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HomeMy WebLinkAboutBuilding Permit #233-16 - 326 FOREST STREET 8/25/2015 y -k I ,r f NORTh q BUILDING PERMIT `"eD0 TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION a � Permit NO: ® Date Received ° Are° Date Issued: S$ACNIlSE IMP(O�RTANT:Applicant must complete all items on this page LOCATION 1:�1/I T � r �+'` rC�'i� AkL'04 129-C PROPERTY OWNER 'T) C4 1*'Nt9n L Act ajciV(`' Pnnt MAP NO: _PARCEL:���ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial PlAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer J961 l (Lh-tIr QAA� pn � t1l", (Rul 61Jxkb 001, S CX FfIACU L-/U V Idenh i a ion lease ype or-Prid Clea y) OWNER: Name: Phone I — Address: Lai Ll it� L��IL C CONTRACTOR Name: Phone: Address: a!l Lowal (fl, epac�Aq Supervisor's Construction License:��, CC�y '�(���1 _ Exp. Date: 3 ,—0� _2Q! .� t�J Home Improvement License: V2 'S9 Exp. Date: -1 - to - 701 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ _ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting1with unregistered contractors do not have access to uaranty fund Signature of Agent/Owner -Signature of contractor , 1 / Location .�r7,� � No. '/J� Date eT j . • TOWN OF NORTH ANDOVER � ��fi•tu r646 Certificate of Occupancy $ ysw Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 'ko,p TOTAL $ q_ s Check# 6.� r Building Inspector .ter 249 Plans Subrnitted�-El- 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 Dempster on Site ❑ 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 Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ,iF,IRE DEP=RMENT JX_ 0,, #iLocatecl e n epartment atar Mat- D, r ...�. .-k ..-; ate-.. -�:•-....,:.-.....�,__e,�...«-... i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land areasq. 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) Ll Notified for pickup Call Email Date Time Contact Name Doc.Building Pemuit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application . Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application Certified Surveyed Plot Plan :rF Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses :rF Copy Of Contract ;a 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 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 4 Certified Proposed Plot Plan 4. 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 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 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 NORTH Town o E �, Andover 0 No. , T Zh C% h ver, Mass, COC NIc"awICK S U BOARD OF HEALTH Food/Kitchen PERM T L D Septic System THIS CERTIFIES THAT A.4. BUILDING INSPECTOR ................... ..�. .......1 .. . ,�.d�.�..................... . ............ Foundation has permission to erect .......................... buildings on ....� ........ ...Q.,�.. ..........,..,,; Rough oug to be occupied a .l. ....... ... . ......10.IL.. &.4.......« �..� . ..�.................. Chimney provided that the person accepting thi ermit shall eve res eciconform to the terms of thea lication g p � p PP 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 6' PERMIT EXPIRES I61kNH ELECTRICAL INSPECTOR UNLESS CONSTRUCS 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. , Sweeprtman, Inc. Proposal 108 Main Street 8/8/2015 Building H North Reading, MA 01864 Phone: (978)664-6642 E-mail:sweepnman@yahoo.com Service Information Billing Information Daniel DelGaudio Daniel DelGaudio 326 Foster St 326 Foster St North Andover,MA 01845-2210 North Andover, MA 0184.5-2210 Contact:Daniel DelGaudio Phone: (617)224-2774 E-mail:dan.delgaudio@gmail.com Job Name DelGaudio, Daniel - 07/24/2015 