Loading...
HomeMy WebLinkAboutBuilding Permit #1126-2016 - 34 OLD VILLAGE LANE 4/26/2016 NORTy (� BUILDING PERMIT 44� � TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: I /�Y^ Date Received RAD p\M G 7 R^7ED �SSACHU`''�.0 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 3q 0 C� VAILA_►-s_ Print PROPERTY OWNERS tN�,A� (-�wv-r\e }-Ir Print 100 Year Structure yes no MAP PARCEL: ( b1(,0 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition El Two or more family El Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 9 Septic ❑Welh FI©'©d lain, O=W-etlantlsa 'I ❑ UVaterst edh®itact„ 'UVater/,:Sewer � a DESCRIPTION OF WORK TO BE PERFORMEQ: Identification- Please Type or Print Clearly OWNER: Name: S N (j r& WL(rn( * Phone: Q1Y�3 Uf3g-• Z3 Sy Address: Contractor Name: _ v 1' % ✓ Phone: Q 3 - 34 Email: YLSVLo-• n Address: P ut3ox 3111 Supervisor's Construction License: � 'zy Q Z Exp. Date: S -Z 5_' Home Improvement License: V�3 -i[0 Exp. Date: t ' \\,O 4 0, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON$925.00 PER S.F. Total Project Cost: $ �s FEE: $ I" Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce to the guaranty fund rte'..;." .� _ We Gz e Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tauning/iblassage/13ody Art ❑ Swimming Pools ❑ I 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_ 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 r A Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPAR+TMERITem` Dum;`stem ontsitexoyes -ziY ' L sated at°12Ma n Street`s •' _ �C@ ,, r d ye• «.._ .. v^ MA/date rr i ct',1 t�;Vit{;! •t �} .!F'Fire Departmentsignaturbe/date it w €e }?a F9}• I �r/ u, i. f°.i»�• ��s r ipt ,t r.a ♦ax',� ! t ° t`ct' t .• � - . r xeAx y., � ! YJ� #CS'� :J�rl'{ t 1t`'�4 hof COMMENTS'' hfi; t; . „r� s e .." i�. r1l 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, trust or service drop requires approval of Electrical Inspector Yes No DANGER.ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA-- (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Suilding Perndt Revised 2014 i 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 i 4� 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 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) 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) 4. Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 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 i Doc:Building Permit Revised 2014 NORTf1 Town of ndover 112% 2-ol _x Mass, �.� o�h > M > COC MIC MlWKN y1. ver, 'ls,9s RAriw V BOARD OF HEALTH PER I Food/Kitchen T L D Septic System e BUILDING INSPECTOR THIS CERTIFIES THAT ......... ..........��......... ... ...... AIA' . .............. .................. Foundation has permission to erect .......................... buildings on . ... .}� .... . ... �::... .. .!.�:. Rough 6' to be occupied as .. "�1�. 1..... .. +.. .. . .. A. .... .::�!'tvef Chimney provided that the person accepting this per i tall in every respe�nform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteraf and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION §TARTS Rough Service ................... ... ...` I............................................... 