter review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zonin — Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies 3 Lot Area Complies 3 Pre' existing frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed I XG Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient I Building Coverage 6 Preexisting setbacks 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Information 2 In Watershed j Sign 3 Lot prior to 10/24/94 1 1 Si n not allowed 4 Zone to be Determined 2 1 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district 2 Parking Complies 3 Insufficient Information 1 3 1 Insufficient Information 4 1 Pre-existing Parkin Remedy for the above is checked below. Item# Special Permits Planning Board Item# Variance Site Plan Review Special Permit Setback Variance Access other than Frontage Special Permit -Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate ousing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housing Special Permit Special Permit Non-Conforming Use ZBA Lame Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Si n R-6 Density Special Permit Special Permit preexisting nonconforming Watershed Special Permit The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new building permit application form and begin the permitting process. Building Department Official Signature Application Received Application Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the application/ permit for the property indicated on the reverse side: Item Reasons for Denial Reference Q r' �G�C' 1� � "�FGG � 4 L�.'•r2s - /S FFG ia<' �U ' L,' f' /�yis��:i+� %�a CC5 1a.-il1Z civ f' /✓u f .�r e. Referred To: Fire Health Police Zoning Board Conservation Department of Public Works Planning Historical Commission Other BUILDING DEPT Town of North Andover ZONING BOARD OF APPEALS poRTH Albert P.Manzi III,Esq.Chaimian �o Ellen P.McIntyre,Vice-Chairnran 3 '"' °� AssodateAfemhers Richard J.Byers,Esq.Clerk A Michael P.Liporto D.Paul Koch Jr.,Esq. * ; * Doug Ludgin Allan Cuscia '� °94.a:,t ^' * Deney Morganthal 9SSq�H�SE� Zoning Enforcement Officer Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Town Hall, 120 Main Street, North Andover, MA on Tuesday, March 11, 2014, at 7:30PM to all parties interested in the petition of Andrew Brien, for property located at 22 Harkaway Road (Map 95, Parcel 51), North Andover, MA 01845 in the R-4 Zoning District. Petitioner is requesting a Variance from Table 2(Dimensional Requirements) for one rear yard setback of the Zoning Bylaws in the R-4 Zoning District to construct an addition of a Mud room to the pre-existing non-conforming structure. Rear setback proposed is 16' the required rear setback per Table 2 is 30'. Also a Special Permit from Sections 9.1 of the Zoning Bylaws is needed for a pre- existing non-conforming Structure or uses however may be extended or altered. Application and supporting materials are available for review at the office of the Zoning Department located at 1600 Osgood Street, North Andover, MA, Monday, Wednesday and Thursday from the hours of 8:00-400, Tuesday from the hours of 800-5:30 and Friday from 8:00 to 11:30 By order of the Board of Appeals Albert P. Manzi II1, Esq., Chairman Published in the Eagle Tribune on: February 25th, 2014 March 4th 2014 Town of North Andover ZONING BOARD OF APPEALS ,10RTH Albert P.Manzi III,Esq.Chairman Ellen P.McIntyre,Vice-Chairman 3� ' ''' '' ° °e Associate Members o Richard J.Byers,Esq.Clerk A Michael P.Liporto D.Paul Koch Jr.,Esq. Doug Ludgin Allan Cuscia , o4Ar'P,,...�y Deney Morganthal �SSACHl15ES Zoning Enforcement Ofcer Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Town Hall, 120 Main Street, North Andover, MA on Tuesday, March 11, 2014, at 7:30PM to all parties interested in the petition of Andrew Brien, for property located at 22 Harkaway Road (Map 95, Parcel 51), North Andover, MA 01845 in the R-4 Zoning District. Petitioner is requesting a Variance from Table 2 Dimensional Requirements)� � q ) for one rear yard setback of the Zoning Bylaws in the R-4 Zoning District to construct an addition of a Mud room to the pre-existing non-conforming structure. Rear setback proposed is 16' the required rear setback per Table 2 is 30'. Also a