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HomeMy WebLinkAboutBuilding Permit #618-2017 - 371 MARBLERIDGE ROAD 12/8/2016�y BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 11 Date Received Date Issued: LOCATION .3 TANT: Applicant must t. V a Print all items on this PROPERTY OWNER Xl-vi L7q Print 100 Year Structure MAP _PARCEL: Z%6% ZONING DISTRICT: Historic District Machine Shop Village 0 yes no y s no v $ no TYPE OF IMPROVEMENT PROPOSED USE Reside 'al Non- Residential ❑ New Building ne family ❑ AV.i-tion ❑ Two or more family ❑ Industrial teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .`Septic 0`V1lelll [5 Floodplar� (]`Wetlands ❑1Nater h tl;fD�stnct, , ❑`W51` 1Sewer DESGKIF I IUN Ut- VVUKIN IV DC rcr�rvr�iriw. lG�litiw C� �ltic �u�-e_ AOMI-L c d2 -t1 q ,ail S Identification - Please Type or Print Clearly OWNER: Name: Sem 641 Phone:J-�l Address: 3 7 % /l%a /-le-nz �d�e— �� • l/V Contractor Name: VY 1 e P41 /t-; Phone q� ��-IL! • ��y 3 Email-. Address: 3 I -A Vr4- - !ten IY4 D Exp. Date: Supervisor's Construction License: Home Improvement License: ARCHITECT/ENGINEER 9-7'i-7 7 2 4 9rJ Exp. Date: 3�/e- �/ �- Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST B ED ON $125.00 PER S.F. Total Project Cost: $ 02 FEE: $ Check No.:119 4 1 Receipt No.: (/W NOTE: Persons contracting w, h unregistered contractors do not have access t the guaranty and 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 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) a, Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products TOTE: 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 TOTE: 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 Doe: Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature 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: Com Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doe.Building Permit Revised 2014 Location Date Check# TOWN OF NORTH ANDOVER Certificate of Occupancy $� Building/Frame Permit Fee s Foundation Permit Fee Other Permit Fee $ TOTAL $ 3"1 �z 0 1 O O 0-0 O x Cn = < m -0 FMU A C• CO (D 0 CD CL C -)m CCL � U) I CDN �_ O O rt IZ O = cn r W a- CD y O —1 J =• CDD m x I QD ! OR CL OS O �o�Zc� 0= z C :� I O � Cr CD y ,Q / Q O — o y. CL — tCD F Q� W CD E 0 r N rt S O O � O O• � CO � 0 rt 0 O CD �! CD : C co :� •� CD C7 y O oCD - �O C o COO CL :1 O N 3 o X- fD O N K m — Z p v T 5 °—' .Z7 O w S T 3 D—' N p < p A O oma T R C � C7 3 3 (D -G POOL T O or O �. N (D LACD .0 T O Q T '+ M D m OCD fi D O _0 CL C--) c� =rO n .+ 3 S fD O 0 m x -0 O h � c CD v� C CL O = �. cr CD CD OCD CD p O Q = CDCD '^5• `� CD ' v h. 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DoesthenabytvnlmgtotLeDutxter i0 ameimp" fatocat oont-Itotsaad ° I2oestltecof Utorhai..,e Pe"Pl�,Room5p�pgesio natiaa Yoninquire eeacopyofa`�roafofias 7dnaimt Ask the Dontrctarforitisiasutaatx 4A02i11 116 OrIl �g6�73-0780 88 aI 3 57. ° Y.aawyoorr,'getsand coma(ioasofhatyoagacan&tmcoverag�or?s'tio Guide tothe lioineiaep v C Read wlmparlaatrnf On an the mversesideo£this g�and get acopy ofiheCoasamer ConlYou M4), cancel this agrecrI rt third business ay athie � ���P�Iaceothathanthecaalt-tae third business g Pubhesh o rceor day foiiouing Lite sigaingof this agmeni, by Cho at7 p by teie� seator y d9li de. �Q�l:TQt RT ��� ^a Inbd7�cesofcanrxyibnnfmaladaigbtofthe CttV SLimaL-,r.�pF-C1 CrtCCC��y �'i IY Ord �'� + L rya ,, A nL arm,V-Q scam 13�AQ;ESM 3iomenivile Si�,� Dale t' Z { Cottttacta; s Signature Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the con �c,,��or,,��lna�e dispute to a private arbitration firm which has been approved by the Secretary o E Vefi3fi'Con er �>?