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HomeMy WebLinkAboutBuilding Permit #063-2017 - 369 WOOD LANE 7/21/2016 NORTl1 BUILDING PERMIT `JI�Y TOWN OF NORTH ANDOVER #0 fn APPLICATION FOR PLAN EXAMINATION Permit NO: 141 Date Receivedey Date Issued: CHU ORTANT:A licant must C, .1 fete all items on this page sr K ....... ..... LOCATION t. Print77. 0 P E RTY-*-Q VV N E-R-1'-� 4 -MAP NO t PARCEL- ONIN6I-Of 'T, RZyes'., no ..... ..... TYPE OF IMPROVEMENT- PROPOSED USE 11 New Building One,family Non- Residential 0 Addition 0 Two or more family 0 Industrial 0 eration No. of units: IJ Commercial 4kepair, replacement 0 Assessor­y_Bldg 0 Others: 11 Demolition 0 Other ES eptle ' ;:Weil 0 d, ain Wetlands nershedADistrict- r � Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 1 - CONTRA"ib-ToRarn Phone Address,"' A I UP9 ryIs 0 t's ns rc iqJdense pate i V, Home "ern 1 IMMM x �21 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULD'NG PERMIT-$1100 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ Check No.: Receipt Na.: NOTE: Persons contracting with unregistered contractors do not have acces tor g tyfund Signature Z- 7,7 Signature I A J 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_ 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 Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP "'' M NTS Temp Dumpster on+site e. .. ,max z -� 4Ltocated at 124 MAO S eet�v "t "�> Oy�fis l - , 't� �"°`- -� �-- < Fire ®�epart nt sig an Lure%ate a . COMMEIV uG w+� rtTF-1, r ,�pp'c' 4"l +�` x parE� r� k l\ t>u;? f rj r7 - •s `?x,"'"'Bs`�.,,�t.; y'r.�'t.ssizn.�a�:dus'a:Yi�..•..rs y'i i L 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) i ❑ Notified for pickup Call Email Date Time Contact Name = Doc.Bi lding Pennit Revised 2014 x 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 4, Building Permit Application 4 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 ;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 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 Doc:Building Permit Revised 2014 A Location '`G' No. VDat ' • • TOWN OF NORTH ANDOVER m Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check# -/17 w • - Building Inspector (" ®Boise Cascade Double 1-3/4" x 9-112" VERSA-LAM® 2.0 3100 SP Floor Beam1FB01 Dry 11 span I No cantilevers 10/12 slope August 16, 2016 11:21:56 BC CALC®Design Report Build 4516 File Name: BC CALC Project Job Name: R. BURTON Description: Designs1FB01 Address: 369 WOOD LANE Specifier: City, State, Zip: NO. ANDOVER, MA Designer: Customer: Company: Code reports: ESR-1040 Misc.. t3 i lIr I I I 0e-00-o0 BO B1 Total Horizontal Product Length=08-00-00 Reaction Summary(Down/Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 2,700/0 1,359/0 B1, 3-1/2" 2,700/0 1,359/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area(Ib/ft"2) L 00-00-00 08-00-00 30 10 13-06-00 2 Unf. Lin. (Ib/ft) L 00-00-00 08-00-00 0 60 n/a 3 Unf.Area(Ib/ft^2) L 00-00-00 08-00-00 20 10 13-06-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 7,214 ft-lbs 51.7% 100% 1 04-00-00 End Shear 2,959 lbs 46.8% 100% 1 01-01-00 Total Load Defl. L/613 (0.148") 39.2% n/a 1 04-00-00 Live Load Defl. U999 (0.098") n/a n/a 2 04-00-00 Max Defl. 0.148" 14.8% n/a 1 04-00-00 Span/Depth 9.5 n/a n/a 0 00-00-00 %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2" 4,059 lbs n/a 44.2% Unspecified B1 Post 3-1/2"x 3-1/2" 4,059 lbs n/a 44.2% Unspecified r� Notes / Design meets Code minimum(L/240)Total load deflection criteria. Design meets Code minimum (L/360) Live load deflection criteria. Design meets arbitrary(1") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. P(III a D � D Page 1 of 2 S Bolse Cascade Double 