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HomeMy WebLinkAboutBuilding Permit #147-2017 - 53 CHESTNUT STREET 8/16/2016 y r BUILDING PERMIT NORrti616 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION n0 Permit No#: 11 Date Received �gSsgcHus���� Date Issued: AL(f� I IM ORTANT: Applicant must complete all items on this page LOCATION S_3 �1-rS=hvi S� Print PROPERTY OWNER n Print 100 Year Structure yesnnn MAP _PARCEL: ZONING DISTRICT: Historic District ye Machine Shop Village y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [I Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial El Repair, replacement ElAssessory Bldg Others: ❑ Demolition _ ❑ Other Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District i _❑_Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: jo;r' S r5 IiNA ATI-,''C 70rc —~�T Jrhr% I4Try(A Identification- Please Type or Print Clearly OWNER: Name: �a r 1�r 5 44&1a . Phone: ? ��o-0600 Address: e L r S-,-K v i -57- Contractor iContractor Name: r7 e-r-r 1 ,e t19 c ' Phone: �/0 2- 243 Email: Address Supervisor's Construction License: /0601 ) Exp. Date-.- . u _ Home Improvement License: /o »- Exp. Date: ? �� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST ASED ON$125.00 PER S.F. Total Project Cost: $ 3300. 0 0 FEE: $ Check No.: 1-ni Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location No. f"� Date`'�� • TOWN OF NORTH ANDOVER Certificate of Occupancy $ 14 Building/Frame Permit Fee $�U� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check 4t :i Building Inspector J I J - Plans Submitted ❑ 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 I r CONSERVATION Reviewed on Signature ' COMMENTS I HEALTH Reviewed on Signature i COMMENTS ,,��ring Board of Appeals: Variance, Petition No: w- Zoning Decision/receipt submitted yes 4 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Si nature Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPq TMENT • -� Located 384 Osgood Street - r3 Temp pste�on s ? no -, -. Lof""ca"ted ate-2 Main Street, -- � F re 0 p nt ii-gnatu e d to t, -•nRTN L Dimension i Number of Stories:_-__ Total square feet of floor area, based on Exterior dimensions.________ Total land area, sq. ft.: t f i' ELECTRICAL: Movement of Meter location, mast or service drop requires ap roval of Electrical Inspector Yes p No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 217—F and G min.$100-$1000 fine No 1 NOTES and DATA-- (For department use) i I f ❑ Notified for pickup Call Email 1 Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application 4, 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 offrom Fire Departmentartmentprior 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 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 4. Certified Proposed Plot Plan ;6 Photo of H.I.C. And C.S.L. Licenses 4 Workers Comp Affidavit 4 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Copy of Contract 4 2012 IECC Energy code 14 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit I 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 getthis recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 1 � Town of n O - �► No. _ 0 y o h ver, Mass, cocaichew¢w 1' SAO S U BOARD OF HEALTH Food/Kitchen PERN, T % D Septic System C Tv 16 THIS CERTIFIES THAT .,,.,,•...................... BUILDING INSPECTOR ............. ....... ...... ....;1;kk... . ..... . .... Foundation has permission to erect .......................... buil Ings on .. .... . . I. . ... ...... p ' `S ... .��� Chimney to be occupied as .. f ........ ...... ..tom► provided that the person accepting th rpermit 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 CONS TIONS Rough Service .... . .... ..... ....... . ...... Final BUILDING IN CTO.. 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. Federal ID 0 05.0406629 RISE Engineering RI Contractor Registration No 9199 A division of'ihielsch EngineeringMA Contractor Registration No 120979 RISE ENGINEERING CO 00 CONTRACT 40 F 401-123-1234 CONTRACT RN<r I 99 Mm Page 9 PROGRAM 1HIS CCN7RpCTta ENTERED MW SEM WO RNSE C -HE DESCRIBED aEIDW elg70r✓ER rCR WORK CUS1d1£R PHONE DALE CUENTK WOa(ORDER Charles C>arugi ! (478)360-0600 06/28/2016 436847 00002 SERVICE BUREEr .