{ . surly Affairs and Business Regulation and the consumer shall be required to submit to such arbltrattfa ,as1p� ���jfp l acbusetts General Laws, chapter 142A. lo' i �I 1$1f ° Homeowner's Sign Con s ngnature NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately sinned by the narties_ Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) may not be waived in anyway, even by agreement. However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters ori which the homeowner and contractor lawfiilly agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer information Hotline (listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract: and the three day rescission period has expired! Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Vi ithdrawal of fiords from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787,838-283-3757 or visit the OCABR website at htto://Ain;nv mass.Qov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at htta:lh►�v�v.mass.so�/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htto://db.state.ma.us/homeimprovement/licenseelist.aso For assistance with informal mediation of disputes or to register formal complaints against a business, call: Cons omplaint Section Office Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114 Version 2.1- I IMP -010 City/State/Zip: Phone #. % 10' 741V - 61—/1-/ 3 Are yo� employer? Check theappropriateboa: Type of project (required):1. [ext am a employer with � 4• ❑ 1 am a general contractor and I employees (full and/or part-time).'` have hired the sub -contractor New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling shipand have no employees These sub -contractors have 3. Demolition working for me in any capacity. employees and have workers- 9. [j Building addition (No workers' comp. insurance comp. insurance.= b required.] 5: Q 'We are a corporation and its 10.❑ Electrical repairs or additions 3 } ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workerscomp. right of exemption per MGL 12.❑ Roof r pairs insurance required.] c. 152, § 1(4), and we have no employees. [No workers' 13. -err /� X el comp: insurance required.] 'rin>> applicant that checks box rl must also fill out the section below showing their workers' compensation policy information. ' Hotneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. yCoraractors that check this box must attached an additional sheet shoving the name of the sub -contractors and state whether or not those entities have employees. if the sub -contractors have employees, they nmst provide their workers' camp. policy number. r ain an employer that is providing ivoi ief s' compensation hislli ante for ap employees. Below is the policy and job site 111 f07'777ation. Insurance Company `came: Policy '-,-'or Self -ins. Lie. jI7" 2 7 0 Expiration Date: _ 31 2-011 -7 Job Site Address: 37/%��arg/ter, 4 City/State/Zip: A/.1-4vdmG�_ Attach a copy of the. -workers' compensation? po3icy declaration page (showing the policy number and expiration date). Fai l tire 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eel tify ulzcler #]f a pants attcl pe,taFties of pef jury that Cher:zf©r1F2atio12 provirlec/ above is trite ttlzt/ correct. Phone 4: % 7 o - 741i/_ .EZ! C Official use only. Do not write in this area, to be completed by city or town of City or Town - Issuing Authority (circle ole): Per'mitFlAcense #F s. Board of T=enith 2. Building DeWtment 3. City/Town Cleric 4. Electrical Inspector S. Plumbing inspector 5.Other Contact person: Phone M The Commonwealth of Pdassochu-selTs f i Deparernen of IndiistrialAccidents n �'f,, ce of 72t�esl��LBdom 600 Washir;c, dfitZ �e e2$ Boston, MA 02711 _ - ;tv:t7a�.iizz€tsse�f�v/lift WoErg" Compensation insurance Afda-vita Buil ers/Contraetors/Electricians/Plumbers Aimileant information Please Pripi Le Myr /A Yy �allle($usinesslOrganization(Individual): yk. 6'-N. Address: yrs - 7t Fi ' 1 tin /F i. to 1 City/State/Zip: Phone #. % 10' 741V - 61—/1-/ 3 Are yo� employer? Check theappropriateboa: Type of project (required):1. [ext am a employer with � 4• ❑ 1 am a general contractor and I employees (full and/or part-time).'