Loading...
HomeMy WebLinkAboutBuilding Permit #Exception - 60 WILLOW STREET 5/1/2018 . I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION R permit N0; Date Received Date Issued: ` pp IlVIPORTANT:Applicant must complete all items on this page Print; PROPERTY=OWNER._ P.nnt= 100_YearOldlStructure yes . no- ,• MAP N® ,-...__� _ PARCEL:, ___ ZONING?DIS-TRIOT Histone®istr ct yes no MachmeFShop�Village yes ; •no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ septic [fl W611 - .0 Floodplain_ @,Wetlands [J.Watershed Distnct�.�_ .- 0 Water%Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name:- Address", Supervisor's Construction License ___. _ _ ____._ Exp Home Imprgvemerit License: . ___ _.. . .. Exp Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t ignatu e of Agent/Owr,:i✓r ;. ...Sig.1atuhp;:bf:.c6ntractoC: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE:OF-SEwERAGE DISPOSAL Public Sewer ❑ Tanuing/MassageBody Art ❑-.. S`,6mming 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 4 -Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes . t Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towz Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Mair.,'Street Fire Department signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions_ Total land area, sq. ft.: ELECTRICAL: Movement of[deter 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.$10041000 fine NOTES and DATA= (For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department "rine fol?owing is a list of the required forms to be filled out for the appropriate permit to be obtained. I'Zoofing, 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 DOTE: 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/Crossection/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 DOTE: 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all ce-ses if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apr),al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bc— submArted with the building application Doc: Doc.Building permit Revised 2012 Location (,q 4 W k { l o W S I ' No. 7!eq, ?d 1 2 Date Vt.-"7 - �a f J • - TOWN OF NORTH ANDOVER Certificate of Occupancyi- Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ � TOTAL $ Check# o�F1 Zi /1vL [� Building Inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date &&IZZ COMMENTS / 6//, az, r- 7 7 NORT1y q _ . wn t _ . ic . . ve" - o No. h ver, Mass o� 42 0 / 7 coc"ICMlWKM S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System 1 THIS CERTIFIES THAT .......... 1.. .`.K ".'............. �..... V i....�. ................. BUILDING INSPECTOR ' o 1 e ..... Foundation has permission to erect .......................... buildings on . if W T......................................... .... . . . Rough to be occupied as ........ .. ............O. �.. e.. . . ............ �.. ...... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the apion 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR: UNLESS CONSTRUCTIO T RTS 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. PIMENTEL 03muffi= January 20, 2017 David Haut Project Manager Dow Chemical Re: 60 Willow Street, North Andover Demolition PROPOSAL Based on drawing by Freestyle Design Services, dated 06/20/16, titled North Andover Facility Map,walk through and 09/14/16 Meeting Agenda, Pimentel Construction Co., Inc. offers this Proposal for the select demolition of assets within the 60 Willow Street, North Andover, MA Dow Chemical facility. Pimentel Construction proposes to supply labor and materials for the following scope of work. Scope of Work: • Permit • Supervision • Dumpsters • Final Clean • Labor, materials and equipment for select demolition: o Demolish, dispose