Special Permit from Sections 9.1 of the Zoning g Bylaws Is needed for a pre- existing non-conforming Structure or uses however may be extended or altered. Application and supporting materials are available for review at the office of the Zoning Department located at 1600 Osgood Street, North Andover, MA, Monday, Wednesday and Thursday from the hours of 8:00-400, Tuesday from the hours of 800-5:30 and Friday from 8:00 to 11:30 By order of the Board of Appeals Albert P. Manzi III, Esq., Chairman Published in the Eagle Tribune on: February 25t", 2014 March 4t"2014 Town of North Andover ZONING BOARD OF APPEALS ,10RTy Albert P.Manzi III,Esq.Chairmano� 'i° ,°qw Ellen P.McIntyre,Vice-Chairman 3= °`'' `'' °t Associate lllemhers Richard J.Byers,Esq.Clerk I A Michael P.Liporto D.Paul Koch Jr.,Esq. Doug Ludgin Allan Cuscia '� °9A - -K•,," Deney Morganthal °AT°SPP °J 9SSge►+us��< Zoning Enforcement Officer Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Town Hall, 120 Main Street, North Andover, MA on Tuesday, March 11, 2014, at 7:30PM to all parties interested in the petition of Andrew Brien, for property located at 22 Harkaway Road (Map 95, Parcel 51), North Andover, MA 01845 in the R-4 Zoning District. Petitioner is requesting a Variance from Table 2(Dimensional Requirements) for one rear yard setback of the Zoning Bylaws in the R-4 Zoning District to construct an addition of a Mud room to the pre-existing non-conforming structure. Rear setback proposed is 16' the required rear setback per Table 2 is 30'. Also a Special Permit from Sections 9.1 of the Zoning Bylaws is needed for a pre- existing non-conforming Structure or uses however may be extended or altered. Application and supporting materials are available for review at the office of the Zoning Department located at 1600 Osgood Street, North Andover, MA, Monday, Wednesday and Thursday from the hours of 8:00-400, Tuesday from the hours of 800-5:30 and Friday from 8:00 to 11:30 By order of the Board of Appeals Albert P. Manzi III, Esq., Chairman Published in the Eagle Tribune on: February 25th, 2014 March 4th 2014 Town of North Andover ZONING BOARD OF APPEALS r10RTH Albert P.Manzi III,Esq.Chairmano�t-(LSD ,61ti Ellen P.McIntyre,Vice-Chairman 32 e. " Associate Members Richard J.Byers,Esq.Clerk Michael P.Liporto D.Paul Koch Jr.,Esq. Doug Ludgin Allan Cuscia °+o��pt '^•,.^' r Deney Morganthal �•9 °AATD PS y SSACHUSE t Zoning Enforcement Officer Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Town Hall, 120 Main Street, North Andover, MA on Tuesday, March 11, 2014, at 7:30PM to all parties interested in the petition of Andrew Brien, for property located at 22 Harkaway Road (Map 95, Parcel 51), North Andover, MA 01845 in the R-4 Zoning District. Petitioner is requesting a Variance from Table 2(Dimensional Requirements) for one rear yard setback of the Zoning Bylaws in the R-4 Zoning District to construct an addition of a Mud room to the pre-existing non-conforming structure. Rear setback proposed is 16' the required rear setback per Table 2 is 30'. Also a Special Permit from Sections 9.1 of the Zoning Bylaws is needed for a pre- existing non-conforming Structure or uses however may be extended or altered. Application and supporting materials are available for review at the office of the Zoning Department located at 1600 Osgood Street, North Andover, MA, Monday, Wednesday and Thursday from the hours of 8:00-400, Tuesday from the hours of 800-5:30 and Friday from 8:00 to 11:30 By order of the Board of Appeals Albert P. Manzi III, Esq., Chairman Published in the Eagle Tribune on: February 25th, 2014 March 4th 2014 Town of North Andover ZONING BOARD OF APPEALS t%ORTH Albert P.Manzi III,Esq.Chairman Ellen P.McIntyre,Vice-Chairman Arsociate Members Richard J.Byers,Esq.Clerk o <A Michael P.Liporto D.Paul Koch Jr.,Esq. * Doug Ludgin Allan Cuscia °+w Deney Morganthal 'JI,9 °scare° �.