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HomeMy WebLinkAboutBuilding Permit #269-16 - 41 MARBLERIDGE ROAD 9/1/2015 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER y� APPLICATION FOR PLAN EXAMINATION 70 z h �� �SRF 1e Permit No � Date Received rep gSSACHUS�� Date Issued: r IMPORTANT: Applicant must complete all items on this page LOCATION n4LT9 Print PROPERTY OWNER ST 465' L &&a Print 100 Year Structure yes no MAPPARCEL: Z ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial )<Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic 0 Well ElFloodplain ❑ Wetlands El Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Z 141m data Phone: �7 GG4 4�68� Address: Contractor Name: /Wlf Phone: 7d�- ���'� day Email: C�61)yY14& C Gari -- Address:_ffi9 ,Oyiyzr ✓y oL✓'a�� �!/� ' Supervisor's Construction License: CS, 0,2, ,7- ISO Exp. Date: Home Improvement License: G • ItI., 2Z Exp. Date: ' 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: $ FEE: $ t No.: Recei Glc Check No.: p NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t Building Department K 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 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) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: - �.,. oca eLocatedx,84 O otree_tg :- = --• iF IREDEP�ARTtMENiT T;empDumpster site;es , 9(Lo ated at �24MamlfStreet en_ y no artmentsignaure/date 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) U Notified for pickup Call Email I Date Time Contact Name Doc.Buildinb Permit Revised 2014 Location t!r L Nd "� Date tt J • , TOWN OF NORTH ANDOVER . Certificate of Occupancy " Building/Frame Permit Fee $ Foundation Permit Fee $° Other Permit Fee $ - TED. TOTAL $ Check# 2 e� � Building Inspector / v r 1 NORTH - A-. .c . : ve 0 _ - o h ver, Mass, �i �a COC LAKIW1 ,CK Nicol AD�gTE S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...................Z%1.04.040.0.640......... ... BUILDING INSPECTOR .... has permission to erect .......................... buildings on ............ .�....... Foundation.�../.. .�....� .. ... Rough .. , g tobe occupied as ......... ..... .... ............... ................... .... ..................................... Chimney provided that the person accepti this permit shall in eve respect conform he 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 MON S ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T Rough Service ............................. ......... .................................... 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. D MITMClo Commercial Roofing Specialists July 31, 2015 Mr. Steve Lanaan Submitted by: Fran McBay 41 Marbleridge Road North Andover,Ma. 01845 Re. 41 Marbleridge Road North Andover Re-roof Dear Steve, I am pleased to provide you with a quotation and specification for the above-referenced roofing project. SHINGLE RE-ROOF (1) Remove all existing asphalt shingles completely on above surface roof. (2) Install new#30 felt underlayment paper. (3) Install new aluminum drip edges and rake edges. (4) Install three foot wide roll of ice and water shield barrier at drip edges and valley locations. Please note that along drip edge areas we will be installing ice and water shield six feet up from drip edge. (5) Install new Certainteed Landmark Ar(limited life-time) asphalt shingles over entire roof area. (6) Membrane and waterproof all units protruding on above surface roof using appropriate flashing components. (7) Provide and install new Cobra ridge vent along top ridge area. (8) Along one(1)front dormer sidewall(left side only)we will remove and replace existing damaged clapboard siding. (9) All debris will be cleaned up and removed by Roof Solutions, Inc. SPECIAL NOTE.- Please OTE.Please be advised that during the ripping operation that dust,dirt,and debris may fall through the wood planks of the roof deck and enter into the building. We highly recommend that precautions be made by the owner in the interior of the building to prevent any damage to items directly below. Roof Solutions cannot be responsible in the event that these issues occur. 2 Aberjona Drive - Woburn, Me.01801 - tel.781-939-5830 - fax 781-939-5831 -www.roofsolutionsinc.net .