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HomeMy WebLinkAboutBuilding Permit #595-2017 - 56 CASTLEMERE PLACE 12/2/2016 NORT/-� F� BUILDING PERMIT 4 V TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION . b nO `eb Permit No#: E2 S` •o"�17 Date Received I ��SsgTED cHus���y Date Issued: i a' ' �` � �° �' I items on flus page IMPORTANT Applicant must complete all a- L® O * � � la�ES �- x $ SPA CELS t Z9N.NGf9IST+,CST }"�Istorlc �astUct 3� h " . ' _ �e " MaChille S] opge ..e sono ' . �,+u«.SSR"�i:�rs.�.,.zfiahr.�t..,fe.sfi'.h..;a=.€n..9.,;�s�.�iy�:� "'�3'.e:' ` .•-..°„�_>a-.xaee TYPE OF IMPROVEMENT PROPOSED USE N Residential on- Residential ❑ New Building �(One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ oliti Demon )(7 Other w.5v]df,, - A d ,, Will DWatecshetlD�stnct p Septic 1Nell�..'� + Ll Floodplain kD Wetlands - . 'k,.d `,ii' . �1Nater/S_ewers = € .. DESCRIPTION OF WORK TO BE PERFORMED: O-LA t Identification- Please Type or Print Clearly 1 OWNER: Name: Phone: q1� -��10'-SaC10 Address S �0 C=-e m C )'2 P C�CSZ w -7T_,7 nw nc 4 .,x 'SF a 3r_''+s�+ ,_.y„ s..3`'�.a� •A "'mr "TGw £ +�'�,s '�v- +c- - 41i �,.4 �af��d. �-�-� a•�..z�"i�f�` �"` 'r � s r w � i- Ct, .-ei V .� � y, ""'mc .*u° ' i' —�.. �:� CantractorFName� rY .� Small TT F dd o-�'�.+Tk�` Aresser ° C'�.7� -. .._ ffi'�-e'.«+'sem° rk.�r t al-9�,.����"r'aF�•-• .{":.'tt 'L c�� .� ° 'z'�"�� �k.°' �s�� �..-ic: t.cF �e �#S £v3`ais •�cio F`Ltc+e{'xn � `^ "K �r P�µ.. � �r; � Ex ®ate , Drne lrn ove ent�,Ucense 1 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: $ M OCA FEE: $ O Check No.:. -7 � Receipt No.: f a' 7 Ll NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund inriati ira of Anent/O.wner Signature of contractor .. Location No. sss� ' a017 Date �� � ^ �Q /� • - TOWN OF NORTH ANDOVER 1 Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check#`7I/1) -75 1274 / ( Building Inspector f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ '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 e 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 AFIRE DEPAR�TME T r _ �K N �Temp Dum seer on site es � x rx� �: -£�•= , � p y � ono � �� . � . ZLocated4at<1-24"Main St�eet '` sE . ` ;.p � ='y.r 1nY ',4FF.v.. M i -FireiDep.artmennt signature/daite-. COMI1/IENTS 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 ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) PU Notified for pickup Call . Email Date Time Contact Name Doc.Building Peimit Revised 2014 I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 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 ConstructionSin le and Two Family) ( g Y ❑ 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 NOTE: 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 � NORF� own o f T Andover . N . h ver, Mass, �� • • ���� �A COCNICNl WICM`y1' ORATED 0a�,�S S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT v�1. .1 ►� .t .1...........10.5{ItI0 00#v...... BUILDING INSPECTOR has permission to erect ... buildings on vfte Foundation s Rough to be occupied as .................. .. ................S-rkw 1W.1&............. Trl..�................ 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 CONSTRUCTIO;tL Rough Service .................. .. .. .. .... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. i Federal ID X 054405629 RISE Engineering RI Contractor Registration No 9166 MA Contractor Registration No 120979 RISE 'S�--�F CT Contractor Registration No ENGINEERING' 60 Shawnim Road,Canton,MA CONTRACT ' (401)784-3700 FAX(401)784-3710 Page 1 PROGRAM TM �+ TCONTRACT IS ENTERED WTO UTWM RISE CMA—H,S EMO WEERM AM TIR:CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER .. _- - PMONE OATS CUENTI t40RKDRDER Nicholas Petrucci (978)686-5290 11/10/2016 427811 35003 Sa W-E STRFEt - ». .