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HomeMy WebLinkAboutBuilding Permit #617-2016 - 40 COACHMANS LANE 11/18/20156'69,4v,.Veo 11 -193 -Is - BUILDING PERMIT TOWN OF NORTH ANDOVER ,fi APPLICATION FOR PLAN EXAMINATION I��'Ij ,jv` Date Received Permit No#: � Date Issued: I 0 1 PORTANT: Applicant must complete all items on this page � LOCATION 40Go.��+•�ci r _ Print PROPERTY OWNER,�. Vic. S ►�E'[tG"��t� Print 100 Years t�ucture MAP' PARCEL:��_ ZONING DLSTRICT: __ .. Historic District Machine Shop Vi /Q•�SLED ,64aNO\ o � m \D K. ,> A� 7a QDRA7ED PPP-'�� yes no no ve no TYPE OF IMPROVEMENT DESCRIPTION PROPOSED USE Residential Non- Residential ❑ New Building kOne family 11 Addition ❑ Two or more family [I Industrial ❑ Alteration No. of units: ❑ Commercial XRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition❑ Other El Septic ❑ Well _ ii Floodplain', ElWetlands n_ ❑Watershed District ❑ Water/Sewer F -1.1 - _ . _ DESCRIPTION OF WUKK I U tit rtKruruvitu: `. Qepk z . kZZVL � 3L0suu4iwK1, Lc�Nls � � ( >`F�oc�i+�cr Nex � xmy_a., Eatelae ��ek w1Tu jZ�4►uruc.s p�� S-�r���,5 (�t ck kx t�� Identification - Please Type or Print Clearly OWNER: Name: Address: ABovE ARCHITECT/ENGINEER �/� Phone: Address: 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: S 35, � FEE: $ 42(-).- r Check No.: 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to r - 5lgnature fund r Locatior M.'s. No. Date Check 2 0 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Owl Foundation Permit Fee $ Other Permit Fee TOTAL '-T6ildi�g Inspector Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS 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 / 6�1 PLAN7&DEVELOPMENT ReviewedOn lljjI/�SignatureOMy- C-Oo L L'r SoSKI�St tae t�s��ed F IAA Vis rT �1y—cjn$nucTt,@rn &rvcje uoskoN,- c��rnk t,,\ pl . U G��,�- - 2� >�P�• Stena ��. � 5-rvct����e -r� �e rm awed c� n ��.x�, ONSERVATION Reviewed on ' - - Si nature U �J' COMMENTS ,(,/J ZAAA)hA LM ko- IX&d -k V - Au. J -&Wu �/ALTH Reviewed on Signature COMMENTS �L �J�1 �-2 ✓� t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes f Planning Board Decision: Comments z Conservation Decision: Comments Water & Sewer Connection/Signature &,Date Driveway Permit DPW Town Engineer: Signature: ARE DEPAR�TM T Tem pi k:D � .. � r ti4 �s2 - oca a goo ree �_ psteons sife,. byes _ n FIor �_ Located�,atµ 124NMainSt --et Fire Depa itment�si"nature/date �_ _ 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 �L/-j �� 11 �J 5Q Cie LW ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application d Workers Comp Affidavit ur Photo Copy Of H.I.C. And/Or C.S.L. Licenses ur Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o 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) ❑ Engineering Affidavits for Engineered products NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 Q\ U) 10 CD 0 z O CLr M D cam. O 00 CD CL cr2 (D O ou % CD Q o CO CD U) 0 �G 0 O N CD CD CD El U) U) O z CD 0 J S V M J CJ Val z m cn O N 0 IO o -O O 2 Or °�<� > c CD, C O ^ CD n O rt = n Z O O �/! rt FD TI o, o CL m CDCD N W D 'a y CD 2 CD O Q� CD D O �• O n CQ• 3 Q rt 0 -.0 � n Wrt CD CD S C CD "0 Q O i < c° co N CD c 0 - O o O CD a Rr rt CD U) 0 3 � < Q. O co O < = Q N 5' o CD WCD CD� e• U) C CD C'1 0 rt .O+ O � � C CD CD CD rr CD �o D CD ;�. @ = 1 rt C.). O � rt p1 O O CL . /1 Ln 7 V) co C O (D jG T Z7 v C T VI (D N �p p C T x N C T y .Z7 T O C C N m -O rr T O O (p — S S S O_ n \ OZ.G O N K m m C ' C 3' S ro W m D 3 r D M > D N cl T 3 V1 m = y z r ® 1 � � O s 7 fogkl iI Ta " �{ ' g rGosuCeCTC AOA.A, 5 L al To .... 