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HomeMy WebLinkAboutBuilding Permit #352-14 - 29 ROSEDALE AVENUE 10/15/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �✓ ( Date Received Date Issued: & l�/-3 ORTANT:A licant must coin lete all items on this age LOCATION • All ,� Print PROPERTY OWNER a Print MAP NO:Dqi—PARCEI :�ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building w6ne family ❑Addition ❑Two or more family ❑ Industrial ❑ ation No. of units: 11 Commercial LvIkepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Flood~ lain �D kWetlands� ? ���©�WatershedtDistr'ict; �, D_S,epticr k D Well - p - XkT !....``D�Water�ewer�__�.: : —__ • } 1."''�" __...::-_.___..__ .._x.. '- ——. _.:..__;...�_ 1�hi�4`-':tt':!_�f a,_ �...:._. .?�.n-�!_a� �+�.it_....1J.d?�.F DESCRIPTION OF WORK TO BE PERFORMED: dentification Please Type or Print CIearly) OWNER: Name: /' ,�' Phond:!� ` ✓ Address: --��,,�� CONTRACTOR Name: Phone: Address: Supervisor's Construction License: ! S-(.- Exp. Date: a / Home Improvement License: �7 .� ;7Exp. Date: /. ARCHITECT/ENGINEER / 1--4A1" - Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $T FEE: $ Check No.: 7 Receipt No.: �� z NOTE: Persons contracting with unregistered contractors do not have access to t e guarantyfund F--- - - -s, Signature_ofcontracto Signa{ure:of Agenf�Owner - .._ __ Pians Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyRrt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature t COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Comments 6 Wager& Sewer Connection/Signature Date Drivewa rLPermit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department ' gn si ature/date p 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: Yes No MGL Chapter 166 section 21A—F and G min.$10041000 fine NOTES and DATA— For department use ® Notified for pickup - Date Dox.Building permit Revised 2008 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ - Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products . OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals ,it the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording is be submitted with the building application Doc: Doe-Building permit Revised 2008mi Location 22A - No. � Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $,, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#//37 Building Inspector NORTH Town of t E : Andover O - 0 aZ ver, Mass, COCHIC"t WIcK y1. A0R'STED /'P��,�S S V BOARD OF HEALTH Food/Kitchen PERMIT . LD Septic System THIS CERTIFIES THAT ......... / 4 0'-V BUILDING INSPECTOR ................... ................................................................................. has permission to erect .............. buildings on ;t F, , ,G,`� �U F Foundation ............ ..... ..... ............................... • Rough to be occupied as 6 ......... P.:'���-..f...�!..1.©d. ......................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the 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 T RTS Rough Service .............. ....... `'"""".............................. Final BUILDING 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. SEE REVERSE SIDE D „ - Proposal H - HIC#174377 Dam housse Roofing LLP A trusted name since 1938 Roofing •Siding •Windows 87 Belmont Street • North Andover, MA 01845 P: 978-683-4588 • F: 978-685-7446 s NAME OF OWNER / C5(1, ADRESS OF JOB ff TEL. DATE: We will remove all roof shingles off total roof area, up to two layers. 