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HomeMy WebLinkAboutBuilding Permit #594-2017 - 42 WEST WOODBRIDGE ROAD 12/2/2016 oRrH (� BUILDING PERMIT TOWN OF NORTH ANDOVER o , •>y -, �-.�-': ' APPLICATION FOR PLAN EXAMINATION ~y _ T bry 'VT Permit No#: � Date Received �qss.rEo Date Issued: Z" V JOVTANT: Applicant must complete all items on this page B n :y prat D a ,.tructure es x, o O 1NG:k 1ST C ist©ri strip#. r des. o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition [ITwo or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition X-Other � ` ' `""" D F:loodlair� p Wands D YWater edistrict =` h -e id I71Nell � A DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: SCGnY� MC,t_.t Phone: q -a 04 _� a-. Address I E,1611'011 Sm VK Wi ag C©ntracorName �u �4 SsRal ME i - ^ia Supervisors Constr ctio Lcense� � ' ARCHITECT/ENGINEER l SICK Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 1 FEE: $ Check No.. vl I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund �r,r h '' of Anent/Owner Signature of contractor .: 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 Packagimg/S.ales ' �❑ 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 CONSERVATION Reviewed on Signature d COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board 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 AFIRE DEPART,MENKTemp,�Dumpster on,site es 1ZLocatea-at 124 Main Street � � z :, � FireDepartmentisignature/date ; , 3 fir*-»-,s. C011/IMENTS.t k �RTH 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) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pemit Revised 2014 1^� Building Department / required forms to be filled out for theappropriate ermit to be obtained. The following is a list of the reqp 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 1 ` Location 44 pp No. � � �+ Date l 2 t . • TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame.Permit Fee Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ Check# "- Building Inspector 127 NORTIi own of� a � Z o h ver, Mass, 9 coCNIc"l WICK 1• gATED I►Pa��.(5 U BOARD OF HEALTH Food/Kitchen TT Septic System PEI I LD • THIS CERTIFIES THAT ,,.. BUILDING INSPECTOR . .... ... ...... ... . ......................................... i�k .......Np� . . . Foundation has permission to erect .......................... buildings on ... ... . .............................. ...........' 6. Rough tobe occupied as ...�. �� ... .. ... ....1..... .�... .... ..................................................... Chimney provided that the person accepting this permit hall 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC T Rough Service ...... . . .... ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. MAT061 RISE nQbI17tCClt1 Federal[DO 05.0405629 Engineering RI Contractor Registration No 8166 MA istration No 120979 CT Contractor rRegistration No 620120 RIE 60 Shawmat Road,Canton,MA 02021 ENGINEERING CONTRACT ONTR A 4a^T 339-502-5197 rAA339-i02fi3#5 9ur�Jlltl /"► Page 1 PROGRAM THIS T IS ENTERED INTO BET%-jEEN RISE CMA-HES FUGIt ERINO RAND THE CUSTOMER FOR YORK AS DESCRIBED BELOW CUSTOMER PHONE DATECLiENTp VJORR.ORDFR 13oanh Mai (978)204-5442 11/1112016 441680 28602 SERVICE STREET BBIDJG STREET 42 West Woodbridge Road 42 West Woodbridge:Road ZI SERVICE CITY,STATE, P BILLRJG CITY,STATE.ZIP 4 North Andover,MA 01845 North Andover,;MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas orvour home against wasteful,excess air leakage. This work will be performed in concert with the use afspccial tools and diaEnostic tests In assure that your home will be left will,a healthful level orair exchange and indoor air quality.Materials to be used n 9 t scat your home can include caulls,;roams and other products. 