� r f - ' i ,i• , �.J � - � . - .. � r i ' , s i 'S ' � _ i ` i }'F i }� . �i4 � 1 i D MOT IT M Commercial Roofing Specialists SPECIAL NOTES PAGE • Please note we must be allowed access of logistical areas surrounding the building for crane access,debris removal and/or dumpster placement. Discussion and contingency must be made with the owner prior to job commencement. s GENERAL MATERIAL INCREASE NOTE: Due to the reality of roof raw materials unexpected shortage and price increase, we will have to pass on any material increase which occurs prior to the signing of the contract This proposal is valid for only thirty(30) days. • Please note installation of ice water shield will not stop ice from forming on the roof surface but should provide extra protection from melt water infiltration into living space. • LANDSCAPING-NO LIABILITY CLAUSE Although every attempt will be made to eliminate or minimize the possibility of landscaping damage,Roof Solutions,Inc. cannot assume liability for any such damage which occurs in connection with the roofing operation. In accepting this contract,the customer agrees to exempt Roof Solutions,Inc.from any liability due to landscaping damage- • DECKING CLAUSE WITH ESTIMATE: Insofar as we cannot determine the condition of your existing deck until the ripping operation has begun, replacement of decking will represent an additional charge on a per sq.f>` basis. The deck replacement charge will be$ 7.00 per sq.ft. 2 Aberjona Drive Woburn,Ma.01801 - tel.781-939-5830 fax 781-939-5831 •www.roofsolutionsinc.net i It . Q .. '.�I f + \ ".• S I l� `� Flt! § . i .Y3�3. i - Sit 49 r in r q n \a ' � ' ° 9 , 'tali, �•.l`F' : !,}+••�` r Commercial Roofing Specialists ROOF SOLUTIONS proposes to furnish labor and materials,complete in accordance with the above specifications,for the sum of-. TWELVE THOUSAND EIGHT HUNDRED & FORTY ****** DOLLARS($12,840.00) *Stock Payment: $6,640.00 %Way Payment$3100.00 *Completion: $3100.00 PROPOSAL ACCEPTANCE The specifications,prices, and attached DATE: "'J conditions are satisfactory and hereby accepted. Roof Solutions is authorized to SIGNATURE: MWA AA perform work as specified. Payment will be made as outlined above. TITLE: I will follow up with you with regards to this proposal. In the meantime,please call me at (781) 858-8594 if you have any questions. Thank you for your consideration. Sincerely, Fran Mcbay, Principal Roof Solutions,Inc. 2 Aberjona Drive - Woburn, Ma.01801 - tel. 781-939-5830 - fax 781.939-5831 -www.roofsolutionsinc.net u The Commonwealth of massachusetts z: Depazrtment ofindlust ialAccldents -..- .. Congress Street,suite 100 R tl - Boston,MA 02114-2017 www,anass.gov/dia sy Workers'Compensation Insuraxice Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE k'ILED WITH THE PERMITTING AUTHOR'Ty- ApliUcaut Information Please Print LedblV Name,(Business/Organization/Individual): l Address: City/State/Zip: Phone##: X I Sly (.f/U U� • • Are you an employer?Check the appropriate box: Type of project(xequired): 1.[]I am a employer with . employees(full and/or part-time).* 7. ❑New construction 2.Q I ama sole proprietor or partnership and have no employees working for me in &. [1 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition I Q I am a homeowner doing all work myself[No workers'comp.insurance required.]f 10 []Building addition 4_❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12..0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.El Other 6.[]We are a corporation and ifs officers have exercised their right o£exemption per MGL c. 152,§i(4),and we have notemployees.[No workers'comp.insurance required.] *Any applicant that checks box4l must also fill out the section below showingtheirworkers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. ?Contractors that check thus 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 workeis'comp.policy number.' I am an employer that ispi'dviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: } Policy#or Self-ins,Lic.4: Expiration Date: Job Site Address: 7f _ /fin/��'_' �� City/State/Zip: IVP XT 7/ 4,eV,00 // IL. Attach a copy of the workers' compensationTolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as welt as civil penalties in the form of a STOP WORK.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 coverage verification. X do hereby cert under thepains andpenalties ofperjury that the information provided move is true and correct: sign e: 6F, Date: Phone#: P Official use only. Do not write in this area,to be completed by city or toren 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 4: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of Hire, express or implied,oral or written." ' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority." .Applicants Please fill-out-the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)aud-phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you.'