HomeMy WebLinkAboutBuilding Permit #491-2017 - 38 MABLIN AVENUE 11/9/20164 I r NORTH 9
(J( u BUILDING PERMIT o
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TOWN OF NORTH ANDOVER o�
APPLICATION FOR PLAN EXAMINATION
T i y
Permit No#: 44g 90 1 '� Date Received ! (— - � ° � � � �
�.9
SSACHUS�
Date Issued: I C ` 01 - XO I(,&
IMPORTANT: Applicant must complete all items on this page
LOCATION
PROPERTY OWNER
Print 100 Year Structure
MAP `� PARCEL: ZONING DISTRICT: Historic District
Machine Shop Village
yes
yes'
yes Z)
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building_ _
❑ One family .
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
D Septic 0 Well,
Floodplain fl Wetlands
0 Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
- Please Type or Print Clearly
OWNER: Name:
Address:
S�N��fContrae<Vho/74a-
Address:
IN
V
Supervisor's Construction License's S_0�2 �/J (DU Exp. Date:
Home Improvement License: // 77 7 Exp. Date: o�"
ARCH ITECT/ENGINEE
Address:
Phone:
Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 9D FEE: $ ( 0q �^
Check No.: -5 13 Receipt No.: 3 / t -5-7
NOTE: Persons contracting with unregistered contractors do not have access to Me, guaranty fund
k
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
TE: 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
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
:rF 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
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
Doc: Building Permit Revised 2014
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. ❑
Pennanent Dempster on Site ❑
THE FOLLOWING SECTIONS'F_OR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
k
IN
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
'Planning Board Decision:
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
uocatea ju4 usgooa Street
FIR�DE TIMI empDurnpsfer ontSi Yew o� .s► ,
Located at 12„4 lam `�`
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Frame Depment
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S1, aturgeat�,��,. _~,�
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
NU I Lb ana UA 1 A — ( t or devartment use
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Buildinb Pennit Revised 2014
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No. qq/— 0-0/7 Date /r" c3C3i
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
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Dam h ousse i 1d
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R LLP
A trusted name since 19386 years running. 1,(�
Roofing - Siding - Windows t (J
87 Belmont Street - North Andover, MA 01845
978-683-4588 - F: 978-685-7446
NAME OF OWNER
ADRESS OF JOB
TEL `�,/- (�`' U��� DATE:
We will remove all roof shingles off total roof area, layer. Replace any boards or sheathing at
additional cost. A new 8" white aluminum drip edge appli on all edges. Approx. 6ft of ice and water membrane
applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing and sidewall junctions. Existing
step flashings to remain. A new base sheet applied. Architectural roof shingle installed with a limited lifetime
warranty. Install new ventpipe boot flashings. Waterproof existing chimney flashin and remove debris.
Shingle Color:
Ridge Vent Upgrade
Wood Sheathing Repair 3.50 per ft. ,� 2
We Propose herby to fumish material and labor- complete in accordance with above specifications r e um of:
r
d&rs `$
PaYPqt to be made as follows '
Authorized
Signature
4
NOTE: This proposal may be withdrawn by us if not ccepted with in _ days
l�
Acceptance Of�ropOsgd - The above prices,
specifications and conditions are satisfactory and are herby
accepted. You are authorized to do the work as specified. Payment
will be made as outlined above.
LIAI)
SignatureDate ofAcce tance: h� Signature
P
R
HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS (M.G.L.142A)
1. WORK: Provided the Homeowner performs under this agreement, the Contractor shall perform the work on the Property as specified Proposal, attached
incorporated herein. The work does not include extraordinary conditions of which the Contractor could not reasonably be aware. If such conditions are
encountered, this shall be an additional cost to the Homeowner. Materials selected by Homeowner may have to be ordered or custom made, which items are
specified in the Proposal. The Contractor is not obligated to agree to any modifications, extras or change orders unless such items are agreed to in writing by
the Contractor. All extras and changes shall be at an additional cost to the Homeowner. Contractor shall perform the work in a good and workmanlike manner
using materials consistent with this contract. Lawn or Driveway may be damaged by dumpster or equipment. Due to material shortages Contractor may
substitute materials of equivalent grade.