3'ILT Pt4�et� o i 3 F�srhx. Ptl.lrti ax a ��"�, 41 (�u v rSOMO ( 4' 3" om 3 ALL J. f r r S � L r i Cowie" STEP i fu c_' 5 r ��� �� C01UC2�TE ph�c�Q.S axe 3a5� ��a��s CG / SCP,Gais S S f L It v 'a. C � CD CDCLo0 r••F� Q �• N 0 0 vCD c� o CL cr CD o W _. v N. CDC � CO v O a Z e0 e�h O CDO m iR 0 0 Z m n Z c 4 m Ec X cn z a� Z < 0 % p aSi O O cnCD CA cn CD —Di CD CL CD O o CL 3 z o•_?= -a cn N' o N rt rt 0 O Q �. N W -0NcD CD CD O C. 0 co' cm � rt 00 CD <D C CD -0 � O c 6 CO 57. rt • O. CCD O = N o 0 a' rt 0 CD y Q NC7 3 7' < O =� Q_ cn N CD U) ' CCDL W� CD CD ; or �FLC :r N 0 do CD to r,. ,� : O O CD CD N CD C)�D n N O O > T . D � ,� LU 0 � o C . 2 n m m co 2 -D•I VI (n Q7 T ;u T V1 ;a -nX T n ;a T N T 3 O (D rt rt (OD rt O O j (D n m rn �• O aq 3" > N A � 7 N m < N O U S m m AZ H � m 0 3 N O m S C W G N m 0 �• cu S 3 O � = O j p 3 C p Z V m O (D �_ n rD 3 O Q - n o0 > p O T m D 2 O Massachusetts Home Improvement Sample Contract This ibrm satisfies all basio requiremcats ofthe state's Honta7mprowa*dContnctorLatv(MaLchaptor 142AI bat does not include shudard laugusge to prolect bemeawners. Seek legal advice Unteusary. Any person pianaing home impmvements should fwd obtain acopy of 'A Massecltusdta Consumer Guide to Home Improvement• befbm apiceing to any work on your rasideam You may obtain a freecopy by calling the Office of Consumer Affairs and h3usiness Regulation's Consumer Information Hofte at 617-973-8787 or 1.888.283.3757 or on our website. Homeowner Information Contractor Information arae C4MP8AyWM idAiWL + +e: " t ' is a t x heetAddFm(donotuuapoitOf&wBoxeddreas) Coatrada! OwaerName 46 oqk' CDyfrotat shte Zip Code Business Address (must Include. a sumer address) W. qtr A, Daytime Phone Ehentngphmo CStylilm- Stater 21P Code, kJoieLL � Mi tngAddrea(11dHArcrtfiwnabow) BusrImphona FecludEmpl�oyetIDor&S,Number Aomsa�pro+awt cermrwwyN� 6paeleidaa LWRta1Rr QIM aKrt aOaf • Iwgwnoratraaeallon hro .yaydrgUtnna oawatr 49 )� 1 ue uorunctor agmu to no taeionowmg worx for tae uomeownerk (Desaibe In deltlithe wort to compkteQ speritjlo8 the type, brand, and Woof materials to be used, use addWorialsheals if000esserv.) i't'sR'•ttZ,RG"Aeee3N` A�otn�,suB�wo{�alFtooRv�.�RYteX4GLZitAlwa, CCM4.%WL 109'eLL (Af?R �`�l�►�) WITH QAtt.l�t+5't tRs RequimdPernsite-Thofollowingbuildingpermitsarorequhtd Proposed Start andCompletionSchedule - 'the fbllowingschedulewill and will be securtd by the contractor as the homeowners agent be adhered to unity elrmmutenoes bcyoM the oontradoes contra arises (Owners who secure their own permits,ii be excluded from the Guaranty Fund provisions of ikX).Wwhm contractor will begin contracted work. MGL chapter 142A.) i � Date wlren contractedvwrkwill be substantially ewmpletrA Total Contract Price and Pavnunl The Contractor mares to perform the work, furnish the material and labor specified above for the total taus of 3').C -VV (�} Paymentswillbemade accordingtothe folloveletgschedule: LUMP SVW1 $ upon signing cou raet (rat to exceed 113 ofthe total contract price gr the cost of spedal order items, whichever is greater) $ by ! / or upon completion of $. by_j^J or upon completion of $ Upon completion ofthe centrad. (Lawforbids demandingfull paymentuntil contract hoompleted to both party's satiatktion) ThefollowingmaiciiaVegrdpmentmust bespecial S to bepaldfor ordered before the marsoted work beams In order to meet the completion whedule.