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HomeMy WebLinkAboutBuilding Permit #665-2017 - 50 HIGH STREET 12/22/2016SOy( ��(��' BNII�®INO PE I VI" TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION In(n� Permit No#: �C`� Date Received Date Issued: 12A'M i `D IMPORTANT: Applicant must complete all items on this page LOCA I®N l _- kin NIhvu Residential (P a0PE_.,R`.�LT�Y®WNE„I '- IRT in � MAP P�, RC, E-�ONINGHi�St £1 D0 Y aar�S ruc ur ye no fIc D strict ❑ Addition Machine oh Villa e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: >4Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .s .,cin,.�I- I Welll �w.sp.'+ ' ®Flood�pla-ink® W�eflands y.y '-�7"'°��,v.ei- v �� lWaters_hed ®istrlctr °° I N IC er/4_ewe��__��j L_.- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Ty e or Print Clearly OWNER: Name: RSG- %i- Iii C- , Phone: 1 '7�f Address a r-& 10d, Z t'a-f retractor N m V__ (&_'G' Supe rs RsConstr6en�Expo; ARCH ITECT/ENGINEER,I -f- h! Phone: �t Ci �Q A Address: 2b O H;5"olec- Si Reg. No. Q�3� FEE SCHEDULE. BULDING PERMIT.' $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ tt-1-1O 1 FEE: $ � 1© 0 (06q, Check No.: Receipt No.: -J ( Y7 I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ---�.,-�� rye--��--,--------- --------�-----� ure.of Aaent/Owrier Simattare:of� Plans Submitted ❑ Flans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/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 o U FORM ' PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS a Zoining Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 'Planning Board Decision: Conservation Decision - Comments Comments i 1 Water & Sewer C®nnectionisignature & 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 drop requires approval of Electrical Inspector lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA -- (For department use) U Notified for pickup Call Email f F Date Time Contact Name Doc.Building Permit Revised 2014 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 ®TE: 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 o 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 ®TE: 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 ❑ 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 Doc: Building Permit Revised 2014 ":51 Location I/S No. Ko 6- Is' Date ,2, 1 � Check # n TOWN OF NORTH ANDOVER Certificate of Occupancy s Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $- TOTAL s Final Construction Control Document W To be submitted at completion of construction by a w Registered Design Professional ,ew"~ for work per the 8a' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: West Mill — 4th Floor Part 2 Date: 3/2/2017 Permit No.665-2017 Property Address: 50 High Street North Andover, Ma 01845 Project: Check (x) one or both as applicable: New construction X Existing Construction Project description: Renovation of existing office space I, Donald M Walter, MA Registration Number: 9536 Expiration date: 8/31/2017, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: X Architectural Fire Protection Structural Mechanical Electrical Other: Describe for the above named project. I, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisionMR 107. 1►�D��� `? h "tiT �'� Enter in the space to the right a "wet" or electronic signature and seal: '` :� � 4'�o.:r,3u� A SCjJATE w 9) k� Phone number: (718) 499-2999 Email: dwalter@doreandwhittier.com 1°\ ''',ti ,V Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Enter construction cost for fee cal - Notfh And6ver Fee Calculation Construction Cost $ 42,010.00 m $ - $ 504.12 Plumbing Fee $ 63.02 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 63.02 Total fees collected $ 730.15 50 High Street Tenant Fit up Suite 45 Genians 665-2017 on 12/22/2016 O� MORTN '14 O • 0 ; tas�c��t CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 665-2017 on 12/22/2016 Date: February 24, 2017 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street — Fourth Floor - Suite 45 MAY BE OCCUPIED AS a tenant fit up — Genians IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill NA LLC 50 High Street North Andover, MA 01845 Fee:Prepaid $100.00 Receipt: 31369 Check: 2569 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 665-2017 on 12/22/2016 Date: February 24, 2017 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street — Fourth Floor - Suite 45 MAY BE OCCUPIED AS a tenant fit up — Genians IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill NA LLC 50 High Street North Andover, MA 01845 0 �r% fA , MARIO! Fee:Prepaid $100.00 Receipt: 31369 Check: 2569 I g01tyk �y &4c, CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 665-2017 on 12/22/2016 Date: February 24, 2017 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street — Fourth Floor - Suite 45 MAY BE OCCUPIED AS a tenant fit up — Genians IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill NA LLC 50 High Street North Andover, MA 01845 ,0 gy- w=� '�Mr- iwildmig Inspector Fee:Prepaid $100.00 Receipt: 31369 Check: 2569 I:� O _ _ O� RS = V C Q. ai O : E v E n (A w u.i - E tm :.Bcc cc � N aL 10 �J N � N � > _ = 1 4) (a � C c dC .y. t Ova -.