1-314" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor BeamT1301 Dry 1 span No cantilevers 10/12 slope August 16, 2016 11:21:56 BC CALC®Design Report Build 4516 File Name: BC CALC Project Job Name: R. BURTON Description: Designs\FB01 Address: 369 WOOD LANE Specifier: City, State,Zip: NO. ANDOVER, MA Designer: Customer: Company: Code reports: ESR-1040 Misc: Connection Diagram Disclosure Completeness and accuracy of input must b d be verified by anyone who would rely on a I output as evidence of suitability for • r• • particular application.Output here based r on building code-accepted design c properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c= 5-1/2" (800)232-0788 before installation. b minimum=3" d=24" BC CALC®,BC FRAMER®,AJSTM, Member has no side loads. ALLJOISTO,BC RIM BOARDTM,BCI®, Connectors are: 16d Sinker Nails BOISE GLULAMTM^ SIMPLE FRAMING SYSTEM®,VERSA-LAM®,VERSA-RIM PLUS®,VERSA-RIM®, VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Cascade Wood Products L.L.C. Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 25,000.00 m $ - $ 300.00 Plumbing Fee $ 37.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.50 Total fees collected $ 475.00 39 Wood Avenue 063-2017 on 7/21/2016 kitchen remodel pORTh BUILDING PERMITS°�'"`� TOWN OF NORTH ANDOVER s APPLICATION FOR PLAN EXAMINATION • � z Permit NO: Date Received Date Issued: SACHUSE��y 411ORTANT:A licant must complete all items on this page t n - Y' I_ocATiON PROPER1W OWI�lER , r t _ x ichirt�Shop'yVfliage,r, .Yes>; -nq,4 , TYPE OF IMPROVEMENT PROPOSED USE Re ste tial Non- Residential o New Building n family n Addition ❑Two or more family F0 Industrial t:�AXeration No. of units: 0 Commercial V"Repair, replacement a Assessory Bldg ^ Others: 0 Demolition D Other E Septic ' 1111Ve1t ��Fiootptatrl: Q UUeTanis� �z }r A p1 �rl� d Dtsttt i n n Ch Identification Please Type or Print Clearly) OWNER: Name: Phone: Address CONTRA� `OR I�la �� Plao l Address _ k - r.... s v_ `3' Su rv!sAr s� x k � P� Ctsar� icehn En w !. - ✓' s _ ;.1} -t.kk,�x,.,/ .I,d;�t,,„,1: 1 x,. ..pSW ,, W ARCH ITECTIENGINEER 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 contracting with unregistered contractors do not have acces to h g r ty fund Si nature ofA en QwnP 9, 9 ._. .,._.. Signature ofi ca tra NORT1y own o ndover 0 z - h ver, Mass, CONIC«e RwTE9) ►PP,`�(5 V BOARD OF HEALTH Food/Kitchen PER L D Septic System THIS CERTIFIES THAT ................ .....C.... .......................................... ............/■�...L........................... BUILDING INSPECTOR 93fr A a��y........... 3 .... ....' Foundation has permission to erec .......................... buil ing on ......... ..... ...................... .......... ...... Rough to be occupied as ....... ......... ...... ..............r `..l....." ►..o.� .................. Chimney provided that the person accepting this permit shall in every respect conform 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, 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 PERMIT EXPIRES IN 6 MON T S ELECTRICAL INSPECTOR UNLESS CONS TIO Rough Service ... ... . ... ........ .. ......... Final BUIL IN ECTOR 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. Permit Services 401 246 2868 p.7 2016-07-20 08:05 2614READING 7819428601 >> 401 246 2868 p 8/10 KIT,','HEN INSTALLATION ESTIMATE WORKSHEET- IDSA 206 7R.j.cao trunden arepry Burton 494403-1816 -T 629116 Dome and HAVI A" WA T1149GOOKSPU9N4006 nagme Jul@ A4idltlonsl Chmrgw I NateAds #??SAO ................ associate 6 gNAvr*-* 7 j I Oak: pjOq')o'- fjCjz:VO9! KITt.:HEN INSTALLATION ESTIMATE WORKSHEET-USA �-- 2666 R,J.Censtruction 2nd Floor _ Gregory Bruton 48d-6331816 5128116 _—,--__ C Orono and Hauiiv ; i2,638A EVactrical i7dllD0 i9,960D0 Plumbing T11siShowerlFloorin8 X3,760. DrywatrlRepalr GadinatrylAppllsnass $42acc Addltlanal ChargeSI MAWlals a71t0•DO i Customar S nature; Dgft: i Aasookta Signature: ---- �.—__._..._..._._._ :080: — G C Slgnotum. 9i:90LLZ,8L6 UGSIPOLN P•1e401� d9Z:-7096 Low 9.d 9990LLZO16 u0slpe"pjey01�j e0L:909L OZ Inf C7 158;" CREG&RACQUEL 13RUTON co 494.633.1816—Greg Mobile (i CL 43; 57" 75" 610.227.S58O—Racquel Mobile 369 Wood Lane 74" SITE:. 2 1 33" 20 North Andover,MIA 01845 . ...... Ce i ling H e ight 9 1-1/2" LW30133361I Top I Z V Alignment 90" W2436 8UTIBLW "Cmtvn doses to ceiling " .- J: Co 001 C1 o ca !;j BER3336R B272FINTOUij:=� . j lIFR36L I IVIXIWER FID Sille Analysis CO PO 4854S9684 SB33 B on AMERICAN WOODMARKCabioetry NZt BUTT I1F3 • Door Style:AsIbl2ad Palated Sq w,rEF Dom Const:laortial-uyrFlay Recessed Center panel O M DRYFR Box Const:Standard Ifl'MDF w/Snme 3/4'Furniture Plywood as noted Cp r-L":Ubell pallit A AI approve the hyuu r of the kitchen. I hav c be c o advised a I rhe m 4%v eek lead ti rxe ('19 for cablGetry 3od dat the dellvM agent wig contact AP, 5 mediradytrDsubi-duletht delivery date and time once Thecablinets bavebeen prodoced r-_ "I havealso b"nadirisedthatc2biremy is CUSTCIM 1`011caled for N't'll"roint-it"eyefore NOI RETURNABLE CO I once produced- py do have 90 days from receipt at c2binalry to report ANY OF ANALYSIS Report ml%.%Ing/dam4Fd iieris fora directrepol2cem tot 1 5 lak C taltered 80"of the left w2Uvv/disp=aI_ ...JF3 2.Drain Q DES into the floo 169"off Lh e right wall 3,DW24centered Wafftlhe left wall. "10TALLA TION NOTES"" T99 i'827 PUTT 4.Stove 31l'g&L free standing centered 4B'off the left wall -24 B27 BUTT 2 FH S Hood vents in.i -Fillem Mddinp/Toe fOcks/Nods provided MUST 6 Pridg,32.x 28d.70 becui too firan4te as needed for lnsullwob. "SBE rICV41110115 101 SPeciRc OU11110100 DOW for cabinets (n 7.Ceilintstio a0l.5' -RAS 980ARD Hear ED be adl umolil to allow Cabinetry as designed -70k hICK Heaher recommended -SINGI.F.E Plate of(town mold Ing Is used to coorml.jpp to -tV 354' 18" -----31 ceiling above cabinetyy- iv At 204 CL O Lr% O All dimensions size designations !This is an original design and must Designed- 7/2/2016 o given are subject to verification on not be released or copied unless Printed: 7f19m-016 lob site and adjustment to fit joh applicable fee has been paid or job condition-. order placed- 70705799.kit Fr_R Plan Drawing,4: 1 No Scale. 2685 GREGORY 8RU7ION,BATH 2ND GREGORY&RACQUEL BRUTON 95 3" 04 484.633.1816-Greg mobile Ceiling Height-87" 610.227.5580-Racquet Top Alignment SITE::169 Wood Laae Over Toilet-84- Ci North Andover,MA 01945 W2432 BUT coufflertop] Site Analysis PO#BS4$9683 Vanity Wall-75'[cab sits on P Home Depot Site Analysis AMERICAN WOODMARKCabinetry VSDB3634,HL VSDB3634HY Donr Style:Ashland Painted Sq. �ej00 Door Const Partial Overlay/Recessed Veneerpanel 00 No i Box Const:1/2"All-Plywood Construction 00 cm w/some 3/4'Plywood on W24 3 9 only N Finish:Linen Paint FS ► Pulls-FULL31295N Bow Full 00 —1 approve the layout of the bathroom. —1 have been advised of the est 4 week lead time for cabinetry and that the delivery agent will contact ME directly to schedule the delivery date and time. A A -[have been advised thatcabinetry is CUSTOM Made o TUB/SHOWERfor MY Project and is therefore mo'r Returnable on produced, TOILE Tel 00 35� —1 do have 90 days from receipt of the cabinetry to report CVis F ANYmissing darnaged items for a direct replacment. N N NEI VC2436 BOTT .6A M:_.' X BATH INSTALLATION NOTES:: -r)FM0 Fxisfing bath I tiles etc, 58 —Haul away all debris —Re-route plumbing as