2. PERMITS: If a building permit is required for the work, the Contractor shall obtain same as Homeowners agent. Contractor is not responsible for any
other permits that may be required for the Work, and Homeowner is responsible to determine whether any zoning, planning or wetland related permits or
approvals are necessary. Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund.
3. COMMENCEMENT AND COMPLETION: Homeowner acknowledges the commencement date of the work is fluid, and is subject to numerous factors
such as scheduling other contractors, delivery of materials and weather. Contractor and Homeowner shall determine the commencement date of the Work
when a more definite determination can be made and shall execute a written acknowledgment of same. The Work shall be substantially completed within 7
days of commencement, except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal, and subject to
delays for circumstances beyond Contractor's control. Notwithstanding, the commencement date and substantial completion date may be extended, and the
Contractor will not be liable for delays caused by, labor or material shortages, delays in delivery of items selected by the Homeowner, governmental action,
and unforeseen events beyond the Contractor's control, including but not limited to weather, strikes, war, the acts of third persons or the acts of the
Homeowner. The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs.
4. PAYMENTS: Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the
Proposal. Thirty percent (30%) of the total is to be paid as a deposit with the signing of this contract. Upon cancellation prior to commencement of the
Work, any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel. Final payment shall be due
upon completion of the Work and Homeowner agrees it may not hold any retainage. Late fees may be applied for late payments. Homeowner shall pay
Contractor's reasonable costs of collection, including attorney's fees and costs. Time is of the essence hereof.
5. WARRANTY: For a period of 2 years after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship,
but not those caused by ice backing -up or extraordinary weather events, including blizzards, tornadoes, hurricanes or storms of greater than a twenty-five
year duration or intensity. Contractor gives no warranties with reference to any materials or equipment installed in the Premises, passes any such warranties
directly to Homeowner, and Homeowner agrees to look only to the manufacturer with reference thereto. This limited warranty extends to the Homeowner
only and is not transferable to succeeding Homeowners. This Limited Warranty specifically excludes (i) all consequential and incidental damages; (ii)
damage due to ordinary wear and tear, abusive use, misuse, or lack of proper maintenance; (iii) defects which are the result of characteristics common to
materials used; (iv) defects in items installed or supplied by anyone other than Contractor, (v) work done by anyone other than by Contractor; and (vi) loss
or injury due to the elements. There are no other expressed or implied warranties or representations made or given.
6. ENTIRE AGREEMENT: This contract and all documents referenced herein constitute the complete and final agreement between the parties. In the event
that any of the provisions of this contract shall be held to be invalid, the remainder of the provisions of this contract shall remain in full force and effect. Two
identical copies of this contract have been completed and signed. Homeowner acknowledges receipt of a completed contract signed by the Contractor.
7. HOME IMPROVEMENT REGISTRATION: In accordance with M.G.L.c. 142 A, § 9, Contractor is registered with the Bureau of Building Regulations
and Standards Registration No: 174377. Homeowner may verify by contacting the Director at (617) 727-3200, ext. 25205. A Homeowner's rights under
the Home Improvement Law (M.G.L.c. 142A) and other consumer protection laws may not be waived in any way. Homeowner acknowledges receipt of a
copy of 780 CMR R6 and Massachusetts General Laws chapter 142A, and which are available online at www.mass.gov. Questions may be directed to the
Consumer Information Hotline, (617)727-7780.
8. ARBITRATION: Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contract,
the Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs
and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A. No lien or security interest is
imposed on the Property as a consequence of this contract, but Contractor has the right to record this contract or a notice of this contract, or seek a lien if the
Homeowner breaches this Contract.
9. HOMEOWNER COVENANTS: The Homeowner agrees, represents and warrants that (a) the Homeowner grants permission to the Contractor to enter the
Property to perform the work as covered by this contract; (b) the Homeowner has funds available to make full payment under this contract to the Contractor
upon completion; (c) the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition, and agrees not to enter
portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed; (d) Contractor may need use
landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and (e) that code requirements may result in
roofing nails penetrating through roof decking and will be visible on the underside of some surfaces. The Homeowner indemnifies, exonerates and holds
harmless the Contractor from any loss, damage, claim, liability or expense (including reasonable attorney's fees, deposition costs and court costs) resulting
from a breach of this provision. Contractor is not responsible for damage to landscaping that will grow back during the next growing season.