�aC /�"• a`> z = o � o = t ! cm > o L Q. m a) as =' ++ _ .0) C _ _ Q L L M Q. 4 LU V O O LU lz .9:'y ? CLMy C N •= — � v v W � v � VQ C (D cn m rc U)� m ,., 0 s w CL 0 t0 F. V Cl) 0 vg m c0 O ZR W Ni a Z x 0 GC co az M m Go L CDE O 'fJ Z O Q ; �o� A' W Q .E m m CL S v O O CL CL CL � C( t v J � .Q O Z W O CL V ^N •� _ CL U) rR �f LU1 LU� x (A LU Vf of V Zoc a Z Z U mp E N _ m J W W LL v ? p \ O A p N \ U O Q O N *' "p L 7 = O OO niz 7 7 7 i O yp L bD p N N Z Y 41 O OLL N LL = LL d' N 4' LL m N N _ _ O� RS = V C Q. ai O : E v E n (A w u.i - E tm :.Bcc cc � N aL 10 �J N � N � > _ = 1 4) (a � C c dC .y. t Ova -.�aC /�"• a`> z = o � o = t ! cm > o L Q. m a) as =' ++ _ .0) C _ _ Q L L M Q. 4 LU V O O LU lz .9:'y ? CLMy C N •= — � v v W � v � VQ C (D cn m rc U)� m ,., 0 s w CL 0 t0 F. V Cl) 0 vg m c0 O ZR W Ni a Z x 0 GC co az M m Go L CDE O 'fJ Z O Q ; �o� A' W Q .E m m CL S v O O CL CL CL � C( t v J � .Q O Z W O CL V ^N •� _ CL U) 3 0 H LUW 2N LL 0 O m N t "O O LL E N N :N CL 41 N O z Q) > m c O a OO LL CA d' C t U O LL O W Z z > d to O — O LL O d Z V u J W tbD0 O d' v O N — C L.L. O w a CA z C7 O Q' CU C LL Z a W LL m N � N O O O O L r L CD CD Q 0 o° U,C �Q U) �r- 4) Em o � 75 77- o " 3 Q' c N1 d � •: � c :> CU = 1 wo O c O > �r ca V Q r-. O Now `0z cn L LLJ GC E- aCl) z W 0 cnV I.fLIJ az E O z° O o = o .= U _ �Emm as ams a 'a O �+ v D O ocx C. ai Q OM c ��- O °r U) V 0 CL CL U) JK Contracting LLC 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 7811-254-2862 (Judy) Bill To: Genians, Suite 45, 50 High St. N.Andover, Ma 01845 Proposal Proposal Date: 11/3/2016 Proposal M 203-62 Ship To Genians 4th Floor, Suite 45 North Andover, MA Ol 845 Project. ou reign st, uenia... -Description Est. Hours/Qty. Rate: Total Permit C of 0. 478.00 478.00 'emo 2,000.00 2,000.00 General Conditions, including dumpsters. 2,000.002,000.00 Wall Framing. 1,200.00. .. 1,200.00 ., Doors and Trim 1,500.00 1,500.00 Heating & Cooling, includes new 5 ton unit and all ' 15,900.00 15,900.00 ductwork [estimate] Electrical & Lighting [estimate] 3,000.00 3,000.00 -Floor Coverings[estimate] 3,200.00 3,200.00 Interior Walls, Board, 2,000.00 2,000.00 Interior Walls, Tape, sand 2 500.00 2,500.00 Painting 3,000.003,000.00 Teie/Data [not priced] 0.00_ 0.00 Insulation 400.00 400.00 Cleanup & Restoration 200.00 200.00 Sprinkler Work 900.00 900.00 'Supervision 3,827.80 3,827.80 Insurance 382.78 382.78 Estimate for your review and approval . Approved: (Initials) I SIGNATURE Total $42,488.58 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER -.•� CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECT TITLE: West Mill -50 High St. 4th Floor PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT a ARCHITECTURAL STRUCTURAL FIRE PROTECTION *' ELECTRICAL ' OTHER (SPECIFY) MECHANICAL FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRES�ENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled m �D A -y�r 3. Be present at intervals appropriate to the stage of construction to become, generally fa is a" with6the progress and quality of the work and to determine, in general, if the work is bNo •g 6 performed in a manner consistent with the construction documents. SLIT A E. SUBMITPURSUANT TO SECTION 116.2.2 1 SHALL TOGETHER WITH PERTINENT COMMENTS TO HE NORTH ANDOVER BUILDING NSP` of�55��e UPON COMPLETION OF THE WORK, 1 SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. -11 ' SIGNATURE SUBSCRI ED AND SWORM TO BEFORE ME THIS DAY OF(j--13 URKINS14AW 61) Notary I°G' C:ommun `�-- -�'� wea`•: it�C4 r'�eGssael3useil NOTA P BLIC MY COMMISSION EXPI+ tuic-an Expires March 7, 2019 lcx The Commons,, alfh c,!f 11assachuseit.s Deparf..rftigt 0'1YM7kYfria1 A. ccid&ts Office1fflnvesfigations 660 Washington Street Boston, MA 02111 wwip.mass.govIdia Workers' Compensation Insurance Affli€laviit. Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/fndividual)' C--- Address: City/State/Zip: Iy • I N� 0�--- M " Phone # Z —6 —? Are you an employer? Check the appropriate box: 1. I am a employer with Lf" 4. El I am a general contractor and I employees (fulland/orpart-time).