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HomeMy WebLinkAboutBuilding Permit #035-13 - 41 FERNCROFT CIRCLE 7/18/2012 NORTFI BUILDING PERMIT o�1% -D bgti TOWN OF NORTH ANDOVER 32 h APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received I �y QDA�TED Date Issued: I� SSACHUs�t IMPORTANT:Applicant must complete all items on this page LOCATION 41 FLYW 3 -T" CA W,. WA-DAlunu PROPERTYOWNER fid(-C-A4AEL --bPrint• Print MAP NO: PARCEL0105 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Oneamity ddition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TOQBE PREFORMED: , Identification Please Type or Print Clearly) OWNER: Name:M)C-HAE kklbZ) Phone: 99'$- 9.x-5' 1286 Address: 41 fjsWc-ac -`i' C uoe . CONTRACTOR Name:+W4 'nI�t �Z1,SL-'ft( hone: �'�$ 9A --iZ&S Address: Pb Ckl-4 6 LL- VU— (M64-S Supervisor's Construction License: Exp. Date: 3- 4 - 2Q 1 Home Improvement License: 1.0 I =+SO Exp. Date: (2,-2 - 2m 1 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: $ --SO •Co FEE: $ Check No.: --,! S1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gua fund Signature of Agent/Owner Signature of contractor _ I Location :P�� C � } Q.0 No. O' Date • - TOWN OF NORTH ANDOVER • ` vfLIDlj�4 • Certificate of OccupancyCrD $ _ • Building/Frame Permit Fee $525, rr a �e Foundation Permit Fee $ P Other Permit Fee $ TOTAL Check#2(A-I 25512 /j Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody Art Swimming Pools Well Tobacco Sales Food Packaging/Sales " Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY j INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT 1�7— COMMENTS 1PIL"2ieJ ") h " 6emer,2� 014e— 4�E Ldl�ey - CONSERVATION Reviewed on Signature COMMENTS V3' b" w HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments t Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 re ares 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 - Date Doc.Building Permit Revised 2008 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑/ Building Permit Application L( Certified Surveyed Plot Plan Y Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Z Copy Of Contract ❑' Floor/Crossectlon/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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 NORTH - c ve" . 0 No. 41 _ ' Y T O LAKE -7912. h ver, Mass, o COC MIC MI WICK V �d AoRATED S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System t7 R THIS CERTIFIES THAT Al �r ..... BUILDING INSPECTOR ................................................................................................... , C�_/V C.",0 �T Cyi '� Foundation has permission to erect .......................... buildings on ... .,....:....:... '..........­­ . ....................................... . / ` / Rough to be occupied as ���� /C. `... .. / Q%�`E.. ,� acmax:./. ..... Chimney provided that the person accepting this permit shall 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 CONSTRUCTIONS ARTS Rough Service ..................../ ..✓....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz 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. SEE REVERSE SIDE � �zbea 1befMPvft=Missd Cboj:dnr-L � � �om ffame��IIar. oh7�rzesideac ��Z_��q �ac�or S°"= t� t . ' oJR:ce&tnd&%=j suft MOcade - ,k vt`�2 MSA Cil -s �mue - ��g sbft ,`tel r „t rte. - a� �� 2°l l 264'°sem baa Jn112 bbe x-30 &-opo- ; the ude ii: emdaded - (4�nerswI�os t+etd .O1 npa=ft W ��eteddbtmkam m MGLcapberl4?Z&) OlwM i� 212 COo°•`�°�SCOnnctmise TheCoiaw mago��andP'+YmmEsebedsle _„ _ � Cownew 1°iO ltie , �l�. to perfoiat the walk Ia6or �Ymemswm be made aboveiosthe aoml sum a8 �'+dmgmmesouo►�gs�atatc �3,�-+�'p .�O t�� s 0 npaosigom �L FA g�uact(natm exeett3 i!3 oft6cfocel comtact � SaOpmpiainnby af °T°p° °.E��tafdneverisgrea ) s by `—crupooCP.f�YJC3Z compledon of S� —'�1==uP°D�letimtofthe �►fnrbidsdemm . vh7 cou t a is completed to hoth penys satidaaion) wmeawep� �naea - IDbowd lvaTM-try tacluding att rmetrae '�`� iiotexaaddievewer awt i�,ayd tAhi$i mmt be cep d mdeM"m»aveclow 1 offt CMUNIII� of, tart a =W Snbeo 'lssa -i Naini ,j ° s$teestabesolely k$r O A UskncsuT6re ma:t6e byt6e tompletioneftbesta&d e�ofthe tD�� CantraetAeezpbn�derthis Mpa$MfD&sofeYy rclosa0'pay tp Gfanythmd _ UP°Qs &8dsdoium�t ,,,,,�aunssmr �l1ybefttsi 6%.!y fs my rM aroffirrs�e '�taestbta�b�rmplcoedotl?he aSd�a"6Lnowdwiunn�dar�ea dReviaw ' ihcfollowmg�ucons and notices llaa`t he-pt��moo: As1cqocs:jDwif=mth-mg a; � �8ybeeoe�.TaYetime bye �•�'�me �esmoasb _ arIMPIrovemmcmdrutOwnd atOneAshb� ,' L?p� at�anYwm8ybq-iwaboa;coII CoubactoGmdemtt and Rmdme rspap��ed �' 517-72732 .ca 2SZQ5 ftao�r ome hQPmvcM= rI.aw �0 s0pansde ail�smtmmadtacopyofvoeCuns YamWISUMg at aseemIhtsbeea sgoedataPhgLriBAmeo��8 � day�m ar See bJ'�msa tar Msmcs4PMvMw3'oaiooaiCy the DO N(?'