� DWJND SREET- 53 Chestnut Street 53 Chestnut Street SERVICE c1w,a1R'IE,aP MUM cfw,wall,zw North Andover,MA 5--" North 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 HAZARD BARRIER We have identified that there are uncovered electrical junction boxes present in your home.These need to be covered prior to the start of your home's weatherization Rork,and are the responsibility of the homeowner. $0.00 HAZARD BARRIER:We have identified that there are recessed lights;present in your home,unless the recessed lights are certified as IC-rated(Insulation Contact Rated)we will create a 3"clearance space around the fixture by using fiberglass blanket insulation as a damming material,no insulation will be installed across the top and cloud cavities which contain recessed lights will not be insulated. $0.00 BARRIER The following contract is not valid unless accompanied by the Pre-Weatherization Barrier Incentive form,signed by, your licensed electrician Work will not proceed with this work until we receive a copy of the farm. $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This park will be performed in concert with the use of special tools and diagnostic tests to assure that your home v(ll be left 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 sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)rmrking hours.A reduction in cubic feet per minute(efm)of air infiltration will occur,but the actual number of cf n 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. $680.00 ATTIC FLAT:Provide labor and materials to install a 6'layer of R-21 Class I Cellulose added to(352)square feet of floored attic space. $626.56 DAMMING Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts to(112)square feet for damming purposes. $229.60 ATTIC FLAT:Provide labor and materials to install a 12"layer of R-42 Class 1 Cellulose added to(396)square feet of open attic space. I I I SLOPES:Provide labor and materials to install a 6'layer of R-21 Class 1 Cellulose added to(88)square feet of slope area.Wherever $633.60 possible baffles will be installed to the entire length of each bay to maintain ventilation space.lZEEP FLOOR $163.68 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the 4 perimeter. $60.00 A Federal ID 605.0408818 RISE g%4neeflag Rl Contractor Registration No else lrAcontree r Registration No 118878 RISEA division otlhielaeh EngineeringR INFERR . Company Address,City,MA 00000 401-123-1234 FAX401-123-1234 CONTRACT page 2 PROGRAM CMA-HES ANDIRROMWERFOR "waaca�i s arasRfiR PHIS Duma ctaxxn trouaxoaoal Chwles Cmngi (978W60.0600 06r28I2016 436847 00002 eaavuQ6$t>var MUM avMr 53 Chestnut Street 53 Chestnut Street eERm cnr.ii 5XP MLM aw,MIL MP North Andover,MA 01845 North Andover,MA 01845 JOB D SON ATTIC ACCESS Provide labor and materials to make(1) access opening from one attic area to another by settings page through sheathing This access will be Left open as it is batvzcn two common unheated non fueaalled attic ar e>s. $31.31 VENTILATION:Provide labor and materials to install(2)12"X 18"aluminum gable end attic vent.RIDGE VENT EXISTS,NOT CUT THROUGH. $247.00 VENTILATION:Provide labor aM materials to install(2)8"diameter roof vents)to increase ventilation in attic areas. The vert can be supplied in(circle colnr ick brovm,gray or mill fmidn..RMM VENT EXISTS,NOT CUT THROUGH. $171.00 VENTILATION:Provide labor and materials to install(1)insdated exhaust hose to existing bathroom f tn(s). $50.00 VENTILATION:Provide labor and materials to install ventilation chutes in(44)rafter bays to maintain air flow $88.00 VENTILATION:Provide labor and materials to install(6)4"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas.Specify color.White or Gray. $150.00 BASEMENT CEILING:Provide labor and materials to install(82)linear fat of R 19 unf>tced fiberglass insulation to the perimeter of the hasement ceiling at the house sill. $143.50 INCENTIVE:RISE Engineering wolf apply all applicable,eligible incentives to this contract. You will only be bulled the Net amount. Currently,for eligible measurM Columbia Gas offers an incentiveof 75%.not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. FOR A