needed for new sinks/drawers Sinks centered one 24.25"off the lettNvall,second centered —Sheet rack/possible painift 24.5"off the right wall. -Replace Toilet-same location a) Drains go into the wall. —Replace TUB/SHOWER-with CUSTOM Standing Toliet centered 16.5*offthe right wall. -let shower-build base with tile&tile on walls W Ceiling centered 87' M Single shower head I faucet —Replace vanity with cabinets as designed "'C DRIAN Countertops by others '''Semi-Recessed lavatory sinks/vessel faucets o —INSTA11,New'rile Floors 00 01 All dimensions size designationg This is an original design and MUSL 'Designed: 7/19.12016 CD given are subject to verification on I not be released or copied unless Printed:7/19/-2016 job sire and adjustrnent to fit job N applicable fee has bem paid or Job conditions. order Placed, 10 o --------------- 7026i `eii�ii____ FLR Plan I The Coutinonwealth ofblassachusetts ' Deprlt't hent of lndustrIalAccidents 1 Congress Street,Suite 100 Boston,MA 92114-2017 Mww.rtrassgov/dia Wavkem' Compensation Insurance Affidavit:Builders/Contractors/EtectricianstPlumbars. TO BE FILED WrM THE PERMTITIING AUTHORITY. Am3licant Information. ` Please Print Legibly t<13i11e (Business/Organizatianllrtdividual); t-th '— Address: ����'�"` City/State/Zip; - Phone#: Ar�yutxa player?Checklhe appropriate boc: Type of project(required): 1. ployer with employees(full andtorpart-time).' 7. []Ne OnShUCtIOri 2.Q 1. m aa sole proprietor or partnership and have noamptoyees working forme in $, •� -modehng any capacity.(Pio workers'comp.insurance required.] 3.r l am a homeowner doin all work myself t 4. ❑Demolition l.J g, y [No workers'comp.insurance required.] 4,0,taim a.hameowner and wd@be hiring contractors!o conduct all work an my property, l will to Q Building addition ensure that all contractors either have workers'compensation Insurance arare sole t l- Electrical repairs or additions t proprietors with no:mployees. 12.[]Plumbing repairs or additions 5.Q t am a general contractor and t have hired the subcontractors Listed on the attached Aect. Theso sub-contractors have employees and have worker,'comp,insurance.t l3.Q E f repairs 6.Q Wa are a corporation and itsofficershave exercised their right of exemption per MGL a 14• other 152,q 1(4),and tvehave no employees.(No workers'camp.insurance required.) 'Any applicant that checks box#(must also fill out the section below shoving Qtetr wor ter; compensation palicy-information:-___ - �� Ffomeowiidrs vviio submit If is atli it drncmingtheyare deg all work and dren hue outside contractors must submit a now 3ffldavit indicating such. tConlraclom that ehxk this box must attached an additional sheet showing the name of the s_uircantractors and state:vhether or not those cntities have employees._If the sub•contractors•havi employees,they mturprovide their uvrkeis`comp,policy number. I am an employer that U providing workers'compensatlon brstirance for my employees. Below is Ute pollcy and f ob site lnformallon. 1 �^ Insurance Company Name: I r Policy#or Self-ins.Lie.f#: off( Exp(ration Date: / Job Site Address: / City/State/Zip: Attach a copy of the workers' compensatipt policy declaration page(showing the policy num er and exp atlon date), Failure to Secure coverage as required under MGL G. 