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Home My WebLink AboutBuilding Permit #836-15 - 48 HUCKLEBERRY LANE 4/22/2015pORTFt 9 BUILDING PERMIT to.,.'°16�°L TOWN OF NORTH ANDOVER' APPLICATION FOR PLAN EXAMINATION �` N-6 � Permit NO: Date Received ,, f 9SSAt� Date Issued: -I Z"�-'I �� CHUS LOCA IMPORTANT: Applicant must complete all items on this Daae MAP NO: th5 PARCEL: din ZONING DISTRICT: Historic District yes Machine ShOD Villaae ves 9 TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ A ration No. of units: ❑ Commercial Q,fRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Y FtL_-j— "6i-Le—O', — 1--PD*1 V -x Ali OWNER: Name: R%6tr Address: Identification Please Type or Print Clearly) q-19-973-1 3 iT �d CONTRACTOR Name:.Phone: — `/6:�7 i98V,U_)-A0(-S q? luic. Address Supervisor's Construction License:L� Exp. Date: Home Improvement License: 1 zZ-y � Jr -_ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ 33`3 Check No.: 4415 Receipt No.: 2 NOTE: Persons contracting wWu a istered contractors do not have access to the ranty fund Signature of Agent/Owner' Signature, of contractorPT-7-f- X Plans Submitted Plans Waived Certified Plot PlaQ,[],Stamr� TYPF, " F SEWERAGE DISPOS Public Sewer Tanning/Massage/B' led - well a inert b obtall Toho � e Dep eOixtto Private (septic tank, etc. pCopC�ate p „ed out {o< the p gyred forms to be h eC�;{s ist °f the reAU b`\eta%Ov p a� teC,ov �eha jne t ,e of Bldg Permit R Pef'm�t PP aav�\, f c S.L. Buy\a�rg Go,cc�p P�` G PndlO ° ofkefs 01 �\ \ ofk oduc�s ° �ho�co coportfact osed \V' -xiee fed pfoPr� c P oC r9 fn .f e o copy °f\ar Of `d �\ts f og ffo F P ° F\o°,reeving P,,s feauffe s`g uses ° Umpstef pefm - O��' P\\ d Decks Applicable) Of Proposed .Work With Sprinkler Plan And C N ) Pdd\t�or OC .ompliance Report (If Applicable) °�af�rEngineered rderoducts Bufrequire sign offfromFir Department prior to issuance of Bldg Permit ..action (Single and Two Family) ❑ ''Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit u 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 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 o Building Permit Application o 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 a 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 BUILDING PERMIT TOWN OF NORTH ANDOVER Permit NO: APPLICATION FOR PLAN EXAMINATION �� Date Received Date Issued: 4 Z11 1,z� IMPORTANT: Applicant must complete all items on this naLae LOCA PROPERTY OWNER__4L _QJ �4 L)a) 7 ( - Print MAP NO: PARCEL: QZ/n ZONING DISTRICT: Historic District Machine Shop Vil e yes 0, TYPE OF IMPROVEMENT PROPOSED USE Resid -tial Non- Residential ElNew Building L;-6ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ A ration No. of units: ❑ Commercial ❑ Others: PIRepair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other ❑ Septic ❑Well p _ _ ❑ Floodplain ❑ Wetlands - -- _ __ ❑ Watershed District ❑ Water/Sewer OWNER: Name: A)A)bt Address: CONTRACTOR Name: Identification Please Type or Print Clearly) Ph( T>__rJt:Q1L7 — Phone- Address- 4 Supervisor's Construction License: Exp Home Improvement License: Exp 1 ZZy/5- 6 q-18 - 973- IWST ne: q 28 316-%(!3 0 Date: Date: 6/96 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: $ ozoo FEE: $ ��`� Check No.: 15 Receipt No.: 2 NOTE: Persons contracting w e istered contractors do not have access to the t ranty fund Signature of A ent/Owner �.�_g_4_Signature of contractor" T Dimension Number of Stories: Total square feet of floor area, based on Exterordimensions. 