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HomeMy WebLinkAboutBuilding Permit #657-16 - 32 ELMWOOD STREET 11/25/2016Se�tiwE� l� -3 .s Permit No#: W Date Issued: iLOCA�TLONI iRROPER;TPY MAP` BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received RTANT: Appli I Lt must complete all items on this /O SSV@U J� A 1. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building B -One family ❑ Addition ❑ Two or more family ❑ Industrial E'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑��Septic ❑'1N t a ��ti❑Floodplain p`W t ntls _ ? 011 r sstrict, Lao ter/Sewer,. DESCRIPTION OF WUKK I U bt FtKrUKivitu: Identi OWNER: Name: c Address: d f - Please Type or Print Clearly ` fv Phone: A fl a-9 Su,pervtsor"s Constru'cti©:ni!License laa��� _Ihxp i®ate g iLJnrr,o.�l�r�.riri`rnvcman+`tl�I�rPG1cP�� I (O �°4 II •iEX[�� ;E®ate:.-� / ,l 7wv_,..� -- ARCHITECT/ENGINEER- Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ J 3 3a 0. FEE: $ y(� Locatio n Z) a 2 - No. (as Date Check # Y -L" 29739 TOWN OF NORTH ANDOVER �:A Certificate of Occupancy Building/Frame Permit Fee s 4'b Foundation Permit Fee LZ Other Permit Fee $ TOTAL $ Building Inspector 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 ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS, t H EA UH s t t COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: soca Osgood Street RUE Tm ®um st orsiteyes� p � P� i sated _`at124MainStreet¢ ° er — .g kir4eDep,rtmentysignafure%cla e 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No Doe.Building Permit Revised 2014 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 o Copy of Contract o 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 o 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) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products VOTE: 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 o 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 a Engineering Affidavits for Engineered products VOTE: 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 v C � � O CD Z N D O CL =r O Co. t=/1 O < vCD (D O CL = CD CD O o Q O CD C• C I � v U) O CD n O ImIlL O 70 (D a C CD c� 0 0 " 0 2 CD 0 c CD CL CD 0 n 0 Q C)"' O s -o T. FD -TI O O .-• C. 0 m h� U) c CD ( _ CL = c 0 CL = Sl (DCD CD CD 0 0 c0 O oCD 0, cr rt c DCD V' Ll = c) = CL 0 - co OCL U) CD �_ CD� `D W r N N CD 0 O jr y „0,� rt V C (ED; Aliy � 'a C09 N r Dm C O � O c� 0 O 0 � CL , m r v Lr) 0 O O E,' N Z Co 7 (D T m c V zO T 70 N ;a om- S � N rn T 7fD N N Z .Z7 O S r m z A M T O R Zo O S C 3 W X n s 7 ry O 3 O j Q N O W C F ° Z r N f1 N N 3 O Q \ 7C ' z 0 CD O C =o Z 'p �. Cl) y CO � c 0 0' 0 M o Z N --i ;a OE C _4 Z 0 3 tg r' Z V/ Z Z tR n 0 " 0 2 CD 0 c CD CL CD 0 n 0 Q C)"' O s -o T. FD -TI O O .-• C. 0 m h� U) c CD ( _ CL = c 0 CL = Sl (DCD CD CD 0 0 c0 O oCD 0, cr rt c DCD V' Ll = c) = CL 0 - co OCL U) CD �_ CD� `D W r N N CD 0 O jr y „0,� rt V C (ED; Aliy � 'a C09 N r Dm C O � O c� 0 O 0 � CL , m r v Lr) 0 O O E,' N Z Co 7 (D T m c V zO T 70 N ;a om- S � N rn T 7fD N N Z .Z7 O S r m z A M T O R Zo O S C 3 W X T D/ s 7 ry O 3 O j Q N O W C F ° Z r N f1 N N 3 O Q \ 7C W O O D x 3 next step living home energy solutions This agreement is made by and among Vito Napolitano Next Step Living, Inc. ("NSL") 21 Drydock Avenue, 2nd floor 32 Elmwood St Boston, MA 02210 North Andover, MA 01845 phone: (866) 867-8729 Site ID: 425085 06 -Oct -15 1. DESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customers address above, in a professlonal manner and in accordance with the tens of this Contra, including the attached reoommendations/work order describing the work in detail (the 'Work") which are incorporated herein by reference. Pricing reflected below may be subject to adjustments In program pricing and offerings and'is guaranteed for 30 days from the date the Contract is printed.. Perform Air Sealing at Work Location: Attic Flat Propavent 2' or 4' Atttc Starr Cover Thermal Garner with: Carpentry 76 $2,00. Each $152.00 Damming 1 $237.65: Each Venf bath fan to roof fla er 103 $2.05 Lnft $211.15 ;' Attic Floor Enclosed Cellulose Dense Pack 6" $118::75< Each $118 75•. Attic F! Open Blow;,Cellulose 12" 600 $1.78 sgft $1,068.00 . Work ti20$160: agft $992:00. Location: Misc Sheathing Access 1 $31.31 Each $31.31 Initial Investment: :. 100% Alrsea Ing Incentive up to Program Max � $510 00 75:%, eatheriza ion Incentive up to:Progratn Max` $2,000:0,0 Total0:. <' Estimated Annual Energy Savings from the Above Improvements '' 77$728;00 2. PAYMENT CUSTOMER agrees to pay NSL for the work as follows: Payment #1: $100.00 -A nonrefundable Deposit by credit card Wasterard, Visa, or Diaeovee card) Is due at the time the Work is scheduled. Required. payment information will be collected at the time of scheduling. Deposit Is not to exceed 1/3 of the total contract cost.. Additional Payments and Final Invoice: $710.86 -Additional payments for the Work shall be due upon completion of the Work and will be charged to the credit card on file within 24 hours of delivery of the Final Invoice. if this,credit card charge is declined for any reason, upon notice from NSL you will be responsible for providing valid alternative credit card information necessary to:oomplate ' G W— Customersignature Date 6 Oct 2015 Elizabeth Venuti NSL Signature Date Name of NSL Representative A1304603 The Terms of this Agreement are contained on both sides of this page Next Step Living a 21 Drydock Avenue a 2nd floor a Boston, MA 02210 a (866) 867-8729 a inquiry@nextsteplivinginc.com a www.ne dstel2livine.com TERMS OF AGREEMENT 425085 3. PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time, subject to the availability of subcontractors or materials, or to delays attributable to the weather or other events beyond NSUs control. 4. CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to: Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116.617.973.8700. 5. PERMITS NSL will be responsible for obtaining any necessary permits as the Customer's agent. Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6. PERFORMANCE OF THE WORK AND CHANGES 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer 6.2 This Agreement may be supplemented, amended, or modified only by the mutual agreement of the panties. No supplement, amendment, or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times, our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents. Such concerns can include but are not limited to ventilation, potentially hazardous materials such as mold or asbestos, or structural concerns. in the rase of health or safety concerns being Identified, NSL reserves the right, per section 9.2 of this contract, to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and incentives available from the Mass Save" Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However, at times our weatherization team discovers situations in the tome during, the course of.the Work that Impactthe avallability of rebates and incentives from the Mass Save Program. in such situations. NSL will communicate such changes to the Customer, including any impact on amount the Customer would be expected to pay for the Work. The Customer will have the option to remove from the Contract the work elements that need adjustment, or setup a separate contract for performing the adjusted work. - . 6.5 NSL represents and warrants to the Customer that (a) the materials and equipment fumished under this Agreement.will be of good quality and new, (b) that the Work will be he from defects, and (c) that the Work will conform with the description of the Work described in Paragraph 1. 6.6 NSL may determine in the course of pre -installation Technical Review that modifications are necessary to the scope of Work In order to ensure professional quality of the Installation. In the event of such modifications, NSL will request a written modification of the Agreement to be signed by all parties. In the event that Customer and NSL cannot agree on the modification, the Agreement may be terminated by either party. . 7. INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration (No: 162111) and the necessary insurance required by applicable law and normally maintained by prudent contractors In NSL's field, including, but not limited to, Workers Compensation insurance for at imp oyees w >f o will perform the Wo cry 8. QUALITY OF WORK NSL agrees that the Work will be performed in a.good and workmanlike manner, and that NSL will repair and replace, at its own expense, and promptly upon Customer's request, any defects in workmanship and materials provided by NSL which appear up to one year after comptetion.of the Work or within any longer period as permitted or required under applicable law, provided NSL has received final payment as provided herein. 9. PRE-EXiSSTING CONDITIONS & PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall, moisture damage, non -code construction, cracked or fragile siding or shingles, old pipes and fittings, rotting wood, etc. 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos, mold, or any other potential health risk to the Customer. In. this event, the Customer is responsible for remedying the at -risk situation, Including any necessary removal of hazardous materials and all bills for services to date shaft be paid immediately. Work cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect, including dust protection, any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not property protected.prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law, to have, file or maintain a mechanics or material men's lien, or to file a notice of intention to lien, and to take any other steps to perfect and enforce such a lien, 9 Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this Agreement, they are not relying on any representations, warranties or terms other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by'both parties. 11. ENERGY BENEFITS. . The Sponsoring Utility Company (the Utility) is entitled to 100% of the energy benefits associated with all Energy Conservation Measures, excluding the value of energy cost savings by the Customer, but including all rights to all associated 180 -NE Energy, Capacity and Reserves Products. NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Udllty's ownership of such benefits'and Products. 12. NOTICE CONCERNING SPONSORSHIP. 12.1 Customer understands and acknowledges that NSL is not an agent, vendor or sub -vendor of The Sponsoring Utility Company (the Utility) with respect to the installation of an energy effrclency measures. In the event of the failure of an energy conservation device to perform as expected, Customer's sole recourse Is to Contractor and not to RISE Engineering (RISE) or to the Utility. The Utility and its operating companies shall not maintain, remove or perform any work whatsoever on the energy conservatibn measures installed; 12.2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. 