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HomeMy WebLinkAboutBuilding Permit #766-2017 - 49 RICHARDSON AVENUE 5/1/2018 NORTH 4(i (� ��"oi BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 7� 1 D I Date Received �' a ��A�'+�rEu �y �SSACHU`'�t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ' l� �a srdSo 0 Svc Print PROPERTY OWNER G 0 L 9 f a v� Print 100 Year Structure yes o MAP PARCEL:2—f ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family= ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg K Others: ❑ Demolition ❑ Other ale9i�'r�iZ4?��ovJ ~ -- ❑ Septic ❑Well ❑ Floodplain [I Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: S1//5 Identification- Please Type or Print Clearly \\ OWNER: Name: Lee G1 F0,114 Phone: f�� yah-y3o) Address: �.,��G�ct�dSO►�t �vr l� Odtl _ Contractor Name: Phone: 629 Email: Address: Supervisor's Construction License: /0600 Exp. Date: Home Improvement License: /06 Exp. Date: 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: $ z"30 0' .0 0 FEE: $ ?0-O 0 Check No.: Receipt No.: 3161 -2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swh ing Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Panning Board Decision: Comments Conservation Decision: Comments Water& Sewer Conn ection/si nature& Date Driveway Permit DPW Town Engineer: Signature: - - - - _ FIRE DEPA -iTMEN:T,'- Temp Dumpster on=site Located 384 Osgood Street f10 c Locatediat 4241MaincStreet Fire-Qdpartment signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER Z®NE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1o0-$1o0o fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date _ Time Contact Name Doc.Building Pennit 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 ;a, 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) 4 Maass 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 ;aF 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 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 Doe:Building Permit Revised 2014 Location r A n 17 S d /\✓ No. -)(9 G,O j Date ; - 10 - d -91 -7 . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check# a 1 Building Inspector NORT1� q Town of t 6 ndover 0 ' ~g No. - �� * h y ver, Mass 0 A_ GOG NK NlWKN �� 7a ADR�TED ►`PP,t�(� 1S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT � .T `� �� BUILDING INSPECTOR 0 04A A.0% Foundation has permission to erect .......................... buildings on ........... ... Axe. ..... k ... ........... Rough to be occupied as ........���....stN(.A".. .......V.. e.�.�t 'I. . ................................... 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 CONSTRU ;#. STARTS Rough Service .t....... . ....... .............. 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. L-A ForT 6 Federal to#054405629 RISE Engineering c�� oMA eg No 120979 Os CT Contractor Registration No620120 R1 I S 60 Shawmut Road,Canton,SMA 02021 CONTRACT 339-502-6335 FAX 339-502.6345 Page 1 PROGRAM TW CONTRACT 16 ENTERED INTO SETWEPII WE CMA-HES ENOWEERWD AHD THE CUSTOMER FOR WORK AS DES RISEDOELOW CUSTOMER. _. -.���.. -T~. PHONE DATE - CLIENT M WORK ORDER Leo Lafond (978)407-9307 01/20/2017 443819 23902 SERVICE STREET -- -• atWNO STREET 49 Richardson Avenue 49 Richardson Avenue SERVICE CTY.STATE.EP —_ eIWNO CRY,STATE.ZIP- North Andover,MA 01845 Notch Andover,MA 01845 JOB DESCRIPTION BARRIER:A Blower Door Test will not be conducted at your home,due to the presense of asbestos. $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be Icll 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 scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(10)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,_but the actual number of cfm 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. VS850.00 STORAGE BARRiER:1•lomcowncr is responsible for the removal of the stored items blocking the installation of wcathcrization - work in the attic. Removal must occur prior to the scheduled work start. (initials) 50.00 1 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with rigid board at R-10 or greater with the required rite rating.Weatherstrip the perimeter. $60.00 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose to existing bathroom fan(s). $60.00 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items blocking the installation of weatherizatian — - work in the basement. Removal must occur prior to the scheduled work start. initials) 50.00 BASEMENT SiLLS:Provide labor and materials to install(122)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $237.90 ID LEadE J. 4N 2 ,, 2017 f i Federal ID#05-0406629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 �� CT Contractor Registration No620120 RISE E 60 Shawmut Read.Canton,MA 02021 CONTRACT ENGINEERING' 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT B ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRISED BELOW CUSTOMER _ �.. PHONE DATE ^^Y— CLIENTS WORKORDER Leo Lafond (978)407-9307 01/20/2017 443819 23902 SERVICE STREET - --'�-.. __.�.. _. - SUAM STREET ..�._ 49 Richardson Avenue 49 Richardson Avenue SERVICE CITY.MATE,ZIP �._- BRIM CRY.STATE.ZIP _ North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION 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'/o for the Air Sealing measures up to the first$660 and an additional$340 if savings are justified by the auditor. For the safety and health of your 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 atter the wcathe67ation work is complete.We will also conduct a full assessment of the combustion safety of your heating system and Crater heater.This has a value of$90 and is at no cost to you. Total allowable weathcrization incentive is$3,110. The Permit will be secured by the insulation contractor,at no additional cost.It is the homcownces responsibility to close out this permit by contacting their municipality at the completion of this work. 590.00 i� JAN 2 3 2017 Total: $1,297.90 Program Incentive: $1,163.42 Customer Total: $134.47 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ""One Hundred Thirty-Four&471100 Dollars $134.47 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREED TO REMIT AMOUNT DUE W FULL INTEREST OF 1%WB..L BE CHAROED MONTHLY ON ANY UNPAID BALANCE AFTER SS DAYS.BEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING.AND