LIMITED TIME:Columbia On wail)also offer an additional$100 incentive towards the vueatherizetion work outlined in this proposal.This spacial Sommer Incentive is available to homeownas who have had their Columbia Cas home energy audit before July 31,2016. A signed proposal for weatherization needs to be submittedA 2 1 by August 8 0 b and work must be completed by September 30,2016. For the safety and health of your home's indoor air quality,we will be conducting a blovmr door diagnostic of the available air now in your home both before the vwrk is begm,and after the weatherization work is complete.We vn'll also conduct a fall assessment of the combustion safety of your heating system and vreter heater.This has a value of$90 and is at no cost to yon The maximmm allowable incentive for all measures including air sealing is$3,210 $90.00 Faderal IDS 060403828 RISE Engineering RI Contreator ReglstrvMon No 8180 t1ACoMracor Registration No 120878 RISEA diNalaa of'I6ielseh I�bgineering ENGINEERING Company Address,City,MA 00000 O CONTRACT�w^RACr 401-123-1234 FAX401-123-1234 V Page S PROGRAM CMA t°aDaMMFORwancR10AS Cuslaw PHONa CAM cuffm MOMItORM Char es Gangi (978 360-0600 OWNW16 436847 00002 SEW=SIRW MUM svm 53 Chestnut Street 53 C3lestnut Street aERME OIM.V%W? JP GULM am.saluo, North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,364.26 Program Incentive: $2,770.00 CusEDmerTblal: $ 4.26 W EAOWIN-i®Y7o PURtt18N OEM=-C0WLETE a A=MXV=WrrN MON SPWfffQA=t8.MR INE SUM OF 'Five Hundred Ninety-Four&W100 Dollars $6,26 UUPON NPAID i<a18PHCWNANDAPPIiOrusrRiseaNaei$a tINPAmBARAORM13RMrfAIM(V$MMRtPau. eMSTOFIsMLSEC ARMWONsa.YORAMY tAMCE roOAYa utn Dsraha ltBVaRBE tilt 4011CH OUARANURS.ROM CIFfMCIPM OCKEDU A AND cogwom nws BwPL NOT THIS CONTRACT IF THEREAREANYGLAMMCES i BNrtALRa CU.VW NO®:4o9 OONtiACTOiY t18 i BYMPN0Qa)@CUMVITI 1 DAIROFACCQPSOM AccGIPMCE OFACIMAPCOIIMiECT-DABOYS PRM SPuNWA40Ma AMD oon m118 ARB mom' ASePF PAYAPMM9E.-0YC110.fED�ABa AU7104f�DAt104@VYOial I i RISE60 Shawmut Road,Unit 2 Canton,MA 020211339-502-6335 ENGINEERING www.1RISEenghw9dng.com OWNER AUTHORIZATION FORM i, C hat-IeSQk2 _ (Owner's Name) ' owner of the properly located at: (Property Address) -- t4j'('0'0 ver/ (Property Address) ' hereby authorize ?6 Beat— —1 kS � . (Subcontractor) ' an authorized subcontractor for RISE Engineering,g g,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. c Owner's Signature i � / r Date i The Commonwealth ofMassachusetts Department oflndustrialAccidents Office oflnvesagations, 600 Washington S'tYeet Boston,MA 0211-1 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers A licant Information pleasePrintLE l Name(Business/Organization/Individual): Address: PO BOX 958 City/State/Zip: Phone A�You an employer?Check the appropriate box: _ 1. I am a employer with— — 4. ❑I am a general contractor and I [1E project(required): employees(full and/or part-time).* have hired the sub-contractorsew construction 2.Q I am a sole proprietor or partner- listed on the attached sheet.temodeling ship and have no employees These sub-contractors have emblition working for me in any capacity. workers'comp.insurance. [No workers'comp.insurance 5. ❑ We are a corporation and its ilding addition 3.Qrequired.] .officers have exercised their Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL mbing repairs or additions myself PT workers'comp. c.152,§1(4),and we have no insurance re aired. ofr0 aws9 ] f employees.[No workerscomp,insurance required.] er Any applicant that checks box#1 must alsofill out the section below showing their workers'compensation policy information. IHomeowners who submit this must aft indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check flus box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing wArers'compensation insurance for information. my employees. Below is tTte policy and job site Insurance Company Name: C6A r t Dk Policy#or Self-ins.Lic.