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.$10o-$1000 fine NOTES and DATA — (For department use) S V\ (N -A o tgAR s R. u's -e l l►� c NI►�-LI � e- ❑ Notified for pickup Call 3 Email t Date Time Contact Name Doc.Building Permit Revised 2014 IL9 Plans Submitted Plans Waived 01 Certified Plot Pl6n. Stamped Plans ❑ 'FypF.,6F IEWERAGE DISPOS Signature -'t,cSewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private (septic tank, etc. El Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ING & DEVELOPMENT Reviewed On Signature f / �i b �, LA 51 d /V - CONSERVATION Reviewed ons#J/4//5' COMMENTS ure HEALReviewed on Signature COMMA%ENTS I ell e"i 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: FIRE DEPARTMENT -Tempillumpsto.ron;site , yes Located at 124 Main Street Located 384 Osgood Street _ no Fire Departmentsign-aturqtdato COMMENTS Location No. Date 616 )/S � Check # 1-6 TOWN OF NORTH ANDOVER I Certificate of Occupancy $ Building/Frame Permit Fee Founclation Permit Fee $ Other Permit Fee TOTAL $ Building Inspector s. 0 E J = LL O D O m .1 \O O 001 LL U1 T N U a N LLI H Z z m O co 7 O LL Cq O O KU T v O L — to O LL O H Z Z 00 J C UA O O d' to O LL cr 0 H Z u ~ W J W to O O Q' U p) Ln co O LL Q: 0 LU Z (a7 bA O O K _ ro O LL Z 2 Q W 0 uj LL N 7 m O Z N v N p Y O N rl J �61 Oam uml O LU Z CD 0 m `I,w■ ) UI O L co Z W ii. CL Z X O W V Cl) CL Z E lw C O O CL �a CcM J -0 O N Z dCL O Co Cc O Q. Ca sz m o N V Q. Y N _ O a) � t Q O E t O = cc r— O L (.i 3 d Q m L m _ 0O U) N c O i t U 'a rnQ r t = t 0 o ��Z tCLr� r„oo �MA3 = O ~ L Q Q d _ U) Vo. w Q L O= _ L M 4) CL m N m d .v W = a "0-oo0 �L �M .E : LU _ U) FE n o = O 1-- 4- O_ 0 U O LU Z CD 0 m `I,w■ ) UI O L co Z W ii. CL Z X O W V Cl) CL Z E lw C O O CL �a CcM J -0 O N Z dCL F I L �E. C•' Y April 15, 2015 Naga & Shoba Donti 48 Huckleberry Lane N. Andover Ma. 01845 Phone: 978 376-4043 ADDENDUM - A We at Marlowe Building & Design, Inc. are pleased to submit a proposal for the following: RECONSTRUCT EXISTING DECK ON REAR OF HOUSE 16' x18' THE NEW DECK WILL BE SLIGHTLY SMALLER THAN ORIGINAL, AS PER PLANS AND AS FOLLOWS: PERMITS & DESIGNS • All permits supplied by Marlowe Building & Design, Inc. • All drawing supplied by Marlowe Building & Design, Inc. EXISTING DECK • Remove existing Deck and put in dumpster on site • Remove existing Concrete footings and pads SITE PREP • Excavate for new Big foot footings place 3000PSI concrete • Excavate for stair pad and pour 3000PSI concrete and finish DECK CONSTRUCTION • All pressure treated framing lumber including post and beam's • Decking Timbertech Earthwood Brown Oak • Railings Timbertech Evolution contemporary Black • Lattice below deck on right side of stair location "Deck Only" • All risers & Skirts to be covered with PVC Board CLEANUP • Total cleanup of site. LANDSCAPING • Due to the severe winter weather you may need to hire a landscaper to repair grass areas as a small machine is needed to dig for big foot footings, which is not covered in the proposal. • 7ti $28,400.00 Thank you for allowing us to quote your work. Peter D. Marlowe President A Marlowe Building & Design 258 west Manchester St. Lowell, Ma 01852 Phone# 978-649-8570 FAX# 978-937-1990 Pelham Buildinp Supply P.O. Box 55 Pelham, NH 03076 SHIP j Li QUOTA {603} 635-7555 FAX {603} 635-9627 ; DESCRIPTION !Alt Price/Uom j PRICE j EXTENSION Page:1 Quote: 00011922 Special Time: 07:23:11 Instructions Ship Date: 04/01/15 Invoice Date: 04/06/15 Sale rep It 03 TOM PROVENCAL Acct rep code: 11 Due Date: 05/10/15 Sold To: MARLOWE BUILDING & DESIGN Ship To: MARLOWE BUILDING/DESIGN 258 WEST MANCHESTER ST. (978) 649-8570 MASS ( LOWELL, MA 01852 (978) 649-8570 3.00 L Customer#: 020525 00001 Customer PO: OrderBy:SARGE MOTH ORDER 1 SHIP j Li U/M 1 ITEM# ; DESCRIPTION !Alt Price/Uom j PRICE j EXTENSION DECK REPLACEMENT 112"X12'BUILDERS ( 3.00; 3.00 L EA I BT1212 TUBE 21.5200 EA 21.52001 64.56 5.00 5.001 Ll EA; 6614PT ***NOT STOCKED*** 1125.0000 MBF ( 47.25001 236.25 2.00 j 2.00 i L EA 1668PT40 j 6x6x8' PRESSURE TREATED ! 