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HomeMy WebLinkAboutBuilding Permit #502 - 2324 TURNPIKE STREET 2/3/2010 (3)Permit NO: 5- O -z-- Date Issued: _-3` 1 U TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential - Non- Residential New Building One family Addition Two or more family- Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Sepfic11/ell _ " Floodplain Wetlands Watershed District -; - Water/Sewer DE CR�IP ION OF WORK TO BE PERFORMED: /•^ 'C. V iiLi S rc Identification Pleas Type or Print Clearly) OWNER: Name: Z 3 z —t-����, L, Lc Phone: Address: z Dv -' Location 2 '"_Ci -- CONTRACTOR Name: .ti`o — No. 2,- Date :Address:, ANDOVER NOATM TOWN OF NORTH r Home Jrnprovernent License _ ARCH ITECT/ENGINEER_ Address: 9 Z Com+ cc.Y. V S�1 FEE SCHEDULE: BULDING PERMIT: $12. Total Project Cost: $ 57 O • �OL Certificate of Occupancy $ �',s ••�• E,�; Building/Frame Permit Fee $---~"" s�cMus Foundation Permit Fee $ -- Other Permit Fee $ -- TOTAL $ Check # 0 L Check No.: NOTE: Persons contracting with > r,1 Building Inspector Signature of Agent/O. er_ - - — r D >y a O F/ y m A N N m 3 O b NO H N O z 2324 TURNPIKE STREET NORTH ANDOVER, MA 01845 SHEET TITLE: REFLECTED CEILING PLANS / APPLIANCES PREPARED FOR: LITTLE SPROUTS, KRYSTA O'NEILL k y e s d e s i g n 354 MERRIMACK STREET LAWRENCE, MA 01843 a r c h i t e c t u r e PROJECT NAME: RENOVATION TO LOBBY 72 green street reading, ma 2324 TURNPIKE STREET 617 -308 - 0454454 � � A X 1� Am C oo m� A Z ?� m=vii DOZ- r r ?O�Z m� II X-0 r m w L( 4t �� X Z r_ N a 00 Z 00 D 0Z= 22 D0z Z a r � Z Z Q 7S Z m m� D >y a O F/ y m A N N m 3 O b NO H N O z 2324 TURNPIKE STREET NORTH ANDOVER, MA 01845 SHEET TITLE: REFLECTED CEILING PLANS / APPLIANCES PREPARED FOR: LITTLE SPROUTS, KRYSTA O'NEILL k y e s d e s i g n 354 MERRIMACK STREET LAWRENCE, MA 01843 a r c h i t e c t u r e PROJECT NAME: RENOVATION TO LOBBY 72 green street reading, ma 2324 TURNPIKE STREET 617 -308 - 0454454 Hm N N c Ma q5 z.. 'o o O 3 ul N O z IOJECT ADDRESS: 2324 TURNPIKE STREET NORTH ANDOVER, MA 01845 SHEET TITLE: 1911010122F1PF9 PREPARED FOR: LITTLE SPROUTS, KRYSTA O'NEILL k y e s d e s i g n 354 MERRIMACK STREET LAWRENCE, MA 01843 a f C h 1 t@ C t U r PROJECT NAME: RENOVATION TO LOBBY 72 green street reading, me 2324 TURNPIKE STREET 617 - 308 - 0484454 Sep 24 09 12:08p SPOLIDORO AND SONS 19786670874 p.4 Features: • Gooseneck spout Cast brass underbody with heavy chrome plated brass shell • Metal handles with acrylic hot and cold index, buttons Compression stems with renewable brass seats • Working pails can be easily replaced • 1/2" NPSM supply connections with brass coupling nuts • ADA compliant handles operate with less than 5 lbs. force 2.2 gpm (8.3 L/min) @ 60 psi maximum aerator Technical Specifications: • ANSI/ASME Al 12.18.1 M • ANSI A117.1 (ADA) • CSA B125 • ANSI/NSF 61-1997b Catalog Numbers: 49-251 Chrome Prefixes Available: None Suffixes Available: None - 4 'i16" i P iii,, Mouni,ino Hole ize--— ( iyn. 2 PICS. ) ---- 7 160„ G E B E , PROFESSIONAL PERFORMANCE (.ierberTolt hrce Techwcal Support; 888-648-6466 cr[monline.com i "vlcx 1_e,dage 112"-14 "VSI°i f yp : 1 Job Name Date _ Model Specified Quantity Customer Contractor Architec'Jengineer Because We are committed to continual product improvement, specifications are subject to change without notice. S.B49251.2 10107 Sep 24 09 12:08p SPOLIDORO AND SONS GENERAL Sink is formed of #23 gauge, 300 series, nickel bearing stain- less steel. Top mount, DESIGN FEATURES Bowl Depth: 5-1/8". Coved Corners: 2-1/4" vertical and horizontal radius. Finish: Exposed surfaces are polished to a satin finish. Underside: Undercoated on bottom of bowls. SINK PACKAGE DP211515C Package includes: (1) D11515 sink, (1) LKA2475 faucet - (1) D5018A drain with basket strainer. OTHER Drain Opening: 2" (D11515, D611515 and DP211515C), 3-1/2" (D11516). NOTE: Unless otherwise specified, sink is furnished with 2 faucet holes as shown, These sinks comply with ASME A112_.19,3. These sinks are listed by the International Association of Plumbing and Mechanical Officials as meeting the 0 requirements of the Uniform Plumbing Code. This faucet is CUPC listed. SDThese sinks are listed with the Canadian Standards Association. SINK DIMENSIONS IINCHESI* 19786670874 p.2 Dayton' Hospitality Sinks and Silk Package Models 011595, DIIS16 and OP211515C _ C �2tif4- i�f-�t� x del x115152 -t.engm ,s 1011 m ngnt, WITH is Inert to back. D -Prefix sinks are packed one per shipping carton. 06 -Prefix. sinks ::re neslcd 6 units por shipping) canon. Model DP211515C Bowl Depth is 5-1/8" Model D115152 Illustrated HOLE DRILLING CONFIGURATIONS (1-1/4" diameter) (1-1/4" diameter) (1-1/2" diameter) ALL DIMENSIONS IN INCHES; TO CONVERT TO MILLIMETERS MULTIPLY BY 25.4. IR AeePin!r s�im )(if policl, o continiflllg pod ;I Wil"n"rnent. F!key re!,,Orvles the right t0 Change This sr"Ciiicali— describC an Okay prod -1 1vith do -scan, qv,,?I (y and t(lnctinital 60111+fits !o the produr.1 cPecilies?ions without nptir, c. user When makinn a Comparisrn of n.her producers' Ot!C."IR,Cj be certem theSe tealures are not ove;!Coked. Elkay 2222 Camden Court Printed in U.S.A- Oak Brook, IL 60523 02.009 Elka elkayusacom y (Rev. 6/09) 2-3I Cutout in No. of Countertop 1l/a' or'I1h" Dia. Model: Overall _ inside Bowl 11/2" Radius Comers Faucet Minimum Number Mores 4" Center Cabinet Size L Vi L W-0 L W DP211515C 15 15 12 10 51/s 143/6 141/a 2 18 D11515 15 '15 12 10 51/s 14% 143/s 1; 2 or 3 18 D11516 15 15 12 10 51/r 143/6 143/s 1, 2 or 3 18 D61151515 15 12 10 5'I/r. 143/8 1431e,1 or 2 18 -t.engm ,s 1011 m ngnt, WITH is Inert to back. D -Prefix sinks are packed one per shipping carton. 06 -Prefix. sinks ::re neslcd 6 units por shipping) canon. Model DP211515C Bowl Depth is 5-1/8" Model D115152 Illustrated HOLE DRILLING CONFIGURATIONS (1-1/4" diameter) (1-1/4" diameter) (1-1/2" diameter) ALL DIMENSIONS IN INCHES; TO CONVERT TO MILLIMETERS MULTIPLY BY 25.4. IR AeePin!r s�im )(if policl, o continiflllg pod ;I Wil"n"rnent. F!key re!,,Orvles the right t0 Change This sr"Ciiicali— describC an Okay prod -1 1vith do -scan, qv,,?I (y and t(lnctinital 60111+fits !o the produr.1 cPecilies?ions without nptir, c. user When makinn a Comparisrn of n.her producers' Ot!C."IR,Cj be certem theSe tealures are not ove;!Coked. Elkay 2222 Camden Court Printed in U.S.A- Oak Brook, IL 60523 02.009 Elka elkayusacom y (Rev. 6/09) 2-3I Sep 24 09 12:08p SPOLIDORO AND SONS 19786670874 p.3 Gerber - Bar Faucets Pagel of] PROFESSION G E R B E R PERFORMANCE PRODUCT CATALOG ...N-oduct Cataloa . ..... . . .. ... .. ... . - . ... .... .... ... -Select One - Bar Faucets 91,00, (+,9,11ZJ- 101 6 49 11 -251 %®7-49-251 Two Handle Bar Faucet C, pliant: Yes Description Cast brass underbody with heavy chrome plated brass shell With Gooseneck Spout 4" Centers for mounting Compression 2.2 gpm @ 60 psi Metal handles (49-251), Wrist blade handles (49-251-66), Fluted Handles (07-49-251) Specifications Name SKU 11 Chrome (metal handles) -49-251 0 P-CfFrome (wrist blade handles) -49-251-66 0 [j Chrome (fluted handles) -07-49-251 0 Product catalog (PDF) S (PDF) (PDF) IMWATTSO WD Series PDI Certified Grease DRAINAGE Tag: WD_ 90 Interceptor SPECIFICATION: Watts Drainage Products WD Series PDI Certified recessed or floor mounted epoxy coated steel grease interceptor with gasketted solid steel cover, hex head center bolt(s), removable baffle assembly, deep seal trap with cleanout, no hub connections, and external cast iron flow control