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. Federal t0#05.0405629 eeeooq� �� RISE Engineet-ing RI Contractor Registration No 8186 ■ 0 I SE 4MA Contractor Registration No 120979 ;+.Z A division ofThiclsch Engineering ENGINEERING 60 Shawmul Unit 42,canton,MA 02021 CONTRACT 339-5024i335 FAX 339-502-0415. Page 1 PROGRAM THIS CONTRACT S ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTQLIERI i.PHONE lm... Yom. .DATE CLIENT s ^WORK ORDER Sandra Barnett V (978)685-2354 03/292016 432943 00003 SERWCE STREET (� G 86UNG STREET 34 Old Village Lane - v 34 Old Village Lane __-�.-. _ _.... . _ _ . __ SERVICE Cf TY,ST-AM HP BILLING CITY,STATE,ZIP North Andover,MA 0 North Andover,MA 01845 JOB DESCRIPTION HAZARD BARRIER:Ave have identified that then are recessed lights present in your home.unless the recessed lights are certified as IC-rated(insulation Contact Rated)avc will create a 3"clearance space around the funure by using fiber-lass blanket insulation as a damming material,no insulation will he installed across the top and closed cavities which contain recessed lights will not be insulated. $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work sill be performed in concert with the use of special owls and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.)This will require(10)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed, At the completion of the wcatherintion work,and ut no additional cost to the homcowner,a final blower door and/or combustion safety analysis will he conducted by the sub-conimetor to ensure the safcty of the indoor air quality. S850.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass baits-to(112)square feet for damming purposes.KEEP DESIGNATED 10X28 FLOOR. $229.60 ATTiC FLAT:Provide labor and materials to install an 8"layer of R-28 Class I Cellulose added to(1052)square feet of open attic space.KEEP DESIGNATED iOX28 FLOOR. $1.441.24 AMC ACCESS:Provide labor and materials to install(1) easily moved.insulating cover for the attic access folding stair. The cover has intcgml wencher-stripping to restrict air leakage.REPLACE THERMAL TENT. $200.00 ATTIC ACCESS:Provide lnbor and materials to insulate the back or the attic door with 2"rigid Thermax board and seal the doors edge with wcatherstripping to restrict air leakage. - $73.91 VENTILATION:Provide labor and materials to install ventilation choles in(42)railer hays to maintain air flow. $84.00 COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(192)square feel of common wall arca. $672.00 BASEMENT CEILING:Provide labor and materials to install(116)linear feet of 12-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. 5203.00 OVERHANG:Provide labor and materials to install 10"R-37 densely packed Class I Cellulose insulation to(63)square feet of extcrior overhang located below a limited floor areal,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be sealed with exterior grade spackle and Iefl in a relatively smooth condition.Finish sanding std touch-up priming/painling will be the customers responsibility. 5252.00 Federal 10#05-0405629 RISE Engineering RI Contractor Registration No 6186 MA Contractor Registration No 120979 RISE -: ` A division nf'171iclscb Engineering ENGINEERING- 60 Shawmut Unit#2,Canton,M A 02021 CONTRACT 339-5024335 FAX 339-502-6345 Page 2 PROGRAMTHIS CONTRACT CMA-HE:S ENGINEERING At D THE CUSTOMER FOINTO R BETWEEN RISE DESCRIBED BELOW Cl1STON:ER PHONE DATE CLIENT d WORK ORDER Sandra Barnett (978)685-2354 03/29/2016 432943 00003 SERVICE STREET SILLBD STREET 34 Old Village Lane 34 Old Village Lane SERVICE CITY.STATE,ZIP ORLtrtG CnY,STATE,ZIP North Andover,MA 01845 North Andover.MA 01845 JOB DESCRIPTION RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures.Columbia Gas offers 75%incentive,not to exceed 52,000 per calendar year,and an incentive of 100%for the Air Scaling mL.