Loading...
HomeMy WebLinkAboutBuilding Permit #745-2017 - 40 PHEASANT BROOK ROAD 5/1/2018 ti BUILDING PERMIT NORTH 0��.(lED Ibq~� 4� TOWN OF NORTH ANDOVER o2 hey.• tb °R APPLICATION FOR PLAN EXAMINATION 9-0/ Date Received !�-solaoi7Permit No#: ' � �SSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page L.O,CA`rTl,ON PR®PER9�Y�O1iUN,E.R T C .�( .(/� NJAP =FAR'.CEL. Nll JI TR ON-, ��st r , Z® G® SD 'IAC esa n;© Mac}ainQ1 P821@499LMesa n:o, 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 ® Septic �r :Wel �iF1'oodplam} 02Weflands L7i' WatershedDisnct DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: y�f rho- oGG,� Address: o PA rQ'5-'.YYt' (3 f eo k /I- Andi ker— a � - Contractor�YName ( r _. S'up�eryis'ors�Consructionl License' /OExpo,. Date_ t e- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125. ER S.F. Total Project Cost: $ /5bo-o 0 FEE: $ � ® Check No.: -7 Y 51P Receipt No.: .31 y YY NOTE: Persons contracting with unregistered contractors do not have acces to the guaranty fund SignatureSigriature�ofcortractor, 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o 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 a Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o' 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses 4 o Workers Comp Affidavit o! Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Doe: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. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS •ZoningQBoard 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 .0;1ARTMENT ' T�emY ®um onsiteers cf,�. z , -� a AsterY �. , lx0 acac ted at 124 MaiNStreetF +*. IFire Depaimens Ce 1,0_ ? .J .+}. _. ?: x, 'X JTZ # R• COMMENTS,_ .. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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) a I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Peimit Revised 2014 Location o OQ ksL-./ 6,Z)1.- �j No. 7 Date yh / • - TOWN OF NORTH ANDOVER 41,. . Certificate of Occupancy $ Building/Frame Permit Fee $ 3 a-...- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# u AY� 34 84 �` Building,Inspector NORTFj Town of 0 No. - F �1 4ph � ver, Mass, 1/4 012017 COC" IC MEWICK U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT PC 4 e.... .. .. o 3,o Nr BUILDING INSPECTOR ................... . ...... ................................................. .. Foundation has permission to erect .......................... buildings on .....Y.0....... Rough to be occupied as ..... ..�Il c��t.e.�!:!�. ...... *rf..c..... .� ...5.............................. Chimney provided that the person accepting this permit slTall 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOWUS ARough OAF GService .............. .............. .. ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Y Federal to#05-0405629 RISE Engineering RI Contractor Registration No 8106 r,AA Contractor Registration No 120979 t?/ CT Contractor Registration No 620120 RISE60 Shawmut Road,Canton MA 02021 ENGINEERING CONTRACT _ 339=102=5197 FAX 334-502-6345 Page 1 PROGRAM. ` EREFRKI CVA-HES EnoEE AND THE CUSTOMER FOR OR WOAS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT wORKORDER Patrick Osullivan (978)590-0662 01!12/2017 444948 28602 SERVICE STREET BILLING STREET 40'Pheasant Brook'Road 40 Pheasant Brook Road SERVICE C"Y,STATE.ZIP BILLING ci7Y,sTATE,LP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION PHASE ONE Proposal,for this calendar year. $0.00 AIR SEALING:Provide labor and materials to seal areas efyour home against wasteful,excess air leakage. This'.vork will be performed in concert with the use ofspecial tools and diagnostic tests to assure that yourhomc will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can:include caulks,foams and other products. Primary a=for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed) 'Mis will require(12)working hours.A reduction in cubic feet per minute(cfm)ofair infiltration will occur.,but the actual number ofcfm isnot_uoruneed. At the completion orthe weatherization work.and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $1,020.00 AIR SEALING ADDER (2)working hours. $170.00 A171C ACCESS:Provide labor and materials to install(t) easily moved,.insulating cover for the attic