10. CANCELLATION: Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not
later than midnight of the third business day following the signing of this agreement. J
HOMEOWNER: DATE:
Shingle: f> DEPOSIT: ��
The Colmnonivealth of Massachusetts
Department of Industrial Accidents
Office o Iia�resti atioras
Mi f ff f g
600 Ifrashington Street
Boston, IIIA 02111
1ViVzi anass govIdia
Workers' Compensation Insurance AffidaAt: Builders/Contractors/Electricians/Plumbers
Please Print I,eeibl,
Name
Address:
6
Phone #:
.Are y u an employer? Check the appropriate bot:
I. I am a employer NNrith , -_
1 ❑ I am a general contactor and I
employees (full and/or part-time).'
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
'T hese sub -contractors have
worldng for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.=
5. We are a corporation and its
required.]
;. ❑ I am a homeox-Nmer doing all work
officers have exercised their
myself. [No workers comp.
right of exemption per MGL
insurance required.] i
c. 152, § 1(4), and we have no
employees. [No workers
coma. insurance rectuired.l
Type of project (required):
G. ❑ New construction
7. ❑ Remodeling
8. Demolition
9. 0 Building addition
10.❑ Electrical repairs or additions
11.0 Ph mg repairs or additions
12. i oof repairs
111 Other
}any applicant that checks box rl must also fill out the section below showing their workers' compensation policy information.
ing all work and then hire outside contractors must submit a new affidavit indicating such.
T Houreorvners repo submit this affidavit indicating they are do
`Contractors that check this box must attached an additional street showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractor have employees, they must provide their workers' camp. policy number.
I am an employer that is providing ivorlcers' compensation insuranee for any employees. Belot$, is the policy and job site
information. .4 ..A; Ji, / — e'7
Insurance Company
FA
Policy T or Self -ins. Lic. r;'' Expiration Date:
Job Site Address's City/State/Zip:
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 cerft in r iliepairrs anidpenalties of perjrtry that t/te iitforn:ation prot,uled aboit�e istrue andel ccorrect.
Cimi�tiira �.LiL�t
Date:
Official use on1j,. Do not it rite in this area, to be completed b}, city or town official
Citv or Town:
Permit/License m
Issuing Authority (circle one):
1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
G. Other
Contact Person: Phone #:
ACVRD CERTIFICATE OF LIABILITY INSURANCE
szzi1
OATE(MhUD0KY1rY►
1011312016
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 endorsements .
PRODUCER
CONTACT
NAMS; Diane LeBlanc
DOHERTY INSURANCE AGENCY INC
P.O BOX 1985
_
PHONE978 475-0260E4M
gti; dieblanc@dchertylnsuranoe.c:om
INSURE AFFORDING COVERAGE
NAICD
UNSURERA: TRAVELERS INDEMNITY CO OF AMERICA
ANDOVER MA 01810
25666
INSURED
INSURER B •
MED EXP ( oM ) S
TWOMEY & LEGARE CONTRACTING INC
INSwwRC:
INSURER 0
87 BELMONT STREET
MURER E:
ZMER F:
NORTH ANDOVER MA 01845
COVERAGES CFJ2TIFICATF NtIMRFR. aniAA D=wRinu k it luneD.
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.