(rs) S to be paid Ar NOM: (r) tmtudingell Boanee charges (e1) Law requires that any deposit ordownPayment required by the wntrsdor betbrowork begins may not axotedthegreaterof (a)OMAN ofthetoterconh apdoaor(b)rheactual cod ofwwspmwcildpaumlorcustommadematerial whkh mail be specie] ordered In advance to mad the completion sededula XxortmWarranty - Is an axaressyramotvbaingRMldcdbyAscoplraetor? LJ NoUYes(All ternuofthawatwrntvmust heattachedtothe eaetracn Subeoetradotb -The contractor Wu to be solely responsible for complatlonofthe work described regardless of(he actions of anythird pmty/suboonitactorudlizedbythecordraotx The contractor lbrdzr agrees to be solely responsible hor all payments to all subcontractors for materials and labor uader this martement ContractAccepUnte, - Upon signing, this document becomea a binding contract under law. UnlessotherAsenoted within this document, the centrad shall not imply that any lien or otherswurity interest has bocu placed on the residence. Review (de fbllowviag cautions sad noeou carafttllybefore signing this centreet: • Don't be, pressured into signing the oontrad. Talm tima to read and My understand it Ask questions if something Is unclear. • Mekesurathewatractorhasl4yalidHomel roya(pc(ntConbectorRcgislratioa The lawvrequfmvmosthomatmprovtmentcontractoaand m&mtiaelorstobargftwredvfithftDmetorofHomeTmprovrmekdConbmztotRegWmtian You mayinquire about coubactor re8'eshation by %wiling to thoDireotor at 10 ParkPlaaa, Room 3170. Boston, MA 02116 or by ca111ng617-973.8787 or 888-283-3757. • Does Are contractor have insurance? Ask the Contractor for his insurance oomparry infin oration so that you can eonfnm coveraM or sok to ace a copy of a "proofofinavraocd' docmnenL • Kaowyour rights and responetbllltiea Read the important InIbirnation on the reverse side ofthis ronn and get a copy ofthe Consumer Quids to tboHomeTmproveruent Contractor Lew. You may cancel ibis agreement if it has bene signed at a plain other than Aro contractors normal place of business, proWtkd you notify tho contrador in writing at his&w main of6oe or branch office by ordinary mail posted, by Wcgmm sent or by delivery, not later then midnight of the third business day following the aitminst ofthis agreement. Seethe a tWA notice of cancellation foan for en taolmstion of thin right. DO NOT SIGN THIS CONTRACT IF THERE ARE AW 1 AM4' ntrnttmmtbetmtpftadandeigned. oncowatwwplaft s Signature Con islamest Date T r Data 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 two automatically afforded to a contractor, however. The contractor would have to resolve any dispute helshe 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 bas a dispute concerning this contract, the contractor may submit (he dispute to a private arbitration firm which has been,approved by the Secretary of the Farecutr-office of Consumer AffWm and Business Regulo1 n ey� the consumer shall be required to subn}it to sych�.atbitroti as provided In Massachusetts General Laws, clr er ®j R"NCE: The signatures of the parties above apply only to the agreement of tire parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142&) and other consumer protection laws (i.e. MOL chapter 93A) may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights ifthe Fontractor they choose is not property registered as prescribed bylaw. Homeowners who secure their building permits are automatically excluded from all Guaranty Fund provisions of the Horne Improvement Contractor Law. The contractor Is responsible for completing the work as described, in a timely and workmanlike maimer. 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 on implied warranty of merchantability and fitness for apartieular purpose. An enumeration of other matters on which the homeowner and contractor lawfully 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 Consimier Information Hotline (listed below). Execution of Contract The contract must be executed in duWicalo and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties on also advised not to sign the document until all blank sections have been filled in ormarked 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 payatonts in advance of the dates specified