�••�. . _ _ SWIM STREET 56 Castlernere Place 56 Castlemere Place SERVICE Ca7Y,STATE,ZIP BILUNO CRY,STATE ZLP North Andover.MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR Si-:ALIAG:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will be performed in concert with the use of spccial tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seai your home can include caulk,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(12)working]ours.A reduction in cubic fat per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed, At the completion of the tiveatheritiation work,and at no additional cost to the homcowner.a final blower door and/or combustion safety analysis-.vil I he conducted by the sub-contractor to ensure the safety of the indoor air quality. $1.020.00 AIR SCALING ADDER: (10)working hours. 5850.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(i)attic hatch with 2"rigid insulation board.Weatherstrip the perimeter. $60.00 V t, a i RISE Engineering Federal ID#05-0405629 1.*! Rt Contractor Registration No 8186 RIS E �' MA Contractor Registration No 120879 CT Contractor Registratlon No ENGINEERING 60 Shawmut Road,(untun,NIA (401)784-374)0 rAX(401)784-3710 CONTRACT Page 2 PROGRAM THIS CONTRACT ENTERED I TEN RISE CMA-IIS ENGIN ERWOAND THE CUSTOMER INTO_OMER FOR WORK AS CUSTOMER - - ..M DESCRIBED BELOW PHONE DATE ENT/ WORK ORDER Nicholas Petntcci CLI (978,)686-5290 11/10/2016 427811 35003 SERVICE.STREET HIL.LINO STREET 56 Castlemere Place 56 Castletnere Place SERVICE CITY,STATE,ZIP 01"0 CITY,STATE,YIP North Andover,MA 01845 North Andover.MA 01845 JOB.DESCRIPTION 12151-linginecmng twill apply all applicable,cligihle inceruk"to this contract. You will only be billed the Net amount. Currently, For eligible measures,Columbia Lias oilers 75%incentive,not t/1 exceed$2.000 per calendar year,and an incentive of 100%for the Air Sealing mcacurec up to the first 3690 and an additional S340 ifsavinl s arcitlstiliied by the auditor. For the savoy and health of your home's indtu,r air quality,de will he conducting a blotwr door diagnosiic of the available air flow in your home both before the work is IHlgun.and after the aethcri ninon stork is complete.We will also conduct a full assewnent of the Combustion safety=of yoar heating s%Ntem and nater heater,'lois has a value of S9r);md is at net cost In%nit. Total 3110Wable ttcatherization incentive is S3.It 0. I he Permit hill bC;venial In the insulation contractol.ul no addifunial COSL 11 k the hanlcunrcl',Icsp0aSIbdiI%111 clow out dlis permit by contacting their municipality it the completion of this pork. 1 �v 11 Total: $2,020.00 Program Incentive: $1,633.13 Customer Total: $386.88 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Three Hundred Eighty-Six&88/100 Dollars $386.88 IKON FINAL RJSPECTION AND APPROVAL BY WSE ENGINEER.-NO.CUSTOMER AGREES TO REMIT AMOUNT DUE 127 FULL.INTEREST OF I%WILL BE CHARGED MONTHLY ON ANY UNPAID BB�ALA N/CII RAFTER iO DAYS.SEE REVERSE.FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING.AJID CONTRACTOR_ R WSTRATION, AUTHORIZED SIGNATURE-RISE Enylm"rAll CUSTOMER CCEPTANCE ' NOIE THIS CONTRACT MAYBE YATHORAWN DY us IF NOT E)IECUTED WITHIN GATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE C/ SA=FACTORY TO US AND ARE HEREBY ACCEPTED YOU ARE AUTHORIZED TO 00 THE WORK. DAYS.. AS SPECIFIED.PAYMENT WILL BE MADE AS OUM11-O ABOVE RISE. 60 Shawrnut Road Unit 2Canton MA 02021 339-502-6335 ENGINEERING' www.RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: _ (Property Address) `? { f ���.. Awtatr Of A o 1 1. t t 1 (Property Address) `t `'�, ,,,•-� Merrimack valley Insulation 23A Sullivan Rd Biiienca,MA 01862 hereby authorize --. — (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform worts 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 homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. Own4i's Signat Date 6 2c16 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t` Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Merrimack Valley Insulation Corp. Address: 23 A Sullivan Rd. City/State/Zip: Billerica, MA 01862 Phone#: 978-888-3495 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 18 4. ❑ I am a general contractor and I em "" employees(full.and/or part-time). have hired the sub-contractors 6. ❑ New construction 2.El I 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. 0 Weare a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. o workers' right of exemption per MGL y � comp. 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.X❑ Other Insulation comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. HomemA niers 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 ornot those entities have employees. If the sub-contractois 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: 5Star V3 AAIC American Alternative Insurance Policy#or Self-.ins.Lic.#: V9WC749118 Expiration.Date: 6/18/2017 Job Site Address: S lU CCySt 12 YY1P.��. PJ City/S#ate/Zip:N,Ar)0Q\1fr,MA QM-S_ 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 pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: J� Phone#: 98-888-349V 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#: a LQiLL D h c��SSS c`ssata<is'Li'ls 'Em.7-vzm,�ningtm 57 orkees ti..Qrajensaa n,12- s,Trance 3ff-5--Ci? L_ i:1GL�3��.GL TQC Q_s �jeCil3CiR 5IPL-='iDE leas ( h t, -N.-a--.—. e CB-usiness10 �nTc' =a-ar.'j 1;LI'r=d-al10 ?8T 3� J F!ra �r"lle'r, riEcd«7f-,�. Gal'0 Citic i3i2.'ft2�_��Jf�F��(G-s_ ✓ <e tilc�ec` � L'775== LTIS`G�� Q � � i Are-you au ez i-olayer? 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ZG L LL:!L L•__cv� iV t. �ti,L:�� C l le t._,iy f ✓Qard oMlmalth BUML2 De0- }-..=era=_ .'•Cori.-s_f Plumb&GT.=r 0 ri c _ - 3 Cor:ac ParrQr_ Eprntl MERRVAL-03 WEJE All-DOIRLY CERTIFICATE OF LIABILITY INSURANCE DATE(MfrdoD/YYYY) kit - 6/13/2016 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 po)icy(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 ofsuch endorsement(s). PRODUCER CONTACT NAME: _ Automatic Data Processing Insurance Agency,Inc PHONE I FAX 1 ADP Boulevard AIC No Ext. ! AIC.No): E-PAAIL- Roseland,NJ 07068 ADDRESS: INSURER(S)AFFORDING COVERAGE NA1C 2 ►NSURERA:5StarV3 AAIG American Alternative Insuran'! INSURED Merrimack Valley Insulation Corp INSURERB 23a Sullivan Rd INSURERC: North Billerica,'MA 01862 INSURER D: --- INSURERE: _ I - INSURER F: v.-----`--' - COVERAGES CERTIFICATE!NUMBER: REVISION NUMBER. i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE-LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOYWrrHSTANDING ANY REQUIREMENT,TERM OR.CONDIT.ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-Laws SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR I TRI -------_------- —ADD L SUER -- -��POLICY EFF POLICY EXP-! TYPE OF INSURANCE INS! R1vwDI POLICY NUMBER 1 M}AtpD1YYYY I h1M19/DO/YYW I LIMITS GENERAL LIABILITY I EACH OCCURRENCE j S 1 C_OMMERCALGENERALUASILITY !DAMAGE E 1 S I I I PREtdISE_SjEaoccurrenc.L—_ _� ' CLA1F.9$44ADE OCCUR. E �Y�EO EXP(Anyone person) i5_ tC� PERSONAL.'.AOVINJtIRY !S -- _ GENERAL A_G_GREGAn S I GEN'LAGGREGATE LIM!TAP(P�LIESPER: i PRODUCTS-COMPIOPAGG 5 I POLICY i ,JET I I LOC I 1 S 1 AUTOMOBILE LIABILITY I i i COMBINED SINGLE UPAIT Ea accident S j At M AUTO i )BODILY INJURY(Per person) Is ALL OWNED SCHEDULED -- ! AUTOS AUTOS i ;BODILY INJURY(Per accident) S i NON-OWNEO ! i I PROPERTY DAMAGE tirREO AUTOS AUTOS I I Peraxid.