1056.2500 MBF 25.35001 50.70 7.00 ; 7.00 ; L 1 EA 1 ABW66Z 6X6 POST ANCHOR BRACKET 1 23.5500 EA 23.55001 164.85 14.001 14.00 (' L! EA LPC6Z fPA66TZDP I P1366-6TZ POST BEAM CAPS 4.7600 EA 4.76001 66.64 4.00! 4.001 L! EA �DTBTZ j DTB-TZ DECK TIE BRACKET I i 7.6840 EA 7.6840 { 30.74 1 125/CASE 1 4.00: 4.00 I Pj EA 12916476 11/2X36" HDG THREADED ROD HOT DIPPED GALVANIZED i 6.9900 EA ' 6.99001 27.96 3.001 i� 3.00 ` L EA ! i 2102OPT I BEAM UNDER ' 2x1 OX20' #1 PRES TREATED 1106.9991 MBF i I 36.89961 110.70 I ; j 1 ACQ 16.00 16.00 Lj EA 21016PT JTS/PLTS i 2xl0x16 #1 PRES TREATED 1 ; 788.7985 MBF I 21.03411 336.55 I! APROX 80pcs/LIFT 2.001 2.00 i ILI EA 12102OPT 12x10x20' #1 PRES TREATED ; 1106.9991 MBF 1 36.89961 73.80 f 32.00; 32.00 i L EA JH210Z ACQ JUS210-TZ 2X10 SINGLE JOIST HANGERS ` 1.2000 EA i 1.2000 1 38.40 1 LUS 21OZ 50pcs/bx j 10.1301 10.00 i Pi{ EA IZ03MO000000704 !A35Z HUTTIG SDS25112-R25 25CT BX 6.2300 EA 6.23001 62.30 4.001 4.00 LI EA MPA1-TZ ALL PURPOSE ANCHOR 0.6120 EA 0.6120' 2.45 100/ctn 32.00; 32.00 i L1 EA H25AZ RT7A-TZ TIE DOWN ANCHOR C 0.4800 EA I 0.4800 I 15.36 2.00! 2.00fL� RL ;7680457 10"x20' COPPER FLASHING 39.9900 RL 1 39.99001 79.98 1.00; I 1.00Ls r i ROLL 9751WB W/BACKER used W/ACQ 9"x75' FLASHING TAPE I 29.9000 R01-1,11. I 29.90001 29.90 CONTINUED ON NEXT PAGE *** 1 - Customer Copy W 1R y C X37 � i C) o 0 Y o o N N Ti o 'im'. dY gV5 ' 0 i � 3:: 0 _ Cts1: 1R y �i A, i Y 0 Ti 'im'. dY _ i 0 _ 1R y The Commonwealth of Massachusetts Department of Industrial Accidents d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): AJ%��L Address: City/State/Zip: Are you an employer? Check the appropriate box: Phone #: 1.M I am a employer with employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 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 proprietors with no employees. 5.❑ I am a neral contractor and I have hired the sub -contractors listed on the attached sheet. T e sub -contractors have employees and have workers' comp. insurance.t 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ N construction 8. �emodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the �,viol-att" copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance I do hereby' certify u r the p f s and penalties ofperjury that the information provided abovf is t ue and correct! Phone #: Td2Z— 0_24- 5 f t 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 #: �� '&4 �.k?id'ui4,e1% Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts -02116 Home Improvement Contractor Registration Registration: 122415 Type: Private Corporation r, Expiration: 8/30/2016 Tr# 256522 MARLOWE BUILDING & DESIGN IN,C:_-= PETER MARLOWE x �{ 404 MIDDLESEX RD. #1 i} TYNGSBORO, MA 01879 Update Address and return card. Mark reason for change. - ❑ Address L Renewal F -i Employment 71 Lost Card SCA i w 2OM-05111 { ��—. V�r (G'n7le7Jre-xcceal//! n,%n/�rt[.f.;(relrceJa/!J' k Office of Consumer Affairs &c Business Regulation N 8[3 OME IMPROVEMENT CONTRACTOR