of or re-claim and remove all designated gyp partition walls o Demolish, dispose of or re-claim and remove all designated act ceiling and grid o Demolish, dispose of or re-claim and remove all designated doors and frames o Demolish, dispose of or re-claim and remove all designated vct flooring/epoxy base level to floor o Demolish, dispose of or re-claim and remove all designated MEP's o Demolish, dispose of or re-claim and remove all designated millwork/casework o All areas to be left broom swept o Does not include epoxy floor removal o Based on machines used for demolition o Does not include any 9 floor prep/glue adhesive removals • Temporary Protection in the form of dust partitions with plastic • Allowance of$10,000 to Patch/seal any penetrations caused by demolition • Allowance of$6,000 to repair acoustical ceiling as needed • Demolition of plumbing as specified, piping will be capped where appropriate, including: o Multiple eye wash stations o Cleaned acid waste piping o Hot/cold potable water lines o Nitrogen/Argon piping o All piping is assumed cleaned and ready for demo • HVAC demolition to include: o Approximately 1,000+/-feet of ductwork and diffusers and drop to ground and removal for disposal o Valve, drain and cap hot water piping on four(4)coils and remove from ceiling o Reclaim Freon from two(2)existing 5-ton unit and properly dispose of o Remove two(2) units from ceiling and cut piping back to roofline o Leave two units running to temper space for construction area Job#116132 Pimentei Construction Co, Inc_ •231 Andover Street,Wilmington,MA 01887 • Telephone(978)657-9600 • Fax(978)657-9603 • Supply and install materials to modify the fire sprinkler system to include the following: o Stamped engineered drawings o Demo all branch lines below bar joist o Cap off and demo dry system at point of entry into lab area o New sprinkler grid above ceiling(cost$4,300)where dry system was removed o Install all new branch lines and upright sprinkler coverage above bar joist where applicable o Existing 6"main is to remain in place • Allowance of$3,000 for plug out of alarm system if needed • Allowance of$5,000 for fire alarm relocation • Allowance of$5,000 for fire alarm reprogramming • Allowance of$5,000 for burglar alarm • Allowance of$4,000 for miscellaneous steel for supporting roof ladder where wall is being removed • During the demolition, if Pimentel identifies a BMS circuit with a wall or ceiling that is coming down, Pimentel will move the circuit if it is staying and disconnect and remove if the circuit is not needed. • Furnish labor and materials for the electrical work as follows: o Disconnect and remove or identify electric circuits to be removed or remain o Reinstall existing emergency lights and exit signs o Remove and reinstall existing fire alarm devices • Additional supervision and equipment rental from to being limited to normal working hours and extending project two weeks. Start date will be Monday, February 13, 2017 and end of project will be Friday, March 31, 2017. Price: $205,203.50 Alternate: If fresh air ductwork is required allow for$20,000 to provide conditioned make up air to one roof top unit Assumption: Dow building will be vacant of any personnel when we can begin demolition project, with the exception of Dow Technicians who will be on site to write SWP. Mark, Paul and David may occasionally have safety walk thrus. No non-essential personnel will be on site. Anthony Pimentel Anthony Pimentel Pimentel Construction Co., Inc Approved: IAIi I I - (f fVV Excludes: Premium time; BMS system, disposing of process piping and equipment, contaminated duct and exhaust fans, fume hoods, lab benches, and process utilities; patching/sealing of and penetrations cause by Dow demolition; hazardous work; painting; and flooring. Note: This proposal may be withdrawn by us if not accepted within 30 days. Job 401618? Pimentel Construction Co, Inc. •231 Andover Street;Wilmington: MA 01887 • Telephone(978)657-9600 • Fax(978)657-9603 ...._._._ P,...,_ iDESCRIPTION DATE y iL - r?