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 applie9rarchitectural roof shingle installed. Install new vent pipe boot flashings. Waterproof`�existing chimney flashing and remove debris. Shingle Color: Ridge Vent Upgrade$8.00 per ft. 'l Wood Sheathing Repair er ft. lr We Propose herby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars $ & ). Payment to be made as follows , til fJ 6 Authorized Signatur NOTE:This proposal may be withdrawn by us if not accepted with in_days Acceptance 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 Date of Acceptance: Signature I-' 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 prior 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 Iyear 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. 142A.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. HOMEOWNER. DATE: Shingle: — DEPOSIT: The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgovldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: tV_ f� City/State/Zip: `' /„(r' Phone#: lcE'-gip --47 / Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurance required.]r employees.[No workers' comp.insurance required.] 13.[❑Other !Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they Are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:. c—f Policy#or Self-ins.Lic.#: C�(���(S - ' 7��—¢.o1 Expiration Date: 17 1 T Job Site Address-, z r/�r rCity/State/Zip: �C/ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL 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 DTA for insurance coverage verification. Ido hereby cert nd r the pains and penalties of perjury that the information provided above is true d correct, Signature: -t' Date:9-7 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 4/23i42013 8 : 32 : 27 AM 8935 Cdt 03/03 TE ACORD 041231 CERTIFICATE OF LIABILITY INSURANCE DADDIYYYYj 04/2312013 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). ACT PRODUCER 00474-001 NAME: Doherty Insurance Agency Inc (a1CNNo.Ext: (978)475-0260 €kc.No.: PO Box 1985 EMAIL Andover,MA 01810 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Damphousse Roofing LLP INSURERC: 87 Belmont Street INSURER North Andover,MA 01845 INS E' INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR TYPE OF INSURANCE !NSR UPI POLICY NUMBER PM OO YY PMNDY LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PME'NI E TO RENTED $ PREMISES Eaocanrence CLARAS-lM DE F—]OJ'UR MEO EXP(Arty one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-CONPiOP AGG $ OLICY OC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ee acddentl ANY AUTO BODILY INJJRY(Per person) $ ALL OVVNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NO"WNED PROPERTY DAMAGE $ HIP,EDAUTOS AUTOS eracadenl UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTIONS A7U $ yypRKERS COMPENSATION X T AY lIM1TS ER AND EMPLOYERS'LIABILITY AN PRopOYERS'P' ILITY UTNE YIN E.L.EACH ACCIDENT $ 500,000 (1, OFFICER1t1Et'BERCLUDED? a NIA AWC 400-7028774-2013A 4!17/2013 4I17/2014 (Mandatory in NH) EL-DISEASE-EA EMPLOYEE $ 500,000 It Y3s des.