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HomeMy WebLinkAboutBuilding Permit #490-2017 - 32 CHRISTIAN WAY 11/9/2016/ ORT{I BUILDING PERMIT o� N�zLeD -b;6 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 2 .- ;. Z * o.—.2. ey Permit No#: 41q0 �/-7 Date ReceivedR°R g3 C"us�� Date Issued: l IMPORTANT: Applicant must complete all items on this page 7:�> -� _ -n / LOCATION l I U u/" Print PROPERTY OWNER Q Print 100 Year Structure MAP PARCEL: ZONING DISTRICT: Historic District Machine Shop Village yes yes —ye s TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ A ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer V OWNER: Nar Address: Contractor Na DESCRIPTION OF WORK TO BE PFK1-OKMEu: tifiction - Please or Print Clearly 0 Phone V/ n� �g -,Pi 7'/ Email: Address: Supervisor's Construction Licen ��%��D Exp. Date: Home Improvement License: 1Z ��17% Exp. Date: l% ARCHITECT/ENGINEER Phon Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 S.F. Total Project Cost: $ A5L%� �` 6:: FEE: $ x'47 Check No.: � 1 2� a'` Receipt No.: 3,r NOTE: Persons contracting with unregistered contractors do not have access t the guaranty fund Location ~��� ► {: /- l r S '` i,. [. i No. �►�� _ G UI•� Date 1(- ; - �:- c Check # ;_/ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �* Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i, Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Tobacco Sales ❑ Permanent Dumpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Sianature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments C)nservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locaiea jo14 usgooa Street FIRE DEPARTMENT - Temp Dumpster on site .yes Located;at 12:4 MainStreet Fire Department signature/date- COMMENTS i 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.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name I 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 All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks TOTE: Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses ;6 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 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) ;r< Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products 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 0 O 0 J Q w LL m �V \ O LL E N j -, O0 a). to 0O w �, Z Z D J mC aO + `6 "6 3 LL L W T v O L U LL u a Z Z m J d L LL 0O V a ? u F' W J LU L bD d' UL N LL d N Q to d' LL z LU2 Q W 0 w U. p CO O Z a) V N v Y (n uj am, 2 Z G co Z W w X ujH W /1 �v Al LS 0 V E O O Z N O wW' N m AWO �+ a CL Q O _ V_ J .CL O 'AD 0 CLW V a V CL U) B C M O O � o S: c o. a� �a O O 2 0: E 4, U IL L N _ •: E r- Cc 40 O (i L �g) ' > L O N N O = � o40 m E c m oz Q+ o. _ 0 coo L Q Q � G0 Q'Cc W o-0 - O O LL � -T Ig N = � O t LLW E V O i L)Q tq 0-0 O '> _ = o OL O O H t cL O U 2 Z G co Z W w X ujH W /1 �v Al LS 0 V E O O Z N O wW' N m AWO �+ a CL Q O _ V_ J .CL O 'AD 0 CLW V a V CL U) B .1 1'loposai • HIC # 174377 .opo 115 Damphousse Ile J iIng L LL A trusted name since 1938 BestOfSurveys. com P(17,f ' ears running,_. Roofing - Siding - Windows 87 Belmont Street - North Andover, MA 01845 P: 978-683 588 - F: 978-685-7446 NAME OF OWNER'0Z&2� A',A % d ADRESS OF JOB M;az2 TEL.�tf -"� �� 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. Install new ventpipe boot flashings. Waterproof existing chimney flashing and remove ldeb/ris. Shingle Colors %J ,� Ridge Vent Upgrade Wood-SheathingWood-Sheathing Repair $3.50 per ft. j✓ 7&4 &e- ot� V, :2!2-,A /r, C A- Cg?,Urri Z, 716xiaQ) r'`cS � �o ,�� or- nyfine eu�� u ea �r�ri/ rytajis rvrntp .7�isv�a-xc� -�v We Prop se herby to furnish material and labor - complete in accordance with above specifications, for the sum of: '1/l wog--ke-r5 40 o b y 051 -Ms in a-�d s �011 Payment to be made as follo /r� d m i Authorized wxCJ / Signature NOTE: This proposal may be w' drawn by us if not acce 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 ev /� t Date of Acceptance: ! Signature`" y �'C" Ne ' rs . IV 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 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 took 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 ReEistration 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. HOMEOWNEfr1�I/moi J�• !