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HomeMy WebLinkAboutBuilding Permit #1060-2016 - 28 MORNINGSIDE LANE 4/11/2016 Location,-.2y / No. 10661- Gfl Date . - TOWN OF NORTH ANDOVER ° Certificate of Occupancy $ Building/Frame Permit Fee 0 - Foundation Permit Fee $ ` Other Permit Fee $ TOTAL $ L Check p�,--?7 Building Inspector I II A 14 4 W BUILDING PERMIT TOWN OF NORTH ANDOVER ,0 3 ll APPLICATION FOR PLAN EXAMINATION Permit NO: ` V I Date Received Date Issued: c,ws� E�PORTANT:Applicant must complete all items on this page Y ui + S► LOCATION � �c �•. P,riat- PROPERTY OWNER " .L ��-ryry Print MAP NO: PARCEL: A)V/ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic 0 Well 0 Floodplain 0 Wetlands 0 Watershed District ❑Water/Sewer n � k i P®/ou / 'n0117� tri CJ d Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: v'�� ma��� s' .46n.t CONTRACTOR Name: C?1 19t-Jar,e Lz; 44 r Phone: Address: 14, In ta Supervisor's Construction License: Exp. Date: Home Improvement License: -2 2 76 Exp. Date: ZDi 7 ARCHITECT/ENGINEER /D Phone: Address: 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: $ 97 -Zhu FEE: $ i' Check No.: a&I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to a uar my fund Signature of Agent/Owner lquature of_contractor -............... --- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Drivate(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Z — — Si nature i 4.11 COMMENTS HALTH Reviewed on Qature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes r Planning Board Decision: Comments 'Conservation Decision: Comments Jt Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: 84 FIRE DEPAR�TMEN�T - Temp�tDurnpster on�stte ,yes-�. _ 3roa oca e Osgood Street . , 4 Locatedtat 12:4tlamtSt�eRet I F.ire(Depa�r�r�ent�_signature/d'a,"te _ _ -_T____n F 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 DANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit 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 . Certified Surveyed Plot Plan 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) 4. Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 Com W p Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) :rc Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products IN OTE: 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 m ust be submitted with the building application Doe:Building Permit Revised 2014 NORTH own of E ndover 0 � - No. h ver, Mass,Aa- �A � C, LAK2 o coc NICHIW1CN y1. �ds RATED 0'P�,��(5 fJ BOARD OF HEALTH Food/Kitchen Septic System PERq[ T THIS CERTIFIES THATi4 ,. BUILDING INSPECTOR Foundation has permission to erect .......................... buildi of ........ ..�.h0wo.. .!! t. .�.... Rough to be occupied as ....... ... ...... .. .... .0.4...�...... ...................................... Chimney provided that the person accepting this permit shall in every respect confor o e terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION_ of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION §TARTS Rough Service .................. ...... ... . .. . . ............. Final *WiILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Paul's Handyman Services Estimate CPL Associates LLC 282 Center St Date Estimate# Groveland, MA 01834 4/11/2016 1534 Name/Address David Evangelista 28 Morningside Lane N Andover,Ma Terms 1/3, 1/3, 1/3 upon c... Item Description Total New Entry Details: Therma Tru Fiber-Classic Mahogany Factory Finish 36 X 80 Single LH inswing,6 panel with clear insulated glass in upper two panels Dbl Bore Oil rubbed bronze ball bearing hinges W/Dble Sidelites both full Clear insulated Glass Crated and delivered onsite Drawing of entry provided Payment Schedule 1/3rd of estimate required to order materials and schedule work 1/3rd of estimate due upon project start date Final payment due upon project completion Estimate is good for 30 Days Subtotal $9,420.00 1/3 Deposit required to order product and schedule projects Final Invoice not to exceed+/- 10%of estimate unless work order changed Sales Tax (6.5%) $341.25 Total $9,761.25 Signature Page 3 Paul's Handyman Services Estimate CPL Associates LLC 282 Center St Date Estimate# Groveland, MA 01834 4/11/2016 1534 Name/Address David Evangelista 28 Morningside Lane N Andover,Ma