` have hired the sub -contractor New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling shipand have no employees These sub -contractors have 3. Demolition working for me in any capacity. employees and have workers- 9. [j Building addition (No workers' comp. insurance comp. insurance.= b required.] 5: Q 'We are a corporation and its 10.❑ Electrical repairs or additions 3 } ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workerscomp. right of exemption per MGL 12.❑ Roof r pairs insurance required.] c. 152, § 1(4), and we have no employees. [No workers' 13. -err /� X el comp: insurance required.] 'rin>> applicant that checks box rl must also fill out the section below showing their workers' compensation policy information. ' Hotneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. yCoraractors that check this box must attached an additional sheet shoving the name of the sub -contractors and state whether or not those entities have employees. if the sub -contractors have employees, they nmst provide their workers' camp. policy number. r ain an employer that is providing ivoi ief s' compensation hislli ante for ap employees. Below is the policy and job site 111 f07'777ation. Insurance Company `came: Policy '-,-'or Self -ins. Lie. jI7" 2 7 0 Expiration Date: _ 31 2-011 -7 Job Site Address: 37/%��arg/ter, 4 City/State/Zip: A/.1-4vdmG�_ Attach a copy of the. -workers' compensation? po3icy declaration page (showing the policy number and expiration date). Fai l tire 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 51,500.00 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. I do hereby eel tify ulzcler #]f a pants attcl pe,taFties of pef jury that Cher:zf©r1F2atio12 provirlec/ above is trite ttlzt/ correct. Phone 4: % 7 o - 741i/_ .EZ! C Official use only. Do not write in this area, to be completed by city or town of City or Town - Issuing Authority (circle ole): Per'mitFlAcense #F s. Board of T=enith 2. Building DeWtment 3. City/Town Cleric 4. Electrical Inspector S. Plumbing inspector 5.Other Contact person: Phone M ••�� •- <-�- ' c.i aai c.V.LU .7..a11.6Y [irl t_r%%JG G/ VV6 CdA o",z-YC.L_ CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYYI TIFICATE IS ISSUED ASA MATTER CERTIFICATE DOES NOT AFFIRMATIVELY THIS CERTIFICATE OF INSURANCE DOS O P O UCE H CE TIF C THOLDER. OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE IMPORTANT: If the certificate holder is he terms and conditions of the policy, certain he certificate holder in lieu of such end, n ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to policies may require and endorsement. A statement on this certificate does not confer rights to emen s . PRODUCER CONTACT NAME: PHONE FAX EASTERN INS GROUP LLC 233 W CENTRAL STREET (A/C, No. Ext): (AIC, No): NATICK, MA 01760 EMAIL ADDRESS: 22MLW INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURERB: INSURER C: 61 REAR JEFFERSON AVE INSURER D: INSURER E: SALEM, MA 0I970 I INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE ANY REQUIREMENT, TERM OR CONDITION OF ANYICONTRACT AFFORDED BY THE POLICIES DESCRIBED HEREIN IS PAD CLAIMS. LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY I! INSR LTR TYPE OF INSURANCE ADDSUB L R POLICY NUMBER POLICY EFF DATE IWWDIYYYY) POLICY EXP DATE INwDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY, ACH OCCURRENCE $ DAMAGE TO RENTED $ (Ea occurrence) CLAIMS MADE � OCCUR. { 1REMISES ED EXP (Any one person) $ GEN'L AGGREGATE LIMB APPLIES PER: � RSONAL 8 ADV INJURY $ ENERAL AGGREGATE $ POLICYE] PROJECT a LO RODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT (Ea accident) ALL OWNED AUTOS BOOILY INJURY $ SCHEDULE AUTOS Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS Per accident) PROPERTY DAMAGE S f f (Per accident) UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE I EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY Y�N UB -58270121-16 