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Home My WebLink AboutBuilding Permit #582-2017 - 46 WEYLAND CIRCLE 12/1/2016 • �ORT/q A BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION moa Permit No#: S I�7 Date Received ATED.pR' / �SSgCHU Date Issued: / 2/� LVIPORTANT:Applicant must complete all items on this page iLCq�TIONx R __ d-2 n 1 l?ROFE.R�TYWNER - -- �_ Fr j v, - -- �.�_- -` re R1 CT:^A �Hi torte®istnct4 lyes no _ ( tiye_s� ono'. ;.. �^s - .p�^c"' Y3c -s'-"`'a`St'�+ •; k� -t J€ �, 3f� - �� , ,, t.r4 .i t ": tx{ MachinexShoVillage: r.YeS . _ n .iS:;'.. 'y»'_'�Sh.J-�Y_.',._:w..C. .-:-.-s,_ ...�,1�._._.f_a✓ �fR.."�...1'.r_�. �.?.r _,za.S.j_!.-'�.k_ .sem-.�a....�w.•'bc_�.a r,_.. � �'S.c C.R - ,no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition 0 Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg 0 O hers: n ❑ Demolition 0 Other i P R ellOweL 0 Septic xWell Floodplain ❑1Netlands 0 W"StersDistrict • 3'.f yY.. -.' v. ._ _ Hwy,.., ..,.-..- MW ater/Sewer :, t ,: • -, L-Mt } , ...... ........�a.�..:.•r..�....��..c:-C.• �r...w..__�...,-...-,..._......�ir._.....:�-.w...- +,s -.f ,- ,.'-r'��i�ti. _.,..t. 'r+fT' DESCRIPTION OF WORKE BE PE FORME :Fo(' relLoL,4 ( tiS �n Identificatign- PIease Type or Print Clearly' OWNER: Name: Wj Kn_`r1 oma-S Phone: �— c17?"G�'� �� Address: f"y�r l e � La"n� c Contractor Name:;('}�;L. fo►� Phone /0 �_3�� <a. _ � ) �3'Ag r ,�,, '-.. v.. v,�r-••w -M�'�'.��:-•rs�._ �•v .z �1•,r�'ai�+^'t'^'�- �'-�crr ,_...�y�.,. . . .� Supervisor,sR-1-nstruction�'License' x. - n - a -;r• -r-"^-.'_. i-.'�+7 ry"° `" 4'' -., +✓� ``� .rte t---.f'i'k.'i3. V r �i ♦�. t�r.,��r �k`^.J �r7 ;HornellmproveentLicense � ter_ ARCHITECT/ENGINEER Phone: Address: Reg. leo. FEE SCHEDULE:BULDING PERMIT.$92,00 PER$9000.00 OF THE TO Tal ESTIMATED COST BASED ON$925.00 PER S.F. .Total Project Cost: f5—(.-7SS FEE: $ Check No.: -Y 4 7 �T- Receipt No.: 3 a' NOTE: Persons contacting with unregistered conga y�do no h ccess to th guaa anty fund S`ignatu�e_of_Agent/Owner Stgnatujre of contractor' Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS. CONSERVATION Reviewed on Signature COMMENTS . I i 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 FIRE DEPARTMENT -' Temp Dumpster on site yes no Located at 124.Main Street Fire Department signature/date COMMENTS limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: of Mete ® V ELECTRICAL. Movement r location, mast or service drop:requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit Revised 2014 ;. if 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.1.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 Engine products g 9 g NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � 9 Y) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Pians (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 d cision from the Board of Appeals that thea appeal period is over. The applicant must then et this recorded at the Registry of Deed One co and roof of recording PP P PP g b Y PY P must be submitted with the building application Doc:Building Permit Revised 2014 J a • I 1 Location 116 tye L7 C 4N�) 1. t Q No. $Tol- VLo 1-7 Date / • ! - d 00 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $53Y r Foundation Permit Fee $ Other Permit Fee $ VT. TOTAL $ Check# y'47- / �� - 4 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 44,558.00 m $ - $ 534.70 Plumbing Fee $ 66.84 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 66.84 Total fees collected $ 768.37 Foundation 100 46 Weyland Circle 582-2017 on 12/1/2016 Kitchen Remodel i � NORTIi Town of A . ,� oh ver, Mass, eZi d; COCHICMEWICR 1 RATED OkP U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System py L 0 vN M s BUILDING INSPECTORTHIS CERTIFIES THAT ...... k........... . ..........................................&.......... �e has permission to erect .......................... buildings on ..........y&.........................!��N�!�.....� Foundation��..... Rough to be occupied as / Chimney ......k s. -c t%Rou.............................o...... .�.:..... .... .... .... 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 CONSTRUCTP r 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. NORT" own o ndover . No. h ver, Mass, 4; coc MIc"IWICQ T x.95 R�reo �P ��5 LU) BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......P0. � ........... . .....................O. w .M.S.6 BUILDING INSPECTOR ....... .... .... Foundation has permission to erect .......................... buildings on ...y ........ e!.&M..�'A...... � ..... tkv�v Aio' 0 im, Awwo Rough tobe occupied as ...... .................... ......................................................./.. ......... 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 CONSTRUCTIO TT 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. t CONTRACT Phil Lacroix & Sons, Inc. BUILDER 1 CONTRACTOR For Over 63Years 151 Shore Dr. Salem, NH 03079 (603) 890-3998 — (603) 893-8915 mandllacroix@comcast.net Submitted to: Mr.Mike Thomas+Ms Caroline Seymour Date:8129116 Home Phone: Street:46 Weyland circle City,State,Zip: North Andover, Ma. Job Name: Kitchen Remodel We hereby submit pricing for the following work: We will remove existing cabinets. We will install new cabinets based on the design by Cyr lumber. We will give an allowance for granite as the countertop as per Cyr lumber. We will rework the gas line for the new cook top. We will run a new gas line for the oven or electrical line (not sure). We will move and install a new line to the refrigerator. . Electric will consist of under counter lights (type to be determined) /we bring outlets and electric up to code where needed. We will allocate for 4 new recess lights and change the old trims to led to match new ones. . Note. There will be some electric that might be need to the panel. Arch fault breakers are needed. Price to be determined. Also they might make you update the smoke detectors in your home. This includes every bedroom / one in each hall (co2 and smoke combo) / maybe one basement/ garage. Depends on the inspector. Usually an additional $ 800.00 to $ 1,000.00. They all have to be hard wired and all have to be the same brand. This could come up; I want to make you aware that is at the inspector's discretion. i i Plumbing will include hooking up sink and waterlines / moving waterline for fridge. Customer will be responsible for buying there faucet/garbage disposal / sink. Note: any additional plumbing needed that I cannot see will be brought to your attention with a remedy to fix and an additional cost. Carpentry will include installing new cabinets/ misc. trim-where needed. Flooring will consist of removing bad flooring and replacing from that point to the outside wall. I am not sure how much has to be taken up but the majority of floor will remain. We will sand entire floor and coat 3 separate times with clear poly. The other rooms I will figure separately in case you want to do at a later date. If so, we would remove the old carpet and make ready for new 2 % unfinished oak (red or white TBD). We will sand / apply 3 coats of clear poly. You will be without your kitchen for at least 3 solid days. Also if the laundry is upstairs we need to move them out to sand the floor. I couldn't remember if they were in the room off the kitchen. Compound will consist of patching walls I ceiling etc. Note: If you move,e�sfia carts and hoes need to be patch the a re ceiling might haws io ba:r because the design will not match. It will always show different. This is not a major price increase. If smooth ceiling is there now then it is a mute point. , Painting will consist of ceiling /walls and any affected trim to match existing. Let 1 me know if you want to paint more. We can do while painter is there. This would be an extra cost above this quote. All debris will be taken away from job per day. We will leave the job broom clean every night. It will be rustic for you at times but you will always have a sink I - fridge / stove. Total for above work: $A158.15 Additional cost for molding under the top cabinets to hide the under cabinet lights $ 375.00 Hardware for cabinets (not sure if these are the handles) Jeff sent me this on the last email. $ 375.00 let me know if this is correct. I didn't know about any hardware. We will install for you. Labor for above: $ 150.00 Permit cost: $ 500.00 Patch in floor from water damage (depends on the amount to replace). I already included price to sand floor in the above bottom line. Not sure how much has to be replaced. Price to be determined. Note: I think we would start the process the end of October first week of November. We would order the cabinets beginning of October. Any questions give me a call. 1 _. 4 TERMS AND CONDITIONS We propose to furnish material and labor-complete in accordance with above specifications,for the sum of: ,558.75 Note: ALL PERMITS AND ENGINEERING COST ARE THE RESPONSIBILITY OF THE PROPERTY OWNER. Payment to be made as follows: 150/6 to order cabinets 120%when start the job 120% after rough inspection 115% at start of cabinet install 115% at floor sanding 110% at painting I Balance on completion. All material is guaranteed to be as specified. All work to be completed in a workman like manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements are contingent upon strikes,accidents or delays beyond our control. Owner will carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Mark Lacroix 8/29/16 Authorized Signature Date ACCEPTANCE OF Contract The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as Ispecified. P ent ade as outlined above. Signature Date Signature 9 Date a 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 bite, express or implied,oral or written." An employer is'd'efinad 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 receivet'or trustee 6fan 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 b6 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 applicautwhii has notproduced-acceptable evidence of compliancewith the insurance coverage xequuited." 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 of this 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 srrb contractor(s)name(s),address(es)and phone number(s)along with their cardf'tcate(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 au LLC or LLP does have employees,a policy is required. B e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city ox town that the application for thepermit 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 Bub. City or Town Officials ' I Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom j 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. Iu addition,an applicant that must submit multiple pemnit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"fob Site Address"the applicant should write•"all locations in (city or j town)."A copy of the affdavit that has been officially stamped or marked by the city or town may be provided to the I applicant as proof that a valid affidavit is on.file for future permits or licenses. A new affidavit must be filled out each j 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-I5 wwwDaass.gov/dia the commonwealth of Massachusetts _ Accidents nts Department ofInd�s0al 1 Congress street,Sitte 100 d MA 02114-2017 Boston, www mass go•v/dia y��M ssti way:kers'CoupensationInsuranceAf6idavit:BuilderTs/COAUISOsRTTS�'•t�rzcians/ lam ers. TO BE FILED`QVl!TEC THE nWff Blease Print Le 'bl A �hicant Information Crd I S Q n +S Name(Business/Oigariizaiion/Individual): \ 1 Address: S c L�v v.3U79Phone#: City/Statefzip: °'/1 , :: .:.•.. : :_.�«_.:. : . rType of project(required); Ase you an employer?Check the appropriate box: 1 full and/or Part-time).- 7. ElNeWd6n.5L7 action LET am a employer with em P oyees� 2. I am a sole proprietororpartnership andhaveno employees Working forme in 8. (Remo delirig any capacity.[No workers'comp,insurance required.] 9. ❑DamolhiOn. 3.0 lam ahomeowner doingallworkmyself.[Noworkers'comp.ins urancerequiredr 10E]Building addition 4.F]I am a homeowner and will be hiring contractors to condnet all work on my property. I will I1.❑Electricalrepairs or additions ensuretl�t a]]co ractbis eitherhave workers'campensation insurance or are sole � b� re airs o7r additions �'`' ees. IZ. Plum. $ p proprietors withno emp�.oy 5.[--1 I am a general confracto and I have hiredthe sub- listed onthe attached sheet 13•.[]Rbof repairs These sub-contractors have employees and have workers'comp.insurance 14. Other We are a corporation andrts officers have exercisedtheir right of°'exemPtionper MGL c. 152,§1(4),and vre have no employees.[No workers'comp.insurance required] licy *Any applicant that rkg&9 box#1 *itmdi out the Y are ao�l�w_rk and.hen hire outside ctheir-workers' montracto s meust submit a n w affidavit indicating sueh T gomeowners Who submft,Ws affi.. !Contractors that checkihis Iioxrirusf attached ha additional sheet r yihde their name of comp poficyynnnmb and statewhether ornotfhose entities ave employees. If the sub-contractors have employees,they mus P X am an employer tliat is pi oviding-workers'compensation insurance for°nV errzployees. Below is tliepolicy arzdjo i site informeon. N S , Insurance Company Name: kaA, t —13 ExpirationDate,1/f.21JI-7 policy#or Self-inns.Lic. (A) y rCLe City/State/Zip: Job Site Address: "Y �e policy number and expiration date). A.tEacha copy ofthewoxkers' Compensationpolxcy declaration page(Showing p y Failure to secure coverage as required under MGL ties in the f m o£�OP.CORK ORDER1ebyafuib and a fine of up to $250.00 a and/or one-year imprisonment as well as civil penal day against the violator.A copy oftbis statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. X do Zaerelry certify under liepain dpenalties ofperjury that the information provided ado e is tr.e ar?d correct. D Signature: Phone#: _ a Official zcse only. Do not write irz this area,to he completed by city or tOwn official. ia permit/License# City or'X'own- 7ssuingA.uthoxd (circle one): gDepaxtment 3.CitylTown Clerk 4.ElectricalXnspector 5.plumbing Inspector 1.Board of Health. 2.B�diri 6.Other phone#: Contact Person: 16 ,n12 307" '13' 24 n> �� h. fir' ._ w _ Fr ,..... I G ( w .......... JTT- ........... y ; g r s 4.Emu � a "d �a 0 �y' 4q Ali ti 3 4 h q , p a x � r ai',• ,� � ,3"F Y X 21 g, 1 ' ri £ N. can ASK-,' Nil ly ill tl 1 1 r O . _ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cor Registration Registration: 103014 Type: Private Corporation Expiration: 7/6/2018 Tr# 419291 PHIL LACROIX & SONS INC. Philip, Jr. Lacroix ? i 151 SHORE DR. SALEM, NH 03079 1, Update Address and return card.Mark reason for change. Address Renewal Employment � Lost Card SCA 1 Ot 20M-05/11 �.c cpo�»r.��zaiuuea;lGf a��taaaac�er4eCrd, Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,.':,""-1103014 Type: Office of Consumer Affairs and Business Regulation Expiration 716/201& Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 PHIL LACROIX&SCINS INC F3 , 1 Philip,Jr. Lacroix ' t k S 151 SHORE DR. SALEM, NH 03079 Undersecretary Not valid without signature PHILL-1 OP ID: NB a�QRv CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYY" 11/3012016 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 pollcy(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 CONT CT Jason M MIOCek Planrlght Insurance-Salem PHONE 224 Main Street Suite 2A Ic No E,, :603-890 439 Arc No;603-890-6521 Salem,NH 03079 Jason M Mlocek ADDRESS:jason@santoinsurance.com INSURERS)AFFORDING COVERAGE NAIC Ir INSURERA:Acadia Insurance 31325 151 Shore Drive INSURED Phil Lacroix Sons Inc INSURERB:American Zurich Insurance Salem,NH 03079 INSURER C; 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCEITWV. POLICY NUMBER MMIDDIMY MMIDDIYYYY LIMBS A COMMERCIAL GENERAL LIABILITY INS EACH OCCURRENCE $ 1,000,00 CLAMS-MADE FIoccUR 13OA5130023-13 11129/2016 11/29/2017 PREMISES 0 Ea Tccurrence $ 50,00 X Business Owners MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ GEN'_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 :OLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY ALTO CAA5130033.13 Ea accident $ 1,000,00 11129/2016 11/2912017 BODILY INJURY(Per pe•son) $ ALL CN'NEJ X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X ilRED.AUTOS X NON-OWNED PROPERTYDAMAGE AUTOS Per accident) $ UMBRELLA LIAB OCCUR FAOH 0C(11RRFN(F EXCESS LIAB CLAIMS-MADE AGGREGATE $ AEU IZENIION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X SEATUTE ER H B ANY PROPRIETORIPARTNERIEXECUTWE YIN 6ZZU60457M12016 10/2412017 6016 10/24/ E.L.EACH ACCIDENT $ 1,000,00 OFFICEPJMEMBER E:CLJDED? Y❑ N I A (Mandatory lb NH) 3A N H E.L.DISEASE-EA EMPLOYEE $ 1 000 0O If yes,describe urder , , DESCRIPTION 0:OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 PROPERTY 11,24 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Phil Lacroix Jr, Mark Lacroix and Phil Lacroix are excluded from work comp. RE: 46 Weyland Circle CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N0110E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of No North Andover, MA 120 Main Street North Andover, MA 01845 AUTHO;RIZEEDDR,EPPRESENTAATiIVVE, O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD f°Massachusetts Department s Building Regulations a Public Standards ard of License:. CS-058730 Construction' u rviso MARK A LACROIX 16 THERESA AVF. � SALEM NH 03019 c � Expiration: 09111/2017 Commissioner s �i NH OSA aa; azo. 09LxM65111 1 Wit: j ss 3.110,,: 08/11/1865 1 IS.EYQ HAZ P�e 1 :�. J 1&.Hair E3R0 f<.MARK L CROIY y r3 19 THERESA AVE r 1