-esun:s up to the first S680 and an additional$340 ifsavings arc justified by the auditor. For the safety and health of your home's indoor air quality.we Will be conducting a blotter door diagnostic of the available air flow in your home both before die work is begun,and after the v%vathcrization work is complete.We will also conduct a full assessment of the combustion safety of pour heating system and water heater.?leis has a T•aluc of S90 and is at no cost to you. Total allowable ncatherization incentive is$3.110. $90.00 A�r6. 4Wi11� S U t Total: $4,095.75 Program Incentive: $2,940.00 Customer Total: $1,155.75 YALE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand One Hundred Fifty-Five&751100 Dollars $1,155.75 UPON FWU INSPECTION AND APPROVAL BY RISE ENOtMERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL DE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER SO DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES. -HTS OF RECWION.SCHEDUL10.AND CONTRACTOR REOiSTHATDN. NOT SIGN THIS CONTRACT IF THERE ARE ANY '_'T SPACES _ - / 4' 'Cl�eo;yc AUTHD�510i4l_ARWEE�in �_-�" CIK.TOE NOTE:THA CONTRACT MAY DE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLIVED ABOVE S�, 60 Shawmut Road,Unit 21 Canton,MA 020211339-502-6335 EivGiN ' ww w.Ri$can ineeriri .yam EEttINv' � g ®WOOER AUTHORIZATION FORM I, SG 14 Ci Vlbw,. (Owner's Name) owner of theroPertY located at: P (Pr rty Address) V�. l u �D) (Property Address) hereby authorize ` lj Ml-cc I ►'LSJ Lwf`�)a 1�--► (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalfxo obtain a building permit and to perform work on my property.This form is only valid with a signed contract. ("/"/ '.14wfl Owner's Si t atur Date i The Commonwealth of.1-tr.vsachusetts Department of Industrial r1 ccidents ' c Office of Investigations 1 Congress Street.Suite 100 Roston,MA 02114-1017 ivww,mas .gutldia N orkers'Compensation Insurance Affidavit:Builders)Con tractors?Electricians(Plumbers Applicant information Please Print Legihh> iv 313'1Cf£4u�tn:•�trranirdtir?,e'4ot3iti�ua4}: (�„�s4"�l�'f(�hSV�f��SZ''� , �'� _..... � _ Address: 130 13ox 314 City,State`7_ip: W% 1 Phone- � V 6 3 S_lst 3`i S3 Are%-on an employer'Check the appropriate box: Tr pe of projecl i required v 1. 1 am a cinplti�°cr ,aitli `^ �,] 13rn t general cowractcx and I crnplovecs ifull and or par-nine 1. 141-,C hired tltc auh i'vtttractcira t" c%% construction Z. 1 am a,ole proprietor or pa:ruier- luted on the ut hcd sheet. T fZcrrx-rtie:ing ship and have no tmployce, I#<<`c`UF-coutr dors haec j Demolition worktn+ty lilt me in aw, c tp tem cinplc cc-,and hank worken' t }. Building addition [\o itorkcr,'comp.ira"urance comp.Insurance. Lt c arc i cv or itw:i and its er�.I3 Lltctrical repairs or addmcm> rc.luiretl., � ?l' viltl'o:,4 hal c e`ari,sed lbor r. t l ain a hotrscukartcr doing all=tc,k i 1.[)Phiribittg rcrairs or addlitioji, mvJf.. I No"orl,cr ' comp. right of eutstplion;v.r MU r ,.[]Rcof tg,11rs tn+uranC.