1'rimary areas for scaling include I air Icakagc to anics o g .basements.attached , amara}es and other nnhcated aTCtLs{windows an not gcncraltp addressed.)This will require(12) working hour.A reduction in cubic fret per minute(C fm)of air infiItralion trill occur,but the actual number of elm is not guaranteed. At the ComplCtion of the%veutherixation work;and at no additional cost to the homeowner,a final blower dour and/or combustion safety analysis xtill be conducted by the sub-contractor to ensure the snfety orthe indoor air quality. $1,020.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid insulation board."fewherstrip the perimeter. $60.00 VENTILATION:Provide labor and materials to install(I)insulated exhaust hose with roofmounled flapper vent to exhaust existing bathroom ran(s). 5118:75 VENTILATION:Provide laborand materials to install ventilation chutes in(140)rafter bays to maintain air now. $280.00 i ----------- 1. Y Federal ID:05-0405629 RISE��ntz R 1[lb Rl Contractor Registration No 8186 MA Contractor Registration No 120979 RISECT Contractor Registration No 620120 i ENGINEERING 60 ShawtnutRoad,Canton.MA 02021 CONTRACT 339.502-5197 rAX 339-502-6345 Page 2 PROGRAM THIS CT ISCMA-HES ENGINEERINGTRAAND TTHEE C HUSbTWER FOR WORK AS DESCRIBED BELOW CUSTOMER .PHONE QOanll Mai (978)204-5442 CUEIITC WORN ORDER (970204-5442 31111/2016 441680 28602 SERVICESTREET BILLING STREET 42 West Woodbridge Road 42 West Woodbridge Road SERVICE CITY,.STA7'E,7JP GILLING CITY,STATE,71P North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION RISE Engineering will applyall applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible measures,Columbia Cas ofTers 75%incentive,not to exceed$2,000 per cllendaryehr,and an incentive or I-0D°o for the Air Scaling measures tip to the first 5680 and an additional 5340 if savings are justified by the auditor. ` for the safety and health of your home's indoor air quality,Nva will be conducting a blower door diagnostic of the available air flow in your home both before the wort:is begun,and alter the weatheftition work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of S90 and is at no cost t 1 n you. Total otal allowable a'gthenwlUon IncenUvc is 53.110. y -nEc Pemuit will be secured by the insulation contractor.at no additional cost.It is the homcownces rLa o ulbllihto close out this Permit bv colnactne their nrunleipahty to the completion ofthis work. 1.._ I $90.00 w G,v, 1 4 tu "total: $1,568.75 i Program Incentive: $1,454.06 Customer Total: $114.69 1AHE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE IN TH ABOVE SPECIFICATIONS.FOR THE SUM OF *""One Hundred Fourteen&69/100 Dollars $114.69 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO RWIT ALIOUNT DUE IN FULL.INTEREST OF 1%VALL DE CHARGED MONTHLY ON ANY UI4PAJD 80,ANCr AFTER 30 DAYS.SEE REVERSE.FOR IMPORTANT REFORMATION Ota GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. V� ujl AUTH MEOSIGIIA R_ EEnalnoml.p T OMERACCEPTANCE ROTE:THIS CONTRACT MAY DE Y/1THDRAWN BY US IF NOT EXECUTED VATH01 DATE OF ACCEPTANCE 30 ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIDHS AND conomOHS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORMED TO DO THE WORK AS SPECIFIED.PAYMENT PALL BE MADE AS OUTUREO ABOVE i i RISL-` 60 Shawmut Road,Unit 2(Canton,AAA 02021339-602-6335 J ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM baoo� Rat (Owner's Name) -" owner of the property located at: i I I /, ll �� ( r1 ,j n 1 � `1 d` "�' oy �Jri C��� 1'i0( (t uoa +fit 1"1"'1doya-" (Property Address) (Property Address) FE IMerrimack Valley Insulation hereby authorize 23A Sullivan Rd f I (Subcontractor ' 81662 OV 1 4 201i an authorized subcontractor for RISE Engineering,to act on m behalf 1 in y a buddm permit and to perform work on my property.This form is only valid with signed contract. _ i a OWnek Signature Date The COa'FtMOT-f-weL-th fl-ll'assa ase S Si_ BQSton, f 021117 lia v or4mes onaoensatio1in rr•I`.Lce3f-fi-d-=Z. Bu-;lC'tvrS/LGSSZaaCLi Tvei> c-, s1I'II�-ane s w?nlzc---L -.jIIFO�i_a�O'?-Ple?ae i-:Y,_?-eg"�Y A. 