Terms 1/3, 1/3, 1/3 upon c... Item Description Total M&S Required materials and supplies 5,250.00T Fiberglass Entry with twin side lights/stain kit application$4200 Primed 2 1/2"colonial casing Primed baseboard Primed exterior brick molding Blueboard/Plaster Azek trim panel Primer/Paints misc materials and supplies Entry Delivery Materials Procurement 25 Cleanup Cleanup&Restoration 200.00 Remove and dispose off all debris Daily and Final Clean up Please Note: Condition sub-floor under the entry is not known.Estimate does not provide for repairs if necessary. Existing storm door is to be reused if it fits the new frame. Since these door frames are cut to fit,it may not fit new opening.If so,it will need to be replaced. Estimate is good for 30 Days Subtotal 1/3 Deposit required to order product and schedule projects Final Invoice not to exceed+/- 10%of estimate unless work order changed Sales Tax (6.5%) Total Signature Page 2 Paul's Handyman Services Estimate CPL Associates LLC 282 Center St Date Estimate# Groveland, MA 01834 4/11/2016 1534 Name/Address David Evangelista 28 Morningside Lane N Andover,Ma Terms 1/3, 1/3, 1/3 upon c... Item Description Total Repairs to Foyer exterior wall and entry 02.10 Demo Demo 960.00 Remove Storm Door Remove Entry with side lights-60"X 84" Remove wallboard(veneer plaster over blueboard)and trim work Remove Insulation 17 Insulation Insulation 60.00 Install Faced R19 fiberglass insulation with vapor barrier 18 Finish Walls Install 1/2"Blueboard 250.00 Plaster 2 coats 20 Millwork&Trim Millwork&Trim 2,100.00 Install new entry and all required hardware(re-use existing lockset if possible) Install existing storm door if possible Install exterior brick molding Install Azek kick panel Install interior colonial casing 24 Paint Painting 600.00 Paint all Jamb and trim 2 coats BM SG white Paint Entry frame and trim(white)2 coats Prime and paint all new wallboard to match existing walls Customer request 2 tone jamb and trim-Exterior break cream l plus 2 coats on outside plus sealer/white on inside as planned Estimate is good for 30 Days Subtotal 1/3 Deposit required to order product and schedule projects Final Invoice not to exceed+/- 10%of estimate unless work order changed Sales Tax (6.5%) Total Signature Page 1 The Commonwealth of Massachusetts F Department oflndustrialAccidents 1 Congress Street,Suite 100 " Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name (Business/Organization/Individual): a Address: c5 e2- City/State/Zip: zS Phone#: J��� - ��7dr-- Xa f Are you an employer?Check&e appropriate box: Type of project(required): L❑I am a mployerwith employees(full and/or part-time).* 7. [:]New construction 2. am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3..❑lam a homeowner doing all work myself[No workers'comp.-insurance required.]t ❑4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ $ 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its,officers have exercised their right of exemption per MGL C. 14.E]Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors 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-c' itraciors have employees,lbey must provide their workers'comp.policy number. I am an employer that is pi'ovidiizg workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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 of the DIA for insurance coverage verification. Ido hereby certifyujm ep ins and enaldes ofperjury that the information provided above is true and correct. Signature: Date: �/ /F 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#: Information and Instructions 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 ofhire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,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. However 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 bd 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 acceptable evidence of compliance with the insurance coverage required." 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 fill 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 certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the 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 foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-iirsur6d companies should'enter their self-insurance 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 submit 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. A new 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 i Aca® CERTIFICATE OF LIABILITY INSURANCE73114/2016 (MMIDDNYYY) `...