fitting. Secured Non -slip Cover Locking - Device Neoprene Gasket One-piece Removable Baffle Static Water Level Baked Epoxy, Coated Body 3/8"(10) Air Space k3t.O5,00 lk.: cJ f -fix M 9002 UPC ... TM N. DxE —� Clean-out Plug (When -O is selected above) Suffix Description 1 ` Air Relief ,C 4 By-pass ------------ - - - - - - - - - - - - - -- No -hub 7 GPM A (MJ) 10 Inlet & F i Outlet (*) B 15 GPM Integral 20 Deep Seal 2"(51) Trap 25 GPM Fixed 35 Note: *Optional Threaded Inlet And Outlet e Imen Baffle (includes Threaded Flow Control) 50 GPM Optional Inlet/Outlet Sizes Flow Rate (Select One) (When -O is selected above) Suffix Description Description 4 4 GPM ❑ 7 7 GPM ❑ 10 10 GPM ❑ 15 15 GPM ❑ 20 20 GPM 2"(51) 25 25 GPM 13"(330) 12"(305) 35 35 GPM JE__3 50 50 GPM 14"(356) 12"(305) WD -15 15 Options (Select One or More) Suffix Description 3-1/2"(89) 22"(559) -B Sediment Bucket ❑ -E Extension ❑ -F Flange ❑ -FC Flange & Clamp Device ❑ -O Inlet & Outlet other than ❑ WD -35 Standard Size 70 -SS Stainless Steel ❑ -THD Threaded ❑ Optional Inlet/Outlet Sizes Flow Rate GPM (When -O is selected above) A Inlet & Outlet Suffix Description E F -2 7'(51) Inlet/Outlet ❑ -3 3"(76) Inlet/Outlet ❑ -4 4"(102) Inlet/Outlet ❑ -6 6"(152) Inlet/Outlet ❑ Interceptor Catalog Number Flow Rate GPM Grease Capacity Lbs A Inlet & Outlet B C D E F Base to Center Top to Length Center Width Height WD -4 4 8 2"(51) 7-3/4"(197) 3-1/4"(83) 16"(406) 10"(254) 11"(279) WD -7 7 14 2"(51) 8-1/2"(216) 3-1/2"(89) 18"(457) 13"(330) 12"(305) WD -10 10 20 2"(51) 8-1/2"(216) 3-1/2"(89) 21-3/4"(552) 14"(356) 12"(305) WD -15 15 30 2"(51) 10-1/2"(267) 3-1/2"(89) 22"(559) 15"(381) 14"(356) p -y 20 40 3"(76) 11-1/2"(292) 3-1/2'(89) 24"(610) 15-3/4"(400) 15"(381) WD -25 25 50 3"(76) 12"(305) 4-1/2"(114) 26"(660) 16-1/2"(419) 16-1/2"(419) WD -35 35 70 3"(76) 14"(356) 5"(127) 30"(762) 18"(457) 19"(483) WD -50 50 100 4"(102) 16"(406) 5-1/2"(140) 32"(813) 22"(559) 21-1/2"(546) Job Name_ Job Location Engineer_ Contractor Contractor's P.O. No. Representative WATTS Drainage reserves the right to modify or change product design or construction without prior notice and without incurring any obligation to make similar changes and modifications to products previously or subsequently sold. See your WATTS Drainage representative for any clarification. Dimensions are subject to manufacturing tolerances. fW R �7® DRAINAGE USA: 100 Watts Road, Spindale, NC, 28160 TEL: 828-288-2179 TOLL-FREE: 1-800-338-2581 Website: www.wattsdrainage.com ® Walls Drainage 2003 tb-vvu-wu btAlLb UbA ua41r WD SERIES B���of�'r'�'c�m��guTatioieS an�d"ai`ds-� Construction Supervisor License *49 License: CS 54300 Expiration .2122/2010 Tr# 15010 Restriction: 00 PAUL R MORRIS 160 LORUM ST�— TEWKSBURY, MA 01876 Commissioner ,rte '�% �a�rz»ronureu`C� a���cauac/iutelta N Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 112224 Expiration: 3/5/2009 Tr# 131840 Type: Private Corporation PINNACLE CONSTRUCTION CO INC PAUL MORRIS 160 LORUM ST-� TEWKSBURY, MA 01876 Administrator CITY OF BOSTON Lic, No 1321111;;() BOARD OF EXAMINERS MAYOR TFOLiMAS M, itil=PsIN-0 PAUL R MORRIS t TO T3KE CHARGE Or IS DULY LiC— — ,'10RK UNDER FROYLSiONS 3F THE ACTS GF 1938 CHAPTEP. 173 AS A."a1ENCED SEE BACK I 219109 9110 BOARD OF EXAMINERS CITY OF LYNN BOARD OF EXAMINERS �- LICENSENO.. #3483........ CLASS ..... 1 Morris, R.Paul residing at ............ 70 Birchwood Rd, Tewksbury, MA ...................is hereby Licensed to have Charge, CoaM and Person uper- vise Construction, Alter o Repair to the Classes of Construction Signed........................ . CHAIRMAA BOARD OF EXAAMNERS RENEWAL FEF S2S.00 LICENSE EXPIRATION 6/1/2008 LATE FEE Ila= • AFTER 3 MONTHS Class IF,IIF.IIIF,IV,V Expires ires x,13' /Uq Date 06/3�� O/r, �:� .. BOARD Of EXAMINERS � CITY OF CAMBRIDGE BUILDING DEPT. LICENSE FOR CONTROL OF BUILDING OPERATION This is to certify that UL i2� is duly licensed to take rso s rge of work under ' the provisions of the B ' ces of . City of Cambridge. Board o ere, o CMAIRMAM CAD Signature of Liceneer£Z c>7 (oven) 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 Name Address: Are you an employer? Check the appy 1. JK I am a employer with employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t /Z one #: iate box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.l 5lh / r Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other •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 bssurance for my employees Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:��� Job Site Attach a copy of the workers' compensation folicy 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. Ido hereby certify under -the t►ainy_an"alties of perjury that the information provided above is true and correct 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 #: ,�,'fjo U,4 In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that tate debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A The debris will be disposed of in: 0 Signature of Permit Applicant atc Gf PORT :,� 032 �..'` ° - •� OG TOWN OF NORTH ANDOVER BUILDING PERMIT FEES ,SS4CNU°+S Building Permit Fees exclusive of mechanical and utility fees A. The estimated cost of new construction shall be based on a cost factor of one hundred twenty five ($125.00) dollars per square foot. B. Estimated construction of additions, alterations, and remodeling shall be the actual contract price. The permit fees shall be twelve dollars ($12.00) per thousand based on the estimated costs of construction. C. Copies of actual contract price may be required with building permit application. Fees adopted by the Board of Selectmen: 6- 26-2006 , Effective 7-1-2006 Miscellaneous Fees Fee Minimum Building Permit Fee $30.00 First $4,000.00 cost (or $12.00) per thousand of estimated construction cost, which ever is greater Certificate of Occupancy — For Existing Structures $100.00 Certificate of Occupancy — New Construction $100.00 (to be paid upon issuance of Building Permit) $50.00 "temporary or Partial Certificate of Use, $50.00 and or Use and Occupancy, per month Chimney/Fireplace — First $1,000.00 cost $30.00 (or $12.00) per thousand of estimated construction cost, whichever is greater) Signs $30.00 (or $12.00 per thousand of estimated construction cost, whichever is greater Temporary Construction Sign — 6 mos. Permit $50.00 Temporary Construction Trailer — 6 mos. Permit $50.00 Reissue of Revoked/Suspended Building Permit $100.00 (per time) Extension of Building Permit — 6 mos., two time limit $50.00 Replacement of Building Card $50.00 Demolition Permit $1.00 to $2,000.00 $30.00 (or $12.00 per thousand of estimated demolition cost, whichever is greater Reinspection Fee — Residential Structures $30.00 per trip Reinspection Fee — Commercial, Industrial or Education Structures $30.00 per trip Certificate of Inspection & Certificate of Structures Per Sec Table 106 — Restaurants, Bars $100.00 Certificate of Inspection - Lodging +5 Units ea add unit $100.00 $ 10.00 In the event that work is started prior to the issuance of building permit, the permit fee will double 274mrars-Equ a r c h i t e c t u r e Architectural Design Affidavit To: Inspector of Buildings, North Andover Building Department Date: February 1, 2010 Re: Little Sprouts, interior renovation 2324 Turnpike Street North Andover, MA 01845 Project No. 0309 In my professional opinion, the plans accompanying this affidavit (Pages Al and A2, dated 02- 01-10) concerning the locus described above are in accordance with the requirements of the Massachusetts State Building Code and applicable laws and ordinances. I understand from a conversation with my client that the Board of Health is requiring only the addition of a commercial refrigerator, an additional hand sink, commercial dishwasher, and grease trap. This has been reflected in the drawing. This affidavit is for architectural scope only. /V 1 Z Gz-a -to Michael L. Kyes, AIA, LEED AP Massachusetts Registration Number 9381 On this I date of 1'e . 