egistration 122415 Type: Expiration ()/201&. Private Corporatio,{ MARLOWE BUILDING & DESIGN'INC PETER MARLOWE _ 404 MIDDLESEX RD. #1' TYNGSBORO, MA 01879" Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - S i a 5170 Boston, M 116 valid without signature Massachusetts - Department of Public Safety Massachusetts - Department of Public Safety ' Board of Building Regulations and Standards Board of Building Regulations and Standards Cenctri,,tction Supervisor 4anstructiim Snpert-isor - License: CS4d8623 License: CS414685 tivl. /i r. DAVID G DEGAN= ' PETER D MARLOWE / 404 MIDDLESM-ROAD 258 West Manchefter;�j e� TYNGSBORO Mal 01819,Lowell MA 01851 ` s .1..G...�.d txpirall:on o-�, ,rs,s Expiration Commissioner 06/0612016 Commissioner 06/1.12016 04117/2015 12:16 9784549376 SZCZEPANIK INSURANCE PAGE 01101 MARL0-1 OP ID: SR - �•-� CERTIFICATE OF LIABILITY INSURANCE VATE(MMtDDIMY) 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(ie5) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the Gartificate holder in lieu of such endorsement(s). PRObUCBR Stephen, l.SzczepanikIns, 471 Aiken Avenue=.Nu Dracut, MA 01828 CONTALr NAME: PHONE FAX E :978-454-3106 No; 878 4549376 ADDAIL RESS: INSURER(QAFFORDING COVERAGE NAIL # INSURER A: Harleyeville Insurance Company 23787H INSURED Marlowe Building and INSURER a:Commerce Ins 34754 DESIGN INC 258 W Manchester St INsuReRc: - COMPIOP A00 $ 2,000,00 Lowell, MA 01852 INSURER 0; CO flBGdeO SINGLE IMIT $ INSURER E: INSURFF+ r: 13 BBQZVR COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE 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. IN LTR TYPE OF INSURANCE L POUCYNUMBER SUOR POLICY EFF M Y YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE 0 OCCUR 3PP35300.1 04/0812016 0410812016 PREMI9EET .. $ 100,00 MED EXP (Any one awn) $ 5.00 PERSONAL 8 ADV INJURY $ 1,000.00 LAGGREGATELIMITAPPLIESPER: GENRRALAGGREGATE $ 2,000,00POLICY jECTCTPRODUCTS MIOTHER - COMPIOP A00 $ 2,000,00 CO flBGdeO SINGLE IMIT $ AUTOMOBILE LIABILITY 13 BBQZVR 04/27/2014 04127/2015 BODILY INJURY (Per porsan) $ 500,00 ANYAUTO ALLOWNW SCHEDULED BODILY INJURY (Per accld4nt) $ '500,00 AUTOS NpN—OWNEDPERTYDAMA X X E $ 100,00 Peraccld HIREDAUT08 AUTOS S UMRRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE H AGGREGATE $ DED I I RETENTION -11, $ ER - YPORKERS COMPENSATION STATUTE R AND EMPLOYERS' LIABILITY Y E.L. EACH ACCIDENT S ANY PROPRIETORIPARTNERiEXECUTIVE OFFICERIMEMBER EXOLUPED? ❑ NIA A E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) "Yea, dsecxibe c,nd;I DESCRIPTION OF PERATIONS belw E.L. 018EASE - POLICY LIMIT $ t7E$CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Acldltlonal RB,11arka Schadule, may be attached if MOre apace Is requited) CERTIFICATE HOLDER CANCELLATION ANDOVEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Andover Building Dept AUTHO D REPRESENTATIVE 36 Bartlet St Andover, MA 01810 ® 4986-2014 ACORD CORPORATION. I rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD A DF CERTIFICATE OF LIABILITY INSURANCE -ATE (MM/UDIYY YY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE -POLICIES -DESCRIBED HEREIN TO ALL THE TERMS, 06/16/2014 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 endorsement(s). PRODUCER AMERICAN HERITAGE INSURANCE AGENCY C/O BATES FULLAM INSURANCE AGENCY, INC. 975 ELM STREET CONTACT NAME: PHONE Wit. FAX No: E-MAIL ADDRESS: West Springfield, MA 01089 INSURERS AFFORDING COVERAGE NAIC0 INSURER A : INSURED Accuservice Corporation INSURERS: AmGUARD Insurance Company 42390 INSURERC: 