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HomeMy WebLinkAboutBuilding Permit #Exception - 52 HEWITT AVENUE 5/1/2018 - BUILDING PERMIT o`"��T b�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received o � ��SSACH►1`+�t�� Date Issued: - IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100,Year Structure yes no MAP _ _.____PARCEL: ZONING DISTRICT:.Historic District yes no Machine Shop Village yes- mo 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 ❑ Others: ❑ Demolition ❑ Other El Septic ❑Well ❑'Floodplain ❑Wetlands Q Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone.- Address: hone:Address: Supervisor's Construction License:_ Exp. Date: _. Home Improvement License: _ Exp. Date.-- ARCH ITECT/ENGI NEER ate::.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. �rotal Project Cost: $ FEE: $ Check No.: Receipt No.; NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund Signature of Agent/Ovv_ner Signature of contractor.'- i I Plans Sub.dtted-E'] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on-site ,yes _ no Located at 124,Main.Strebt Fire Departmentsignature/date COMMENT limension 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 ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Pen-nit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r f 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 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 ❑ 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 VOTE: 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 buildingapplication pp cation Doc:Building Permit Revised 2014 Location No. -Y�7 - 0 Date /0 f9' SCI • - TOWN OF NORTH ANDOVER N, Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# r � .�It � �r��•--•r n, (J Building Inspector r i 110RTH own o 1�. Andover No. s p i oh ver, Mass, COC MICNl WIC/I A�RATEO S U BOARD OF HEALTH Food/KitchenPERMIT T LD } Septic System THIS CERTIFIES THAT ...... . .f .Vt.AE..........EN ��.�..� BUILDING INSPECTOR ............ ............................................ ... Foundation has permission to erect .......................... buildings on ....Ol......: .....!. . ..�.... .. .. E. Rough to be occupied as 1DoOK .*AJ...... 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 CONSTRUCTION ST R. Rough Service ......................'".. ,.:......... ... ... ... .................... 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. NORTH Town Of _ Andover p to I No. �� a1 * - ti h ver, Mass, /Q • 1 1 COCMK NIwKM y ADRATED s V BOARD OF HEALTH I Food/Kitchen PERMIT . T L D Septic System THIS CERTIFIES THAT ..... �. g e e.. ............................................ BUILDING INSPECTOR ... Foundation has permission to erect .......................... buildings on ....._ ...,,�j�................................. ....... ..�...- .S. Rough SAI� .. ...........to be occupied as .......4.1A.......... 0 ...........� ...... 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 CONSTRUCTION SZ R ;S Rough Service ..................... .......... ... ... ... ... .................... 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. REVISE ENERGY RM A O'IPIETRQ COMPANY As an employee of Revise Energy (DiPietro Home Energy) holding an Unrestricted Construction Supervisor Llcense (CS-056846), I hereby grant permission for either Dan Carroll, Matt Hammer or George Desroches of Revise Energy to apply for and or pull a permit in my name and under my license for Weatherization work. Weatherization work may include, air sealing, blown cellulose insulation, installation of weather stripping, door sweeps, thermax, etc. approve this permit to be file un n Junder ,/ my name by either gentlemen listed e town of. �U� above in the cp Sincerely, John Cullen License # CS-056846 Cell: 781-526-5581 t _ REVISE ENERGY twang This agreement Is made by and among ncyn NaeRevise Energy "'W- Hewitt Ave 5 South Summer St North Andover,MA Haverhill,MA,01835 437901 Phone:(800)885-SAVE Tuesday,July 26,2016 L DESCRIPTION OF WORK TO BE PERFORMED Revise Energy 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")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. Part QuaM price unit $ Custom Item 10 $85.000 Air Sealing $ -� - --- Ce 850,00 - - - _ - IFP —Er, Item 254 $3.500 Poly KWS $ 889.00 Custom Item 216 $1.650 3.5"FG KWS $ �qo (DFy- 356.40 - - -- Custom Item 24 $3.500 Poly Gable $ 7-0 84.00 j Custom Item 64 $3.700 - - Poly Rim Joist $ /ID236.80 ZD $ Mass Save Incentive: $ 2,024.65 C t Q*T"Sig a Date 691- t 7/26/2016 Lt zz 16 YE AJ c(T-I Re46 Energy ture Date Name of Revfte Energy Representl* t.PAYMEM:CUSTOMER a4rae6 to pay Revise Ener`y for the work as follows: PaymEnt#1: $ 50.00 Credit card or check deposit is due at the time the Work is scheduled.Required payment information will be collected over the phone by a Cusbomw servke at the dme of scheduling. (Nobe:Mastercard,Visa,and Discover accepted). AddidonM Payments and Rnal Invoke: $ 341.55 Iddi'tionad payments for the Work shall be due upon completion of the Work. If the final khKA a Is being paid by deck,credit card information wi41 stili be required at the time of sche&AIng.Notify the customw service represent We that you are Pawl by check and yaw card will not be charged Unless we fail to receive payment within hin 5 days of Involve. The Terms of this Agreement are conuftied on both sides of d us page Revise Energy•5 South Summer St•HaverhAi,MA 01M•(800)885-SAVE•helloOReybe£nerp.mm•www.RevixeEnargy.cnm TERMS OF AGRITMrN71 3.PROPOSED START DATE AND COMPLF,TION SCHEDULE. REVISE ENERGY 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 otherevents beyond REVISE ENERGY'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,"fen Park Plaza,Suite 5170,Boston,MA 02116.617-973-8700 S.PERMITS. REVISE ENERGY will obtain any necessary permits as the Customer's agent.Customers who secure their own permits or deal 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 REVISE ENERGY 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 r 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 i being identified,REVISE ENERGY reserves the right,per section 9.2 ofthis 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 SaveR Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the REVISE ENERGY home energy advisor.However,at times our weatherization team discovers situations in the home during the course of the Work that impact the availability ofrebates and incentives from the Mass Save Program.In such situations,REVISE ENERGY 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 REVISE ENERGY 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 die description ofthe Work described in Paragraph 1. 7.INSURANCE AND REGISTRATION. REVISE ENERGY represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration(No:185083)and the necessary insurance required by applicable law and normally maintained by prudent contractors in REVISE ENERGY's field,including,but not limited to,Workers Compensation insurance for all employees who will perform the Work. 8,OUALPTY OF WORK. REVISE ENERGY agrees that the Work will be performed in a good and workmanlike manner,and that REVISE ENERGY will repair and replace,at its own expense,and promptly upon Customer's request,any defects in workmanship and materials provided by REVISE ENERGY which appear up to(1)year after completion of the Work or within any longer period as permitted or required under applicable law,provided REVISE ENERGY has received final payment as provided herein. 9.PRE-EXISTING CONDITIONS&PROPERTY PROTECTION. 9.1 REVISE ENERGY 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 REVISE ENERGY reserves the right not to perform Work upon the discovery of asbestos,mold,or any other potential health risk to the Customer.to 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 REVISE ENERGY will make best efforts to protect any property of the Customer,it is the Customer's responsibility to remove or protect,including dost protection, any personal property including the home itself,REVISE ENERGY will not be responsible for damages to or losses ofany of the above mentioned property not properly protected prior to the commencement of the Work. 10.GENERAL PROVISIONS. 