Job Type PO# Invoice# Scheduled Start End 08/08/2015 11:00 AM 1:00 PM Item Description Quantity Rate Amount LINERALLET INSTALLATION OF PELLET LINER: stainless steel with 1.00 $1,220.0000 $1,220.00 LINER all stainless steel.components. LINER:OiL LINER installation of Oil Flue Liner including all components 1.00 $2,385.0000 $2,385.00 necessary at termination and breaching to connect existing vent connector. Permit- Permit Fee for pellet stove installation 1,00 $250.0000 $250.00 CAP:MF SS CAP INSTALLATION OF MULTI FLUE STAINLESS STEEL 1.00 $475.0000 $475.00 CHIMNEY CAP TO COVER ENTIRE CHIMNEY CAP:MF SS.CAP INSTALLATION OF MULTI FLUE STAINLESS STEEL: 1.o0 $45o.o00o $45o.0o CHIMNEY CAP TO COVER ENTIRE CHIMNEY WATERPROOF/ APPLICATION OF "CHIMNEY SAVER' WATER 1.00 $425.0000 $425.00 CHIMNEY SAVER REPELLANT TO ENTIRE EXTERIOR CHIMNEY Left side chimney WATERPROOF/. APPLICATION OF "CHIMNEY SAVER' WATER 1.00. $375.0000 $375.00 CHIMNEY SAVER REPELLANT TO ENTIRE EXTERIOR CHIMNEY - Right side chimney: MISC. SERVICES Left side chimney: Application of stucco to base of the 1.00 $235.0000 $235.00 chimney where needed at cinderblock_ Total Due: $5,815.00 � / System Info Home Heating System Chimney info Chimney Cap Job (dotes and Instructions: i6 5'x 30'corrugated SS Liner kit$2,385.00 4'x 20'conru ated liner kit SS$1,220.00 with pellet stove installation. Permit$250 Two stainless steel mufti-Flue chimney caps 450+475 6 17 x29 and 17 x35 Parge base of left side chimney exterior where needed. Application of waterproofing to left side chimney 425 Application of waterproofing to rlght side chimney 375 DelGaudio, Daniel - 07124/2015 Proposal(continued) All pricing and proposed work is based on visual inspection. If other conditions are discovered upon commencement of work,it may increase the scope of work and if additional work is mutually agreed upon,may increase the price. All material is guaranteed to be as specified. All work is to be completed in a substantial workman like manner according to specifications submitted,per standard practices. Signature: x 1 DelGaudio, Daniel - 07/2412015 Proposal(continued) Images: `• `-F '� 'r wpm i J .p .S. I.� 'll Wt 8/8/15,10:37 AM 818115, 10:38 AM 8/8/15, 10:38 AM •�:LI Vis:" 8f8115,10:38 AM 8/6/15,10:38 AM t Sweepnman, Inc. Proposal 108 Main Street 8/8/2015 Building H North Reading, MA 01864 Phone: (978)664-6642 E-mail:sweepnman@yahoo.com Service Information Billing Information Daniel DelGaudio Daniel DelGaudio 326 Foster St 326 Foster St North Andover,MA 01845-2210 North Andover,MA 01845-2210 Contact: Daniel DelGaudio Phone: (617) 224-2774 E-mail:dan.delgaudio@gmail.com Job Name DelGaudio, Daniel - 07/24/2015 Job Type PO# Invoice# Scheduled Start End 08/08/2015 11:00 AM 1:00 PM Item Description Quantity Rate Amount LINER:PELLET INSTALLATION OF PELLET LINER: stainless steel with 1.00 $1,220.0000 $1,220.00 LINER all stainless steel components. LINER:OIL LINER Installation of Oil Flue Liner including all components 1.00 $2,385.0000 $2,385.00 necessary at termination and breaching to connect existing vent connector. Permit Permit Fee for pellet stove installation 1.00 $250.0000 $250.00 CAP:MF SS CAP INSTALLATION OF MULTI FLUE STAINLESS STEEL 1.00 $475.0000 $475.00 CHIMNEY CAP TO COVER ENTIRE CHIMNEY CAP:MF SS CAP INSTALLATION OF MULTI FLUE STAINLESS STEEL 1.00 $450.0000 $450.00 CHIMNEY CAP TO COVER ENTIRE CHIMNEY WATERPROOF/ APPLICATION OF "CHIMNEY SAVER" WATER 1.00 $425.0000 $425.00 CHIMNEY SAVER REPELLANT TO ENTIRE EXTERIOR CHIMNEY Left side chimney WATERPROOF/ APPLICATION OF "CHIMNEY SAVER" WATER 1.00 $375.0000 $375.00 CHIMNEY SAVER REPELLANT TO ENTIRE