CONTRACTOR REGISTRATION. _ �� DON T SIGN THIS CONTRACT IF;THERE AREA LANK SPAC _ _yAUTHOR E1G TORE-RISE 2npingAnQ STDNER ACCEPTANCE �— NOTE:THIS CONTRACT MAY DE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT.THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE 30SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AYTHOF ZED TO OO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE t RISE60 Shawmut Road,Unit 21 Canton,MA 02021 1339-502-6335 ENGINEERING www•RISEengineering.com Z .;citncy Enc rEi_td. OWNER AUTHORIZATION FORM I, e� /— 4 Yo7 12 d (Owner's Name) owner of the property located at: '-t C? o4�c�,yx�,rSy(n ,� l �(Property Address) /�' (Property Address) hereby authorize 'P0 & P b r4 V, -� �f✓�ti T G 9 (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. The Permit will be secured by the insulation contractor,at no additional cost. It is the homeowners responsibility to close out this permit by contacting their municipality at the completion of this work. Owner's ignature i Date JAN 2 3 2017 6.2016 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information POLAR BEAR INSUIATION Please Print Legibly Name(Business/Organization/Individual): PO BOX 958 ANDOVER,MA 01810 Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.N I am a with employer 4. ❑ I am a general contractor and I � 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I 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. #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: jo q)[` M A S :4�S v r A W t' 61 1M N tA Policy#or Self-ins.Lic.#: pt7WC' P1 01/ Expiration Date: at • �o��' Job Site Address: N q ►"e-ti 4 rdStt, 19ye, City/State/Zip: J4Ve( 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 civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ains and penalties of perjury that the information provided above is true and correct. Sip-nature: Date: G -112 Phone#: 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#: Office of Consumer Affairs and Business Regulation 10 Park Plaza.- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration - Registration: 102726 Type: DBA Expiration: 7/2/2018 Trt 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX 958 ANDOVER, RM 01810 _ Update Address and return card.Mark reason for change. SCR 1 ea 20M-W11Address E]Renewal E] Employment 0 Lost Card ✓ICC�r.p//IIIJp/lfl'lllf(![1�'gl�fi.Lifit7lflSC/!.i Office or Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. Hfound return to: Regis&atior.: 102726 Type: Office of Consumer Affairs and Buent a Regnbtion Expiration: 7/2/2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST-45A __ :�,�:�_+�v��. ••l/``,_�....d'� LAWRENCE,MA 01841 .Undersemtnrf I IV Piot valid without signature 'SDET- o'3LIiidina Reg Lila ans's and iETIda dis AMIN _ta:-se: CrvSL406017 t PETER A LEBLANC 2 EASTPINE STREET Plaistow NH 03865 .-:r.••a_S.C;V.e 04MB12018 9 AC40 CERTIFICATE OF LIABILITY INSURANCE DATE Fs/lo( sY) 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 polies)must be endorsed. 9 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 endorsemen s. PRODUCER CONTACT NAME Linda 8 daaowicz Insurance Solutions Corporation PHONE (603)382-4600 FAX1A_N =(603)362-2034 60 Westville Rd E-MAIL INSURERM AFFORDING COVERAGE NAIC/ Plaistow N8 03865 INSURER Western World INSURED INsuRER B Mantilus Insurance group Polar Bear Insulation Company Inc INSURER C: PO Box 958 INSURER D: INSURER E: Andover HA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632326234 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. NOTVNTHSTANDING 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. INSRLTA TYPE OF INSURANCE D POLICY NUMBER POLICY EFF POLICY EXP LTALIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS MADE $ OCCUR PREMISES Ea occurrence $ 100,000 UPP9274967 3/24/2016 3/24/2017 MED EXP one $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2,000,000 % POLICY❑PRO- JECT F]LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL AUTOOS AUTOS ED BODILYINJURY(Per accident) S NON-OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS Peraccid $ S $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESSLIAB CLAIM"ADE AGGREGATE $ 1,000,000 DED I I RETENTIONS AN026107 3/24/2016 3/24/2017 y WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERSCECUTNE OFFICER/MEMBEREXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE5 If yes,describe under DESCRIPTION OF OPERATIONS be EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached K more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/SJA (���--- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r7ntnntl 1/3/2017 Insurance Services ACCORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 0110312017 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(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 endomement(s). PRODUCER CONTACT NAME: Automatic Data Processing Insurance Agency,Inc. J PHONE Ext): aC,No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC R INSURERA: NorGUARDInsuranceCompany 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER c: PO BOX 958 Andover,MA 01810 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 598370 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 504K POLICY EFF POLICY EXP LTR TYPE OF INSURANCE MSD WVD POLICY NUMBER MMIDO MIDD/ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE D OCCUR PREMISES Ea occurrence) $ MED EXP(Anyone person) S PERSONALS ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑1PE�T [7]LOC PRODUCTS-COMPiOPAGG $ OTHER: $ AUTOMOBILE LIABILITY $ Fa accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS Per accident S $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ S WORKERS COMPENSATION x AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOMPARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCWDED? Y❑NIA N POWC840361 01/01/2017 01/01/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 11000,000 If yea describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if merespace Is required) Contractor License:CSL 106017 HIC 102726 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main st North Andover,MA 01845 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD https://adpia.adp.com/ISExtemal/app/index.htmi?clientid=2037315&requestFrom=mn#/home 1/1