12.3 Customer agrees that it shall not hold RISE, the Utility, their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement, for failure of the energy conservation measures to function, for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13. LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14. CONTRACT CANCELLATION Under Massachusetts law, you may cancel this agreement Olt has-been signed by a party thereto at a place other then an address of the seller, which may be his train office or a branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by fax, or by e-mail sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Planview Diagram Customer V ITb i�n(�TM�i c) Advisor Name:r � v N un Address 32 rawW000 S' Advisor Phone #: ClaL 3T =tom Town Npitr" Any limitations to access by truck? Site ID 42 S2St�c" SCD NOTES Any work scoped outside of Best Practices? Approved by: t�-:6) PfS Ai-nC..TFI, (prM- (,zotis WX CQNi't��1NS. cid► RTncr-L (1,zoo) LS) i2" 016L �` j�SKIM Nc, wcK-.gS, 6? -rt I �(3�T-IbrnE, C�tv(I iov 5� v&-qr 6Tb E06f, QM INSUUFVTe (4�NCLQSW) ftVnLV-L W( (v" DPL(WOO) lye 2 v \o N o t�E� (►� x 4L �0� The Commonwealth of Massachusetts Department oflndustrialAccidents - I Congress Street, Suite 100 Boston, MA 02114-2017 r www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeLibly Name (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston MA 02210 Are you an employer? Check the appropriate box: Phone #: (866)867-8729 1. ✓❑ I am a employer with 850 employees (frill and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am 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 ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 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. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑✓ Other Weatherization "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 -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy # or Self -ins. Lic. #: AWC-400-7030025 Expiration Date: 9/30/16 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 this776 ay be forwarded to the Office. of Investigations of the DIA for insurance coverage verification. I do hereby certify under the Phone #: (866)867-8729 ofpeiryury that the information provided above is true and correct 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 #: Im J01te ® ice ® Consumer Affal ani business Regulatl®n 10 Park Plaza e Supe 5170 Boston, Massachusetts 02116 Home Improves ent= C®ntractor Registration NEXT STEP LIVING INC. ROGER OUELLETTE 21 ®RY®OCK AVE. 2TH FL BOSTON, ISA 02210 DPS-CA1 is 5OM-04/04-G101216 ,�,� �tC -V 0�92�7247LElJ6ll.(.[/2C�._./I�CQddILCiE(lbP.�.G r Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR Registration. ,..162111 Type: Expiratidni-'1/1412017 Supplement Card NEXT STEP LIV)NC'INC.k' ROGER OUELLETT.E ; _ 21 DRYDOCK AVE: 2 T FL- BOSTON, LBOSTON, MA 02210 Undersecretary Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 r- q Update Address and return card. bark reason for change. Address F-] ]Renewal F] Employment F-] Lost Card 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 - Su to 5190 Boston, MA 021)V e without signature NEXTS-1 OP ID: EL �A%_ O CERTIFICATE OF LIABILITY INSURANCE � DATE 0 09/309/30/2015 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 McLaughlin Insurance Agency 828 Lynn Fells Parkway Melrose, MA 02176 John E. McLaughlin Jr. CONTACT PHONE FAX A/c No EXt:781-665-2775 ac No: 781-665-0295 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 09/30/2015 INSURER A: Nautilus Insurance Company 17370 EACH OCCURRENCE $ 1,000,000 INSURED Next Step Living, Inc. ck MA 02210 Avenue, 2nd Floor 21 Boston, B Boston, M INSURER B: A.I.M. Mutual Insurance Co. INSURER C: Commerce Insurance Company 34754 INSURER D : AXIS U.S. Insurance Company 15610 L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT M'OTHER: INSURER E: PRODUCTS -COMP/OP AGG $ 2,000,000 INSURER F: C 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. INSR LTR OF INSURANCE L ADDTYPE POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR ECP2010198.13 09/30/2015 09/30/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO HFN I FD PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT M'OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ C AUTOMOBILE X X LIABILITY ANYAUTO ALL OWNED X SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS Comp $1000 X Coll $1000 15MMBGKKDM 09/30/2015 09/30/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccid.nt $ D UMBRELLA LIAB EXCESSLWB X OCCUR CLAIMS -MADE ELU783547/01/2015 09/30/2015 09/30/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 7 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A TO BE ISSUED BY CARRIER 09/30/2015 09/30/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FOR INFORMATION ONLY l;tK 1 II-II:A I t MULUtK UANI:tLLA I IUN INFO -01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Onl THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ak ✓'6w� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Mil Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor SpeciAN License: CSSL-102811 ROGER A ® LLETT 55 STANl®ice Wau Ack RI 0280 a 5 11" Commissioner Restdcted To: CSSL lC e insulation Contractor Expiration Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For ®P§ Licensing information visit: www-Mass.GoV0®PS