� DATE: DEPOSIT: Shingle: �7GJi /)-�:r✓t / Nai ne (Busin - organizationtIndividuaI): �A IJ e Address: The Commonwealth of Massachusetts 41 onnm �- v Department of IndustrialAccidents _ Office Of. jnl7esligatlons 600 N'ashutgton Street Boston, MA 02111 Type of project (required): 3vl'owanass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Nai ne (Busin - organizationtIndividuaI): �A IJ e Address: U, , ! 41 onnm �- v City/State/Zip i �' Phone #: F417 Are y an employer? Check the appropriate box: Type of project (required): am a employer with L 3 1. 1 _ _— 4 ❑ I am a general contractor and I G. ❑ New construction employees (full and/or part lime).T have hired the sub -contractors listed on the attached sheet. 7. ❑Remodeling Z. ❑ I am a sole proprietor or partner- ship and have no employees These sub -contractors have g. Demolition working for me in any capacity. employees and have workers' g ❑ Building addition [No workers' comp. insurance comp. insurance.- 5. We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeoxNmer doing all work officers have exercised their mg repairs or additions 11.0eoof myself. [No workers' comp. right of exemption per MGL 12 Lepairs insurance required.] = C. 152, § 1(4), and we have no I3.❑ Other employees. [No workers' coma. insurance required.] *1ny applicant that checks box l 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 lure outside contractors must submit a neje affidavit indicating such. `Contractors that check this bot must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractor have employes, they must protide their workers' camp. policy number. I aIll all ellipl0}'er that Is prot'idlllg Ivorkers- conlpeyisatioli IIisIIl'anee for Illy eliiplo)%ees. Beloitt is tale policy acid job site ill orinatioll I urance Company Name Policy r or Self -ins. Lic.': L ���.- 1 Expiration Date: Job Site Address: City/State/Zip Attach a copy of the workers' compensation policy de aration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment. as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi uI r the pains and penalties of perjlir}y that the information provided aboue is true and correct. / / Official use onljt Do trot Ivrite in this area, to be completed b}t city or ton ii official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Totivn Clerk 4. Electrical Inspector 5. Plumbing Inspector G. Other Contact Person: -_ Phone A� O CERTIFICATE OF LIABILITY INSURANCE °A,a,�no°1�s ' nPE OFwsURANCE 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 polley(les) 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 IC 421rT Diane LeBlanc DOHERTY INSURANCE AGENCY INC OK 978 475-0260 KNIL rIAI dieblane(�dohertyinsurance.Com P.OBox 1985 INSUREFMIAFFORONDCOVERACE ANDOVER MA 01810 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 •— -- — -•- WSURER 6: nlsuREo TWOMEY & LEGARE CONTRACTING INC INSURERC: _ - 87 BELMONT STREET INSURER 9:J�� -INSURERF: - NORTH ANDOVER MA 01845 COVERAGES CERTIFICATE NUMRER- Q97AR DCVr41Ald W IUMCD. 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 8Y PAID CLAIMS. nPE OFwsURANCE NuweER ExP _ LtMRs COMMERCIAL GEMMMLIABILITY CLAIMS -MACE o OCCURMI EACHOCCURRENCE f 10 RERMU— g, MED EXP w* NIA PERSONAL a ADV WWRY f GEML AGGREGATE LIMIT APPLIES PER: POLICY Q rcTT :J LOC _ GENERAL AGGREGATE y f PRODUCTS • COMPIOP AGO S OTHER: s A1ITOMG&LELIABILnY o Itt+dorl LIMIT f ANY AUTO �-� — -- BODILY INAIRY (Pa PSM) iALL AUTOS OWNED H SCHEAUTOSDULED HIREO AUTOSAUTOS 0 WA BODILY IFUURY (Por 3eode l) I i — pe, lTY AAdE f~ f UMBRELLAUM OCCUR EACHOCCURRENCE i EXCESS UAS CWus.MWE NIA-- AGGREGATE f •— _ . -- --- O RETENTION S f A YrORKERBCOMPEMaATION ANO EMPLOYERS' LLManY Y 1 N CUTNE OFICER°n a SEERREXCCtwEED wa Iyas. In N14ler DESCRIPTION OF OPERATIONS' - WA NIA 6HUS0290M9%16 09118/2016 09/1812017 X A TE ER — E.L.Fa1GiACCIDENT f 500,000 E L DISEASE . EA EMPLOYE f 500.000 E L. DISEASE • POLICY LIMIT S 500.000 NIA oEsaBPtaNOFOPERATasNarL,oc�►TraNsrvElacLEs tAcoaD�oT.AeaUomlRe,nelasaloaae.R,eFeoatdcl,aen�lero.Po�ohr.a,moet Workers' Compensation benefits will be Raid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B. no authorization Is given to pay dalms for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. Tlds 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 Oft certificate of insurance). The status of this coverage can be monitored deity by accessing the Proof of Coverage - Coverage verification Search tool at www.mass.govRwdlworkers-oompm=UonAnvesdgaU°nsl. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED SI Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTNORUB° REPREBENTAnve North Andover MA 01845 Daniel M. CrOi ey. CPCU, Vice President – Residual Market – WCRIBMA 01988.2014 ACORO CORPORATION. All rights reserved. AWKu 90 IzvT4/Olj The ACORD name and logo are registered marks of ACORD Client#• 14415 DAMPHOUSSE ACORD- CERTIFICATE OF LIABILITY INSURANCE 'ATE IYYYY) MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 11/09//2012016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency, Inc. P.O. BOX 1985 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street POLICY EXPIRATION D4/12/17 Andover, MA 01810 INSURERS AFFORDING COVERAGE MAIC # INSURED INSURER A Western World Damphousse Roofing LLP 87 Belmont St North Andover, MA 01845 INSURER B: INSURER C: INSURER 0: 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. LTA MAd TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION D4/12/17 LIMITS EACHOCCURRENCE S1,000,000 A GENERAL LIABILITY NPP8296488 04/12/16 X COMMERCIAL. GENERAL LIABILITY DAMAGE TO RENTED $100,000 MED EXP (Any one person) $5,000 CLAIMS MADE Q OCCUR PERSONAL 6 ADV IN.IURY $1.000,000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S2,000,000 X POLICY JECT�0 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea aoddent) S BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per persm) $ BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per ecofdenq S PROPERTY DAMAGE S (Per I&Wdorn) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO AUTOONLY: ACG $ EXCESS(UMBRELLALIABILITY EACHOCCURRENCE S AGGREGATE S OCCUR F-1 CLAIMS MADE S $ DEDUCTIBLE S RETENTION S WORKERS COMPENSATION AND IWC STATU-DTH• EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S OFFICERNEMBER EXCLUDED? 11 yes. Cestnoo under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... Town of North Andover 1600 Osgood Street North Andover, MA 01845 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL �1 Q_ DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IE NO OBLIGATION OR LIABILITY OF 6MYJQND UPON THE INSURER, ITS AGENTS OR AUTHORIZED ACORD 25 (2001108)1 Of 2 #S34292/M34248 / / DML 0 AOAD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Awnu cav tcuu1rtw) 2 012 #S34292/M34248 ACCORLf CERTI FICA` E OF LIABILITY INSURANCE DATE{MMIDDnYYY) 04/18/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG14TS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOf1 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 PkbDUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certlfi`cate holder Is an ADDITIONAL INSURED, the policy(les) 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 Ij DOHERTY INSURANCE AGENCY INC I CANE; CT Diane LeBlanc PHC, No, ExIll ONE (976) 475-0260 AooESs: dieblanc@dohertyinsurance.com P.0 BOX i9B5 ANDOVER MA 01810 INSURER(S) AFFORDING COVERAGE NAIL 0 INSURER A: AIM MUTUAL INS CO ; 33758 INSURED ` INSURER 8 DAMPHOUSSE ROOFING LLP tNSURERC: INSURER D : j 87 BELMONT STREET I INSURERE: NORTH ANDOVER MA 01845 INSURER F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANbING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V:'HICH 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. IHSR 'I AWL UBR POLICYEFF POLICYEXP TR TYPEOFIHSURANCE POLICY NUMBER MMMD1YYYY] I (MlkllDDNYYYI I LIMITS COMPAERCIALGENERAL i:ABIUTY CLAIMS -MADE OCCUR EACH OCCURRENCE PREMISES Ea occunancoS 5 J s MED EXP (Any one person) I) IS I I N/A PERSONAL d ADV INJURY 1 GENERAL AGGREGATE • PRODUCTS-COMP/OPAGG GGEENj L AGGREGATE LIMIT APPLES PER: PRO - POLICY ❑ JECT II LOC R I S 5 .