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HomeMy WebLinkAboutBuilding Permit #869-2016 - 241 WAVERLY ROAD 2/3/2016L— �-4�I p AA `� 11� BUILDING PERMIT ` T®WN OF NORTH AND®VER APPLICATION FOR PLAN EXAMINATION Date Received 2 Zi 1 IIS _ Permit No#: Date Issued: TANT: Applicant must complete all items on this Th FK LOCATION tM I aver )(TC6 Wf,+h A�loy Y Yet Print PROPERTY OWNER S`QN\nV S& LLC• Print 100 Year Structure yesno MAP PARCEL:L�_ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building E(One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial E'Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition Other ❑ `Septic; ❑ UVell4 p _❑ ❑`FI©otlplaini O Wetlantls. ❑ Watersledr®tstrcict �� 0 Water/Sewer;• z"� --- - DESCRIPTION OF WOKK i (J tat 1-tMt-UM1v1cU: Nem , �neW W iV)�ws 7bx-a aho rF, rernoclel 1 yz Ana d.�� �- CIneY1� ay)� new WAO( iCK' kM - Identifica ion -,.Please Please Type or Print Clearly OWNER: Name: 5 •" \vim PhoneA01 .0 Address " CharA le!r A ndm9 y -AA D I M LLC Contractor Name�Q�US''o CUl\ytt1n0 4`-SicicrPhone: �� Addres Supervisor's Construction Licensecs 0�6 !0 Exp. Date: 014 10q /0?01� Home Improvement License: � �OGJS6T Date: 07 /057 ARCHITECT/ENGINEER NIA Phone: i Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.0000 PER S.F. Total Project Cost: $ 10%1 FEE: o O Check No.: ��zpReceipt No.: NOTE: Persons contract g with unregistered contractors do not have access to the guaran and A /� A Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN ®FF m U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signatu 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 A Conservation Decision: Comments Water & Sewer Connection/Sianafiure � Dafie Driveway Permit DPW Town Engineer: Signature: r Located 384 Osgood Street Ail E DEP R`TMEIV�T Temp Dum�pster onsite no aLoeatecl at 124 Main Street�f;r „ c . f H - ire Depart�m,"ent,signaturk%date y�ly��iGd.`�',+�j.��k�}#,�`M1�;:f�"j„�Yr;+ia" ,:t "��ii�s',,�ls'x <'i L�'��ik"it�;Z7' en}��,�'��3�i" ��`Yajyi{�}�„rY,f-:•,.�,t.x,�.w.�...,,���,.�.�..�.�.�,,.,�, rl 't• Tet , h,. � `C+C!'� f:` fta ttii'Y �'r '!. SY,�'r`-'kt7i1 � --<i� J'� COMMEIVTS����`.:�;�,�h'�c�sffW'�z-•�;.<'= a 'kri�� <1 1Y`����a�.°��',�',:�'i{a�.xny'������`�`���s Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, avast or service drop requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use Notified for pickup Cal Date Tim Doc.Building 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application iL Certified Surveyed Plot Plan A. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 TOTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products TE: 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 Location Lk k oc" i e No. Date Check # 29989. TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee� TOTAL BUilding Inspector $ 2- Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 68,800.00 m $ - $ 825.60 Plumbing Fee $ 103.20 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 103.20 Total fees collected $ 1,132.00 241 Waverly Road 869-2016 on 2/3/16 Remodel House 0-9 O O C R p V �+ cc D Q �oo rn V E L- c. y 0 DoE- oIS L fA " 3 Q' J 1. OF. 3�m m L O 4: C m > U) _ -OO O 'a r \� � •LUQ CO y d 0 Z a� 0 � � c ca o y H U) c = _ 0 Q 0 F— O v� 0 m co O -0 -. m a,O O uj P: LL 'N Vl C �� t O U) �+ :E .2 w .r V Q O -a fn > i►- C U) -= O F=- t w `0.oU O O W CL U) z m �Iv N CD E O z CL O N o IM Nom •Emm a� O w 0 0 no CL CL a� Q o v J � 0-0 �z O V N !u c U) W G o a. o a O s x a H H zcc u Q Z Z:.. .:.:a Z CA W LU u ` t •. LLI W u l ' v itoO ,� C �" m _ O a O (D 7 7� O O t C 7 f0 O C to 7 f0 O N C . 7 O UJ O kA 0-9 O O C R p V �+ cc D Q �oo rn V E L- c. y 0 DoE- oIS L fA " 3 Q' J 1. OF. 3�m m L O 4: C m > U) _ -OO O 'a r \� � •LUQ CO y d 0 Z a� 0 � � c ca o y H U) c = _ 0 Q 0 F— O v� 0 m co O -0 -. m a,O O uj P: LL 'N Vl C �� t O U) �+ :E .2 w .r V Q O -a fn > i►- C U) -= O F=- t w `0.oU O O W CL U) z m �Iv N CD E O z CL O N o IM Nom •Emm a� O w 0 0 no CL CL a� Q o v J � 0-0 �z O V N !u c U) cJ .O N El 0: r O LL G Q m L u O LL E i0-+ T 01 U) U Z z Z � m C O O LL O = C t U LL O iy kn Z Z m � J a L O OC LL O d 4n Z Q U W J LU L O K u N C LL oC 0 d Z H Q toaL O K _ LL Z W 0. W Im W 25 LL N L m O i O (% }i N Y O (n 7MM7M7 O R R 0 V w �CL (D R EC. L � 2 c -on.: m ai V • �' AW v E o = ��'•, c a 0CD V N Q J -S`V= 3�= R L -��0 O c NVQ l� 0 .0 0 m oz a o • �� H CD r .N 0 R _c i R 'a = F— O r. L N •O y v m N = O O O W LL H -0— Q. N C W U y.E 0-0 cn Q y � c F=- t O Z- Q. 0 U E CD a cn :a N _ CD m O tm O N O t O Z O O 0 N G Z co 0 Z F— Lu IL Z UJ0 W V W JCL z O W a Z Z CO 9, 2 W L V W 00 O CL CL � Q Cc M J � O z� U) r_ 325 Main Street P� �� North Reading, MA 01864 64-4300 PAINTING & RESTORATION H9C #669554 ADDRESS i ;Jason Chute Swift Sell 241 Waverly Road i North Andover, MA i i i i PROPOSAL# DATE 1108 01 /21 /2016 PHONE NUMBER (603) 793-7292 DESCRIPTION Carpentry 241 Waverly Road Andover, MA 01810 General Conditions $2,750 -includes Porta -Potty rental, snow removal, pressure wash exterior, permitting, and dumpster Roof $9,250 -house, two car garage, and small re -pointing of chimney Carpentry $19,350 -Basement stairs and railing, bathroom closet, bedroom wall, interior doors, kitchen install and vanity install -Material includes studs, drywall and plywood $1,350 Plumbing $3,500 -Kitchen and two bathroom fixture install Electric $5,000 -New service, bathroom GFCI, bedroom arc faults, 8 dedicated kitchen circuits, new dryer line, new stove line and hard -wire smoke detector upgrades Windows $8,000 -All house and basement windows (6 over 1 grids with screens for house windows) Total of 23 house windows and 4 basement windows Insulation $500 -As needed throughout project Heating Boiler Rebuild $200 -(budget item for boiler tune up. Price is subject to change) Tile $2,500 -Entry way, kitchen and two bathrooms Hardwood $3,500 -New hardwood installed in kitchen. Sand and three coats throughout rest of house Painting $11,900 -Patching holes as needed (not skim coating entire walls) -Paint garage and exterior doors -Paint basement walls, basement floor, and sewer pipe -Prime and paint all interior ceilings, walls and trim -Epoxy paint garage floor We propose to furnish labor and materials in complete accordance with the above specifications. TOTAL Accepted By Accepted Date Proposal AMOUNT 68,800.00 Ae Commonwealth ofMassacasetts Department ofIndustrio Alcczdents M ; X Congress Street, Suite 100 r< Boston, MM 02114-2017 www.mass.gov/dza Workers' Compensation Insurance Affidavit: JBuiriders/Contractors/Electrx'icians/Plumbers. TO BE PILED '6 TH TM 1PERMLTT1 NG AUTHORITY. Name (Bus:mess/Organizadon/individual): Address: City/State/Zip: N00h •v�• ' N l • 1_" 'Qes�acarKGn LLC Are you an employer? Cheek t& appropriate box: 1.[ I am a employer with .O. • _ employees (full and/or pari tune).4' 2. ❑ I am a sole proprietor or partnership and have no employees working for mein any capacity. [No workers' comp. insurance required.] 3.[] I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. C] I am a homeowner and will be hiring contractors to conduct all work on my property. 1 -will ensure that all contractors either have workers' compensation insurance or are sole 5.L] I am a general contractor and haye hired the sub-coiitractors listed on the attached sheet. These sub- contractorsbade employees and have workers' comp. insurance. 6.E] We are a corporation and its oftigers have exercised their right of exemption per MGI. c. 152, § 1(4), and wa have nq en4plciyees. [No workers' comp. insurance required.] Type of project (Tgquired): 7. [1 New construction 8. Ei R.emodeli ig 9. ❑ Demolition 10 [] Building addition 11.n Electrical repairs or additions 13. [] Rooffepairs 14. ❑ Other xAny applicant that checks box4l must also fill. out the section below showing theirworkers' compensation policy information. t Homeowners who stbi fif 1t is affidavit indicating they are doing all work and then hire outside contractors must submit a new afCdavit 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-conlraclors have employees, ley must provide their workers' comp. policy number. lam an erriployer that is pi ovidirzg war•kers' compensation insurance for my employees ' .below is the policy and joie site information. /� Q' j�� Insurance CompanyName: A �Ur, �V 1Yiswa�(1�- C Expiration Date:�� Policy # or Self -ins, Lic. #: �V�- MA- fob Site Addressla� ""-' City/State/Zip:NG�-th ndoye �.� �1�} Attach. a copy of the Workers' 6ompeM&ion policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. X do -hereby cert yXnder• the the inforination provided above is true andcorrect C)2- /02 /XJ(v Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License issuing.A.uthority (circle one): 1. Board of E(ealth 2. BuildingDepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Cather Contact Person: ]Phone i Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract bf litre, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, ox any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. Ho*ever the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptalile'evidence bf compliance with the insurance�coverage i equired." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fil 'out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractors) name(s), address(es) and -phone number(s) along with their certificates) of iasuxaaee—Umited4aabiiiiyeompantes_(LLG}orL�mitedL�abilii� ParEttierslu (LDP ithno emp ogees oth or tfliain thic, members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The'afddavit'should be returned to the city or town that the application for the permit or license is being requested, mot the Department of Industrial Accidents. Should you have any questions regarding the law or if yoware required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter'their self insurauce license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only subniii one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations.in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the ` applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia A� " CERTIFICATE OF LIABILITY INSURANCE (MMIDDIYYYY DATE 2/3/2016 ' 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 policy(ies) 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 CONTACT NAME: PHOAIC.NENo, ( 9'78) 664-2000 FAX No): (978) 664-0180 Linnane Insurance Agency Inc. E-MAIL ADDRESS: 280 Main St. #101 INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,000 INSURERA: N. Reading MA 01864 INSURED INSURERB-Main St. America INSURERC: Peluso Painting & Restoration LLC INSURER D: $ INSURER E: 325 Main St Suite 301 INSURER F: North Reading MA 01864 COVERAGES CERTIFICATE NUMBER:CL1313100854 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E_x] OCCUR North Andover, MA 01845 MPT0501H 1/28/2016 1/28/2017 EACH OCCURRENCE $ 1,000,000 TO DAMAGE PREMISES ( RENTED 500,000 Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT F-1PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PPReO�PEcRdTntDAMAGE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE - - EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU-OTH- TORY LIM TSPR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 r?ninnsi m ©1988-2010 ACORD CORPORATION. All rights reserved. Tha Arr)Pn nnma nnri Innn nra ranictarari mnrirc of Armon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 241 Waverly Rd AUTHORIZED REPRESENTATIVE North Andover, MA 01845 M Linnane/JUSTIN ACORD 25 (2010/05) INS025 r?ninnsi m ©1988-2010 ACORD CORPORATION. All rights reserved. Tha Arr)Pn nnma nnri Innn nra ranictarari mnrirc of Armon A^� 76 CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) TYPE OF INSURANCE 02/03/2 /03/2016 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 policy(ies) 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 NAME: Automatic Data Processing Insurance Agency, Inc. PHONE FAX Alc No Ext): A/C No): E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S) AFFORDING COVERAGE NAIC # Roseland, NJ 07068 INSURER A: AmGUARD Insurance Company 42390 INSURED PELUSO PAINTING & RESTORATIO INSURER B: INSURER C: 325 Main Street INSURER D: Suite 301 North Reading, MA 01864 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 444860 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 LTR TYPE OF INSURANCE A O INSD B WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS North Andover, MA 01845 COMMERCIAL GENERAL LIABILITY -7 CLAIMS-MADE OCCUR _ EACH OCCURRENCE $ DAMAGETO RENTED- PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO - LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS NON -OWNED CEa OMBINED SINGLE LIMIT $ accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N PEWC666045 07/09/2015 07/09/2016 X PEROTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION A©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 241 Waverly Road AUTHORIZED REPRESENTATIVE North Andover, MA 01845 A©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD doamonottrucall� off.'G'uac/aje Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR egistration:. 169554 Type: xpiration:: -7/5/2017., Individual THOMAS PELUSO THOMAS PELUSO 200 CHANDLER ROAD. _. ANDOVER, MA 01810 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Nde ot valid without sign e Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cnn.ctructior, sunert';snr t-----�. License: CS_102590 LQ j THOMAS 1W PEL�O 200 Chandler RoaS + � Andover MA 0180 Y • Commissioner F"Piration 04AW2017