EXTERIOR CHIMNEY Right side chimney: MISC. SERVICES Left side chimney: Application of stucco to base of the 1.00 $235.0000 $235.00 chimney where needed at cinderblock. Total Due: $5,815.00 System Info Home Heating System Chimney Info Chimney Cap Job Notes and Instructions: 5"x 30'corrugated SS Liner kit$2,385.00 4"x 20'corrugated liner kit SS$1,220.00 with pellet stove installation. Permit$250 Two stainless steel multi-Flue chimney caps 450+475 17 x 29 and 17 x 35 Parge base of left side chimney exterior where needed. Application of waterproofing to left side chimney 425 Application of waterproofing to right side chimney 375 DelGaudio Daniel - 07124/2015 Proposal continued P (continued) All pricing and proposed work is based on visual inspection. If other conditions are discovered upon commencement of work,it may increase the scope of work and if additional work is mutually agreed upon,may increase the price. All material is guaranteed to be as specified. All work is to be completed in a substantial workman like manner according to specifications submitted,per standard practices. Signature: x DelGaudio, Daniel - 07/24/2015 Proposal(continued) Images: t � 1 66,�il� rj (+Iql 8/8/15, 10:37 AM 8/8/15, 10:38 AM 8/8/15, 10:38 AM v „ R �F l 4 l � , lr 8/8/15, 10:38 AM 8/8/15, 10:38 AM I The Commonwealth of Massachusetts Department of Industrial Accidents Z n Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):�SL.c��P�i'l YY1 Q Yh .l jQ a Address: dI kn-J CIL &d City/State/Zip: Phone #: Are you an employer? Check the appropri box: Type of project(required): 1.[KI am a employer with 4. ❑ I am a general contractor and I have hired the sub-contractors employees (full and/or part-time).* 6. F1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its l0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs t c. 152, §1 4 ,and we have no ❑ P insurance required.] ( ) q ] 13. Other 01 Like�V J employees.to ees. IN o workers comp. insurance required.] -� *Any applicant that checks box#1 must also fill out the section below showing theirXorkers'compensation policy information. 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 far my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie. #: ��[�[�'�^31 S ^`?j�'�'13�f_�l� Expiration Date: Zoe Job Site Address: �� 7 Qy p/Y�! City/State/Zip: �D/7'�� /�r�d6A,,- <k Attach a copy of the workers' compensation policy declaration 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. Ido hereby certify under t ea' �ndl penalties of perjury that the information provided above is true and correct. Si ature: // Date: Phone#: 7� (�(D 7 ^"ldlO 7 Z, 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#• 8/12/2015 6:10:05 AM PST (GMT-8) FPOM: 100005-TO: 19788875517 Page: 2 of 2 AC n� CERTIFICATE OF LIABILITY INSURANCE DATE-(MMJDD"YYY) 1*�l 8/12/2015 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 terrns 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 endorsements . PRODUCER D-JOHNSON INSURANCE AGENCY INC NAME: 7 GROVE STREET STE#201 PHONE pqX TOPSFIELD, MA 01983 E-MAIL A1C No:_• ADDRESS: INSURER(S)AFFORDING COVERAGE _NAIC9 _ INSURED INSURER A: LM Insurance Corporation 33600 SWEEPNMAN INC INSURER 6: 27 LOWELL RD INSURER C: NORTH READING MA 01864 INSURERD: INSURER E: INSURER FCOVERAGES CERTIFICATE CERTIFICATE NUMBER: 25934393 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 ADDL SUER ---- LTR TYPE OF INSURANCE POLICY NUMBER MM/DDY EFF MMIDDIIYY;Y LIMIT'S COMMERCIAL GENERAL LIAOILITY EACH OCCURRENCE $ A CLAIMS-MADE EJ OCCUR PREMCSES(Ea occttffonCpI MED EXP(My one person) $ -- PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY E__1 TEC 0 LOC PRODUCTS-COMPJOP AGG $ OTHER: $ AUTOMOBILE LIABILITY O =)S E . I $ COM a I enl ANY AUTO BODILY INJURY(Pot person) $ AU.OWNED SCHEDULED AUTOS AUTOSBODILY INJURY(Por accident) $ HIRED AUTOS NON-OWNED PROPER DAMAGE AUTOS Pet eCCid M $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE DEDRETENTION $ A WORKERS COMPENSATION WC5-31 S-388139.014 12/18/2014 12/18/2015 AND EMPLOYERS'LIABILITY YIN ✓ 37 T STI{_ ANY PROPRIETOWPARTNCRlL=XECUTIVCE.