*. havehiredthesub -contxac#ors 2. ❑ I am a soleproprietor or partner- listed on tb.e attached sheet ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. (No workers' comp. insurance 5. � We area corporation and its required.] I officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp, c. 152, § 1(4); and we have no insurance required.] t employees. [No workers' comp. insurance required.l Typo of project (required): 6. ❑ New construction 7.Tg Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs ad 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 aie doing all work and then hire outside contractors must submit anew affidavit indicating such. lContractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. .1 am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name% � � � V y.6,�, c -'s- Cz M q �� Y Policy # or Self -ins. Lic. #:_ W C_� _ Expiration Date: 2 i 7 A Job Site Address:_ Ml 6--.x k—, F I d s, - City/State/Zip 1 V T lam) n m - � ) 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 ofMGL 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 sof investigations of the DIA�for insurance coverage verification. r do hereby cell under theme pains andpenaldes ofperjzity Mat 67;e information provided abovq is trueland correct. V/i_T1, 6 Official use only. Do not write in this area, to be completed by city or town official. City or Town: s Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: JKCON-1 OP ID: CD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDMW) 07/26/2016 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 DeSanctis Insurance Agcy, Inc. 100 Unicorn Park Drive(AIC, Woburn, MA 01801 CONTACT NAME:-------- ._...-----.. - ------ --- .--- PHONE I FAX No Ext): _ __•_-_ �_a( C, Nom EMAIL ADDRESSa.__-----..--- --____-- __ INSURER S AFFORDING COVERAGE NAIC # --- — -- S-1-- — — AGE 02/10/2017PREMISES INSURER A:Star _Insurance Company 012245 _ -- __-- — --- - _ INSURED JK Contracting, LLC. INSURER B: Selective Insurance Company 19259 4 High Street Suite 108 North Andover, MA 01845 INSURER C �p // INSURER D: INSURER E: PERSONAL & ADV INJURY $ 1,000,00 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 FFOR THE POLICY PE�f00— 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. -- -- --;A�56T.(FBR ILTR — TYPE OF INSURANCE ----- —�— —� POLICY EFF yV POLICY NUMBER MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS BX COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-il OCCUR �S2205113 02/10/2016 02/10/2017PREMISES EACH OCCURRENCE $ 1,000,00 (Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 �p // PERSONAL & ADV INJURY $ 1,000,00 I I GEN'L AGGREGATE LIMIT APPLIES PER -- ' GENERAL AGGREGATE $_ 3,000,00 -- x POLICY PRO- I JECT —i LOC i Ir PRODUCTS - COMP/OP AGG $ 3,000100 1 $ OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) BODI' LY.INJURY (Per person) $ BODILY INJURY (Per accident) $ ANY AUTO ALL OWNED y—I SCHEDULED I AUTOSNED AUTOS �{ AUTOS ) HIRED AUTOS � AUTOS I I i PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS MADE i DED RETENTION $ $ ( A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE®I OFFICERIMEMBER EXCLUDED? (Mandatory In NH) I N I A i IWC0853742 ,MA I 02/17/2016 I 02/17/2017 PER OTH- X STATUTE ER E. L. EACH ACCIDENT $ 100,00 —"— E. L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 If yes, describe under IDESCRIPTIUN OF OPERATIONS below I I i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN CONTRACT" Illustration of Coverage; Town of North Andover is add'I ins'd as respects to the GL policy. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) C 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NORTHA- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 43 High Street N. Andover, MA 01845 AUTHORIZ PRESENTATIVE �p // ACORD 25 (2014/01) C 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I I TMassachusetts Department of Public -'Safety Ir Board of Building Regulations and Standards License: CS -066334 Construction Supervisor KIERAN T WHELAN` 31 RICHMOND STR WEYMOUTH MA: 02'..r -1r= Ott �(./��— Expiration: Commissioner I--09/26/2017. 1. j - m 941- rrrrurr:rrrurvi�(� -' Office of Consumer Affairs & Business Regulation �� t�,HOME IMPROVEMENT CONTRACTOR ( ;Registration ' .171393 Type: Expiration 3/l5(2Qa8 Individual -;. V KIERAN WHELAN KIERAN WHELAN ` 31 RICHMOND ST WEYMOUTH, MA 02188 Undersecretary License or registration Valid for Individual base only fore the expiration date. If found return toi (Dffce of Consumer Affairs and Business Regulation. ;.10 Park Plaza - Suite 5170 r Boston, MA 02116 J - f ' Not valid without signature C��Le c�'arrerraarruncrl��r o�C��aa;rnc�aoeCt .'; Office of Co 9itiner Affairs & Business Regulation HOME IMiPROV*EMENT.Cl3.N7RACTOR RegistrType: ation:=.._ V71393 :M •. # /7 Exp iratia� _-3t5t2418 Corporation _:,-._ +. X CONTRACTING LLQ:` KIERAN WHELAN 31 RICHMOND ST t,:wr_.z WEYMOUTH, MA 02188 Undersecretary i.