°requir d] } c. l5'.,,i i4 t.wid t+,tial e tit, euip,10"ecs. [N't)k%orkers' cotmp. insurance rcquired.J 'An4s�l�!i:an-tnstch.c,c,heix=4mu<ta'-tialllt,us4r:rctr;�:r'I�rlse•,.w1, tis.....,.,1..,:u�y�:n'a ,�•Fk�t<ttat,,, ,u.;-,rta:,rn Hr mn�anc a:„,nhxt:if. at}i13ti tr r_„.c 't.r,,ts Fth dnr._*?3 tt,r,5 ,',c r s. .x,t:tdi r z r�:t,re mutt j&r.w t n_-A vt'Ux it:::dt._tttrp MIL �Ctut:�.ws,rttit.rn,F,«t:.:.�]L'Ttica,t:,z_i°xtt n att,a:,.:ai:.t�r:.,tr;a,;.r t6C rsrae t r.,._,uL w.,..:t.ls:,n�..i;auto tt;:.3.�•r ur:t.+^si:,r.ct„t;;c,t'ac c tr.:t�tu .;tl•.c suh•Cnr:tG�e ,.F'��e=-r;`,�.ec,.:.'zry nt�s.t+r:rrr��t7trr. +,,t•-h;t, i+.-•t_t•.�,!3t.•.;:uttt?x; um ten emph�ver that is pr<auiding rsorlcerrc'compen ution ins uruncc fiar m)`emplo,t'een. Brlut,•is the lrrrli(t-andlob.si'lea itrfnrneation. litsuranet t'unipanr ,nit::-A- _ i;a, Ik,)t 3t'AnLt I'vltcy=or scis ins, l ic. A W3.00.3-n- Exprattc+rt Daw:_t 0 3 Job Site Address 3y V N Ciit State Zip: e U_ h n-0 1sIt J Attach a copy of the vtorkers'ca,mpencation police declaration page(shouing the polio)number and expiration date). VAlurc :(i,ecure coverage as required unidcr 4etion_5A tint M61,c. 15_'can lead to the inipto,inon of criminal pmaltics o`a tune up to*1.5{)ftM and or enc- 4iir m­;p�,onsucnt.as well as c.r,il pcnAw:.N m the forin of3 S 11 OP WORla ORDER and a tine of up to k_'5(I 00 a day against the 4 itilatarBe ad%Bell that a cop4 of this siateincfa nid4 I) 1<+mardt'd*o the Offiicc of i.ntestic:ttinns ofthe PIA filvinsurance cw.cravc%en caticm. /do hereb.v certify imder the pants and penallies of perjuq that the informadon provided above is true and correct. ti� n3turc: �.^-t• .. Official nee only. Do not w-rik in this arra.to be Completed by citta or tasen ofrial. Citi or Taun: Perntitll.icense Issuing Authority tcircle orae): I.Btrar- of!leaph ?.Building Department 3.C'itifl'tnwn Clerk 4.Vlectrical Inspector 5.Munibing inspector 6.Other Contact Per%on:_ _ __ __ Phone#: 1 CERTIFICATE OF LIABILITY INSURANCE E THIS CERTIFICATE IS ISSUED ASA MATTER OF i:fMIIAxION ONLY AND COWERS NO FUG,"ITS UVII TrIECERTIFICATE MOiDEF..THIS t1 CERTIFICATE DOES NOT RF1'IRMATRIELY Oda'N[GATWELY AMZN,`Y,1PTZND OR G,LTEP THE COVER4Ge AF CRDEO 6Y TC1C.POLICIES !i BELOW.THIS CERTIFICATE Or INSURAMCE.GOES N'DT CC..o,ITUTZ.A CQNTPL.ACe BL7VIEEN 7??.r IS51}1..y M51JRER(S).ALI'Ti(ORUED PRESENTATIVE OR PRODUCER,AH]IKE CERTIFICA 401.09;1, IWORTA-NT:I`the cute homer is an ADDITIOXA.ItiSLI ED,tdst_'poicy;en}crust be endcrsed_If SUBFC}GATI0N 15 WANED.£lbjeet�the teems and Cc.6t;ons of the polr:^t,certair.pztines mar rf'aai e 0n Ct+CricS r,.ent.A statelren:on this cenif c to doe2 no:confer aFg`.ts to the Ce1'S11-4CBte holder in Neu of s a emoorse-nent(5). _ # Clayton Martin J Ins Agency Inc Berkley Assigned Risk Services d 1649 Northampton St PO Box 989 �,v;I I804j'634 L569 .AC w,, (666)215-8118 Holyoke MA 01041 „ �c,GeySe vi esckryf sk oD M.Am:S tYsFR k. A:n^..m ns-w"C, i Gauthier Insulation Inc W-11ASA 6, PO Box 344 Nv'Asr c, Ipswich,MA 03938 n=om.a J COVERA ES CERTIFICATE NUMBER- REVISION NUMBER: TH S IS TOC RTIFY TkAT Tk*POLICIES OF V Su1=.tiP: jCT,ED SELOW,1AVE EE ENiSSUED TC T-iE RSURID t5RFD A$O`+=Kw T,-i=P (CYFTE*:i Z N:'ICAk'rE0 NOMITHSTANDING ANY RECU;^EM IFT,TEFYtJ.OR CONf)a'KX*017 ANY CONTRACTOR OT,:.ER Di3G:34:EENT t'+7Til RESPECT TO ANIC=" HIS CcRTIFICATE MAY SE iSSUED OR N.AY 4Xaa iAINt IH=INSURAf,:--E AFFORDED BY)tiE POLICIES DESCRISfo iiEREN IS SU3JECT TO ACL T'"F TERMS EXr-AJ,Sf0i4S AHED COt�_tTKWS OF SUCx POLiCrES_IDAT.S St4iO N PAY KAVC KEN REDUCED 8Y r-MO S: STP TIME�iE7iitYE Gnu. 1 .ACy CCC:RkLI-Cf 1 0C+.affRCt;L^.,£rsERt�i.;a6t�v _ r ClAA•.1Sibl�F ;YY;JR 4i 4•c rp rA+r cw Ir+�1 s _ RSMA1&,%:)V R W?Y fwkvtArZAICArttw.t ci<s-sR- =Beau=*'-c W 3 I �x 1-4 k0c s ! .utr�e+oen.