---- � S OTHER: I AUTOMOBILELlABILnY � ANY AUTO ALL OWNED AUTOS HIRED AUTOS NON -OWNED AUTOS I N/A N/A COMBINEDSWGLELIMIT {Ea acaCCnT) I S BODILY INJURY (Per person) 15 BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accidonl - IS UMBRELLALIAS EXCESS LIAR B ' i� 11 OCCUR CLAIMS -MADE NIA ( EACH OCCURRENCE i s I s AGGREGATE DEC) I I RETENTIONS! FS A WORKERS COMPENSATION, AND EMPLOYERS LIABILrTY '' ANYPROPRIETORIP ARTNER)EXEUT(Vc OFFICERMIEMBEREXCLUDE07 '! f yes.lotory In NH) i r yes, dosuibe under DESCRIPTION OF OPERATIONS.balaw YIN NIA !I NIA NIA AWC40070287742016A ) 04117/2016 04/1712017 _ I X I STATUTE I OERH I E L. EACH ACCIDENT 15 500.000 — E.L- DISEASE - EA EMPLOYEE 5 500,000 E.L. DISEASE - POI CY LIMIT I S 500,000 t NIA 1 I i lI 11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Romarka Schedule, may be attached If more space is required) Workers' Compensation benefits claims for benefits to employees will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B. no authorization is given to pay in states other than Massachusetts if the insured hires. or has hired those employees outside of Massachusetts. This certificate of insurances lows issue date of this certificate of Search tool at www.mass.gov�lwdlworkers-compensationrinvestigations/. the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WfTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Andover MA 01810 t Daniel M. Crony ey. CPCU. Vice President — Residual Market — WCRIBMA 11 ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25 (2014101) 1 The ACORD name and logo are registered marks of ACORD Client#: 14415 DAMPHOUSSE ACORM CtRTIFICATE OF LIABILITY INSURANCE ,I 4/181MIDDlYYYY, 4411812016 PRODUCER 11 Doherty insurance Agency, ine. P.O. Bax 1985 21 Elm Street Andover, NIA 01$10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE MAIC # INSURED iI Damphousse Roofing LLP 87 Belmont St INSURER North Andover, MA 01845 INSURER A Western World B: INSURER c INSURER D: 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 Oji 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 LIMITP SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'I NSR A POLICYNUMBERPOLICY EFFECTIVE DATE (MKrDOfYYI POLICY EXPIRATILTR O E MfDYN LIMITS A GENERAL LIABILITY NPP8202847 04112/16 04112/17 EACH OCCURRENCE S1,000,000 )( COMMERCIAL GEARAL LIABILITY CLAIMS MADE; a OCCUR DAMAGE TO RENTED �PREMISES (CA omirre S100,000 h1E0 EXP (Any One Deism) 55,000 PERSONAL d ADV INJURY $1.000,000 j GENERAL AGGREGATE S2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I }( POLICY gTT LOC PRODUCTS- COKIPioF AGG 52.400.000 AUTOMOBILE LIABILITY ANY AUTO ' COMMINED SINGLE LIMIT (Ea amcenn S ALL OWNED AUTO SCHEDULED AUTOS BODILY INJURY (Per :)e(scq) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY S (Par accidera) PROPERTY DAMAGE S (Per arbdenq 11 GARAGE LIABILITY AUTO ONLY • EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY, AGG S - ANY AUTO, EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE S OCCUR El Z' ARAS MADE S DEDUCTIBLE ij S I 1 RETENTION S WORKERS COMPENSATION ANO I WC STATU• 0TH- EMPLOYERS' UABILITY E.L. EACH ACCIDENT S ANY PROPRIETOR•PARTNEWE ECUTIVE OFFICER,MEMBER EXCLUDED? 11 cs, de=rie under SPECIAL PROVISIONS bctma i El DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT ( S OTHER I DESCRIPTION OF OPERATIONS I LOQATIONS Covering operations usual I i I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS to Damphousse Roofing LLP... CERTIFICATE HOLDER i) CANCELLATION 10 Days for Non -Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _40 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEEP, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RI NTA I ACORD 25 (2401108)1 Of 2 i �I #S334841M33480 15ML 0 IWORD CORPORATION 1988 Massachusetts Department of Public Safety :wl; Board of Building Regulations and Standards License: CS -067560 Construction Supervisor SHAUN M TWOMEY k �l 61 PATROIT ST t �' NORTH ANDOVER MA 01845 �- Jzzx C,),— Expiration: Commissioner 10/25/2017 - ✓ize 1° uae¢CC� o�rr�nov a a�✓��raaar�iueP,fla Office of Consumer Affairs & Sifsiness Regulation HOME IMPROVEMENT CONTRACTOR a Registration: 174377 Type: Expiration: -2/4/2017 LLP DIMPHOUSSE ROOFING LLP SHAUN TWOMEY 87 BELMONT ST N. ANDOVER, MA 01845. Undersecretary