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HomeMy WebLinkAboutBuilding Permit #306-2016 - 49 COBBLESTONE CIRCLE 9/9/2015 T � �wwG b Q�2�/iS : BUILDING PERMIT of NoRTN A>-N TOWN OF NORTH ANDOVER 0 A APPLICATION FOR PLAN EXAMINATION = ,� I q Permit No#: —7,61.6 oTED Date Received � R c....9 e `5 gSSACHUS Date Issued: I� IMPORTANT:Applicant must complete all items on this page LOCATION 7 C6.4�/ S�b � �I /Z-, Print �, / PROPERTY OWNER J if /1.� 13 rP C P/l �\\��- Print 100 Year Structure yes no MAP / PARCEL: vt� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family El Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: U Demolition ❑ Other .Septic n Well ❑ Floodplain E],Wetlands p Wateshedi D..istnct DESCRIPTION OF WORK TO BE PERFORMED: ///V( Al(2- &a 4 /J Identifi ation- Please Type or Print Clearly OWNER: Name: T�d/�/�7�7-�� �Q� G ��1/ Phone: Address: a Contractor Name: 0 e Phone: Email: 41 Address: ,S5- S-geti .� Q2u�' 4 Supervisor's Construction License: &? S-11 Exp. Date: � > Home Improvement License: 6afl� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: b U Receipt No.: NOTE: Persons contracting with et ed Tactors do not have access to the Location/q No. J — ���° Date • - TOWN OF NORTH ANDOVER LE10 • a>. _ Certificate of Occupancy $ � Building/Frame Permit Fee $ � Foundation Permit Fee $ ` s Other Permit Fee $ TOTAL $ Check# r -- r Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 HEALTH Reviewed on Signature COMMENTS r 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 D - T � _ . ,. _ ,.� _ .� EEP�RaTtMEIV �T;�eDu ps er ntsite lyes m wm t o q rh .�. �IF ocated at1w24!<Main 5t«eet'ie`Department gi,— s Dimension i 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 pp requires approval of q 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 Pennit Revised 2014 4 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 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 4. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products . OTE: All dumpster permits require sign off from,Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers. Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products IN OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH own of �.. � �� Andover 0 - . � No. 3 j _ qw2o Ila ,h verMass, o a COCNICNEWICK 11A U BOARD OF HEALTH Food/Kitchen LD Septic System I�N BUILDING INSPECTOR THIS CERTIFIES THAT .....PER4T� .. .. ........... ........... ...... �...0`r .D p ; C.. Foundation has permission to erect .......................... buildings on .... .. '!�X Ti4r.... ............. �.. ( Rough to be occupied as ....... ... .. ..... ....... ..... .mow .. .►.444................................. Chimney provided that the person accepting this permit 11 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 WONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC I TA Rough Service .............. ...... ...... .. ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. ►v next step living® i home energy.solutions This agreement is made by and among i Annette Brecken Next Step Lt urng Inc.("NSL") ) 21 D dock Avenue, 2nd floor ry 49 Cobblestone Cir Boston,MA 02210 North Andover, MA 01845 phone: (866)867-8729 Site ID: 419184 02-Jun-15 1. DESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customer's address above,in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work's which are Incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. 'Description Quantity Investment Air Sealing •mniendations $1,020.00 Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 12 $85.00 Hr $1,020.00 I Weatherization Recommendations $1,9it .11 Work Location: Attic Flat Damming 52 $2.05 Lnft $106.60 Uaen rath%nit osoff Propavent 2'or 4' 37 $2.00 Each $74.00 Install 2"Thermal Barrier Polyiso on Kneewall 14 $3.50 sqft $49.00 Install 2"Thermal Barrier Polyiso on Kneewall � 33 $3.50 sgfl $115 50 Work Location: Doors Door:Thermal Barrier Polyiso 2"(Attic) ,� 1 $73.91 Each $73.91 Initial Investment: 000 7' r� z a:� Q -r Y � � bdlo Alrsealing fticentie�p tt Pr;�rt Max 4 � � 2 �0 ' '`' , <t a r yn r �('."$ .rp y�,� r.F,y,z-Cs.S�j.� F.�r'��' z!Z7 �+.a 'F.'r t' r,;1;.; ,r±.l r'S -•3`r33�.s fu..-s SL��_,x 'r�.X. f 'r,7 j �'3 /V-YY atfi6_ization, I ell,iVe urs V r-r �GT�IYIQ `3r`�� y'• 1�0�5XI� t .h�:y x..., '� _ J/M M"O A z.,4t)yjf- , z [� Customer Signature qa - 2 Jun 2015 Andrew Carpentier N ignature Date Name of NSL Representative Al 107661 The Terms of this Agreement are contained on both sides of this page Next Step Living a 21 Drydock Avenue o 2nd floor o Boston,MA 02210 a(866)867-8729 o inquiry@nextsteplivinginc.com o www.nextstepliving.com v TERMS OF AGREEMENT 419184 3.PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time,subject to the availability of subcontractors or materials,or to delays attributable to the weather or other events beyond NSL's control. 4.CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to: Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116.617973.8700. 