(h SSACt1USE Zoning Enforcement Officer Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Town Hall, 120 Main Street, North Andover, MA on Tuesday, March 11, 2014, at 7:30PM to all parties interested in the petition of Andrew Brien, for property located at 22 Harkaway Road (Map 95, Parcel 51), North Andover, MA 01845 in the R-4 Zoning District. Petitioner is requesting a Variance from Table 2(Dimensional Requirements) for one rear yard setback of the Zoning Bylaws in the R-4 Zoning District to construct an addition of a Mud room to the pre-existing non-conforming structure. Rear setback proposed is 16' the required rear setback per Table 2 is 30'. Also a Special Permit from Sections 9.1 of the Zoning Bylaws is needed for a pre- existing non-conforming Structure or uses however may be extended or altered. Application and supporting materials are available for review at the office of the Zoning Department located at 1600 Osgood Street, North Andover, MA, Monday, Wednesday and Thursday from the hours of 8:00-400, Tuesday from the hours of 800-5:30 and Friday from 8:00 to 11:30 By order of the Board of Appeals Albert P. Manzi II1, Esq., Chairman Published in the Eagle Tribune on: February 251h2014 th March 4 2014 Town of North Andover ZONING BOARD OF APPEALS NORT11 Albert P.Manzi III,Esq.Chairman Ellen P.McIntyre,Vice-Chairman 3 e Associate Members Richard J.Byers,Esq.Clerk � p Michael 1'.Liporto D.Paul Koch Jr.,Esq. 4t, ; �* Doug Ludgin Allan Cuscia '� °9 ��--• ^'� Deney Morganthal ��SSACHUSZoning Enforcement Officer Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Town Hall, 120 Main Street, North Andover, MA on Tuesday, March 11, 2014, at 7:30PM to all parties interested in the petition of Andrew Brien, for property located at 22 Harkaway Road (Map 95, Parcel 51), North Andover, MA 01845 in the R-4 Zoning District. Petitioner is requesting a Variance from Table 2(Dimensional Requirements) for one rear yard setback of the Zoning Bylaws in the R-4 Zoning District to construct an addition of a Mud room to the pre-existing non-conforming structure. Rear setback proposed is 16' the required rear setback per Table 2 is 30'. Also a Special Permit from Sections 9.1 of the Zoning Bylaws is needed for a pre- existing non-conforming Structure or uses however may be extended or altered. Application and supporting materials are available for review at the office of the Zoning Department located at 1600 Osgood Street, North Andover, MA, Monday, Wednesday and Thursday from the hours of 8:00-400, Tuesday from the hours of 800-5:30 and Friday from 8:00 to 11:30 By order of the Board of Appeals Albert P. Manzi III, Esq., Chairman Published in the Eagle Tribune on: February 25th, 2014 March 4th 2014 Town of North Andover ZONING BOARD OF APPEALS yORTH Albert P.Manzi III,Esq.Chairman o`t,�.o Ellen P.McIntyre,Vice-Chairman 3r " ''' ''' ° °e Asso6iateMembers Richard J.Byers,Esq.Clerk o p Michael P.Liporto D.Paul Koch Jr.,Esq. it �* Doug Ludgin Allan Cuscia °9 �-••-••," Deney Morganthal �SSACHUSEt4 Zoning Enforcement Officer Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Town Hall, 120 Main Street, North Andover, MA on Tuesday, March 11, 2014, at 7:30PM to all parties interested in the petition of Andrew Brien, for property located at 22 Harkaway Road (Map 95, Parcel 51), North Andover, MA 01845 in the R-4 Zoning District. Petitioner is requesting a Variance from Table 2(Dimensional Requirements) for one rear yard setback of the Zoning Bylaws in the R-4 Zoning District to construct an addition of a Mud room to the pre-existing non-conforming structure. Rear setback proposed is 16' the required rear setback per Table 2 is 30'. Al Special - so a S ee a Permit from Sections 9.1 of the Zoning Bylaws is needed for pre- existing g Y p existing non-conforming Structure or uses however may be extended or altered. Application and supporting materials are available for review at the office of the Zoning Department located at 1600 Osgood Street, North Andover, MA, Monday, Wednesday and Thursday from the hours of 8:00-400, Tuesday from the hours of 800-5:30 and Friday from 8:00 to 11:30 By order of the Board of Appeals Albert P. Manzi IIl, Esq., Chairman Published in the Eagle Tribune on: February 25 ', 2014 March 4t" 2014 The Commonwealth of-Massachusetts Department of Industrigl Accidents Office of Investigations qV 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual): l�v r t'✓� Address: PO 3 J X 1 3l- City/State/Zip: Anh,�>u-c-(' UA'l Phone#: Are you ployer?Check the appropriate box: Type of project(required): 1, am a employer with 4. ❑ I am a general contractor and I 6 ' employees(full and/or part-time).