10.1 REVISE ENERGY reserves the right,the extent permitted by applicable law,to have,file or maintain a mechanic's or material men's lien,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 REVISE ENERGY as provided herein. i 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 REVISE ENERGY 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 I Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties.You may cancel this Agreement if it has been signed at a place other than the REVISE ENERGY's normal place of business,provided you notify REVISE ENERGY in writing at its main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this Agreement.See the attached notice of cancellation form for an explanation of this right. 11 ENERGY BENEFITS, 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.REVISE ENERGY agrees to provide the Utility with such i funiher documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. r 12.NOTICE CONCERNING SPONSORSHIP. '12.1 Customer understands and acknowledges that REVISE ENERGY 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 sok recourse is to Contractor and not to Clearesult or to the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the enorgy 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 Clearesuit,the Utility,their affiliates or operating companies liable for Contractor's to perform its obligations wider this agmoentrnt, for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 11 LLMffFD TIME OFFER The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mas Save Home Energy Services Program crffm. 14,CONTRACT CANCELLATION. Under Massachusetts lair,yon way cancel this agreement if it has been sigeed by a party thereto at a place other than an address of the taer,which may be bb main office or a branch thereof,provided you notify the seller in writing at his main office or branch by ordinary wail posted„by dram seat or by delivery,aat later than midnight of the third basiness day following the signing of this agreement. REVISE ENERGY DATA COLLECTION FORM Advisor Name&# LI vue vem n Site ID 13:�qd( Date Customer NANrg F-Vk4 Address S-� H wir.r 8VTown -f�.--ANnr)v"t-, _ Phone# 0Ij1($J_J0Jq Elec.Utility Ki/_VA0 Acct#CJJ0DL_ f Gas Utility Acct#gbg Owner ender -;'u'�.►•c. nA Siding Type &Lun - Year Built ants w Occupants ..Z Fridge Make Checked under siding? N Balloon framing Y Bedrooms Fridge Model Roof Mat. }P � Winter T-Stat° / Summer° Fridge Year _21 i `t Mechanicals Health and Saf DHWType �W%DNF HVAC Type Asbestos Y K+T YL/ Unvented r��� Kitchen Fan Fuel C-6S yr '){�I� Fuel _ Yr (� VB Required Y� Structural Y N in attic Y�N uf-� �1+� .(�,, ' AFUE Size Iy °F Jd_ Distr 1» /SSE `v,� Moisture Y© CO Detector G N #Floors Style Ct}IPb- Deeper Savings Ceilings / Colongi,Victorian,Ranch,Cape,Mansard,Gambrel, Triple Decker,Contemporary,etc, HVAC Service Opp? Y N Windows Opp.' Y N Area 4 Type SI_&-LF r-Arni(_c4 HVAC Sales Opp? Y N #Single Pane Finished BSMT? Y N Partial Single Family,Multi�Family,Condo,Townhouse Electric Service Opp. Y N Values ANN VR-(— LrsA& ' s- / 043 -How long have you cmc (goo)a32_-01ao F64 4r or lived here? fH Inll ,Sfl IT _ ���.� � LrRO SA- -What projects have PAASy SftC E�aO lNS TO (X(J, co cnn- NO. J �{�� 9{7� you completed? r_rVr_0fu Oigoyfy 1 al,l- 'le-S Ro-O -How long do you plan 12-I&PL60 t �ANa &Z 10 g1lZ& to five here? �'�� --- Comfort 13o •Most important (S (0 W A LRMrS cSC'pi(PtL - 137118143 �gc rooms? a S W CFhlpL,t S 0 rX ( 1 -What temperature do 02 you set the heat when SLS CAS �IQ you're home? *Do you turn it down at night? �1�J��o -is that for savings or comfort? -Do you notice a temperature difference throughout the home? Where? -Have you done ( Q MO / anything to address comfort? Windows *How do you like your windows? t __ e What solutions have you considered? /l" 5S SSS r HVAC *How old is your J heating system? r -Any concerns about u it? *Who services it? 1 *Noise a concern with your heating/cooling? IONS 1 v^+ t r *Distribution? ,lU. I r a� I Planview Diagram Custo FANCY RYAN Advisor Name: U??