PLTROOR
TYPEOFWSURARGEADUL
WMR
ICYNUMBVI
POLICY FF
POUCYEXP
LIMITe
COMMERCIAL GENERALLIABILrTY
CLAW -MACE 1:1 CCCUR
EACH OCCURRENCE f
INUMMIORENIED
PREMISES(Ea Onra S
MED EXP ( oM ) S
PERSONAL & ADV INJURY i
NIA
GEWL AGGREGATE LMT APPLIES PER:
POUCV Q JPEMCI LOC
GENERAL AGGREGATE f
PRODUCTS . COMPIOP AGG f
— - - - —
OTHER:
f
AIRONOBILELIABILITY
e� I NG LIMIT f
ANY AUTO
BODILY INJURY (Pet peno IALL
OS NED Au�HEMED HON.OWNEO
HIRED AUTOS AUTOS
WA
BODILY INJURY (Pmt aWdent) i
UMBRELLALIAB_H
OCCUR
EACHOCtURRENCE t
EXCESSlJAB
CAAU IS MADE
WA
AGCRECATE _ - --
---
0 RETENTION
A
M fORKERSCOMPENSATION
AND E MPLOYERW LIABILrrY Y 1 N
OffANYer GEREXCLUDEO?ECUITIVE IIIA
ayes �ta Hider
DESCRIPTION OF OPERATIONS doiew
WA
WA
6HUS0290M9%16
09118/2016
09/1812017
X S ATIUTE ERS
---
E.L. EACH ACCIDENT s 500.000
E L DISEASE . EAEMPLOYEE S 6_00.000
E L. DISEASE - POUCY LIMIT 6 500.000
WA
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORO 144. AddttIaW Remarks Sdwdule. may bo ariehed U cew spam h fewA d►
Workers Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B. no authorization Is given to pay
daims for benefits to employees in states other than Massachusetts it the Insured hires, or has Hired those employees outside of Massachusetts.
This certificate of insurance shows the Policy in force on the date that this certificate was issued (unless the expiration date an the above policy precedes the
issue date of this certificate of lnsurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification
Search toot at www.mass govRwdlworkers-compensationrmvesdgaUonsJ.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
Town of North Andover ACCORDANCE IMRH THE POLICY PROVISIONS.
1600 Osgood Street AUT ROMMO REPRESENTATIVE
L� [4�
North Andover INA 01845 Daniel M. Oro ay. CPCU. Vice President — Residual Market — WCRIBMA
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are reglstered marks of ACORD
[11ionNf- 1A415
DAMPHOUSSE
ACORDry CERTIFICATE OF LIABILITY INSURANCE
11%0912016"�'
PRODUCER
Doherty Insurance Agency, Inc.
P.O. BOX 1985
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
21 Elm Street
ROO1
Andover, MA 01810
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A Wester World
Damphousse Roofing LLP
87 Belmont St
North Andover, MA 01845
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
04/12/16
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
ROO1
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFEC7IYE
POLO EXPIRATION
LIMITS
A
GENERAL LIABILITY
NPPS296488
04/12/16
04/12117
EACH OCCURRENCE S1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED S100,000
CLAIMS MADE Q OCCUR
MED EXP (Any one person) $5,000
PERSONAL 6 ADV INJURY $11000,000
GENERAL AGGREGATE s2.000.000
GENT. AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOPAGG S2000000
X POLICY F1 PRO- LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT S
ANY AUTO
(Ea accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person) $
BODILY INJURY $
HIRED AUTOS
NON -OWNED AUTOS
(Per accideno
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC S
ANY AUTO
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE S
AGGREGATE S
OCCUR CLAIMS MADE
S
$
DEDUCTIBLE
S
RETENTION S
WORKERS COMPENSATION AND
WC STATU- 1 OTH-
FEL
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
E.L. EACH ACCIDENT S
E.L. DISEASE • EA EMPLOYEE S
OFFICER/MEMBER EXCLUDED?
Des descrioe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT S
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
Covering operations usual to Damphousse Roofing LLP...
Town of North Andover
1600 Osgood Street
North Andover, MA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL in DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF AWLWND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED
ACORD 25 (2001108)1 Of 2 #834292YM34248 / / DML ` 0 APAD CORPORATION 1988
1
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS -067560
Construction Supervisor
SHAUN M TWOMEY
61 PATROIT ST
NORTH ANDOVER MA 41845
r'-- Jzu� CA-- Expiration:
Commissioner a 10/25/2017
�� . _ �� � � a�'✓�iaaaac�ucaeL"la
Office of Consumer Affairs & S-.rsmess Regulation
HOME IMPROVEMENT CONTRACTOR
r'Ia Registration: :.174377 Type:
'N =
Expiration: -2/4/2017 LLP
-
D IPHOUSSE ROOFINGLLP::-.s
SHAUN TWOMEY:
87 BELMONT ST - -
N. ANDOVER, MA 01845. Undersecretary
0