19 Leisure Drive Holland, MA 01521 INSURERD: INSURER E: INSURER F: $ 0 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 TO ALL THE TERMS, -IS-SUBJECT EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - IkSR ADOL 5 B --` POLICY EFF POLICY EXP -—--"'�— " "—"—"--- LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMlOD YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 0 COMMERCIAL GENERAL LIABILITY PREMISES (Ea owurtenceL $ O EI MED EXP (Any one person) _ S 0 CLAIMS -MADE OCCUR PERSONAL & ADV INJURY S 0 - GENERAL AGGREGATE $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: F-�UISC-COMPIOP AGG $ 0 POLICY PR O.LOC JECT - -- - $ _ .. - - --- - AUTOMOBILE LIABILITY CO BINE SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED NIREDAUTOS AUTOS PROPERTY DAMAGE $ .Ter accident $ UMBRELLA LIAR OCCUR w E_ACHOCCURRENCE EXCESS LU48 CLAIMS -MADE AGGREGATE S DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' WC STATU- OTH- X $ LIABILITY Y / N E.L. EACH ACCIDENT $ 100,000 B ED ECUTIVEa N/A R2WC501176 06/14/2014 06/14!2015 (MandaOFFICER/MEMBER )EXCLUDANY (Mandatory In I yes, describe under and E.L. DISEASE - EA EMPLOYE S 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mora space is requirsd) r�on IOIn 11 ---- Marlowe Building & Design 404 Middlesex Rd Tyngsboro, MA 01879 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 01988-2010 ACORD CORPORATIAN All rin64c rc�nrvnd ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD �AVs• d m ' �� '�'t.R+s �':'^}*-••mow fi �s �Jp�3Ck � i j+.«Harr .i1. � • ,FS' ��?. r � �i $ ..+^• "r'^w.. ,y,� 't. q � 1. M� �U•�q p �}�iiA j '6 I'1 ', ky � kf x � r 7 r, ! �.Pf 3 �b ' I�,q,t"4~�-.•."S'4 �-j ,,,meg v , ry yyy Y< O - F o yc E i i ® North Andover MIMAP April 22, 2015 104.D -0032R I 104.�D-0047 1.99� 39 989 SALEM ST Se/e 065.0-0019 10.0 tj 104.D-0070 0 28 38 et 1049 0 SALEM ST 104.D-0192 065.0-0208 00 1055 SALEM ST 104.D-0069 065.0-0209 42 HUCKLEBERRY LN 35 HUCKLEBERRY LN1, 065.0-0220 R2 48 HUCKLEBERRY LN 106.A-0048 N*1 065.0-0210 �� p: -.- _��l'..'-?:.: r •.i;-' '-ate. r ,�i,..: a .. . `° . 9 SALEM ST 47 HUCKLEBERRY LN 065.0-0219 mw j 56 HUCKLEBERRY LN .. . .... . ...... . . . ... .... . 065.0-0211 .A "W1 065.0-0218 d- ------ 59 HUCKLEBERRY LN k 065.0-0212 7 62 HUCKLEBERRY LN W 065.0-0217 67 HUCKLEBERRY LN 065.0-0213 065.0-0216 10,6:A-0049 Rail Line Wetlands Zoning Interstates C Exempt Lands Busime! I District Bu:lne! 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, — SR Buin' 3 District Buse 4 District VtORT01 Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads %-I Easements 0 GeneraBusiness District 10 Planne, Commercial - 0 North Andover. Additional data provided by the Executive Office of Environmental Affaim/MassGIS. The information depicted on this map is Corrido Development Dist Dist for planning onty. It may not be adequate for legal boundary E3 MVPC Boundary E3 Municipal Boundary C Corrido Development Dist 13 Corrido Development Dist n purposes definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, Zoning Overlay [3 Adult Entertainment �ndu:16::'113 !c ndu ri, nc� CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT [3 Downtown Overlay District 13 lndu::d 13 District ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 13 H District ndu ri S District s c Reside ca, 1 District THIS INFORMATION 0 Water ater Protection Reside ce 2 District L1 Parcels Reside ce 3 District C Hydrographic Features de -4 District �. 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