-jE V�n/un Address Advisor Phone #:l93$Tgf y-C)(SK Town _N, t?nlpoV - Any {imitations to access by truck? Site ID AtC) NOTES Any work scoped outside of Best Practices? Approved by: 0 A/S 2T Cc 4') * kW Tf-ANS. (S-') 10 R.S W k:Q I NSU At,. ,R:T W' '2„ ro Ly ((A q, Q INSULA* k-WS W1 3,S"F&Z 4 0 "POLI (at(R¢� Q EW-&VO MOCI I"ro rLIE-4T- 7rAnlSrnW (38) IAO ULATC- G 6LC' 6tioS W/ .2" PO(-j (Q LIA) '�iSYYCC' 38` �v Z -Doem62 tS t�hC3DUE eC-No,ice K.AxtteN- V W S mA y ".gE N Y-.W& SUT 1 SM-'C-0 f�N►s�r>va �v jN cRsc NO ACCESS 'R> CAP- WAY 'No SMALL. (� b 5.s` Ds 03 Lk SALE I N rf-O ET ofDo�,06e-s 15 b SCQ Bus CD--ftLF- rarm 1 he Commonwealth of Massachusetts f. _ _ _,rani _ j Department of Industrial Accidents Office of Investigations kf I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Ob Please Print Le0b Name (Business/Organization/I individual): Q-, Address: St1ti�h 5o nn1n�_t-- City/State/Zip: ✓ i ,,,� S Phone Are you an employer? Check the appropriate box: Type of project(required): 1.ZI am a employer with—'�j ; 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance. 9. E] Building addition comp.[No workers' comp. insurance p• 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.❑ 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 �_7_r_ 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 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: Policy#or Self-ins. Lie.#: C 1 y (o �\j C�c6g (as ZS Expiration Date: o LA I l-0 ( Z O 1-7 Job Site Address: S�a� Q t�J. /�I/ City/State/Zip: 'l A v-__�dA ®05(�j 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. Ido hereby cern nder the ai and enalties o er'u that thein ormation provided above is true and correct. Si nature: .. _7Date a 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#• Aco V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) `...,� 10/25/2016 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 CONTACT ONTCT Emily Costello Costello Insurance Agency, Inc. PHONE (978)374-6352 ac No:(978)521-5127 2 S. Kimball St. -MAILecostello@costelloinsurance.com ADDRESS: � PO BOX 5248 INSURERS AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURERA:Colony Insurance Company INSURED INSURER B:Commerce Insurance Co. 34754 Dipietro Home Energy Solutions, Inc. INSURERC:Star Insurance Comte _ DBA: Revise Energy INSURER D: 5 South Summer St INSURER E Bradford MA 01835 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1642500527 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 TYPE OF INSURANCE ADDL S R' POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE a OCCUR A GN 50,000 PREMISESSEa occurrence $ PACEP305047 4/25/2016 4/25/2017 MED EXP(Anyone person) $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY:]PRO- ❑LOC JECT PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea Me ED SINGLE LIMIT $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS RS6325 4/18/2016 4/18/2017 BODILY INJURY Per accident) $ — AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS I Per accident $ $ X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I X (RETENTION$ 10,000 EXC305048 4/25/2016 4/25/2017 $ WORKERS COMPENSATIONj X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 C OFFICERIMEMBER EXCLUDED? a NIA ._ (Mandatory in NH) WC 0856525 00 4/20/2016 4/20/2017 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 business personal property �PACEP305047 4/25/2016 4/25/2017 25,000 A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if 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 120 North Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Emily Costello/HOYECI f ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onldnll Office of Consumer Affairs and Business Regulation % 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 185083 Type: Corporation DIPIETRO HOME ENERGY Expiration: 4/25/2018 Tr# 288111 JOSEPH DIPIETRO 5 SOUTH SUMMER ST. HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. SCA 1 00 20M-05111 Address ❑ Renewal ❑ Employment Lost Car (514e f'11wW?0W0ea1M office of Consumer Affairs&Business Regulation } HOME IMPROVEMENT coNTRACTOR Type: I� Registration: 185088 Corporation Expiration:_ DiPIETRO HOME SOLUTIONS,INC- JOSEPH DIPIETRO ^fit _r 5 SOUTH SUMMER ST. ` HAVERHILL,MA 01830 Undersecretary Unrestricted-E _ itmem rub!Ic 5a e:•;� _ Buildings of any use group which Massachusetts -cepa, contain less than 35,000 et(991m) Ua, , o, =. ziicimg Regu,ac:ons a ,� -.ar -dards cubic£e ®£ ""; enclosed space. icense CS-056846 JOHN D CULLEN= 46 VALLEY ST MW W.keffefd NLA ONO Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. °�,.`... � • „ at c For DPS Licensing information visit: www.Mass.Gov/DPS 04103/20,