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? NNIA (Mandalory in NH) E.L.DISEASE•EA EMPLOYEE $ 100000 crb II yas,dose un dor _• _._ DESCRIPTION OF OPERATIONS bobw E.L.DISEASE-POLICY LIMIT f$ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Romarks Schedule,may bo allaehod it Moro spoca is required) Workers compensation insurance Coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION DANIEL DELGAU DIO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 326 FOSTER ST A THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE LM Insurance Corporation f6 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25934393 1-380139 14-15 mC yoyesii.laati L@LLbegtymutua L.ccam 8/13/2015 6:07:11 Am {PDT) pay, 1 of L DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/11/2015 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(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). 30DUCER dl CONTANAME: DALE E.JOHNSON D-JOHNSON INSURANCE AGENCY, INC PHOIC,NENo. 978 887-8304 Fvc No: 978 887-5517 DALE JOHNSON-AGENT AD aless:DALE JOHNSON@FARM-FAM ILY.COM 7 GROVE STREET, SUITE 201 INSURERS AFFORDING COVERAGE NAIC# TOPSFIELD, MA 01983-1862 INSURER A:MESA UNDERWRITERS SPECIALTY SURED INSURER B:CERTAIN UNDERWRITERS AT LLOYD'S, SWEEPNMAN INC. INSURER C: 27 LOW ELL ROAD INSURER D: NO. READING,MA 01864 INSURER E: INSURER F: OVERAGES 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. 'R TYPE OF fNSURANCE ADDL SUBR POLICY EFF POLICY EXP LfMITS -R POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY MP0004018000569 11/18/201411/18/2015 EACH OCCURRENCE $ 1,000,000 DAMAGETO CLAIMS-MADE 1 OCCUR PREMISES E Iooccu ence $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY❑ JELOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ CONTRACTORS PROFESSIONAL LIABILITY AND SPO0221 11/18/2014 11/18/2015 $100,000 EACH CLAIM-PROFESSIONAL LIABILITY POLLUTION LIABILITY $10,000 EACH CLAIM-POLLUTION LIABILITY ?SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) :HIMNEY CLEANING/INSPECTION, MASONRY,APPLIANCE DISTRIBUTOR ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DANIEL DELGAUDIO ACCORDANCE WITH THE POLICY PROVISIONS. 326 FOSTER ST. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Daly�, dI ©1988-2014 ACORD CORPORATION. All rights reserved. .CORD 25(2014/011 The ACORD name and Joao are registered marks of ACORD t 1� Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty � License:nse: CSSL-100886 1 1 DAVID A BANCOFT '? r 27 LOWELLRD.. MD North Reading iVIA 0186 ] ,1 >> Expiration Commissioner 03/09/2016 Commonwealth of Massachusetts �-° Department of Public Safety Oil Burner Technician Certificate License: BU-026558 DAVID A BANCR©FT 27 LOWELL RD North Reading M 01864''- . Commissioner 3109/ 016 03/09/2016 %/. er Affairs usi l(n lotion License or registration valid for individul use only �+ Office of Consumer Affairs&Busin�ss Regulation g y COME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ,- egistration: 160389 Type: g _P.Expiration: 7/16/2016 Private Corporatior. 10 Park Plaza-Suite 5170 Boston,MA 02116 SWEEPNMAN, INC. DAVID BANCROFT 27 LOWELL RD. NO.READING,MA 01864 Undersecretary Not valid without signature