2010. before me. the undersianed notary public, personally appeared 111— tYrIc,- , provided to me through satisfactory evidence of identification, which were MA dilue-:-�/ibe the person whose name is signed on this document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief. Notary Public p is iorkgxpires, G 5 COrnn"iCfi nJ !th `. di8'S3ChU5cuS _ �. ti Niy �OCC;t'n55:•i:•7 c"pa '�., i. 2Cii 5 _., �%'swrvv+vrn-cs.rvPsvrvvmvwraev�+roavr:+3 I 1�4 _ o,v ` y O m c as o ao o A C O H m c ;c g w x N •E O z w `m �.V c �� C ac cv cv am o w° .a U) � 0 � w° o CD v U m w d w 92 cn w J S o. oo w �' U) a U) _ o,v ` y O m c as o ao acr C CCD;h o IN .5 C O H m c ;c g c � O N N •E O V `m �.V c �� C ac cv cv am O fl F— caCD t $ aim o CD Ea D c .. ca J S o. N D • co ". �� me O O C2 N cm 3: :M.O! m Cc N �mo _ o,v ` y O m c as o ao acr C CCD;h o IN .5 (q;) 1 ■ 1 z • � o ao H CO3 j= W N •E a�`!c ro o V `m �.V c �� C Vj am O fl F— caCD t $ aim E i CD N N C O cmO cm c m `o a C C N CD O Z O CD U O O � O v Z O C. O y C C O Om CA O COD CD O W W CD CD CL ~ ♦_-+ L O � Im CD C O CD env o CLC - a CM< c CO2 *" c cc c V C. O D CODC Z s CL Ci CO) O C — C C CO2 C LLI U) LLI U) W W 19 uiW U) _F OPID LZ DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE PINNA -3 02 /03/10 PRODUCER Dennis F. Murphy - Harvard PO Box 190 276 Ayer Road THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NWADUL LTR Harvard MA 01451 Phone: 978-772-0070 Fax: 978-772-2920 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Insurance Co. of Pennsylvania 19429 INSURER B: Netherlands Insurance Company GENERAL LIABILITY INSURERC: Peerless Insurance Company Pinnacle Construction Co., Inc INSURER D: Hanover Insurance Com an 22292 - 160 Lorum St Tewksbury MA 01876 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. NWADUL LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS 120 Main Street North Andover MA 01845 GENERAL LIABILITY EACH OCCURRENCE $1,000,000 C X COMMERCIAL GENERAL LIABILITY CBP8165147 05/07/09 05/07/10 i rUAFAA-GETU KILD PREMISES(Eaoccurence) $ 100,000 CLAIMS MADE Xa OCCUR MED EXP (Any one person) s5,000 PERSONAL &ADV INJURY $ 1,000,000' GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 POLICY PRO- JECT Lac Emp Ben. 1M/ 3M AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 $ ANY AUTO BA9729055 05/07/09 05/07/10 (Ea accident) BODILY INJURY $ ALL OWNED AUTOS X SCHEDULED AUTOS (Per person) BODILY INJURY $ X HIREDAUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10 , 000 , 000 C X OCCUR 0CLAIMSMADE CU9720156 05/07/09 05/07/10 AGGREGATE $10,000,000 $ $ $ HDEDUCTIBLE X RETENTION $10,000 WORKERS COMPENSATION AND TORY LIMITS_ ER A EMPLOYERS' LIABILITY WC3966045 08/02/09 08/02/10 E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $ 1,000,000 OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 OTHER DIST OPEN BOND BLN8872812 11/14/08 11/14/09 T/O TEWKS 20,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 2324 Turnpike Street CERTIFICATE HOLDER CANCELLATION AM0003 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Building Department REPRESENTATIVES. AUTHORIZ EPRESENTATIVE 120 Main Street North Andover MA 01845 ACORD 25 (2001108) © ACORD CORPORATION 1 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001