�rtJ S--`_.__. UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAS CLAWS-MADE AGHGREGATE _ S DEO I RETENTION S WORKERS COMPENSATION ! WCSTATU- OTH- j.ANDEMPLOYERS"LIASIUTY YIN TORYUMITS A I ANY PROPRIETOR/PARTNER/EXECUTIVE V9WC749118 6/1812016 6118/2017 E.L EACH ACCIDENT — 9_--- 1,000,000 tfBEPEXCLU0E0? j!. NIA OFFICERItlE - I tMandataryinNH) EL DISEASE-'cAEIAPLO 5 1,000,Ot) IE qqes,describe Under _ i DESGRIPi>ONOFOPERATIONS Mw i EASE-POLICY LIMIT- S 1,000,00 I I i I i DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Adach'ACORD 101,Additional Remarks SchedWe�ifmore space 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,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street T North Andover,MA 01845 HORIZED REPRESENTATIVE ©1988-20'!0 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and Logo are registered:marks of ACORD ACC>Ra DATE(MM/DDNYYY) 111. CERTIFICATE OF LIABILITY INSURANCE 11/07/2016 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), AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 Carolyn A Coughlin Charles J Coughlin Insurance NPS: 14 DinleyStreet PHatNo M (978)957-3588 FAX No: P.O.Box 10 ADDRESS, carolyn@coughlinins.com Dracut,MA 01826 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURER B: Safety Standard 39454 23A Sullivan Road INSURERC: Torus Specialty Insurance Company A0159 N. Billerica,MA 01862 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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. I TR TYPE OF INSURANCE IVSD WVD SUER POLICY NUMBER MWDDPOLICY EFF I�pY EXP LIMITS A COMMERCUILGENERALLIABILITY WS274182 01/21/2016 1/21/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100'000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ 2,000,000 J POLICY E]PJECT RO- F-1LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 6205006 11/25/2015 11/25/2016 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED / SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY �/ AUTOS / HIRED / NON-OWNED PROPERTY DAMAGE $ V AUTOS ONLY �/ AUTOS ONLY Per accident C V UMBRELLALUIB OCCUR 87593L161ALI 01/21/2016 01/21/2017 EACH OCCURRENCE $ 1,000,000 EXCESS LtAB CLAIMS-MADE AGGREGATE $ 1,000,000H 'I DED RETENTION $0 $ WORKERS COMPENSATION PER OTHF AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insulation Installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover,Massachusetts 120 Main Street AUTHORED REPRESENTATIVE North Andover,MA 01845 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _ Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home ImprovemerA, .otractor Registration Type: Corporation Merrimack Valley Insulation Cor ,"'." Registration: 180506 Expiration: 11/23/2018 23 A Sullivan Rd Billerica, MA 01862 a .o �e O,qM Sve Update Address and return card. Mark reason for change. SCA 1 €s 2OM-05111 - -- -- n Addre—agLID_Ra.,—A-1 r1 EmploMentn f-1 I est t :; ,yam �e c(�o�rrorzantrsea,�o���craarr.�rcoella \ Office of Consumer Affairs&Business Regulation - HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Corporation before the expiration date. If found return to: 'RU'istration Expiration Office of Consumer Affairs and Business Regulation "�i e9 P 10 Park Plaza-Suite 5170 v $0506— 11/23/2018 Boston,MA 02116 Merrimack Valley-lrsulatioia Corp Ryan Joseph R Y 23 A Sullivan Rd 3 t Billerica,MA 01862 -.f` Undersecretary Not valid ithout signature lAassachusef¢s-Department of Pubfic S2fE-W Scard Gi 3u tai a .—� �y aic s a Standard:; i ui7+r;a ilttivi::31fi:s�3 i+:�i Lrense:CS-075541 JOSEPH ARYAN=• 200-King Rail Dr_-Ape20 Lynnfield MA 0040 i �{ 02/0412017 Co: stllss�arter