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter'their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill.out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating cuiTent policy information(ifnecessmy)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fulled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia TE(MM/DDlYYY1C. ACCIODA ® CERTIFICATE OF LIABILITY INSURANCE a„ TEE ' „ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG ITS 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 endorsgd. 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). CONTACT PRODUCER NAME: FAX The Driscoll Agency,Inc. PHONE AJC No: - 93 Longwater Circle AF-MAIL p P.O.Box 9120 Norwell MA 02061 ►NsuR Si AFFORDING COVERAGE NAIC B INSURER A'.W surance Company INSURED 4007 INSURER B:Be e J I Specially Insuranc Roof Solutions,Inc. iNsumc:Pmlgdm Ins,QQ; 21750 2 Abe4ona Dr. INSURER D: Woburn MA 01801 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:50791296 ='- 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 CR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DES RIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CJ NMS. IlTYPE OF INSURANCE 05CUBR POLICY EFF POLICY.EXP LIMITS POLICY NUMBER I MIDD MMID B GENERALLIABILITY Y CGLOD72706 31112015 /1/2016: EACH OCCURRENCE $1.000,000 Ft ED TO X COMMERCIAL GENERAL LIABILITY PREMIE rr n $100,000 CLAIMS-MADE W-1 OCCUR MED EXP one ) $ PERSONAL&ADV INJURY $1,000.000 0 GENERAL AGGREGATE 52,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlOPAGG 52.000.000 is POLICY PFC:rRO LOC _ C AUTOMOBILE LIABILITY Y PRC00001001114 1/2015 1/2018= accident 1 000.000 BODILY INJURY(Per person) S ANY AUTO ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ HIRED AUTOS X AUTOS er a S B UMBRELLA LIAR X OCCUR Y C000T2706 112015 r11201�'-' EACH OCCURRENCE $3.000,000 X EXCESS UAB I I CLAIMS-MADE AGGREGATE $3,000,000 S DED RETENTION S WC STATU- OTH- A WORKERS COMPENSATION TO BE ISS LIED BY CARRIER r112015 1I201H LIABILITY S AND EMPLOYERS' Y/N E.L.EACH ACCIDENT ANY PROPRIETORIPARTNERIEXECUTNE❑ NIA OFFICERIMEMBER EXCLUDED? E.L DISEASE-EA EMPLOY S (Mandatory in NH) Iryes describe under E.L DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS below r DFSCR1P71ON OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddlUonal Remarks Schedule,H more space Is requireQ� CERTIFICATE HOLDER SHOULD ANY OF THE A4QVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAT.i? THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THI:POLICY PROVISIONS. AUTHORIZED REPRESENTA11- ©1988-20'0 ACORD CORPORATION. All rights reserved. ,,a,,,oa„�,._re registered marks of A�ORD r i ' i '• i l DATE(MM1DD/YYYY) ACOR CERTIFICATE OF LIABILITY INSURANCE 04,17,2015 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 endorsements. PRODUCER CONTACT NAME: DRISCOU AGENCY PHONE FAX Not. 93 Longwater Drive E-MAIL Norwell, MA 02061 ADDRESS: ' INSURERS AFFORDING COVERAGE NAIC# INSURER A: INSURED INSURERS: AmGUARD Insurance Company 42390 ROOF SOLUTIONS INC INSURER C: 2 ABERJONA DR INSURER D: WOBURN, MA 01801 INSURERE: 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. INSR TYPE OF INSURANCE B POLICY EFF POLICY EXP LTR S POLICY NUMBER MMIDDIYYYY MMIDDIY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 0 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES a occurrence) S 0 CLAIMS-MADE F]OCCUR MED EXP one person) S 0 PERSONAL&ADV INJURY S 0 u GENERAL AGGREGATE S 0 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/0P AGG $ 0 POLICY PRO- LOC S AUTOMOBILE LIABILITY Ea aanESINGLE LIMIT en S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S(Per accident HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR j EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE I AGGREGATE S DED I I RETENTIONS _ S WORKERS COMPENSATION wCy TATO- i X O R AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE❑ N/A R2WC627084 03/OU2015 03/01/2016 E.LEACHACCIDENT S 1,000,000 B (Mandatory in H)EXCLUDER? N E.L.DISEASE-EA EMPLOYE S1,000,000 (Mandatory m NH) If yes,descnbe under I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 101,Additional Remarks Schedule,U more space is required) 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor r" License: CS-022830 FRANCIS J MCBtA-V 9 OAKWOOD RD Wilmington MA 0188 Expiration Commissioner 01/13/2016 •I