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S- Nifewiv =JO 3 "i C Oi� RE_z'r_=s v _> - eI?Cti Or B�nitin-s'Edit7L? 10- Electrical 11. pllumb.12- `zO Q L J_ 1 f v mel 2iC 3II erl.¢io_ fiat Lorre=i¢Ia_�czs�rs'r�:nac�saaoa FIIav nuc=:er sr:;m3iole�-Eeh y is the aolim,S iob sirs iria_ C. •1QU Si-LehlLf�:F'J u:cCCi g ca Ur Cit?Criees corgT)ariSat!OIiaO;IC-T,.'Lart arntiop ngre(shcm,ingtha r,rlicy ZnTaZL'sr,elempira£an(late. r`�+_tom 5--:; . cevarag aS:aciu:?C m,der-Se i Qi n!c_i]?can le=d to t la.:•• "=s..i:c.•: _ '=LO�t_0�c7a..�'=1�a ac?2L`e5 o a i_ti_e tl_W S 0fl-1.}an.d-,U_'iorm t e`?*meZ ornmrFit,as•eil as Ll-Al pailuilrs i.1 theb,mm 0= 1 OF IV0R ORDEM,EL71LI a uC:e:1 ��C��{��u� `-'_--aid�t the.TOZciion_ B'�advise[`that a CO+:>t=i iIL'•S :mzeri em nu-.v be€Orwwded To the C ,yesd e�OCS Cs Ylte DIA for,LlSs1fr?iLe mier-aiw CcdOav Date- c:ia!ICi et]3' 8i c.[-=L•:.��-���7�'•i2S 3L:i O��jO:S'slI aei fL':_==ham�i�iaie-ei_lauaR�LI3':cep�o�=e l5 L'!ICTs.0:'J!�CI_ (f es 3 .�:T' '1 �T'_ "- -G{?v�l�rj�.lata, Z. - f- ,i��iLy Iai us-- o�1_ CI no YJ_LL:'iL L.is%%SG t t.tt.L 3Cil:-!,�l LQ `-`=--M pla -T Mir [. Daard o Flealth - Building Jept Ci°:k •n�.i�.a= c ect iii ani sp. Plumb:z:G� - Wer _ The Commonwealth of Massach usetts Department of Industrial Accidents Office of Investigations 640 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbe>rs Applicant Information Please Print Legibly Name(Business/Organization/individual): Merrimack Valley Insulation Corp. Address: 23 A Sullivan Rd. City/State/Zip: Billerica; MA 01862 Phone#: 978-888-3495 Are you an employer?Check the appropriate box: Type of project(required): L 7X I am'a employer with 18 4. ❑ I am a general contractor and I ❑ employees(full and/or part-time). have hired the sub-contractors 6. New construction 2.❑ 1 am' a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10:❑Electrical repairs.or additions 3.❑ I am a homeowner doing all work officers have exercised their I I-El 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' 135-1OtherInsulation comp. insurance required.] "A.ny applicant that checks.box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: 5Star V3 AAIC American Alternative Insurance Policy#or Self-ins.Lie.#: V9WC749118 Expiration Date: 6/18/2017 Job Site Address:Aa City/State/Zip:lv.AndOvgr. mA 4►�45 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 g q osition of criminalpenalties of a . _ p 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. X do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Dater Phone#: 4_8a'8-349V 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#: ACvR�® DATE(MMflDDIYYYY) `..� CERTIFICATE OF LIABILITY INSURANCE 11/07/2016 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 - NAME:CONTACT Carolyn A Coughlin Charles J Coughlin Insurance PHONEFAX 14 Dinley Street (978)957-3588 Iac No: P.O.Box 10 ADDRRESS, carolyn@coughlinins.com Dracut,MA 01826 INSU S)AFFORDING COVERAGE NAIC# INSURER A: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURER B: Safety Standard 39454 23A Sullivan Road Torus Specialty Insurance Company A0159 INSURER C: p `7 h y N. Billerica,MA 01862 INSURER D 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. I TR TYPE OF INSURANCE INSD w D POLICY NUMBER MDNPOLIYFF P�CDY«P LIMITS A COMMERCIAL GENERAL LIABILITY WS274182 01/21/2016 1/21/2017 EACH OCCURRENCE $ 1.000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENLAGGREGATE LIMITAPPUESPER GENERAL AGGREGATE $ 2,000,000 POLICY DJE�CT El LOC PRODUCTS-COMP/OP AGG $ 2,000.000 OTHER $ B AUTOMOBILE LIABILTTY 6205006 11/25/2015 11/25/2016 CEOMa acciBINenED tSINGE LIMIT $ 1.,000,000 d ANY AUTO BODILY INJURY(Per person) $ OWNED / SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ V HIRED / NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ C UMBRELLAUAB OCCUR 875931- � � 161ALI 01/21/2016 01/21/2017 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,0001000 I DED RETENTION $0 $ WORKERS COMPENSATION PER OTT+ AND EMPLOYERS'LIABILrTY YIN STATUTE ER ANY PROPRETOR/PARTNERIEXECUTNE OFFICERNEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Insulation Installation 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. Town of North Andover,M assachusetts 120 Main Street North Andover,M A 01845 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD MERRVAL-03 WEJE DATE(tAfA1Di)IYYYI) 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 IN 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 1S%11AIVED,subject to the terms and conditions of"the policy,certain ipolicies 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: Automatic Data Processing Insurance Agency,Inc PHONE I FAX 1 ADP Boulevard (AIC. -No Ext I(AIG,No): E-MAIL- Roseland,NJ 07066 nDDREss: 1NSURER(S)AFFORDING COVERAGE NAIC 9 [NSURERA:5Star V3 AAIC American Alternative insuran. INSURED Merrimack Valley Insulation Corp INSURER B, 23a Sullivan Rd INSURER C: North Billerica,MA 01862 INSURER D: ---� - - - -- - — INSURER E_ INSURER F: COVERAGES - 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 f INDICATED. NOTWITHSTANDING ANY REQUIRENIENT,.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO wKICH 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_Laws SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ _ _ fLTADDL R I TYPE OF INSURANCE NSR IND I POUCY NUPABER _ PouCv EFF POLuCY EXP up,P DtYYYY I t411LVDDIYYYY UMRS 1 GENERAL LIABILITY ! I EACH OCCURRENCE 15 I DAMA t C_Ott11ERCIALGENERAL UASIUTY i ! I PREidISESjEaoccurtencal i 5 _ -- CA04S-MADE OCCUR i NiED EkP(Any one person) IS INJURY S k�1014'1_ GENERALAGGREGATE 1 Si AGGREGATEUR4rAPPL1ESPER: { j PRODUCTS-COEPPIOPAGG s POLICY 171•ISCr F LOC AUTOSOBILEURBIIITY ! I CONMINEOSINGLcUtAtf I Ea accident s ANY AUTO i BODILY INJURY(Perperson) IS ALLOWNED SCHEDULED - — - _.. ---L AUTOS A11T05 i ;BODILY INJURY(Per accident)I S NON-OWNED i I I PROPERTY DAfAAGE HIRED AUTOS AUTOS l I Paraxid-nJ S . ! E (�------- -- - 5 ---- URIBRELLA UA8 _ OCCURETCH OCCURRENCE 5 EXCESS UAB CLAIMS-MADEi AGGREGATE __ S DEC) I I RETENTIONS ( S WORKERSCONIPENSATTON x WCSTATU- OTH- IANDEf1PLOYERS`tJABIUTY YIN TORYLIh1ITS ER A {f-AY PROPP.IETORIPARTNERIEXECUnticV9WC749118 6/1812016 6/18/2017 E.L EACH ACCIDENT S^ 1,000,00 _OFRCER11/Et1EEP,EXCWD'c0? a NIA — — 1 QfiandatoryinNti) E_LDISEASE-EAEr1PLOYE S 1,000,00 If�es,describe-under i D�SCfZIMIONOFOPERATIONS below 'c.LDiSEASE-POLICYLIrA1T- .5 . 1,000,00 I DESCRIPTION OF OPERATIONS I LOCATIONS VEN16LES(Atfach ACORD 101,Additional Remarks Schedule,if more space is required) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL I D.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED -IN Town of North Andover,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 1IMORtZED REPRESENTATIVE 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered Imarks of ACORD 0 77-1 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home ImprovemenYG-(")'�'ntractor Registration Type: Corporation e w Registration: 180506 Merrimack Valley Insulation Corp. Expiration: 11/23/2018 23 A Sullivan Rd r o Billerica, MA 01862 A ,� Update Address and return card. Mark reason for change. SCA 1 et 2OM-05/11 1 -- _ (yam-----/— J/ E_AS]dre-s t 1-l_P-n—P-1 r FmP t l (92111( G TP0W?1-7Z07"(Vea'A11 O�VC�GILd'JCLG/ZC[QCLf _ __ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only - Type: Corporation before the expiration date. If found return to: Beyistration Expiration Office of Consumer Affairs and Business Regulation - 10 Park Plaza-Suite 5170 1130506 11/23/2018 ui Boston,MA 02116 Merrimack Valley`Insalation=Corp Joseph Ryan 23 A Sullivan Rd Billerica,MA 01862 Undersecretary Not v id ithout signature Pjassachuse::s-Departm.ent a=Public Sa et sr Scare of Bu idinrg F?--,W—ons.env S and .Ttipv-e iss3a �,. License: GS-075541 JOSEPH A RYANt-` , 200 King"I Dr:AWI D2�. 3 ynnfield MA 01940 Expiration Co i :ss;cre: 02/04/2D17