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HomeMy WebLinkAboutBuilding Permit #517-2017 - 24 COBBLESTONE CIRCLE 11/15/2016BUILDING PERMIT A444 � LF TOWN OF NORTH ANDOVER APPLICATION FOR -PLAN EXAMINATION Permit No#:, Date Issued, Date Received 5-4 6 1 /0 TYPE OF IMPROVEMENT PROPOSED USE I Residential Non- Residential D New Building 0 One family 0 Addition El Two or more family 0 Industrial 0 Allration No. of units: El Commercial —Vepair, replacement El Assessory Bldg F1 Others: 0 Demolition 0 Other Septic Ew EFloodplain eids V1/a District 0 .- - F_" - a L, 1MU W11.101.14 iY11 Mori DIdeittifieation MeType or Print ClearlyOWNER:' Name:/ql Phone: Address: Odfitrabtb one::._ *b8s .97 :. e s Sur Horne m., P rovement License: / _ Exp. Date? _ .^'l.lY _ - ARCHITECT/ENGINEER Phone: Address: Rect. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. ,notal Project COSI: $ FEE: Check No.: .3 r3t Receipt No.. NOTE: Persons contracting with unregistered contractors do not have. access to the gm my fund �Sigriature: of_Agenfi/Ow der SignatureR-cohtraicto'."', LocationS60-� CrL,oSs X ID. No. $'t S'--991-7 Date it - /5-- �-VJ TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check # 4i ` W Building Inspector $ J 0 Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ i YPIF SEWERAGE DISPOSAL Public Sewer ❑Swimmin Tanning/Massage/BodyArt ❑ g 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 e U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH z� COMMENTS Reviewed On Signature. Reviewed on Signature Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes s Planning Board Decision: Conservation Decision: Com Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT* -Temp Dumpster on site yes Located at 124. Main. Street Fire Department sig nature/date COMMENT Located .384 Osgood Street no F -imension 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine Doc.Buildiug Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. 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 4 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/EIevation 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract act o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 40TE: 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 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 Doc: Building Permit Revised 2014 O �� a) z O y<M ~, > �. C o o O Q' Z c -c U) C rt O. O CL O m rt CD W CD O CO) N CD CD 2 �• 0. CL Q. C 0 O rt N � rt � ON CD ° =r:3 W = CD CD N rt ° CO) O O O -a CL z CD D c� N M "� O I O rt _ m° O rn n CD -.1Z /�\ < = ci 7V �_ CD CD V .•' Cr 4. WCD Z `D r N � CD O 'C Z� " ���� ��� cZ �" 0 �O vim• —�� cn ky �c=n 0o 0 CO CD cn =r v C'co rt ° i V� �' ov � v' CD 11 Z C r O CO ° r -r 0� O �_,: 0CD CD Z O S Z . CD N: ° m. rt �D 0 O O; O O CL O 7 un N W T � T N A T = T n m T N T 0 v � o C 7 rDD �. c 3 ._, (D < fD , 3 r S S 7 � S C Q O -O = n < O \ rt m o m z m O r m f1 > N m r C y m 0 m C z Z to n O K O 3 S (D W o x n = 0 s a vgJFaraas • e - NIC # 174377 Damp Ousse -no Ong LLP BestMurveys.com J; 0�0' X015 A trusted name since 1938 Roofing - Siding - Windows 87 Belmont Street - North Andover, MA 01845 P: 978-683-4588 - F: 978-685-7446 NAME OF OWNER l 15t '41 ADRESS OF JOBS r'li TEL. /` / DATE: We will remove all roof shingles off total roof area, Z layer. Replace any boards or sheathing at additional cost. A new 8" white aluminum drip edge applied on all edges. Approx. 6ft of ice and water membrane applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing and sidewall junctions. Existing step flashings to remain. A new base sheet applied. Architectural roof shingle installed with a limited lifetime warranty. Installw ventpipe boot flashings. Waterproof existing chimney flashing and remove debris. Shin le Col.4, zv -& "/-/ d f ' Ridge Vent Upgrade .f/ / 0 Wood Sheathing Repair $3.50 per ft. �� 7 fi We Propose herby to furnish material and labor - complete in accordance with above specifications, for the sum of, Q �C dollars ($ Payment to be made as follows l' Authorized Signature NOTE: This proposal may withdrawn by us if not accepted with i11A Accepftnce of Proposal - The above prices, specifications and conditions are satisfactory and are herby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature DateofAcceptance:A/ Signature HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS (M.G.L.142A) 1. WORK: Provided the Homeowner performs under this agreement, the Contractor shall perform the work on the Property as specified Proposal, attached incorporated herein. The work does not include extraordinary conditions of which the Contractor could not reasonably be aware. If such conditions are encountered, this shall be an additional cost to the Homeowner. Materials selected by Homeowner may have to be ordered or custom made, which items are specified in the Proposal. The Contractor is not obligated to agree to any modifications, extras or change orders unless such items are agreed to in writing by the Contractor. All extras and changes shall be at an additional cost to the Homeowner. Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract. Lawn or Driveway may be damaged by dumpster or equipment. Due to material shortages Contractor may substitute materials of equivalent grade. 2. PERMITS: If a building permit is required for the work, the Contractor shall obtain same as Homeowner's agent. Contractor is not responsible for any other permits that may be required for the Work, and Homeowner is responsible to determine whether any zoning, planning or wetland related permits or approvals are necessary. Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund. 3. COMMENCEMENT AND COMPLETION: Homeowner acknowledges the commencement date of the work is fluid, and is subject to numerous factors such as scheduling other contractors, delivery of materials and weather. Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same. The Work shall be substantially completed within 7 days of commencement, except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal, and subject to delays for circumstances beyond Contractor's control. Notwithstanding, the commencement date and substantial completion date may be extended, and the Contractor will not be liable for delays caused by, labor or material shortages, delays in delivery of items selected by the Homeowner, governmental action, and unforeseen events beyond the Contractor's control, including but not limited to weather, strikes, war, the acts of third persons or the acts of the Homeowner. The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS: Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the Proposal. Thirty percent (30%) of the total is to be paid as a deposit with the signing of this contract. Upon cancellation p rior to commencement of the Work, any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel. Final payment shall be due upon completion of the Work and Homeowner agrees it may not hold any retainage. Late fees may be applied for late payments. Homeowner shall pay Contractor's reasonable costs of collection, including attorney's fees and costs. Time is of the essence hereof. 5. WARRANTY: For a period of 2 years after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing -up or extraordinary weather events, including blizzards, tornadoes, hurricanes or storms of greater than a twenty-five year duration or intensity. Contractor gives no warranties with reference to any materials or equipment installed in the Premises, passes any such warranties directly to Homeowner, and Homeowner agrees to look only to the manufacturer with reference thereto. This limited warranty extends to the Homeowner only and is not transferable to succeeding Homeowners. This Limited Warranty specifically excludes (i) all consequential and incidental damages; (ii) damage due to ordinary wear and tear, abusive use, misuse, or lack of proper maintenance; (iii) defects which are the result of characteristics common to materials used; (iv) defects in items installed or supplied by anyone other than Contractor; (v) work done by anyone other than by Contractor; and (vi) loss or injury due to the elements. There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT: This contract and all documents referenced herein constitute the complete and final agreement between the parties. In the event that any of the provisions of this contract shall be held to be invalid, the remainder of the provisions of this contract shall remain in full force and effect. Two identical copies of this contract have been completed and signed. Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION: In accordance with M.G.L.c. 142 A, § 9, Contractor is registered with the Bureau of Building Regulations and Standards Registration No: 174377. Homeowner may verify by contacting the Director at (617) 727-3200, ext. 25205. A Homeowner's rights under the Home Improvement Law (M.G.L.c. 142A) and other consumer protection laws may not be waived in any way. Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A, and which are available online at www.mass.gov. Questions may be directed to the Consumer Information Hotline, (617)727-7780. 8. ARBITRATION: 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 such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 1.42A. No lien or security interest is imposed on the Property as a consequence of this contract, but Contractor has the right to record this contract or a notice of this contract, or seek a lien if the Homeowner breaches this Contract. 9. HOMEOWNER COVENANTS: The Homeowner agrees, represents and warrants that (a) the Homeowner grants permission to the Contractor to enter the Property to perform the work as covered by this contract; (b) the Homeowner has funds available to make full payment under this contract to the Contractor upon completion; (c) the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition, and agrees not to enter portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed; (d) Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and (e) that code requirements may result in roofing nails penetrating through roof decking and will be visible on the underside of some surfaces. The Homeowner indemnifies, exonerates and holds harmless the Contractor from any loss, damage, claim, liability or expense (including reasonable attorney's fees, deposition costs and court costs) resulting from a breach of this provision. Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10. CANCELLATION: Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third business day following the signing of this agreement. H6MEOW�NEI,J�l/"— DATE: Shingle: —�j DEPOSIT: I r P Tile Commonwealth of Massachusetts I'� - Departinent of Industrial Accidents Office tt,} :p i ofianlestigatiotls MA 600 f'ashington Stt'eet --,,�� Boston, MA 02111 i Iir ow.mass golv/di<a Workers" Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers •Y Name Address: 6 Are van employer? Check the aper f' i. I am a employer with employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees worldng for me in any capacity. [No workers' comp. insurance required.] ,_ CI I am a homeonner doing all work myself. [No workers' comp. insurance required] �' .. Phone #: 7 riate box: 4.E] I am a general contractor and I have Hired the sub -contractors listed on fine attached sheet. These sub -contractors have employees and have workers' comp. insurance.= 5. F J We are a corporation and its officers have exercised their- right hemright of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers - comp. insurance required.] Type of project (required): G. ❑ New construction 7. ❑ Remodeling 8. Q Demolition 9. ❑ Building addition IO.❑ Electrical repairs or additions 1.0 Plumbing repairs or additions 12.[214�o"of repairs 13.n Other *A.ny applicant that checks box :'1 must also fill out file section below showing their workers' compensation policy information. T Homeowners tvho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Connectors that checl- this box must attached an additional sheet shoe*in.- tate name of the sub -contractors and statewhether or not those entities have employes. If the sub -contractors have employers, they must provide their tit=orkers' comp. policy number - ,l and alt elltploj.,er that is providing ivorlcers' colllpensatiotl illsilralice for iizjy elllploj-Les Below is thepolI 3j atldJob site 111 arlllatloll_ Insurance Company _ Expiration Date: Policy T or Self -ins. Lic. 0: .1 J, ' Job Site Addres City/State/Z' - Attacil a copy of the workers' compensation policy declaration page (showing the po ick' number and expiration dpte). 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 x;250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office or Investigations of the DIA for insurance coverage verification. f do hareby certif} lI1d r the pains andpenalties of perjury that the information provided aboPe is true and correct. �: , ....,. �ll Date: A - .7 I �/ -- Official use olllj: Do not write in this area, to be completed by. city or town officiaL City or Town: Permit/License n Issuing Authority (circle one): 1. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector G. Other Contact Person: __ Phone =: A` 40RD ' CERTIFICATE OF LIABILITY INSURANCE DATE(MWOONYYY) TYPE OF INSURANCE � 11109/2016 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 pollcy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 CONTANME: Diane LeBlanc DOHERTY INSURANCE AGENCY INC I PHONE 978) 475.0260 ac No Ao Imo: dleblan dohe 'nsurance.com _ INSURER(S)AFFORDING COVERAGE MAIC 0 P -O BOX 1955 MED EXP (Any one person) $ WSURERA: AIM MUTUAL INS CO 33758 ANDOVER MA 01810 INSURED INSURER 8: DAMPHOUSSE ROOFING LLP INSURERC: INSURER 0: GEWL AGGREGATE LIMIT APPLIES PER PRO• POLICY El JE LOC El 87 BELMONT STREET INSURER E: NORTH ANDOVER MA 01845 INSURER F: _ COVERAGES CERTIFICATE NUMBER: 101761 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 REOUIREMENT. 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. INSRLTR TYPE OF INSURANCE � OL e POLICYNUMBER POLICY EFF MPOMIuOD EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR i EACH OCCURRENCE 5 PREMISES Ea owmenco S MED EXP (Any one person) $ PERSONAL 8 ADV INJURY S NIA GEWL AGGREGATE LIMIT APPLIES PER PRO• POLICY El JE LOC El -- _ GENERAL AGGREGATE S PRODUCTS - COMPIOP AGG { S S OTHER: j AUTOMOBILE LIABILITY i COEaMccdont BINED SINGLE LIMIT S a ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS, N/A _ BODILY INJURY (Per parsm Is — BODILY INJURY (Per accident) $ PROPERTYDAMAGE S Per acddont S — UMBRELLALIAB OCCUR HCXAJMSAqAOE1 EACH OCCURRENCE S EXCESSLIAe NIA _ AGGREGATE S $ OED RETENTIONS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFF CER/ EEM ER XCLUD�ECl1rNE NIA] (Mandatory In NH) II DEyes. describe under SCRIPTION OF OPERATIONS below MIA NIA AWC40070287742016A 04/17/2016 04/17/2017 PER OTH- X STATUTE ER - E.L. EACH ACCIDENT S 500,000 E L. DISEASE - EA EMPLOYEE S 500,000 E L. DISEASE. POLICY LIMIT S 500,000 iNIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101. Additional Remarks Schedula. may be attached It more apace is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this cov6rage can be monitored daily by accessing the Proof of Coverage -Coverage Verification Search toot at www.mass.govllwdtworkers-compensationrinvestigationst. Town of North Andover 1600 Osgood Street North Andover ACORD 25 (2014101) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MA 01845 Daniel M. t,ror ay, CPCU, Vice President — Residual Market — WCRIBMA ©1988-2014 ACORD The ACORD name and logo are registered marks of ACORD All riOtltS ranaruArl Client#:14415 DAMPHOUSSE ACORD- CERTIFICATE OF LIABILITY INSURANCE 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. LTR 11109/2016YYI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency, Inc. P.O. Box 1985 21 Elm Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LIMITS EACHOCCURRENCE $1000000 Andover, MA 01810 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A Western World Damphousse Roofing LLP 87 Belmont St North Andover, MA 01845 INSURER 8: INSURER C.INSURER O. 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. LTR NSRC TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION 04/12/17 LIMITS EACHOCCURRENCE $1000000 A GENERAL LIABILITY NPP8296488 04/12/16 DAMAGE TO RENTED S100,000 MEO EXP (Amr one Person) $5.000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX OCCUR PERSONAL A ADV INJURY S1 000 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY PROJECLOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea aoddent) S ALL OWNED AUTOS SCHEOULEDAUTOS BODILY INJURY S (Por person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY S (Por socideni) PROPERTY DAMAGE S (Par axidw) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC S ANY AUTO AUTOONLY: AGG S EXCESSIUMBRELLALIABILITY EACH OCCURRENCE S AGGREGATE S OCCUR a CLAIMS MADE S S GEOUCT18LE S RETENTION S WORKERS COMPENSATION AND WC STATU• I OTk- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT S ANY PROPRIETORIPARTNER/EXECUTI'VE E.L. DISEASE • EA EMPLOYEE S OFFICERIMEMBER EXCLUDED? If ya,. de5piD0 under SPECIAL PROVISIONS below E.L. DISEASE. POLICY LIMIT IS OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... Town of North Andover 1600 Osgood Street North Andover, MA 01845 LO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN ;E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL OBLIGATION OR LIABILITY AUTHORIZED UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001108)1 of 2 #SM292/M34248 - DML 0 AfflWD CORPORATION 1088 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -067560 Construction Su; .-;arv1sGr SHAUN M TWOMEY 61 PATROIT ST NORTH ANDOVER MA 01845 (�-JZZK- CA- Expiration: Commissioner - 1012512017 92. . Office of Consumer Affairs& Bi&�Iness Regulation HOME IMPROVEMENT CONTRACTOR E,Registration: 174377 Type: Expiration: .214/2017 LLP DAMPHOUSSE ROOFING LLP SHAUN TWOMEY 87 BELMONT ST N. ANDOVER, MA 01845 Undersecretary