5.PERMITS NSL will obtain any necessary permits as the Customer's agent. Customers who secure their own pemtits ordeal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6.PERFORMANCE OF THE WORK AND CHANGES 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer 6.2 This Agreement may be supplemented,amended,or modified only by the mutual agreement of the parties.No supplement,amendment,or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times,our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents.Such concerns can include but are not limited to ventilation,potentially hazardous materials such as mold or asbestos,or structural concerns. In the case of health or safety concerns being identified, NSL reserves the right,per section 9.2 of this contract,to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and incentives available from the Mass Save®Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However,at times our weatherization team discovers situations in the home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations,NSL will communicate such changes to the Customer,Including any Impact on amount the Customer would be expected to pay for the Work. The Customer will have the option to remove from the Contract the work elements that need adjustment,or set up a separate contract for performing the adjusted work. 6.5 NSL represents and warrants to the Customer that(a)the materials and equipment furnished under this Agreement will be of good quality and new,(b)that the Work will be free from defects,and(c)that the Work will conform with the description of the Work described in Paragraph 1. 6.6 NSL may determine in the course of preinstallation Technical Review that modifications are necessary to the scope of Work in order to ensure professional quality of the Installation. In the event of such modifications,NSL will request a written modification of the Agreement to be signed by all parties.In the event that Customer and NSL cannot agree on the modification,the Agreement may be terminated by either party. 7.INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration(No:162111)and the necessary insurance required by applicable law and normally maintained by prudent contractors in NSL's field,including,but not limited to,Workers Compensation Insurance for all employees who will perform the Work. 8.QUALITY OF WORK NSL agrees that the Work will be performed in a good and workmanlike manner,and that NSL will repair and replace,at its own expense,and promptly upon Customer's request,any defects in workmanship and materials provided by NSL which appear up to(1)year after completion of the Work or within any longer period as permitted or required under applicable law,provided NSL has received final payment as provided herein. 9.PRE-EXISTING CONDITIONS&PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall,moisture damage,non-code construction,cracked or fragile siding or shingles,old pipes and fittings,rotting wood,etc. . . 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos,mold,or any other potential health risk to the Customer. In this event,the Customer Is responsible for remedying the at--risk situation,including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot-resume until remediation Is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect,including dust protection,any personal property including the home itself. NSL will.not be responsible for damages to or losses of any of the above mentioned property not property protected prior to the commencement of the Work. 10.GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law,to have,file or maintain a mechanics or material men's Hen,or to file a notice of intention to lien,and to take any other steps to perfect and enforce such a lien,if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that In executing this Agreement,they are not relying on any representations,warranties or terms other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. 11.ENERGY BENEFIT& The Sponsoring Utility Company(the Utility)is entitled to 100%of the energy benefits associated with all Energy Conservation Measures,excluding the value of energy cost savings by the Customer,but Including all rights to all associated ISO-NE Energy,Capacity and Reserves Products.NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the.UUlity's ownership of such benefits and Products. 12.NOTICE CONCERNING SPONSORSHIP. 12.1 Customer understands and acknowledges that NSL is not an agent,vendor or sub-vendor of The Sponsoring Utility Company(the Utility)with respect to the installation of an energy efficiency measures.In the event of the failure of an energy conservation device to perform as expected,Customer's sole recourse is to Contractor and not to RISE Engineering (RISE)or to the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed. 12.2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. 12.3 Customer agrees that it shall not hold RISE,the Utility,their affiliates or operating companies liable for Contractors to perform its obligations under this agreement,for failure of the energy conservation measures to function,for any damage to Customers Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13.LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14.CONTRACT CANCELLATION Under Massachusetts law,you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or a branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mall posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. Plainview Diagram Customer eQ Advisor Name: �,►,��-- Address k �.