* have hired the sub-contractors ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.]q officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing.repairs or additions myself.[No workers' comp. c. 152,§I(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 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 aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis 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. Insurance Company Name:. A— L Policy#or Self-ins.Lie.#: G' 4-vU--"7eZ. 371 Q_7 "Z-W tpiration Date: Job Site Address: Z-Z City/State/Zip: � , A W�10 1 � Attach a copy of the workers'compensatio 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 Itereb cert under the pains and penalties of er_Hy that the information provide abov is true and correct. Si afore: 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#: ! tom). ,•":(: r �•:: .. s'` •/ •1 r rr _ �� ,r �'IC(; Cori 8-m .. i, •'s. ., ,:• ..r.'It 1 1. r.•1 b• , O'f't.ori8t•1_T1Ci' F1 111 �'�Y'fLJR'S 141711 s' 17C'aS .��'sia's ' L.,�1 10 1 E11 P1L1zil 311tc 5170 Boston, Al.ssclell:I1-setts ,021. 16 flome m1provelaaelat Contractor Registradoij I l3ehistlaU011: '1375;12 i _ I•ype: 131•Ivatc.,Corpwe►lias) ' NOF-11TH ANOOVEF.? BUILD r)gylrr�tian: I'1/7•.G/2U1�1 In Jr• a.�llcl:;r1 { BUILDING COI;I'. ! JOHN LEEMAN P.O. 130)( 9 32 N. ANDOVER, 1845 ........ ...... .......,..•.......... ..... ...•.. ........ iIUpthats Address sua►1 rc t►sA►a cssA cp. kill 80A s cosou 7i)r ct►o»is. e:cn i ra ;:nirs•o:va, ilcpcpness L.I 1.••I pls.ls��wsi H)san >Do� edeot ' i I:.,I i 3 ss 1.:1 post 2.s1A'si ;a 01'11ca(11'Q1 /IMirs d:U61rrlts'ess AciplIali�►ro p�ipLlttie or rogls;tr:►tiaus v:alic4 flim asscfe'vid►st a►sc ustt}' OIVIL'IIVit't�OVf-NIEN7'CO �) 4; N3RAC'i'Ot'2 bel'osn tine e).pi►:►tions llnfle. pfl't'osssslp nlster►n to; t'sl„I� rllr; 1, gistration: '137552 \;'y ppl;:�F_upiraatioa�: i'l/2G/?UI�I Type: 'O66lec nfC01seu►aca•affairs and Irmsilless,I;3e1;ul atio►► f+ I'rivaie Corporation liU 111118.1c R him-Suite 54 70 i r►or,rl 1 N�IC)OVER 13UILDING CORP, Boutoss,IWAe 028 ed IJOHN LEEMAN %0 NILLON RD 11AII.:fON,MA 02'186 %,'s''. -,•� ,. • 1 lot vslid g^ritl►out si(s►:sturc CS-082816 16' JOIN R LEEMAN JR 70 PILLON ROAD MILTON MA 02186 ;` 06/16/2014 12/4/2013 9 : 15 : 38 AM 8740 ® 03/03 A -0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMWNYYY) 92/0412013 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:B the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,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 04,)S g3-001 RRAL4CT MTM Insurance Associates LLC r mm o : (978)681.6700 Na. (978)881.6777 1320 Osgood Street ass. North Andover,MA 01846 AFFORDING INsuileg A. A.I.M.Mutual Insurance Company 33758 INSURED INISURER B; North Andover Building Corp 70 P(llon Road Miton,MA 02186 INSURER 0 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. i TYPE OF INSURANCE AIR&WVD POLICY NUMBS LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea ooe EDrree E CLAIMS.MADE OCCUR MED EXP(Anyone person) b PERSONAL&ADV INJURY E GENERAL AGGREGATE E EML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG E ICY ECT OC AUTOMOBILE LIABILITY (Ea aeddent E ANY AUTO BODILY INJURY(Per person) E ALLONMEO SCHEDULED ALTOS AUTOS BODILY INJURY(Por accident) E HIRED AUTOS ANUTOS�M PROPERTY OAMAGE- E Peracd E UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS MADETI AGGREGATE E �rp��DpEo ,p�I RETENTION S �/y�ST T� log E gAqNNNyyDppEIR�NooR►►L�S�I�Y��E77AppS 11ppA�RB7TIlIERIRY�/ X TORY L%1 I DERI-_ A 0192RMIEMBEMD(CLUDED?`'� N N/A AWC-400.7023267-2013A 11111/2013 11/1112014 E.L.EACH ACCIDENT E 100,000.00 �(MYYa�nsd�atoryy�iin��Nu�H))a� ttt•••___ �� E.L.DISEASE-EA EMPLOYEE E 100,000,00 D Nd%SN of OPERATIONS below E.L DISEASE-POLICY LIMIT E 800,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule.It more space is nequlred) CERTIFICATE HOLDER CANCELLATION Mr.Richard Stearns 30 H(ckiey Road SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Milton,MA 02186 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE 0 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1899