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HomeMy WebLinkAboutBuilding Permit #1176-2016 - 32 PARK STREET 5/11/2016 i BUILDING PERMIT t10RTy q TOWN OF NORTH ANDOVER02 � L .Q p APPLICATION FOR PLAN EXAMINATION � nD `• = e Permit No#: �!' Date Received Date SACHUS�Issued: 1� IMPORTANT: Applicant must complete all items on this page LOCATION 3a- :\dam� f • � �c v�eY � CV� sss .. PROPERTY..OWNER. Print Nazk + i `Print 100 Year Structures no MAP PARCEL: 11 ZONING DISTRICT:` Historic District yes `W Machine-.Shop Village yes; no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family RrAddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: eCommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑1Nel El ,Floodplain, p Wetlands ❑ V1/atershed District , DESCRIPTION OF WORK TO BE PERFORMED: 11q a1zQ0<deQQt den ficati n- Please Type or Print Clearly OWNER: Name: �. Phone `" 7�b! Address: N, AaL '( a �}5 ContractorName: J�`l�e�1A t am e-Q Phone: `M Email: Address. . ZL5S OC Supervisor's Construction License: ba-�5 .:� '� Exp. Date: .. Home Improvement License: Exp. Date: `7 a y � ARCHITECT/ENGINEER ���'�=l ►c�en Phone: 97S 3Ja � Address: '�Q21 � . Reg. No. c9 77 FEE SCHEDULE:BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ G64, E,c C. c;t, FEE: $ 3 Check No.: X11 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 4. Copy Of Contract :4. 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 Comp Affidavit ae Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit Ila 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 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 - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ � f COMMENTS �1�11 �Y1 ZulQ,o� �( �11�111G� Gi �lUL, LV CONSERVATION Reviewed on Signature �-i cf) r COMMENTS HEALTH Reviewed on Signature 17 C MMENTS G �C,elJ DSO /4�- Z CU JZ7, , JAJ ,Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes S '- Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIR€ DEPARTMENT, ca.Temp D_w�rnpster onsit vest Lo ate at 1r2„4 Main Fire Depart,merit s_i,gnature%dated �- . � �• �, ., r 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) 2-0 ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Location ,3e Z NoJ VI(o —2G( Date • • TOWN OF NORTH ANDOVER rte;, Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# /1 30357 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 26,,0010.00' m $ - $ 312.00 Plumbing Fee $ 39.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 39.00 Total fees collected $ 490.00 32 Park street 1176-2016 on 5/11/2016 28x11 addition I I I NORTI1 I Town of 3� : _ 1, ndover 0 o _ h ver, Mass > > coc"Ic Nl WIcM A. X1,95 RArEo ►P�,�qS U BOARD OF HEALTH Food/Kitchen PER101T T LD Septic System THIS CERTIFIES THAT ......... BUILDING INSPECTOR has permission to erect buildings on Foundation .......................... ...a&-.... ......................................... �♦yy � Roughh to be occupied as Mee�*;es�"ect 16gu.................................................. Chimney provided that the person accepting this permit sh ll-ii conform to the terms of the application Final% ft 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS \ ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST RTS Rough .................... Service ............... ... ... .,rcT.,....... 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. North Andover MIMAP May 6, 2016 199 PLEASAN0 00 T ST , �b Q85 0�1Ps0.•0001� a 085.0=0003 � 45 0,710--0016r085.0'-000.^s 071.0-0015 3 535 CHICKERING RD 085"0 000 / B4 �222�LrEASANT65�Td 0710 OQ®3522 CHICKERING RD - 535 CHICKERING RD 1522 CHICKERING RD M- 535 CHICKERING RDS :O 085 O 0 1 31FRA�NICLINST -� 535 CHICKERING RD < dSd� 2281P E;ASANT ' X710 223jrMUEASA"N�T SaT c Th 985°0'=0030` r 4 125 � ,� � ,� �: � �� �22T:PLEASE►N7`' 498 CHICKERING RD .n .£ X235 I FIV NTMR Sly +'� .y 1 G�3 � � N Y� +��� �y. 'QBE,SU Q��Q...,�•,rQ' •3 .PARK STf ' 241t PLEASANT;S� .5PARK3S�T�j' ! 108510-0050' a: 4. S 4- !,, ark Sire et h ' „ t ,Q71 0 0038 KI �w� �� T' 478 CHICKERING RD �� O 1ho' 004 39 PARK�S '47,PARK 5 -�� �� � 483 CHICKERING RD 55iPARfC SaTr 48._�5!'Q=- 005'1 00.2 A } r 159 P,RK = 9j—LO-0046 a Qr71 0-0030 071(:0 0044 � 085 O 00 � 508 MAIN S,T QT7,�1�:�0 0039; *Y MVPC Be Zoning Overlay Zoning 0 Municipal Boundary 0 Adult Entertainment Distric Busine s 1 District 0 Machine Shop Village Ove D Businez s 2 Districl Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line ®Watershed Protection Dist Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates 0 Historic Mill Area O Businez s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of _1 0 Medical Marijuana O Goner Business District Of t`i u 9,y North Andover.Additional data provided by the Executive Office of —SR 0 Downtown Overlay District D Planne Commercial Dev ? �a� r yea�O Environmental Affairs/MassGIS.The information depicted on this map is - Roads 0 Historic District Cl Carrico Development Dist 3 _ L for planning purposes only.It may not be adequate for legal boundary 0 Osgood Smart Growth(40 O Comido Development Dist O .-- definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 17,Easements ID Hydrographic Features 0 Carrico Development Dist MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Induslri I 1 District ❑Parcels —Streams '< THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 13 Induslri 12 District * S ^ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands C!Induslri 3 District a .� x ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF C!Exempt Lands G Induslri I S District 940+�•�•rw „ THIS INFORMATION P Reside ce 1 District �,9 •r.o. Reside cc 2 District SSgCH G Reside ce 3 District 4A de ce 4 District 1"=90 ft w4 AFde ce5 District YYY de ce 6 District o e esidential District North Andover MIMAP May 6, 2016 � _ w e,.. r !rr Ry4 `��7 may , A j r ..�.. Car .. �• � � y � N �, `f° ' � paw S re ' +y sr - iK _ 9. .-•t` o �--5.,.# �..i{ $ •$' -"'�f Ate::" l µ A� T r • W� „rr r r fi _ C-MVPC Bo Interstates Horizontal Datum:MA Slaleplane Coordinate System,Datum NAD83, I — Meters Data Sources:The data for this map was produced by Merrimack p0RTM Valley Planning Commission(MVPC)using data provided by the Town of Roads Of ,So q� North Andover.Additional data provided by the Executive Office of Easements i ��t '�+S O O Environmental Affairs/MassGIS.The information depicted on this map is t ? a for planning purposes only.It may not be adequate for legal boundary ❑Parcels O —• definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING i • i THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY µ s K OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT iF�o� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 'MA US 1"=90ft w�° Page 1 of > RODDEN CONSTRUCTION License# 28538 47 Prescott Street Expires: 9/5/2016 North Andover, MA 01845 (978) 687-2934 PROPOSAL TODAY'S DATE ]OB NAME 4/28/16 V.F.W. Post 2104 DATE OF PLANS/PAGE#'S ]OB LOCATION 1/21/16 32 Park St. North Andover Ma. 01845 We propose hereby to furnish material and labor necessary for the completion of: Supply materials and labor for the construction of an addition to the existing structure.The materials used and the building practices followed will be as specified in the plans submitted and stamped by Lawrence Ogden, registered engineer in the state of Massachusetts .Any new roofing or siding that may be used will match the existing as nearly as possible.The interior of the structure will be left in an unfinished state with no finished ceiling or wall area.Any work involving the existing canopy is the responsibility of others and is not included.This agreement also does not include any electrical,plumbing or H.V.A.C.work. If the owners decide to hire and pay for a foundation and concrete slab,including excavation,rather than the sonar tubes and wood frame floor and decking as speced on the drawings,there will be a savings of 6500.00 deducted from the total of this proposal... We propose hereby to furnish material and labor-complete in accordance with above specifications for the sum of: twenty six thousand dollars ( $26,000.00 ) Payment as follows: 10,000.00 start, 10,000.00 roof tight, 6,000.00 completion All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices. Any alteration or deviation from above specifications Involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. If either party commences legal action to enforce its rights pursuant to this agreement,the prevailing party In said legal action shall be entitled to recover its reasonable attorney's fees and costs of litigation relating to said legal action,as determined by a coLRt of competent jurisdiction. Authorized Note: this proposal may be ithdrawn by us Signature if not accepted wi in days. ACCEPTANCE OF PROPOSAL The above prices, Signature specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Signature Payment will be made as outlined above. Date of Acceptanc WWW.THECONTRACTORSGROUP.COrA&Diane Dennis Enterprises 02004 PROP-001a.doc Rev 10-04 -: No I EE ROOF RAEDKi 1POSTS � t '. r I 1r '., y RBAOVE EXISTOM CANOPY. EKTE D NEW NOOFTO PROVIDE ENTRANCE ALCOVE PROPOSED ADOTTION EXISTIM DOOR CONCRETE GUARD RAL&LANDSCAPE POUNOATM eC.R®iq NOT OHO ML BEE REAR ELEVATION VIEW AND FLOOR PUN =N*OM�M�DOVM ST 2104 RIGHT ELEVATION sTREE MA W�f� PROPOSED J EDaemN0 - I NPNROOF. - PANLM LAwW PE sem"m OONCAEM F;Wm m °`"RDS` REAR ELEVATION RM ORME(VAFWM VFW POS'T2104 PARK STREET NORTH ANDOVER, MA .w.,.