�rtbeun 3r EL.DISEASE-POLICY LIMIT $ 500,000 OESCRIPIIDH-0 cPEP.ATIONSbel. DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) No partners are covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION Town of North Andover 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 4454 APN22-2013 MON 12:24 PM FAX NO. 9784750303 P. 03 Client#:14415 ! ACOI Ck. C �- DAMPHOUSSEATEa ` LIABILITY IN���� "�� —YY) YY ,DATE(MMDprYY PRODUCER 04/ZPI1 3 THIE CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doheny insurance Agency.Inc. ON AND CONFERS NO RIGHTS UPON THE CERTIFICATE P-O'Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 21 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover,MA 01810 -— INsuR[D INSUR, RS AFFORDING COVERAGE NAIC tt DaMphouSse Roofing LLpINSURE A. Atain Specialty Insurance Company INSUR6�t+— -- — -- — 87 Belmont St -- — — North Andover,MA 01845 !N`UR�' �• --` '—'-' , 1 r 1 —Y– COVERAGES —�— 1Nsur�R!� -- THE POLICIES OF INa11RANCE LISTED BELOW HAVE 13EEN ISSUED TO THE iNSUkED NAME ADOV(;FOR THE ptjLIGY 'CH'00INUICATEU.NOTWIfHSTANUIN7 ANY REOUIREMENT,TERMOR GONDIT ION OF ANY'CONTRACT OR OTHER DCLAIMEN1 WIT AF5PECr T()WHI(:1•I THIS rFR IN MAY PERTAIN,THE INSURANCE AFrORDED pY THE POLICIrS DES(.PI8 U HrkE1N I.^• U£i.I GT 1 O ALL 711E 7CRM�,ES rF ION-.,A, "ON'AY BE ISSUED OF St) .11 POLICIES.AGC-RELATE LIMIT,SHOWN MAY HAVL'BEEN IREnUCED BY PAID GLAIMS LTR NSR TVPE OF INSURANCE POLICY EFFE TIVG r'OLICY ExPIRA1IDN POLICY NUMBER DA MM1D •- A GENERAL LIABILITY _Dpi. E MM/DO1YY) LIMITS CIP169387 04/12/13 04112114 EACH OC(;UKRENCI: ` X (:OiAMEH(IaL Lt NEf7Al,LABILITY S1 000 000 CLAIMS � I 11AMAGt:Its RCN'I.CLAIMSMnUt 1-^+OCC1'kYR •`5 rte"'^'^ 1 .01000 2L BI/PD Ded:1 000 i MLU Fxr(Any nA.;m r-xr,) SS 000 i .•FrccINAL&AUV(N•IukY s1000000 rCN'_HA,.AGGr,FrarL• s2,000io00 CErli AI:I;RGGn�F LiMli APPLIES PER I X1 P01 Ir.Y •IFCT1 OC FROuuc I;-COMpIOf,Ata: x2,000,000 AUTOMOBILE UABIL1TY —� ANY AUTO ! r:OtaBlur.!I SING r LIMI) -- I (Eh�lrrl•YA�I!) b Al 1.O W Nf p AUTO.s SCHEDU(ED A(m.1s i 60011 Y PJJIIRY [Per Pk'ntv.) HIRCU AI)TOC i NON OWNFD At I IQs i 00011 Y INJURY 1 (Pet nuidcnl) S PROFF11 TY DAMAGE [r•rr nmrEanq S GARAGE LIABILITY A1)TCi<)Nly-[A AC('.IO+tr%. l OTHER r)4AN AAAt_tTrJ ONI Y EXC[SSIIIMORELLA LULBII,RY EACn t1CtaIRRENCFOI:CUri r,LAlMSLgaDC � RETCtmo.,4 5 E WORK[Re COMPENSATION AND1 F,MPLOYF,RS'LIABILrfY I , STATU OT. IC ` T Ry t NjIj, _ ANYfHr)rRIE7i)WP ARINEI(ICXF(:UTIVi OE.L.rnrra ACiatlaNr g rFIGFRIMEA)RER CX(:t tlr)C09 - lrvn:•An:a-einu.ncAmf.F.MPLO FE SPtrQ1AlPROJI„IAAIK1Wfmv - - -- OTHER — L.L.UI:--, iAC,L•• Fr111CY LIN.1I S j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENOORsEMENrl SPECIAL Covering operations usual to Damphousse Roofing LLP... PffoVImONS - i i CERTIFICATE HOLDER CANCELL TION SHOULD AMY F THE ABOVE DESCRIBED POLICIES RE CANCELI•EU BEFORE THE EXPIRATION Town of North Andover DATEYHEREO .THEISSLUNCIINSURERWILLENDEAVORTOMAIL �— OAYSYyRRTEN 1600 Osgood Street NOTICE YO TH�CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO So SHALL North Andover,MA 01845 Impost NO OB ,DATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTAT ES. AUTHORIZED R FN'TAT ACORD 25(2001I0e)1 of 2 #S29121�M29119 ii DM AC CORPORATION 1988 - - t =lassachuseuN- Devai iment of Public Safety SOat-tl stf Builtlin� ke'aulation• and Swndai-6 rJ��i tli`t[ is t_Irt'vi_ut •_!Cc7SC License: CS 67560 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER, MA 01845 Expiration- 10125/2013� C „urtisi,.i ,�e; Tr=.. 4913 1 dicCciC: Sci?= -11ePa7MS!1?i -:i; inc- <vC-i cL;cm%S CS-055108 - - DOUGLAS J LEGARE 79 GARY AVE HAVERHILL MA 01830 r 09/0212014 JXC Yr n?M CVII fCull1?a�C(jr��rcc�u�elG "L\ Office of Consumer Affairs&Business Regulation a� OME IMPROVEMENT CONTRACTOR I _-: egisttation: 174377 Type: K - \ �eExpiration: 2!4/2015 LLP DAMPHOUSSE ROOFING LLP SHAUN TWOMEY 87 BELMONT ST N.ANDOVER, MA 01845 Undersecretan