access folding stair. A small net surface of plyivood will he created around the opening within the attic. This will allow the cover's integral weather- stripping to restrict air leakage. $237.65 oIS0V JAN 2 0 2017 Federal 10#05-0405629 RISE Engineering Rl Contractor Registration No 8986 CT Contractor Registration o 20120 CT Contractor Registration No 620120 RIISE" t 60 Shnwmut Road,Canton,MA 02021 A� p� � ENGINEERING C'ONTRAC 1 339-502-x197 FAX'339-502-6345 Page 2 PROGRAM .t THIS CONTRACT q ENTERED INTO BETWEEN RISE CMA—TIES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT* WORK ORDER PatrickOsulGvan (978)590-0662 01/12/2017 4144948 28602 SERVICE.STREET BILLING STREET 40 Pheasant Brook Road 40 Pheasant Brook Road SERVICE CITY.STATE XIP BILLING CITY.STATE.ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed 52,000 per calendar year,and an incentive or 1001/a for the Air Scaiing measures up to the first 5680 and an additional$340 ifsavines nm justified by the auditor: For the safety and health of lour honte'S indoor air quality:%vc will he conducting a blower door diagnostic ofiltc available airflow in}aur home both before the work is begun,and utter the LCcathcri7zion work is complete.We will also conduct a full assessment of the combustion Safety ofyour heating system and water heater.This has a value of$90 and is at no cost to you. 'total allowable ttcatherizntion incentive is S3;110. The Permit will be secured by the insulation contractor,at no additional cost.It is the humcowncr's Tcspoasibility Lia close Out this permit by contacting their municipality at the completion of this work. $90r00 G%60 = 0 VL JAN 2 0 2017 Total: $1,517.65 Program Incentive: $1,383.86 Customer Total: $133.79 LVE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF k"One l-lundred Thirty-Three&791100 Dollars $133.79 UPON FINAL.SPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT AUE IN FULL INTEREST OF I'6 VALL BE CHARGED MONTHLYOtI ANY UNPAID UAL#NU AFTER SO DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF.RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. AUTHORIZED SIGUATURi• ISE EnBln cAng CUSTOMER AC N ANCE 1 NOTE:THIS CONTRACT MAY DE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATEOF ACCEPTANCE "N--f ACCEPTANCE OF CONTRACT THE ABOVE PRICES,GPECtFICATIONS AHDCONDMONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO OO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AD OUTLINED ABOVE MSE60 Shawmut Road,Unit 2 I Canton,MA 02021 1339-502-6335 ENGINEERING www•RISEengineering.com OWNER AUTHORIZATION FORM I, Patrick OSullivan (Owner's Name) owner of the property located at: 40 Pheasant Brook Rd, North Andover, MA (Property Address) (Property Address) hereby authorize �t7 f V l r ct d_ __J- t�S v/4�-f a 14 (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Ther Permit will be secured by the insulation contractor,at no additional cost. It is the homeowner's responsibility to closeout this permit by contacting their municipality at the completion of this work. l Owner's Sigriat re Date 6.2016 Office of Consumer Affairs and Business Regulation ,- 10 Park Plaza.-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registrafion: 102726 Type: DBA Expira_tion: 7/2/2018 Tr; 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. SOX 958 ANDOVER, MA 09810 - Update Address and return card.Mark reason for change. SCA 1 v 20fi4-05t11 Address [:]Renewal n Employment ❑ Lost Card Jac�icvrr»rninwrri�fl a��'%flaz;rr�rrlc!(� Office or Consumer Af1hirs&Business Regulation License or registration valid for individual we only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r Registrefion: 10Z726 Type: Office of Consnmer Affairs and Business Relation a £ Expiration: ?12!2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION C0-.- Vincent O.Vincent LeBlanc 51 SO.CANAL ST:;r5A LAWRENCE,NLA 01841 Undersecretary WNNtva fid without signature yr LJac'^t 7'suliding RegL3 avanss and:---ndards . ..+�....•.i:.':�'-�t'.1+42+1iSE �?ji(:l.i _C� 3 CSSL406017 k. PETER A LEBLANC 2 EASTPM STREET Plaistow NH 0388 - sJ�� 04128/2018 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street = Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N Name(Business/Organization/Individual): PO BOX 958 ANDOVER,MA 01810 Address: City/State/Zip: Phone#: I? CT b- S"I??