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 tho Violator.A copy of this statement may be forwarded to the Mee of Investigations of the DIA for insurance coverage vedfica' I do hereby cer fy in r I/ pair and penalties o,f perJrrry Ilial the Information provided above!s rue and correct. Si nature. Date: Phone#: Offlclal use only. Do not write in this area,to be completed by clty or town offletal. City or Town: Permit/Llcense# 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#i.. AC<>RU® CERTIFICATE OF LIABILITY INSURANCE DATE (Mo sD �) 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 TliE-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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE Pax 3560 LENOX ROAD,SUITE 2400 EMAIL AIC No ATLANTA,GA 30326 ADDRESS: INSURERISAFFORDING-COVERAGE NAIC* 100492-HomeD-GAW`-16 17 INSURER A:Steadfast Insurance Company 26387 INSURED THE HOME DEPOT,INC. INSURER a:Zurich American Insurance Co 16535 HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins Co 23841 2455 PACES FERRY ROAD,NW BUILDING G20 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: NSURERF: COVERAGES CERTIFICATE NUMBER: ATL-003741310-08 REVISION NUMBER:O _ Tii'S i5'M Ct RTifl TH RT-THE-POLI"CIES 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. 1NSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE wvnPOLICY NUMBER MWDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL04887714-06 03101/2016 0310112017 EACH OCCURRENCE S 9,000,000 CLAIMS-MADE r7l OCCUR DAMAG ESO R occurrDanee S 1,000,000 LIMITS OF POLICY XS PREMIMED EXP(Any one person) s EXCLUDED op S.R.&I WPER OCC PERSONAL a ADV INJURY s_ 9.OW,01D GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9,000,OOD X POLICY❑PRI rl LOC PRODUCTS-COMPIOPAGG S 9,000,000 OTHER: I S B AUTOMOBILE LIABILITY BAP 2938863.13 03101/2016 03/01/2017 COMBINEDSINGLEUMIT s 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED 07 SWNED N1RE0'r':UTJS 111 -PgOPEi2T Y DA74AGE ,S ' ° Wer 2 cidant S UMBRELLA LIAR OCCUR EACH OCCURRENCE S _ EXCESS LIAB HCLAIMS-MADE AGGREGATE S __TDEIT I RETENTIONS C WORKERS COMPENSATION WC015519215{AOS) 03101/2016 03/01/2017 X PER OTH• s C AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORRARTNER/EXECUTIVE N D OFFICER/MEMBER EXCLUDED?. JNIA WCD15519217(AK;KY,NH,NJ,VT) 03101/2016 0310112017 E.L.EACH ACCIDENT Is 1,000,000 _ (H13ndaiaylRNH}. SVC01.551321.6"(11). GTO-W016 .031011X17 EL.OISEASE-EAEIv+PLOYE S i'law,$G`s' If yes,,describe under DERIPTION OF OPERATIONS below Continued on Additional Page E.L.DISEASE-POLICY LIMIT S 1,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is"required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER11500 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NORTH ANDOVER, THE. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mtikherjeeotti�a,�c ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD J r � cLLL' l f i �p1`tlal� i Oftir'- Oi Co,-1su as -,L3 anu �Li�ll1�5� 1 10 P� Li t3 4OF c-uk Plaza - S i.� 170 P octan Massachusetts 02116 Home Irnprovement.Contractor Registration - P.egistraSon: 125a93 Type. supplement Card EniratiOn: 8/312015 THD AT HOME SERVICES, INC. RICHARD FALLONE 2690 CUMBERLAND PARKWAY ATLANTA, GA 303391 = update?address and return card.Ylark reason for choose. J Address .71, Renewal L� Employment Ls Lost Card / •'. cz o€Consumer�i'fairs&Business Ra�ulatian License or registration valid for indiridul use onl}• �� o o before the expiration date. If found return to: UP '' ='nEyT COPiT„��i 0,. 0M,;e D Cansuinar Afmirs and Business lta�n[aEion d fIp'- Lo Park1'laza-Suite 5170 'i?agistration:_mfii — B osto a, vr-k t)?Ili �' Expiration=8l31�G 3upplemsRt Cazd 0 AT HOiLIE SER`J..ICESSt�I_ _ HOLIc Di-PO i PtiT.RO�IESEP�%ICES 'HARD FALLON- ' ==f4 3o CUMBERLAND PAARO- `":t:— ' GA 30339 tndersecratary Not lid wt out signature Massachusetts Department of Public Safety Board of Ruitding Regulations and Standards License: CS-030000 , Construction wuper,/izo( l RICHARD J MADISON 3 MADISON AVE GROVELAND MA 02834. (�✓���,ti Expiration: Commissioner 0712112017