•.n. umr�. NEW ROOF STRUCTURE sxeo+?o- Roof: ABMT NOME8 WTCH EXNTNB) ICEIWATER 89B)&BANtAM LS'COX PLYWOOD DECK RAWNIM CONIU41dJB LEDGER. FRAMM OON BMM Z X_ SEMM TO EXWM PRAWN TYWPALIRmoffM UUE TMM MAST BOLTS FAWK&SMWTOVAMS W 00mmal momVMNNUALMPENS -- FRAYBp OONL3L•fOR ICiiIYATBt��D FINISH 2ND FLOOR HEADER L-ZXS NNPORA'POST e>oeTLto WALLFRAMND LANDSCAPE BORESNM MEYOND) RAINS GUARD RAL. N @QESIPROOF aFRRwJaaetHEAD FLASH GRADE(VARIED) APE TO DRAK 4•CONCRETE SLAB D08TNB cAa1 WALL FINISH 18T FLOOR T 't7 .VEL BMW F -1 El wria PROP08ED E)awnNO POLUR®CONCA6lE FOM0IITION VFW POST 2104 PARK STREET NORTH ANDOVER, MA TYPICAL CROSS SECTION Y t0. n FIRST FLOOR PLAN STORAGE STORAGE OFFICE �> ¢y MEN ' BAR WOM LOUNGE BOILER NWAL,,.,MFPAMM GL#MDOOR1MM saffF OCMW LL a rAd1TE DOOrtAT OOffr q PROPOMAODMM vurcmopEpx . e� K la, lr< O i wafff com— TTOO F13 I I +' KITCHEN STORAGE STORAGE I RooPUEcAewq � � RAn� � � � Poffm ❑ I — --- i�•-, RELOCATED MVAC EDIOfBdf -0. O e ' h h•,-� h MEIN oumm RAL VFW POST 2104 PARKW TO REMM! PARK STREET EXWrM RMP NORTH ANDOVER MA TO REMAN �aw••+voars The Commonwealth ofMassachusetts Department of IndustrialAccidents ", 1 Congress Street,Suite 100 -T 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 Legibly Name(Business/Organization&dividual): Address: �A'[ sc City/State/Zip:- LJ 145 Phone#:T f� 4� Are you an employer?Check the appropriate box: ' Type of project(required): 1.XI am.a.employer with .. , employees(full and/or part-time).* 7. ❑New eon§truction 2.[]I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself[No workers'comp.-insurance required.]t 9. F1 Demolition 10 wilding addition 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 11.0 Electrical repairs or additions proprietors with no employees. 12,❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ � 13.[�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. Other 152,§1(4),and we have na employees.[No workers'comp.insurance required.] r: *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 anew affidavit indicating such. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not,those entities have employees. If the sub-coriiraciors Tiave�employees,&yt 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: ��C�S Policy#or Self-ins.Lie.#:L, A C 311 l0'1 S3In Expiration Date: lob Site Address: � sk• City/State/Zip:)J. e Ot�S'A Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp'•ation 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. I do hereby certify under the pains d penalties ofperjury that the information provided above is true and correct. Signature• )),Q Date: �� ' 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 o hire, 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 enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 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 be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced 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-contractor(s)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-insured 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-NUSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia OP ID: PS CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/06/2016 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(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 CONTACT Foster Sullivan Insurance NAME: Pete Sullivan 163 Main St. a/CCNe F,1:978-686-2266aC No): 978-686-6410 North Andover, MA 01845 AIL AbDREss:psuilivan@fostersuilivangroup.com Stephen Sullivan PRODUCER CUSTOMER ID#:RODDE-1 INSURERS AFFORDING COVERAGE NAIC# INSURED Michael V. Rodden INSURER A:MERCHANTS INSURANCE GROUP 12775 dba Rodden Carpentry INSURERB:WESCO INSURANCE COMPANY 13188 47 Prescott Street North Andover, MA 01845 INSURERC: INSURER D INSURER 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. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY BOPI054995 02/01/2016 02101/2017 DAMAGE T R NTED PREMISES Ea occurrence $ 500,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB POCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITSI ER B ANY PROPRIETOR/PARTNER/EXECUTIVEWWC3176746 01/01/2016 01/01/2017 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? F—] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) **INSURANCE EVIDENCE** CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BLDG. INSPECTOR 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD { Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-028538 Construction Supervisor ` MICHAEL V RODDEN 47 PRESCOTT STREET, I NORTH ANDOVER M -01846' =. i r r Expiration: Commissioner 09/05/2017 (Poria"w' y I Office ofConsumer o�zL , Affairs&Business RegJ"0-/%ute�rj. ME IMPROVEMENT CO ulation egistration: 105903 CONTRA fes. xpiration 7/21/201.6 TYPe: i,Q IAELV.' r Individual #�1icl;l'ael ROdden l� I h 0a, Co�:street 4 � ft' '4'01845. Undersecretary - i j i