-- Are you an employer?Check the appropriate box: Type of project(required): 1.(l I am a employer with_(!5p 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I ani a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' y p ty• 9. ❑Building addition [No workers' comp.insurance comp.insurance J required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: q�{" V A k(. :1�S v r 41N r Ca Yn N to Policy#or Self-ins.Lic.#: (?Owe FrY 0 3G ► Expiration Date: a i • e 1.? Job Site Address: `'( o h S ✓I T Look k K 4 City/State/Zip: '- JtA d 0t1'� �3 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. I do hereby certify under the ains and penalties of perjury that the information provided above is true and correct. Signature: �^%� Date: 3 / Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# 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 1/3/2017 Insurance Services J ? ® OATE(MMIDDNYYY) ,�►coRo CERTIFICATE OF LIABILITY INSURANCE 01/03/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: AX Automatic Data Processing Insurance Agency,Inc. aMONNi Ext): AIC,No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIL 9 INSURERA: NorGUARD Insurance Company 31470 INSURED INSURER 8: POLAR BEAR INSULATION CO INC INSURERC: PO BOX 958 Andover,MA 01810 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 598370 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE tNSD WVD POLICYNUMBER MWDD MIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F—]OCCUR PREMISES Ea occurrence $ MED EXP(Anyone person) $ PERSONAL 8 ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PECOT- �LOC PRODUCTS-COMWOP AGG $ OTHER: $ AUTOMOBILE W4BILITY $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS A�llTO�•SWNED PROPERTY DAMAGE pg accideri $ UMeRELUL ALAAB OCCUR EACHOCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE ER A OFRCEIW ANY ORMIEMBEREXCCLUDED?ECUiIVE YIN NIA N POWC840361 01/01/2017 01/01/2018 E.L.EACHACGDENT $ 1,060,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYUMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is raquhed) Contractor License:CSL 106017 HIC 102726 CERTIFICATE HOLDER CANCELLATION 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. 120 Main st North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD https://adpia.adp.com/ISExtemallapp/index.html?clientid=2037315&requestFrom=run#/home 111 AC40RV CERTIFICATE OF LIABILITY INSURANCE FOATE(MNYDD/YYYY) 6/10/2016 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 WANED,subject to the terms and conditions of the policy,min policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsamen s. PRODUCER CONTLinda "danowicz Insurance Solutions Corporation PHONE(AT.NIL 140 (603)3$2-4600 FAX Noll:(603)382-2034 60 Westville Rd ADDREDREss:lindab@isc-insurance.cam INSURER AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURER A.Mostern World INSURED INSURER s nautilus Insurance Gro" Polar Bear Insulation Company Inc INSURER C: PO Box 958 INSURER D.- INSURER :INSURER E: Andover PSA 01810 INSURER F COVERAGES CERTIFICATE NUMBER4-IL1632326134 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH 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- ILTR AD LSUBR TYPE OF INSURANCE POLICY NUMBER POLICY EFYjn F POLICY� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 NPP9274967 3/24/2016 3/24/2017 MED EXP Arty one n $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 8 POLICY❑PROJECT LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: r $ AUTOMOBILE LIABILITY COMBINED SINGLE UMI $ acektent _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) S HIRED AUTOS H S NON-OWNED PROPERTY DAMAGE AUTOS Peracciden $ R UMBRELLA UABOCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DEO I RETENTIONS JAN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION pER OTry_ AND EMPLOYERS'UABILITY Y/N STATUTE ER ANY PROPRIETOR)PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? El N/A EL.EACH ACCIDENT $ (Mandatory In NM EL.DISEASE-EA EMPLOY $ IF yes,describe under DESCRIPTION OF OPERATIONS be EL.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Reith Maglia/SJA � �7—- ��- 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 oI+emi