0320/2016 03/20/2017 wO swuroRY OTHER LIMITS ANY PROPERITORIPARTNERIEXECUTIVE OFFICERIM12MBER EXCLUDED? aN/A E. L EACH ACCIDENT $ 500,000 (f yes, describe If yes, describe under under E.L. DISEASE - EA EMPLOYEE $ 500,000 E -L DISEASE -POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNE}UCLESIRESTRICTIONS/SPECIAL THIS REPLACES ANY PRIOR CERTIFICATE ISSUED ITEMS TO THE CERTIFICATE HOLDER AFFECCING WORKERS COMP COVERAGE. CERTIFICATE HOLDER = CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. N. ANDOVER, MA 01845 AUTHORIZED REPR A E _ t1 �- er_nan 91: r�nagl05 Th ACORD I e name and logo are registered marks of ACORD 1998=2010 ACORD CORPORATION. All rights reserved. A CC>R0 CERTIFICATE OF LIABILITY INSURANCEDATE(MWDDIYYYY) 3/9/2016 THIS CERTIFICATE IS ISSUED AS A M�TTER 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, AN6 THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder islan 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 Const action NAME: Eastern Insurance Group LLC PHONE (800) 333-7234 FAX 233 West Central St E-MAIL AIC. IC No: Natick MA 017 INSURED Atlantic Weatherization 61 Rear Jefferson Avenue Salem MA 01910 INSURERF COVFRAGFS PCoTIt[I/nAlr= ki .,.- .. Insurance Ins. THIS IS TO CERTIFY THAT THE POLICIES OF INDICATED. NOTWITHSTANDING ANY REQUIREMENT, RCYI.11VP/ NUMOCK: INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. INSR OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER MPO�pCY EFF Dft-fM POLICY EXP (MM JDDnIYMEACH LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X1 OCCUR X CONTRACTUAL LIABILITY ((' j 8500042816 /20/2016 /20/2017 OCCURRENCE $ 1,000,000 PDAMAGE REMIE EaE-N—TEnce $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 X CG0001 10/01 FORM GENE RAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYFX PRO- LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO AUTOS ATOS X SCHEDULED AUTOS HIRED AUTOS X NON -OWNED AUTOS 020015871 /20/2016 /20/2017 COMBINED SINGLE LiMff a accidem 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ PIP -Basic $ EACH OCCURRENCE $ 1,000,000 A X UMBRELLA UAB X OCCUR EXCESS LIAR CLAIMS -MADE N1 ft 600058654 /20/2016 /20/2017 AGGREGATE $ 1,000,00-0 DED RETENTION$ 10,00C WORKERS COMPENSATION AND EMPLOYERS- LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑. (Mandatory In NH) "yes, describe under DESCRIPTION OF OPERATIONS below $ WC STATU- OTH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L DISEASE -POLICY LIMIT 1 $ B POLLUTION {{{i PL200378614 0/1/2015 0/1/2016 EA POLLUTION CONDITION $1,000,000 GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CFRTI1:It1ATF I.Ini n=o I _ 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. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE (John Roegel/SME ACORD 25 (2010/05) C 1988-2010 ACORD CORPORATION. All rights reserved. INS025 minnsi n1 Tihift ACnRn nnma onA Innn - rnnic+nroA mnrtrc of ARnon F Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -087977 Construction Supervisor. ERIC W PALM ` 3 MILTON ST SALEM MA 01970 �%"IZCK CA Expiration: Commissioner 04/2312018 i, J�r.` cinrirasigrr�l� n�s' �pir.;.:rr�tr,;Fll: Office of Consumer Affairs & Business Regulation t .Q -q�DME IMPROVEMENT CONTRACTOR e—In -registration: 142089 Type: £xplration: 3F17J 018- Ltd Liability Corpor ATLANTIC WEATHERmAnbaLI_C-. I ERIC PALM 61R JEFFERSON AVE SALEM, MA 01970 Undersecretary Construction Supervisor Restricted to: Unrestricted - Buildings of any use group which contain less than 35,000 cubic feet (991 cuble meters) of - enclosed space. FailuTe to possess a-cummt edition ofthe Massachusetts State Building Code is cause for revocation of this Gcense- DPS Licensing information vista WWW.MASS.GOVIDPS P License or registration valid for individul use only before the expiration date- If found return to:, - Offiffice of Consumer A11itirs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature