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HomeMy WebLinkAboutBuilding Permit #721-2016 - 47 MARBLEHEAD STREET 12/15/2015se^,v FA I�'- )�-�'s BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:"l o1/ Date Received Date Issued. �7i1 1 LVVIPORTANT: Applicant must complete all items on this page LOCRA; 10N n � A°RATED OD ° TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other ❑ Others: �MS ic ;; ©V1/e l ", � ®Floodpla n 01NefLands a r �•F Watershe�er/;S�.. DESGKIP I IUN UI- VNUKK I U tit t't:KrUra1v1Cu: lcneeuiol ZpSvlaT� e Identification - Please Type or Print Clearly OWNER: Name: Tm r-, t7 L- -e v-, Atgr1rracc' -.i -> ekA 1' h f" L rani ri Phone: 4103 NK ;:1 c I`h {5}i% mho e;F,'ye,>, Will. Exp. Date Su ervsors Construc'i®n Licenset0�01�''� a66 !Q ryf < �y - .,®ate: Zp• Home Imp.ro.vement !• Livens—e:K ��„ ARCH ITECT/ENGINEE Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ I )- o - o o FEE: $ 30 Check No.: �P� Receipt No.: ���l2- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature :off 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 DTE: 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) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ATE: 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 Doe: 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. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS f HEALTH Reviewed on Signature COMMENTS 1. . Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes e Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: 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 drops requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ® Notified for pickup Call Email F Date Time Contact Name Doc.Building Permit Revised 2014 4 - - - , - -- � - - - - . Location 4rze� No. Datel2d '—S�—Ib 157 Check 03M 2981-2, TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ Building Inspector v FW 0 C E N 0 O n Z N CD CL O a iw _. _� ��y >c O v� CL CD CD O ou W CDCD Q O cn CD CO 41D � v O CD n O roolLO O N d � N ro ru rr zD 0 C T S. v �1 .c c o0 5,rD T o, N < .Z7 c c 00 Z V T7 0 c oa r m .Z7 o c T o c 0 m� V1 0 o � N T 0 0 A y T m o V '� G7 H 0 a r m '° n > m A 700 oO C C) m A 0 M w C z G) m (D 3 3 rD 0 X Z -v m Z 0 CD O e� Z T T r: r z CD M O r - O O M O CD N O _O O- to O W S.Q 7 CD ca 0 cn 0 coCAPCD 00� O ai 7 a cn CD C CDCL CD ' CD n 0 3 O N „O► CD O O .+ C Wft 0 CD (n 0 SD ID CD Q. O @CD O• O rt CQ Q' O N O O �• " ~ n r+ CD O• CD _ CD 0 O CQ c C O y oCD 0. Cr > CAI ' r. 0 = co < CD CD N m•'��� C CD W � CD CO's F.-� sm 0 O CO O ..i O CE CD C CD U) CCD N C CD 0 cn D m C� 0 c) 0 CL LA o 0 � rD 0 ro N ro ru rr zD 0 W c � (� T S. v �1 .c c o0 5,rD T o, N < .Z7 c c 00 T E' m T7 0 c oa T 3' fl n .Z7 o c T o c 0 V1 0 o � N T 0 0 A T m o V '� G7 H 0 a r m '° n > m A 700 C C) m A 0 w C z G) m (D 3 3 rD 0 W > o 0 D r S I VAa Federal ID # 06-MS629 RISE Engineering RI Contractor Registration No 8186 NIA Contractor Registration No 120979 A division of Thielsch Engineering CT Contractor Registration No 620,120 60 Shawmut, Canton, MA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 R1 S S.i PPage 1PROGRAM E DIGIN E E RI NGTm CONTRACT is ENTERED INTO BETWEEN mSF CMA-HES ENGWEERMG AND THE CUSTOMER FOR WORK As DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT® WORK ORDER Janet Lees (978)885-1203 06/11/2015 040.11820 00003 SERVICE STREET BILLING STREET 47 Marblehead Street 47 Marblehead Street SERVICE CrrY, STATE, ZIP BILLING CnY, STATE, ZIP North Andover, MA 01845 North Andover, MA 01845MY Jct JOB DESCRIPTION AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This work will e concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed) (4) working hours. A reduction in cubic feet per minute (cfin) of air infiltration will occur, but the actual number of cfin is not guaranteed. At the completion of the weatherization work, and at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality. $340.00 ATTIC ACCESS: Provide labor and materials to insulate the back of (1) attic hatch with 2" rigid Thermax board. Weatherstrip the perimeter. $60.00 KNEEWALLS: Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to (128) square feet of kneewall area $448.00 BASEMENT CEILING: Provide labor and materials to install (120) linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $210.00 BASEMENT DOOR: Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2" rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and seams with FSK tape. $72.22 RISE Engineering will apply all applicable, eligible incentives to this contract You will only be billed the Net amount. Currently, for eligible measures, Columbia Gas offers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 100% for the Air Sealing measures up to the first $680 and an additional $340 if savings are justified by the auditor. For the safety and health ofyour home's indoor air quality, we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun, and after the weatherization 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 $90 and is at no cost to you. Total allowable weatherization incentive is $3,110. $90.00 Federal ID # 05-0405629 RISE Engineering RI Contractor Registration No 8186 MA COrllraCtOr Registration NO 120979 A division of Thielseh Engineering CT Contractor Registration No 620120 60 Shawmot, Canton, MA 02021 339-502-5197 FAX 339-5024x345 CONTRACT R i CS E Page 2 PROGRAM ENGINIEERING CKA-HES EEGINNEEER�GAArroCT ��OOMEINTRFOOR RKAAs DESCRIBED BELOW CUSTOMER fl��7 NE DATE CUENTA WORK ORDER Janet Lees I� t✓ =' 8)885-1203 05/11/2015 401820 00003 SERVICE STREET LLNG STREET 47 Marblehead Street J UL 7 2015 EA7 Marblehead Street SERVICE CRY, STATE, ZIP G CTTY,STAW-2V North Andover, MA 01845 lo, h Andover, MA 01 845 JOB DESCRIPTION Total: $1,220.22 Program Incentive: $1,022.66 Customer Total: $197.56 WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE VJRH ABOVE SPECIFICATIONS. FOR THE SUM OF ***One Hundred Ninety-seven $ 56/100 Dollars $197.56 UPON L INSPECTION AND APPROVAL BY RISE ENGINEERING. CUSTOMER AGREES TO REMIT AMOUNT DUE N FULL INTEREST OF 1% WILL BE CHARGED MONTHLY ON ANY UNPAI - CE AFTER 30 DAYS. SEE REVERSE FOR RTANT INFORMATION ON GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Ln�;� t2 A G URE- RISE Engineering CCEPTANCE J// NOTE: THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WRHIN DATE ACCEPTANCE l/ r/" - 2O ACCEPTANCE OF CONTRACT -THE ABOVE PRICES, SPECIFICATIONS AND CON13MONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTHORED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM I Janet Lees (Owner's Nam) owner of the property located at CC EOV 47 Marblehead St North Andover;;: fill (Property Address) ' 47 Marblehead St North Andover, (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. G - // - 61r//S Date Tile Cominoltti'ealt%1 of f;ff((ssacliusetts d Deparfuzent of 1trr1alstr(a1 Acc(rlellt5 Office of'hzvestigation5 t _ =ice - 600 TT!asJ&1gto11 Street =tom= Boston, 3,1A 02111 ivt;vlP 121ass. 9av/tlitt Work -erg' Compensation Insurance Affidavit: Builders/ Contractors/Eiectricians/Plumbers Name (Business!Organization/individual): ro i4'L rd 1 -ea r lj o tj fa ry'.'t' n C, tq Address: phone:: P 7 Are you an employer? Check the appropriate box._ I.9I am a employer with h 4- ❑ 1 am a general contractor and I employees (full and(or part-time)_" have hired the sob -contractors 2_ ❑ I am a sole proprietor or partner- listed on the attached sheet - ship and have no employees Tlresesub-contractors have working for me in am capacit%"_ en'Pla ees and hay -e Ny orkers [No xtorkers' comp. insurance camp. insurance.Z required.] 5. ❑ We are a corporation and its 10 lain a homem-Imer doing all work officers have exercised their myself. N_ workers' comp. right of e-vemption per MGL insurance required_) ` c- 152. §1(4). and are have no enyiavees. [No work -e& comp. insurance required.] ig 5 -- Type of project (required): 6_ ❑ Vie«- construction 7. Remodeling S. L7 Demolition 9- ❑ Buildinge addition 10-❑ Electrical repairs or additions I I -El Plumbing repairs or additions 12.17 Roof repairs l3-[_0ther A51 q? D � `am" applicant that checks box =1 rnt6t also fill old rite section 1100 t sltotcina. their ceorkers compensation policy inrornatinn. ' I (omeatcners who submit this afridayit indicatins they are doine all .con!; and then hire outside eontrctars ntttst Submit a new afiidaVit indicating such. `Contractor that clic-- this box ntust attached an additional sheet shotyine the name of tyle sub-catnraciors and state uitetlter or not those entities hate ernpitn"tes. tripe sub -contractors (tare employees- they Durst protide their corkers' comp" policy number- 1(tm on snlplore_r Mai isprovitrin wor/(erS' compensatloll i/tsarunce for n7 r entpIq ees. Before is the podicr and job site i1t rol-111arioll. Insurance Company Name: Policy = or Self -ins- Lic_ ;p�" - Vje—_ 6-- Z9V & �� Expiration Date: f p O& Job Sitc Address: /NIAJ 19Iv It ecc0[ 'j i City/State!Zi j Attach a copy of the tyorkers' compensation nolie4 declaration pave (shot,.ging the policy number and expiration date). Failure to secure coverage as required under Section 25A of 11GL c- 153 can lead to the imposition of criminal penalties of a fine up to S1-500-00 andlorone-year imprisonment, as ~yell as ciNzil penalties in rhe form of a STOP WORK ORDER and a fine of up to 5250.00 a da- ao_sinst tate violator- Be advised that a copy of this statement may be for\tarded to the Office of Investigations of Ste DIA for insurance coverage vel ifreation. 1 do hereby rertyy antler file pains and penalties ofperjllrr- that the information prorlrted abose is trlre allyl correct. f%, '_s Officiall(se onlr. Do not write in this area, to be colnpdeterd br city (tr totetll official. City or Toww. I'ermit/License R Issuing Authority (circle one) -- L Board of lit -111th ? Building Department 3_ Cit%/To%vn Clem: -l. Electrical Inspector a. Plumbing Inspector 6. Other Contact Person. Phone'—:-, CFR-FIFICATE OF LIAGILI-IY INSURANCE )2/18201JL01OATE(tY,� 4 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, ANDTHE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed if SUBROGATION 15 WANED, subject to the terms and conditions of the poficy, certain pofiicies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AL1 NM1E: PHE (A.0 NIXExtr (nc nvk Automatic Data processing Insurance Agency, Inc. ADDRESS: 1 Adp Boulevard Roseland, NJ 07068 INSURERS) AFFORDING COVERAGE NAM -4 INSURER A. NorGUARD Insurance Company 31470 INSURED POLAR B EAR INS ULATION CO INC INSURER B: LYSURER C: DBA: Polar Bear insulation CO Inc PO BOX 958 Andover, MA 01810 INSURER D: INSURER E - -INSURER F: COVERAGES CERTIFICATE NUMBER: 191629 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA\SED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRE \,E NT. TER M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ;SAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. imsitTYPE LTR OF INSURANCE INSD t VU POUCYNUMBER 0.1KODYYYY) (ldMDD:YYYY) LM"S COSitiEROAL GENEItAL UABILRY EACH OCCURRENCE S CUMIS-MADE ❑ OCCUR PRELUSES 1Ea ucunrrrsr! S MED EXP 1lnper•.e peur:ny S PERSOML E M721N) URV S CENL AGGREGATE LR.111M'PUES PER. GENERAL MCREGATE POLICY a J ECT FILOC PP.ODUCTS-COLtP.OP AGG S � OTFgit. AUTO6bBLLE LIABtLFIV tEa aL[ 12erti 1 . 1' 5 BODILY INJURY tPe arson! S ANY AUTO ALLO:FNED SCHEDULED AU i 05 AUi OS HIREDAUTOS NON-0l';NEU AUi OS BODILY IN) URY (Per aLuder..r S (Pet2WLE31tk •1. 5 5 Uh 3PEU.A LUIB Occult EACH OCCURRENCE S ACCREGATE S EXCESS UAB CLAMS-r•U1DE DED RETENTION i S A WORKERS CMIPENSA7*N AND EMPLOYERS' LIARtLrrY MY PROPRIETOR.i'ARTtEREXECUiIt•E Y!N OFFICERS«M1tIER EXCLUDED, � (Idmdatm m NH) N:A N POWC660990 01101/2015 01/01/2016 x SLITUIE ERH ELEACHACCIDENT S 31.000.000 EI_DISEASE-EAEt11'LDYEE 5 1,001)01)0 dOde 0r EL.DISEiL-E-POUCY LIMIT 1,000,000IUlyCRIPTnxOF DESCRIPTION OF OPERATIONS ;LOCATIONS (VEHICLES (ACORD 101 Ad&t6wJ Re -6 Sc -re. nw he attached if marespaee is required) Columbia Gas massachusetts CERTIFICATE HOLDER rANCELLATION AG lVdIS-1014 At.UKU LiJKFORATION. AU ngnu re t:Ivww ACORD 25 (201401) The ACORD name and logo are registered marks of ACORD LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Theilsch Engineering, Inc. ORDANCE WMiTHE POLICYPROVISIONS- FAVniOlUMDREPRESENTATiVE 29SFrances Ave Cranston, RI 02910 AG lVdIS-1014 At.UKU LiJKFORATION. AU ngnu re t:Ivww ACORD 25 (201401) The ACORD name and logo are registered marks of ACORD ®1310- SS ®_ CERTIFICATE OF LIABILITY NSURANCE DAZE cM>xmnmxn 03t83f2015 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 COmmeT i3ETWEEN THE iSSUifilia tRPSURER(S), A9iCIiORIPED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTAi\ . if the cerEificaYe holder is an AiSDMONAL INSURED, the pa., ., 013S) must foe endorsed if SUSROC�A iORP IS WAIVED, su(ojeci to the terms and conditions of the Policy, cartafn 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 Durso I& Jankowski Ins Agcy LLC 198 Massachusetts Avenue North Andover, MA 01845 Durso i& Jankowski ins. Agcy. coNracs NAME: PHONE Em FAY. No): Ift A: c Dag lD e_ POLAR -1 INSURER(S) AFFORDING COVERAGE NAIL s POLICYNUMBER INSURED Polar dear lydsarlariora Ca. InC. P 0 Box 958 INSURERA:Fenn America 32859 MuRERRB:Snfety Insurance Co. Me Andover, Mcg 0181D iNsuRe+c: INSURER D . INSURER E INSURER F: EACH OCCURRENCE S 1,0001000 GVvIZK^"CS L;r-n l Irlwe I U ,au.e,wa . - - --- LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. LTR TYPEOFINSURANCE POLICYNUMBER MMM EfF PAMIO QtP UBM GENERALUABILRY EACH OCCURRENCE S 1,0001000 PREMISES o0� S 50,00 A COMMERCIALGENERALLIABILITY AC7052023 0=412015 OT24PL016 CLAiMS-MADE f XI OCCUR MED EXP (AnY one PetS-) S 551000 PE RSONALBADviNJURY S 1,00Q,01) GENERALAGGREGATE S 4000,00 PRODUCrs-comPIOPAGG S 1,000,000 GENLAGGREGATE LIMIT APPLIES PER- S POLICY PRO LOC COMBINWSINGLEUMIT S 11000,000 AUTOi OBILELIABILi'iY (Eeaccident) ANYAUTO 01)926 01104MIS 01104=6 RODILYINAURY(PerPe—) S AU.OWNED AUTOS BODILY IN a rdd-i) S SCHEDULED AUTOS PROPERTY DAMAGE S }C. HIREDAUTOS (PERACCIDENT) S NON-OWNEDAUTOS 5 UPSBRELLAI.= OCCUR EACH OCCURRENCE S 1,000,00 A EXCESS uae CLAIMs�iADE PAC5906M 032412015 0312412016 AGGREGATE 5 DEDUCTIBLE S S E H RETENTION S WORKERS COMPENSATION ANDEPAPLOY11iS LUiB1UTY ANY PROPRIETORIPARTNEROIECUiIVEYQ E.L. $ MELDISMEASE-FAEMP LOY S OFFICERIMEMBER EXCLUDED? (Niaedawy in NH) NIA UMiT S If yes, describe underDESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATONS ILOCATIOUSIVSUCLES (Atladr ACORD IM. AdeManal Remarko St hedtdq If more epaco is required) Insulation Work - Mineral; Additional insured forc� eneral liability blt III ects to worn performed ora their behalf by $hc above insured is teisch res oineering Thlelsch Enginearing Columbia Gas 195 Francis Ave Cranstan, RI 02910 ACOR® 23 (2009109) THIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EI(PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988-2009 ACOtRD The ACORD name and logo are registered marks of ACOIRD An rights reserved. onsumer Ams and 'mess g,elatlon Office of C Plazaite 5170 - Su 10 Park 02116 Boston, Massachuse gyration Home �rovement Cont>��or �� tte9on: X02726 '� VW DBA YI# 2=49 ExP�on: 72016 POI -PLR BEAR (NSULP`T[ON CO- Vincent LeBlanc P.O. BOX 958 1810 = - - _ _- , moa for ckange- ANDOVER, MA - - Update Address and retmra EmPio�` t 0 bast Card Address geae%val _ . x1216 OPS�CAt Ar `�� -- Massaci.usEL�s = Department oe PuasaCdards Hoard of Building Regulations and C„n,tructinn Supernianr Specisln, r; . License- CSSL'l9W7 PETER A LBBLAN+C Z WT pME ET W 03865 . rxpira#ien %A, i4iUW-18 Commissioner