�h f 11 e ,� C-�-= Advisor Phone #: 17 --6q �, ss�_r Town —A). Any limitations to access by truck? Site ID NOTES Any work scoped outside of Best Practices? Approved by: +twos��n JLC 0 12 �X� -76yc 7 1vu� �atii,,n 5-2 3 veSe�3 ne ., fob' �-3, CV i9-bfiZ, �L—q"oAC,-?2.p JS Dw Fps 31 0L5- A-t 4Z NoA44eo P IVa p I i12. oo titi s1 orG Y �2 v w l� 6 i Lf (� 13 — ® ice ol Consumer Affai and Business Regulation 10 Park Plaza - Suite 5170 7 4i Boston, lVlassachusetts 02116 Home ImprovementContractor Registration -. Registfation: 162111 Type: Supplement Card Expiration: 1/14/2017 NEXT STEP LIVING INC. ROGER OUELLETTE � 21 DRYDOCK AVE. 2TH FL - BOSTON, MA 02210 - -,; Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 0SMA-04104-G101216 Ej ,:/f18 �IOM27J'LOOLC(k-CLL�K d�../��;scr�ir�aelta . _ Office of Consumer Affairs&Business Regulation -License or registration valid for individul use only 41 " !_ before the expiration date. If found return to: �IiOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration .162111 Type: 10 Park Plaza-Su' 15170 ` !t' EWratl=n—.1!1.412017 Su lement Card ` PP Boston,MA 021 NEXT STEP LIVING 1NG ROGER OUELLEWTE Y_ t 21D RYDOCK AVE,2Tki_FL BOSTON;MA 02210 Undersecretary PIW/Valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents v Office of Investigations u ' d I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston, MA 02210 Phone#:(866)867-8729 Are you an employer? Check the appropriate box: Type of project(required): I.N I am a employer with 850 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition [No.workers' comp.insurance comp. insurance. required.] 5. n We are a corporation and its 10.[]Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no OtherIn§ulation employees. [No 130 _ comp.insurance required.] '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 affidai it 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins. Lic. #:AWC-400-7030025-2014A Expiration Date: 9/30/15 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civilp enalties 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 cover v hition. Ido hereby certify under the pains and en es perjury that the information provided above is true and correct. Signature: Date: I D I l Phone#: (tom)&_7`9-720 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#: i a �1 NEXTS-1 OP ID:EL ACORO' DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10/0112014 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ON1 y AND CONFERS NO RIGHTS UPON TH9 WTIMPATF HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AI_TER THE COVERAGE AFFORDED BY THE POLICIES BELOVy. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AIJTHORIZIEp RIcP PSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the gertificate holder is an ADDITIONAL-INSURED,the policy(ies)must be endorsed. If SUBROGATION IS W'AI 9R,SBIi1P6 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 CONTACT MCLaughlip Ipsuiance Agency PHONE Erin Lyons FAX 826 Lynn fells Parkway AIC No Ext:781.665.2775 ac No):781-665.02 Melrose,MA 02176 ADDRESS: John E.McLaughlin,Jr. INSURERS AFFORDING COVERAGE NAIL S INSURER A:Nautilus Insurance INSURED Next Step diving,Inc. INSURER B:Commerce Insurance Company 3475 21 Drydock Avenue,2nd Floor Boston,MA 02210 INSURER C:A.I.M.Mutual Insurance Co. INSURER D:AXIS Insurance Company 15610 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 P RIIQp INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC T}(19 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDfYYYY).(MMIDDfYYYYI LIMITS A * COMMERCIAL GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED CLAIMS-MADE F_XI OCCUR ECP2010198-12 09/3012014 09130/2015 PREMISES Ea occurrence $ 190,000 MED EXP(Any one person) $ 0,90 PERSONAL 8 ADV INJURY $ 1,019,19 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ +!1400109 POLICY OJECT PRO- POLICY PRODUCTS-COMP/OPAGG $ PRO- OTHER: Ea accident $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 909,09 ,. B ANY AUTO 14MMBGKKDM 09130/2014 09/30/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA U B X OCCUR EACH OCCURRENCE $ 5,000 00 D REXCESS LIAB CLAIMS-MADE EIU783547012014 09/30/2014 09/30/2015 AGGREGATE $ 6.00Q.099 DED I I RETENTION$ $ WORKERS COMPENSATION X PER EOR AND EMPLOYERS'LIABILITY STATUTE ER Ci ANY PROPRIETORIPARTNERIEXECUTIVE YM N I A TO BE ISSUED BY CARRIER 0913012014 00/30/2015 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) FOR INFORMATION ONLY CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information OnlyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014191) Tho A99RR 94rRo NO Im,are qq1%t : 9!ACORN t�T ' Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supenisor SpccifllN License- CSSL-102311 ROGERAOVELLET 35 STANMORE Wannek ILII 028,� ., d� Expi ration Cornmissione+ 09§1312016 RestPicted TO: CSSL 0C-Unsulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing Infemation visit: www.Mass.Gov/DPS