>cwerm I a.�., ALL(1AMID w ycM s Aytr- , ea M ax+u.ei _I S ►aria&Lw«+a oc £ a S FXCE9&LV5 CA.*V-VA:P' ttoRKERs comp"urNA AND EWI.QYV*t UA $2V {t;'4�: Ak?-A'R0PgT10"AA1I.X0A'xih.1�'m tvl. Z;a t !' EL EAC,•.U_Li7lA' $- u5d]ri. A 0rFPCE.'6'tWV1,,bcttu_ru:� --..! tt e M.AA;RP3003 i 1413CJ2131 r 1 Q,f(tY.01f, ...._ IWnar+wr a,Nx; :xti-aSE.{k€ti¢YCaFIF '$C'Rf—nOFc*'EVTIOPaea,as t .arAs—K-—cria.r- S i9G0.Fa LJ TO Fieo.�,+raraw.r Es.rtxS�2 r.m-.r A:?r.♦a��tra�: ,cr CERTIFICATE HOLM CANCFLLA ON Sti IA-V,AVY OF T IE A,Lm'E C_6{-,-j3E D PO"CZIE Sr- 4XV0RE Clearesult THE EKDRA:TraN 3A'E THE'rcOt V0V-S DELIVEFM N Contractor Svcs .ccc�wa a wv i THE�a c v xCy c,ONc 50 Washington Street Westborough.MA 01581 Signatum ACORD 25(2010105) BRAC 3139 CO® DATE(MMIDD/YYl'Y) A 6 CERTIFICATE OF LIABILITY INSURANCE 7/7/2015 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 CONTACT NancyUsher NAME: Martin J Clayton Insurance Agency, Inc. acoNro Ext, (413)536-0804 A/C No:(413)534-7874 1649 Northampton Street ADDRESS: P. 0. BOX 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURER B Allied World Natl Assurance Co Gauthier Insulation INSURER C: 44 ESSEX ROAD INSURERD: INSURER E: IPSWICH MA 01938 INSURERF: COVERAGES CERTIFICATE NUMBER:CL157701379 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 SUBR POLICY NUMBER POLDICY EFF POLICDY EXP LIMITS LTRAMDNYYYI X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR PREM SES1A R5E OEa oNcurrence $ 50,000 X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO-JECT ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COaa accident SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION �BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I DISEASE-POLICY LIMIT $ ::: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MPIMM-d with pdfFactory trial version www.pdffactory.com m ` Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10/1/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 IPSWICH, MA 01938 Update Address and return card.Mark reason for change. LJ Address Renewal t Employment Lost Card SCA 1 is 26M-OVI7 !'"��e Y'c.rruruir�n<vrl//r r f r'f�iaarrr/,u�/!i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only I ;HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: . tegistration: 173410 Type: Office of Consumer Affairs and Business Regulation ;Expiration: 10/1/2016: Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD IPSWICH,MA 01938 Undersecretary of vali4wW.iutsignature "a�rsachusetta Department Of Public Safety Board of Building Regulations and Standards f"���w�ar��:teaexi Ser�trrt��r�r�ilr�:t:�!#t .License:CSSL-102562 ,�k KURT R IDAUTt1A c LU K 0.Sox J44 1prwkd MA 0193 ti v Expiration omussaca�yr r 05/25/2o17 Location No. bate �U `r" P Date L TOWN OF NORTH ANDOVER ,y a. Certificate of Occupancy $ Building/Frame Permit Fee $ 4`t Foundation Permit Fee Other Permit Fee $__ TOTAL $_, Check x2 C.— Building Inspector