on the payment schedule in cases where the homeowner deems him1herself to be financially insecure. However, in instances where a conttaetor deems himrlherself to be financially insecure, the contractor may rcquire thatthe balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal of funds 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 Guido to Home Improvement" contact Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park plaza, Rcom 5170, Boston, M& 02116 617-973-8787.888-283-3757 or visit the OCABRvrebske at http:11ww+v.mas9.govlocabr1 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, 888-293-3 757 or visit the HRC website at litto:Lw_w_ w_mp Lwv/ocebr/ Go online to view the status of a Home rmprovemetit Contractor's Registration: mod//db state ma uslhomeiniprovementllicenseelistasn For assistance with informal mediation of disputes or to register formai complaints against a business, cal: Consumer Complaint Section office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114 venkaz.r -I 1=010 ge �. a �{ i 'lam Cokeecrc wWc ,t 5 l o P! 16 Q. 14u 1 L 'lx% To ifN mug t 6 ►ti 4 SoHo "wgt r _3„ om T ALL C%E 1 S � G � J ` U sTEQox s � / �o►vc� a►x��.s s EP r LES axV atx5% VkAUC--es CG � © Seg X 04+ IL---4 &ALU cer - (S s� .40 O En CD O a •&< �av»: ©• » � « �� «>� ® [ < � . � J4 A ( \f_\)/§ (®§ -T§ [ -- - f _�-� k(\§§ z Aw<Z ,e�®= `ee ! 2!!;;§22 Cl) $ « w-<�/& §)i `®©§ a r ! . 44® C) :`°�` ® - 3l \)�� \§ww k f ok;}§/ \ k}{\k){/\§W, •&< �av»: ©• » � « �� «>� ® [ < � . � J4 A D O coam . 0 m 0 m Amy ��CD 2L 2L 2L 2L j CD 0 'CD, =;'C CD 0 xa o� a'a (D 1 N �CICD D vD o < -i'' 0 '0 m a 7 fD wo<< _ O N 3m = 0 0-1 r W = Z m v D CD m O V o <D 3 o r fp 3 D f .. � c o 3 0 G�vx Z z o p n z <xor y w n O NA D rn D0000 mxmm2TW� m X --i --i-i c O,O N yo CD - - X m CO 0 'X r: 0X N_�C W OCL._ ' a) 2 o 7 NO CO w Q D' vim, m r Dom. r O o'R n O Q ai mm,wa'o n. fn �O pJv � sEp 3 3 T1 — O C co S .n Ti w X (0) m Ln eCAEOA313 OD 13 w - i�OwNAw m N e e e Da w z �T()m -ic n O!m N (D y1, m D) .-0 0 O (D., O O Q -p N m - iii . a 0 o - EL D o•oELa.�.� -n,5 m- Z OQO ,;N W03 Do T o;oxOo ��=6 >i>@ D O n �� eco �' CDvED EA - 6� D< C'com .4- -4 Ch. 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TO BE PILED WITH THE PERMITTING A.UTECORITX'. ,Applicant Information /i Please Print LeaiblY Name (Business/Organization/individual):?CWfIALr.E .A_ddxess: f 0 l ANA) � citV/state/Zin: 1,-1WF_1 _(I v! Phone #: Ctl Axeyou an employer? Checkthe appropriate box: 1. [Al amaemployer with employees (full and/ozparitime).x 2.[] lama sole proprietor or partnership and have no employees working for me in any capacity. Wo workers' comp. insurance required.] 3.. [] T am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.[] lam a homeowner and will be hiring contractors to conduct all work on my property. 1 -will ensure that all contractors either have workers' compensation insurance or are sole propiietors withno employees. 5. ❑ 1: am a general contractor and Z have hired the sub -contractors listed on the attached sheet. These sub -contractors hada employees and have workers' comp. insuranco.T 6.[] We are a corporation and its officers have exercised their right of exemption. per MGL c. 152, § 1(4), and we have nQ emplayees. [No workers' comp, insurance required.] Type of project )Vequired): 7. ❑ New construction &. Q Remodelfiig 9. ❑ Demolition 10 n Building addition 11.