�Sj( COAP�RAiG'Pg mtinw f0=forgo o �t Ortho t om.-a•.w:��m..., ,- PAC$g►it '�aaG+Di'SSit�ap� , toti NOTICE OF CANCELLATI®N ;, You may cancel this transaction,without any penalty or obligation,within three business days from the 7 date above. If you cancel,any property traded In,any payments made by you under the agreement,and any nego- dable Instrument executed by you will be resumed within ten business days following receipt by the seller of your cancellation notice,and any security interest arising out of the transaction will be can- celled. f You cancel,you mast make avallable to the seller at your residence..In substandaffy as good condition as when received,any goods delivered to you under this agreement;or you may if you wish,comply cask the htstrncdons of the seller regarding the return shipment of die-goods at the seller's expense and If you do make the goods avakNe to the seller and the seller does not pick them up within twenty days of the date of your notice pf ancellation,you may retain or dispose of the goods without any further obUgation. If you fall to make the goods available to the seller,or if you agree to return die goods to the seller and fall to do so,them you rernala liable for performance of aff obligations under the contract To'cancei this transaction,man or deriver a signed and dated copy of this cancellation notice c;'any Otherwritten notice,or send a te�l�eggnm to: - ;•; ame a naactor ��X ror . c.anvx 'tS Ulm and rtil�i� oJ�/O not later than midnight of ate o a a t 1 hereby cancel this transaction. aneowner's Slttuwre ate II SII CONSTRUCTION INC. Scope of Work: 41 Ferncroft Cir,North Andover, Ma. July 1.7,2012 Overview: Construct a 16 foot by 16 foot screen porch per the attached plan and plot plan. Existing exterior vinyl siding,windows and doors and soffit materials that that will be inside the new screen porch are to remain as is. Homeowner is to remove existing stone wall and patio pavers to allow room to fabricate the new screen porch before work can begin. Existing radon removal system is not functioning but piping will be rerouted below the new screen porch floor framing to the garage where it will be routed to the garage attic. Termination through the garage roof will be by others at a later date. Screen porch will have removable screen and PVC panels, Trex or similar decking, Kleer '/z"T&G wainscoting on the inside of the porch knee wall,Kleer trim at all posts, a custom fabricated 4' by 6'8"+/- screen door and a cathedral ceiling of pre primed 1"by 6"T&G boards with exposed 4"by 6" collar ties.Exterior of screen porch knee walls will be vinyl siding to match the homes existing as closely as possible. Roofing will be new asphalt architectural shingles per homeowner color choice.New shingles will be woven into existing roof shingles at garage and breezeway roof. Electrical: Replace existing fuse box with a new 200amp 40 circuit box.Install 4 recessed lights, outlets to code and one homeowner supplied ceiling fan in new screen porch. Existing exterior lighting at screen porch will be removed. No painting of any kind is included in the contract or scope of work. Contact Total: $43,750.00 Homeowner: �'ee Date: Ot` /7, a0/a HRH Construction,Inc: Date: ril� HRH Construction,Inc. 80 Campbell Rd,North Andover,Ma 01845. 