#:_ W C `7> f Expiration Date:_ Job Site Address:_ ele,-e 57A City/State/Zig . _ �— Attach a copy of the workerscompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as xequired under Section 25A ofMGL c.152 can lead to the imposition of criminal p enalties 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 maybe forwarded to the Office of Investigations of the DIA,for insurance coverage verification. �rdo I'ereb ce fp1 ry.Y y der thepains andpenaltles o er'u fbattize informationprovided above is true andcorrect:ature: G Date: 'hone#: Offrcial use only. Do not Write in this area,to be corzzpTeted by city or town offrcial. City or Town: 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#: i ACCORV CERTIFICATE OF LIABILITY INSURANCE FD6,ioi2o16Y) 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 endorsemen s. PRODUCER NAME: Linda Bogdanowicz Insurance Solutions Corporation PHONE (003)382-4600 IFAX No:(603)382-2034 60 Westville Rd E-MAIL ADDRESS:liadab@isc-insurance.com INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURER A.-Western World INSURED INSURER B Nautilus Insurance Group Polar Bear Insulation Company Inc INSURER C: PO BOX 958 INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBERCL1632326134 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MWDQ YYYF EXP LIMITS $ COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE ❑R OCCUR DAPREMISMAGET ES OEaRENTEDoccurrence $ 100,000 NPPS274967 3/24/2016 3/24/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 H EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace 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 Reith Maglia/SJA �^ ' @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r?ntann 6/10/2016 Preview:Certificates of Insurance AC CO CERTIFICATE OF LIABILITY INSURANCE FDATE(" 1'6"•' 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 NT NAME: CT FAX Automatic Data Processing Insurance Agency,Inc. PacNN .E:1: Uva.Not 1 Adp Boulevard ADDRESS; Roseland,NJ 07068 WSURER(S)AFFORDING COVERAGE i NAICR INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER 8: POLAR BEAR INSULATION CO INC INsuRER c: PO BOX 958 Andover,MA 01810 INSURER D INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER: 503587 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. LTR TYPE OF WSURANCE INSD WVD POLICY NUMBER MW&YYYY) MlDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S ,CIAIFAS•f:lAOE OCCUR PREF.11SE5(Ea occurrence) S MED EXP(Anyone person) S PERSONAL 8 ADV INJURY S GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PCLN'Y PRO JECT LOC PRODUCTS-CO`1P.IOP AGG OTHER: S AUTOMOBILE LIABILITY COMBINED S "I S (Ea accident) _ ANY AUTO BODILY INJURY(Per pecan)ALL O�iS AUTOSTNED AUTOSSCHEDDLED BODILY INJURY(Par acaden) S ....ED S (P HIRED AUTOS AUTOS er aCci e 5 UMBRELLA LIAB OCCUR EACH.OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE s DED I I RETENTIONS S WORKERS COMPENSATION X H• AND EMPLOYERS'UAe1LITY Y/N STATUTE I IFR A ANY PECUTIVEa EL.EACHACCIDENTNIA N POWC772258 S 1.000.000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 Ifya.describe under DESCRIPTION OF OPERATIONS bee. E.L.DISEASE-POLICY UMIT S 1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N morospam is required) 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. 1600 Osgood st.I suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD25(2014101) The ACORD name and logo are registered marks of ACORD https://adpia.adp.conVicertcf/#/run/previewi503587/900012975 1/1 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement C ntractor Registration L,a-.mob; Registration: 102726 (# Type: DBA y" ,•. 4 Expiration: 7/2/2018 Tr# 419291 POLAR BEAR INSULATION CO. z, Vincent LeBlanc 1PC P.O. BOX 958 4.. ANDOVER, MA 01810 Update Address and return card.Mark reason for change. Address E] Renewal n Employment Lost Card SCA 1 Cs 20M-05/11 V�C 077Y771477(!/CClLUO�CJ�'CflJ9ClC�llJC� Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 102726 Type: Office of Consumer Affairs and Business Regulation Expiration:-^'W2/201-8 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULAdbN CO = Vincent LeBlanc - , 51 SO.CANAL ST.#5A1 `' LAWRENCE,MA 01841 Undersecretary Not valid without signature f` Massachusetts -'Department of Public Safety Board of Building Regulations and Standards Construction Supcn icor Specialty License: CSSL-106017 q PETER A LEBLA f 2 EAST PINE STREET rn Plaistow NH 03865 A Expiration Commissioner 04/28/2018 � I