•� 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 NONTACT MK Sullivan M K Sullivan Insurance Agency (SAN Group Member) PHONE Es (978)3467200 FWC.AX Nc:(878)346-4846 30 Grove Street AGDREss: INSURER AFFORDINGCOVERAGE NAIC# Merrimac MA 01860 INSURERA:Utiea First INSURED INSURER B Paul Lecessel INSURER C: 282 Center St INSURERD: INSURER E: Groveland MA 01834 I SURER F COVERAGES CERTIFICATE NUMBERCL1631401147 REVISION NUMBER: THIS IS TO CEIRTIFY 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. LTR TYPE OF INSURANCE DL UBR POLICY NUMBER MMOIUDC EFF MOMA3D EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑x OCCUR PR LJAFVLPUES TV RENFED Frence $ 50,000 ART5040832-02 6/3/2015 6/3/2016 MED EXP(Any one person) $ 5,000 PERSONAL BADV[NJURY $ 1,000,000 GENLAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 % POLICY❑ja F LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIAB]LITYMBI SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) S ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS UTOS PPROPf Dant)AMAGE $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LTAB CLAIMS-MADE AGGREGATE $ DE RETENTION S $ WORKHRS COMPENSATION IPER AND EMPLOYERS'LIABILI Y YIN STAT ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA EL.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOY S "M f yeas desa�e under DESCRIPTION OF OPERATIONS below F-L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Groveland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 183 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Groveland, MA 01834 AUTHORIZED REPRESENTATIVE SAN Group Inc by ©998 14 ACORD CORPORATION. All rig s reserved. ACORD 25(2014101) The ACORD name and logo are registered marks bf ACORD INS025(201401) Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY k. � 4/11/2016 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: MLC Sul ivan M IC Sullivan Insurance Ageacy (SAN Group Memberj PHONE (978)346-7200 FAx o (978)946-4866 30 Grove Street EMAIL DDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Merrimac MA 01860 INSURER A:IItica First INSURED INSURER B: Paul Lecesse INSURER C: 282 Center St INSURER D: INSURER E Groveland MA 01834 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1631401147 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. 1NSR ADDL SUBR POLICY EFF POLIC LTR TYPE OF INSURANCE INISD wVD POLICY NUMBER IDD MIDDEXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑7c OCCUR PREMISES (ENTED PREMIEa acarcence $ 50,000 ARTSO40832-02 6/3/2015 6/3/2016 MED EXP(My one persw) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 S POLICY F-1JELOC PRODUCTS-COMPIOPAGG $ 2,000,ODD OTHER: Employee Benefits $ AUTOMOBILE LIABILITY CCO0Mac NED dent) NGLEL[MlT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per cadent $ $ UMBRELLA UAB OCCl7R EACH OCCURRENCE $ 4 EXCESS LIAR CLAIMS MADE AGGREGATE $ DED I I RETENTIONS $ WORIO=RS COMPENSATION PER _ AND EMPLOYERS'LIABILITY Y/N FJZ ANY PROPRIETORMARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLO $ If es,describe under DESCRIPTION OF OPERATIONSbelow EL DISEASE-POLICY umrr I$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD lei,Additional Remarks Schedule,may be attached If more space Is reguked) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 'sown of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. Building 20, Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE SAN Group Inc by ©998 0 ACORD CORPORATION. All rfpffils reserved. ACORD 25(2094101) The ACORD name and logo are registered marks WACORD INS025(201401) - e Ifarxri�air[u�:Ul��c/�'7%tiJJCIrY7tNr/�' �L\ office of Consumer Affairs&Business Regulation =_ OME IMPROVEMENT CONTRACTOR Type: egistration: 162376 _ /Expiration: 2/23/2017 LLC CPL ASSOCIATES LLC PAUL LECESSE 282 CENTER ST �.c,<• GROVELAND,MA 01834 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen icor License: CS-106802 PAUL LECESSE = 282 CENTER STREET Groveland NIA 0f834 Exp1ration Commissioner 05/30/2016