978-314-7263 www.hncconstruction.net dave@hncconstruction.net Miscellaneous: HRH Construction will provide an on site dumpster for the duration of the project. All waste, scraps, and cut offs will be placed in the dumpster for removal upon completion of the project.The site will be kept clean and orderly and swept daily. The contract total is based on the homeowners providing adequate parking space for HRH Construction Inc. employees and sub-contractors and sufficient off street space for the dumpster and HRH Construction Inc.work trailer within 50 feet of the job site and providing a dedicated 20 amp duplex outlet within 100 feet of the work trailer. HRH Construction accepts no responsibility for the structural integrity,level,or plumb of any existing structure,wall, floor or ceiling. Homeowner understands that while repairs to level or support existing structures may be required, for example,to provide adequate support or a plumb wall for kitchen cabinets,they are not included in the contract price. No changes to the Contract, Scope of Work, or Drawings will be undertaken without a signed change order. No painting or staining of any kind, other than that specifically stated is included. It is the homeowner's responsibility to remove all personal belongings from the work area prior to work commencing. While every effort will be made to minimize any dust or mess, homeowners understand that due to the nature of the work some mess and certainly some dust contamination of non-work areas is inevitable. Standard permitting fees are included in the contract total,however, additional meetings that the building department may require or meetings with other boards such as,historic,health, conservation, wetland etc. are not included. Any additional engineering that may be required for the project will be charged to the homeowners at cost plus 15%. Schedule dates are tentative and include no allowance for weather days. Changes to the contract or Scope of Work will impact schedule dates. Homeowner: Ju% C �• Date: WVJ 1 I HRH Construction: Date: J4 ffk6bZ HRH Construction,Inc. 80 Campbell Rd,North Andover Ma 01845. 978-314-7263 www.hncconstruction.net dave@hnceonstruction.net d A,6 II SII CONSTRUCTION INC. Payment Schedule: 41 Ferncroft Cir,North Andover, Ma. July 17, 2012 Deposit to book time $1500.00 Paid: C Pre construction start deposit. $12,250.00 Paid: Installation of Sono Tubes and Concrete. $5,500.00 Paid: Completion of rough framing. $5,500.00 Paid: Installation of roofing. $5,500.00 Paid: Installation of Trex decking. $5,500.00 Paid: Installation of interior trim. $5,500.00 Paid: Project completion. $2,500.00 Paid: Homeowner: �� �&I Date: HRH Construction,Inc: Date: HRH Construction,Inc. 80 Campbell Rd,North Andover,Ma 01845. 978-314-7263 www.hncconstruction.net dave@hncconstruction.net ��� fl scr2•�.�u ,�c�rat -cit le 2 x 16' Pyr' Lia r¢�»2- typ. Toto cul •q' i6CI.gW dwwo16 ax 10 ecieu lAe r 2~x 1.0 x 16' Ps 1 �� rnu C. .d Z -Ex(spAi4 TIIN C O tit IPOs.CI* C��c.GtllaCc �--• sciLt O 'fit:�DGtGt Ilt i�•' T p. i ak • inn cin 4nrrtn "44 E r ,191 sad ► a x l s say Qi a� • ;1. 0 »o,b- - SQ LL My"Q�) N.4 9 x tr _ v 2► rr►ro�t �'� b. "a"� •-�c�ar�r►•a� 1 I� . I i "Opt -Moe ; j RA "LLS IN ,TQC" 'I Y NIJ �7 "a1 Y1 1�A7��Y1r7Ki 1 � �• The' Com onwealth of Massach usettS Department of Fire Services Office bf the State'Fire Marshal. 0.BO-.10Z State Road,Stow-MA 01775 . ' 'APPLICATION FOR PERMIT Date: N. A n:d'o v e r Termit'No Dig Safe Numb (City or Town.) (HApplicable) !n accordance.with the provisions ofMG.L. Chapter 10 as provided in Section 5.2 7 .C MR 3 4 application is-hereby made Start Date l(/ 7 I 6y R l-E u5r 2-rc c a' ICU, (Full.name ofpersoq Firm or Corporation) 'State clearly Address ' M j0* l l 1 purpose for (Street or P.O.Box City orTowr} which.petmatt For p.emissionto locate dumpster for construction/renovati nn_/ripmnl i ti nn is-requested .Of b u i 1 d i n it. Co=euts: . dumpster must be 25 t from structure or covered when not fn nse (Give location by street and no,or descri a m suchmanner as.to provied adequate idcatificadon oflocatica) Name of competent-operator Cert No. *Z401 (lf Applicable) Date Issued-rejected 'RJ `2–D 1.7— By (signature ofAp licant) Date of c cpiration -7 Fee S 50 -00 Paid (� ' Due _ cut s The Commonweafth of Massachusetts Departmen'nt of Fire Services Office of the State Fire Marshal P.0.Box 1025 State Raad,Stow,MA 0I775 PERMIT Date: North Andover JPermitNo Dig SafeNvm er (City of Town) (If Applicable) In accordance with the provisions of M:G1,_1 L 8.Chapter1Q_asprovided in section 5 7 7 CMR 34 Start Date This Permit is granted to: Full name ofperson,Firm or Corporation Permission to locate dumpster - for construction/renovation/demolition of building. ConUmcnts: dumpster must be . 