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HomeMy WebLinkAboutBuilding Permit #388-16 - 407 MASSACHUSETTS AVENUE 9/25/2015 t NORT►r BUILDING PERMIT 0 1 %-ED " - TOWN OF NORTH ANDOVER -.0 APPLICATION FOR PLAN EXAMINATION i c7 b Permit No#: �� r/ro Date Received w �•9 �RA7eo IPP�.(5 SSgCHU`�� Date Issued: IMPORTANT:Lpplicant must complete all items on this page LOCATION � Print PROPERTY OWNER ��'/�,�" � � 4 t�= Print 100 Year Structure yes n MAP �d PARCEL: L�`� • ZONING DISTRICT: Historic District yes / Machine Shop Village yes r TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non- Residential _ ❑ New Building- _ ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Allpration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESC IPTIONF WORK TO BE PERFORMED: L� o Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Na -ro Phone: 7 �l 7 G Email: Address: 6� o Supervisor's Construction License w� Exp. Date e -14� / / Home Improvement License: / Ex p. Date: ARCHITECT/ENGINEER x Phone: Address: Reg. No. FEE SCHEDULE:BULDING PEWIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ "40 FEE: $ 11700 Check No.: 4 C� Receipt No.: :P NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund i Ii 4 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ t TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 'I 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 i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 4 d � COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: . Located 384 Osgood Street FIR 0DEPARATM T TemDurnpster.onsite ,. am _ �GLocated at R124 MStceet� .... Fire�D;epar"t�,,�ment�sigr�ature/dafe,,�, _ _ _ ' CQIVIMENT�S. 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) ❑ 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 Workers Comp Affidavit �. Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan �. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4 Building Permit Application 4 Certified Proposed Plot Plan 4 Photo of H.I.C. And C.S.L. Licenses 4 Workers Comp Affidavit 4 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Copy of Contract 4 2012 I ECC Energy code 4 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location No. Date • - TOWN OF NORTH ANDOVER Seri ED X64 4eT - Certificate of Occupancy $ Building/Frame Permit Fee $,, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# r? ; r 66ilding Inspector �_ .� O ,/ pORTH Town Of . � Ando' ver No. K ver, Mass, �A COCMIc"IWICK y1. U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System lvlTHIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect buildings on ... ..~ -C_. Foundation Rough tobe occupied as ................. . .A .�.......... .1�... ..... .......................................................................... Chimney provided that the person accepting this permit shall in a ery 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 CONSTRUCTIO T RTS Rough Service .............. ....... ..... .. ... .. ..,+,r........................ 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. �M - > Proposal - HIC#174377 zoo �o Dampouss 5 he BestOfSurveys,comRoofing LLP A trusted name since 1938 Roofing -Siding -Windows 87 Belmont Street - North Andover, MA 01845 P: 978-683-4588 - F: 978-685-7446 NAME OF OWNER / A 0�ADRESS OF JOB TEL. 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 applied 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 flashing and remove debris. Shin le Color: Ridge Vent Upgrade Wood Sheathing Repair$3.50 per ft �� ` �_'fZ_ We Propose herby to furnish material and labor-complete in accordance with above specifications,for the sum of: 10 ./ dollars($ Pay, e made as follows0.1 —;o Authorized Signature 400-1 NOTE:This proposal may be withdrawn by us if not accepted'ito in�days Acceptance of Proposal - 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. )i Signature i0ov Date of Acceptance: IL Signature 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 Homeowner's 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. I 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 Y is responsible to provide Ovide rote . p 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 Y gr ent rovided Homeowner later P e notifies the Con er than midnight of the third b i ss ay followingthe signing of this a tractor in writing at the address listed in the Proposal not 1� g agreement. HOMEOWNE)� 1 UU DATE: i i Shingle: + DEPOSIT: The Commonwealth of 1Mlassachusetts Department of IndustriqlAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1dia `workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 440 126ai3t, 6e, Z, Address: e X 2�� dm� L<> - City/State/Zip: I' IV% Phone#: ?7r �J— Al Y 7 Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I ❑ ` 6. New construction employees(full and/or part-time)." have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1LEI bing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12 Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: �. P Y Policy#or Self-ins.Lic:.: � j--��� ��, d1,r dExpirationy Date: Job Site Address:_ y a Z �_S City/State/Zip: �,j� Ag Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 cert der he pains and allies of perjury that the information provided above is true and correct Sienature Date: Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: 4/ 17 / 2015 11 : 05 : 02 AM 8790 02/02 DATE(MM(DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 0411712015 *is CCRTIFICATE 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 endorsement(s). PRODUCER 00474-001 CONTACT Doherty Insurance Agency Inc (A1C.NNo.Ext): (978)475-0260 1rxx-No.: PO Box 1985 EMAIL Andover,MA 01810 ADDRESS: INSURERS AFFORDING COVERAGE NAIC t INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED INSURERS: Damphousse Roofing LLP INSURER C: 87 Belmont Street INSURERD: North Andover, MA 01845 INSURER E INSURERF7 COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE SSP U POLICY NUMBER MMIDONYYY POLICY MILDI DNEYXYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Eaoccunence CLAWS-MADE r OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ OLICY CT OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident' ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAR F OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ OED RETENTION$ $ W IIKEERSCOoMMP NSgqTON V STATU- OTH- ANDpEMPLOYER VIABILITY X TO YLIMITS ER A OfFICER/�AEP18�R�EXCLUOEDi �TIVEY� NIA AWC400-7028774-2015A 4/1712015 4/17/2016 E.L.EACH ACCIDENT $ 500,000.00 (Mandatory ninNH) E.L.DISEASE-EA EMPLOYEE $ 500,000,00 UESCRIPIIOI'OV9PERAT 10NSbelow E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) No partners are covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE F ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 6913 • Client#:14415 DAMPHOUSSE ACORD- CERTIFICATE OF LIABILITY INSURANCE DA1`M�Q ' 04/17/2015 PROQUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO R113HTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE:DOES NOT AMEND,EXTEND OR 21 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover,MA 01810 INSURERS AFFORDING COVERAGE NA1C# INSURED INSURER A Western World Damphousse Roofing LLP 87 Belmont St INSURER 8'. C: North Andover,MA 01845 INSURER D: INSURER E: 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. INSR A001 LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICYM�GYNE POUCY EXPDATE IMMIIRATION LIMITS A GENERAL LIABILITY NPP8202847 04/12115 04/12/18 EACH OCCURRENCE S1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100000 CLAIMS MADE Q OCCUR MED EXP( one person) $5,000 PERSONAL 8 ADV INJURY $1.000.000 GENERAL AGGREGATE $2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGG s2,000,000 X POLICY PECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 8 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON�OWNED AUTOS (Per agent) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ RANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR F—I CW161SMADE AGGREGATE 8 S DEDUCTIBLE S RETENTION $ 8 WORKERS COMPENSATION AND WC STATU- DTH• EMPLOYERS'LIABILITY OFty ANY PROPRIETOR(PARTNERIEXECUTIVE E.L.EACH ACCIDENT S OFFICER.'MEMBER EXCLUDED? "Ars I yrs.doscribe under E.L.DISEASE.EA EMPLOYEE S SPECIAL PROVISIONS below E.L.DISEASE.POLtCY OTHER LIMIT S DESCRIPTION OF OPERATIONS/ LOCATtONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT lSPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL ICL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESEHTATIV AUTHORQEDRESENT E ACORD 25(2001108)1 of 2 #S31838IM31835 DML Q/AWAD CORPORATION 1988 1 Massachusetts =Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-067560 SHAUN M TWOM Y 61 PATROIT ST ; ? N ANDOVER MA 01845 t;i 921 Expiration Commissioner 10/25/2015 Office Of Cons mmcrAf�it&BVine�ss�Reg�h TU HOME IMPROVEMENT CONTRACTOR Registration: ;-174377 Type: Expiration: -2/4!2017 LLP SSE ROOF1[-tG-L,---LP--'. ' SHAUN TWOMEY�y 87 BELMONT ST N.ANDOVER,MA 01'85`;s Undersecretary