❑ Electrical repairs or additions ftF1 Plumbing repairs or additions 13. [! Roof repairs 14. [] Other *Any applicant that checks box#1 must also Mout me SBCIIOn oelow snowing uioii WUMVIO ur �u ,�npolicy information. Homeowners who submit; •this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. ?Contractors that check this box must -attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. if the sub-contrac6s have employees, they must provide their workers' comp. policy number. I am an employer tr at ispioviding workers' compensation insurance for my employees ' .below is the policy arzd fob site information. Insurance Company Policy # or S elf -ins, Lic. #: Expiration Date:, Job Site Address:�`�`(J + 0� � City/State/Zip: A) Attach a copy of the woAlrers' connpensation'policy declaration page (showing the policy number and expiration elate). Failure to secure coverage as required under MGL o. 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 WORD ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be, forwarded to the Office of Investigations of the DIA for insurance covexage, verification. I do hereby certify Uy Phone# SU ` S-O�—T —U9�� ofperjury that the inforrmation provided ahov is true and correct. Official use only. ))o not write in this area, to be completed by city or tolvrt official. City or Town: Permit/License 0. Issuing Authority (circle one): 1. Board of health 2. lBuildinglDepartment 3. City/Town Clerk 4. )Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone �.•� PERFBUI-01 CLEDDUKE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/16/2015 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). Rogers & Gray Insurance Agency, Inc. 434 Rte 134 South Dennis, MA 02660 CONTAPRODUCER NAME: Kelly Estano, AAI, CISR PHONE FAic, No): ($77) 816-2156 A/c Ext A IL E-MAIL DRESS: mail@rogersgray.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Peerless Insurance Company INSURED Performance Building Company, Inc. 50 Tanner Street Lowell, MA 01852-4419 INSURER B:Arbella Protection INSURER C: Navigators Insurance Company INSURER D: National Liability & Fire Insurance Company INSURER E: INSURER F: rrnvCoAr±oc ,"CGTIGIr`ATG fd IMRGR• REVISION NUMtStK: . 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 LTR OF INSURANCE ADDLITYPE INSD IVSD S D WVD POLICY NUMBER MMIDDY� EXP MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR X XCU Included AUTHORIZED REPRESENTATIVE 7 CBP8051843 07103/2015 07/03/2016 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 X Contractual Liab PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO F LOC JECT OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS 1020004067 07/03/2015 07/03/2016 Ea accidentSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ C— X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NY15EXC7310221V 07/0312015 07/03/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10,000 $ D WORKERS COMPENSATION - AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA V9WC651428 07/0612015 07/06/2016 X PER OTH- STATUTE ER 1 E.L. EACH ACCIDENT $ ,OOO,OOO E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 A Leased Rented Equip CBP8051843 07/03/2015 07/03/2016 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) non r,nATS Un, noo CANCFI I ATION U 1988-2014 AGUKU GUKVL)KA I IUN. AU rignis reserves. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of No. Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE 7 U 1988-2014 AGUKU GUKVL)KA I IUN. AU rignis reserves. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ��c �n»rairnrrmrallir of p/l�rrJJac/rr�ellJ \ Office of Consumer Affairs & Business Regulation License or registration valid for individul use only ROME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 161993 Type: Office of Consumer Affairs and Business Regulation Expiration;.:<,!12l22120.16 Private Corporation 10 Park Plaza - Suite 5170 = Boston, MA 02116 PERFORMANCE BUILDING C NC. JAMES MCCLUCHY,;` ...:;?:;`. .. 50 TANNER ST LOWELL, MA 01852 Undersecretary Not valid ►vi out si ature • � •/ s C / J • • Y