25 ' from structure if unable to place with required Restrictions:clearance dumpster must be covered with plywood or tarp end of work -day at (Give location by street and n `;or descnhc ins' manner as to provied adequate identification of location) .FeePaidS 50 .00 ( 'b" Fire Chief This Permit will expire did (Signa(ture of o asu uu pe Ohica grantuig'perriut` (Tide) . l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 °'^ Sv•,, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/lndividual): . YQA G'��yQ IZ_MM )&U Address: gp CAM P(-fi t City/State/Zip:N,• Loa/ , �qk M84SPhone.#:_-►�$ . 91!+ 7+2.9 Are yo" an employer? Check the appropriate box: Type of project(required):. 4. I am a general contractor and I YP 1? J ( q ) . 1. I am a employer with 3 � g 6. E]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. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ olition workingfor me in an capacity. employees and have workers' Y p �'• 9. Building addition [No workers' comp.insurance comp.insurance.# required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I 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.❑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. tContractors 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: -&Qm q Policy#or Self-ins.Lic.#: aCW411A 66 23- Expiration Date: 12 o2_0 12- Job 2Job Site Address:_i .A&ICACrr hut— City/State/Zip: K1. amw. Wk f0.ADAS Attach a copy of the workers' compensation policy declaration page(showing the polity 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 u der th and penalties of perjury that the information provided above is true and correct II Si nature: Date: t 4- _ 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#: AC(:>Ro® CERTIFICATE OF LIABILITY INSURANCEDATE(MMID NY1^0 12/13/2011 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 1S 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 endorsemerrt(s). PRODUCER CON-NAME., Michael Emond Emond&Associates PHONE FAX 857 Turnpike Street E-MAIL Arc Not: -208-4716 Suite 133 ADDRESS" — 1NSURE 5 AFFORDING COVERAGE NAIC 9 North Andover MA 01845 INSURER A: Farm FamilyCasual Insurance Com an INSURED HRH Construction INSURER B: 80 Campbell Road INSURERC- INSURER D: North Andover MA 01845 INSURER E: INSURER F 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_ NSR DD SUBR POLICY EFF POLICY EXP --- ILTR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY r PREMISES Ea=l S 50,0()o CLAIMS-MADE a OCCUR 1 ... MED EXP(Any one person) S 5,000 A 2001X0726 11/20/2011 11/20/2012 PERSONAL BADV INJURY S Included GENERAL AGGREGATE S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 X POLICY JECT 1-1 PRO LOC $ AUTOMOBILE LIABILITY r COMBINED SINGLE LIMIT I Ea accident) _ $ 1,000,000 ALLOANY WNEUTO BODILY INJURY A AUTOS � x AUTOS 0 (Per Person) $ BODILY INJURY(Per accident) S 200104287-4A 03116/2011 03/16/2012 X HIREDAUTOS X AUTO QED PROPERTY DAMAGE Peraotldent $ $ B EACH OCCURRENCE $ 1,000 000 X UMBRELLA LIAOCCUR A EXCESS LIAB CLAIMS-MADE 2001E1169 12/14/2011 12/14/2012 AGGREGATE $ 1,000,000 DED I I RETENTION S $ WORKERS COMPENSATION VNC STATU- OTH- AND EMPLOYERS'LIABILITY L I TI A ANY ER OFF1CFJMEMBER EXCLUDED? ��� YIN N 1 A F- 2005W6827 12/07/2011 12/07/2012 EL EACH ACCIDENT $500,000 (Mandatory in If yes,describe under aE.L.DISEASE-EA EMPLOYE $500,000 DESCRIPTION OF OPERATIONS below nd E.LDISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Operations by named insured CERTIFICATE HOLDER CANCELLATION HRH Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 80 Campbell Road ACCORDANCE WITH THE UCY t? OYISIONS. AUTHORREDT/1 North Andover MA 01845 7 7 ©i988-201 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD %lassachusetts - Deoar+men: ci D - `u' Board of Building Regulations l 'In%[YUL'i1,rn �niJCt'J)tt' _icense: CS-057754 i. WILLIAM D HOPE 80 CAMPBELL RD N ANDOVER MA 01845 Commissioner 03/04/2014 T ''je "16,91I)eautvca/l1i'I"O m"waCftl idli License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR egistration: 101730 Type: Office of Consumer Affairs and Business Regulation > , Private Co oratic•F, 10 Park Plaza-Suite 5170 ' 6129 !2014 rP r to P F a in: -r Boston MA 02116 HRH CONSTRUCTION INC. r William Hope 80 CAMPBELL RD — NORTH ANDOVER,MA 01845 Undersecretary Not valid without si ature