�� fj(� :y r fed C'( r Ir; ,nnt?..rrrY •3/`'. 15 , D t E t •i L .. ., i _..__...__. ....._.. i I t yKnde, I .:-�?C-I'•^.-1:F 'eY urCl'��... I,. E U Prep ? ca t .......... a ay 1! i z F wy - ' c:]� ....oto! •i: — SZ ;•,.7--ai^ ...:] F I gl.ryab . LCHOj I Y,..3 � :7 r, '.LC jf,:-.E> PAD 4 � = i.oi;is E ; J. I ,, •qn J : : i I __......_i ?;rll_i " c i1 R,12 3 Y Lot ..,,:`t-. ,c �� '?•t' '` ., 4 V1"._.. ?O!'^ 4{yi I c 3 t ._� •._ - � ` v .e-.eF, ti:.,,,r ,:,� ..�.-,x—;.ie �.-�.__•„n __ � u.-1 .. __.� ....-._.M .,.e I�I �I I i I C• 1 90 _ I ... [ X -'-- t I � � i ter.-'Z S t � ee a Purx g; j� :"❖i 3 i .r. i ...� „, sc. t ;, a Il t L aa st ,113 I ,".. J.':.e "-as..r• .. � f 11 15 - G _ a : _ ! � r n r - f..._ THE Dery CHEMICAL COMPANY ADVANCED MATERIALS _9� _.. .. jF"s 'iIt`�iiiT. 5097 PAX. 'r��'.���.�."i7 19 q I i ...._...... E__ >+i?: I TIT F- - -.__._--_____-_- Noah Artdai✓Er Faciiiiy Map ' i ro4Bf4,. 't5 E € r .• r n E - `t-:"!Li;r4i.1J ! XXX i y<r xyy XkkX i-. .__ ..._.__ _.___--..—_.,.......__. .-_..._..........._......_._____..__--.____.._......-......__ - za �x. asrntc c�k.:aeu:iAL — _.__..._..._.-- f.Ctr I ��v s !'f vru.,h.•.i�:- ..„..:. .'t^a EtiC X'"�r ,rty^dX£. _:- I RAA'.V,:I �H Decra.. . .. :t -- --- - .__------- - ------ Facility C'7�= a i lNorth Andover 1000 fy t��rC�i�!"s`�,C:: �,:�r:l� 1 - .,-. _ �..... - _------ Dow —.,.,. — ._. - _.-___.._ ...... . _... -- ' f-I r p�'t F �;" i }F. -1. - L 4. _f f- kY�YYj{X, ' o th Andover'..�t1e IINIA. ...i i_ �1 Mi a:.. +.�. ...3Y._ J ta• Tf WQ K S D R A:r; •r r:.. -.^_. - _ —------ ............................................... -— — -. — -- — _ i Rol 14 Fm D y .i •x Eyc. 3 f' L ___._....__ C}r-S:-R°1 TI! ?JF i J ; r • YJ I r .. Tr+f(-,!� v. -if r: r r d t � . ,,,, pre•,i _ i S'i��/-,t r JU - cles Z COW ` ^:( .., 'tet •__ ` ti;C - ' - -_ i I I t I • ; i I ] , ] mi101 y i . _y - t]}pRfaa i XJ 1 - , i 7 ;— .a::. c t , J I f v '- �' >.•,ac -: f '' 't CTO -rz'r-�r7 �i�m � �L� '_-Y .-_ .,. I: - 1 ,� ' EE;9' r, h ! �¢ li 2 J �f nrf.arrrce 4 i� I ' � 9t � �! � 1% Li} 4r ,`•' �-c":,.,� .^civ `' - .,. _ >t ...:a_,_.,._� _ I I f Co 73 _—I I 7 , 41 _ I i .... 4 { +yi _ :1 r li 7Elmit R� `t u II Y ---- _. _- --- .. r t ERIALS TRC .-...... f - ,1•ti,20 i 1 s LF. �l�`/ • f Axt� " NILE- '1/ E:. :__ ., -x v ,�. ,• , Nor 3 r;c..r f • .r.. --......-- Andover .. ..-'?.i `i E f.�r 'a: _ _ C -'< :r:.,;: ap . t --•--- r.:,tlfXkq I.__ �.,(� r ,,ir?, :�I U_ ,i.,p _---- ]" z,./kx�x; N �ne --- r (..� sl A , t ' I I I ,_•Fe j :f" ._. P.P .TE. 1 A I _,.. ••:,.. :,..�..:..,..... ! r r I r . Cr�S.unt rprrna' r d �Ct . ^n 7f-J 1(Ft>r . i 56x;., I ••n'e' �•t - ..t, Cc: ;v E•r•�,r.., ' U pfep Lor,.;! y Do,-7k x ' e i is sis C7.r.k0ty S2 lovk Aie. — - i i It!.i, r ' a .-..;;!•, ALU.1!Nlodl)i Shop 21 4 r.J L.6 Y 1 , Pcc, � Arm 1 ; � - t` !:Jr. i 1 r C f:XP' L L._. ik=<D _. I ,_. _ F_;{li_, -I .:!'::i;11, i nII t i er 131P 1 L Y i r r 3F I�1 i a 3 a LLJ CO z nrr r'C£4p t �4 .fi i i e ` : _ 3 3;£ ` i ' {—wi SII t 3 vq y � ^--- _ __�_ -_:�� 3 .—�!"�•�. tl, i 5 �• II(..v 1 7F Q{S":63.�__.......�...- -_ I 1 .. V+ —� 1 V 1i ' � "mar -. ..�:--_-.:< _ -�'_-._... -i• - f - - , �I Vin,-.,-.-.r.---•-- I i ,. '+ � a ; i ---_ •_---'-_—' _ is I I ,: r �j i i _m . CO'c _Az t.. _- . - _I .. ,r s -- 3 1 a r ra 3sf --� ---- - __ �. ryh.E �� IV S IE 1 ; I'! E tyCRPT "I)AFE. �,t-''�tC:r'v{::Gt , I It'„d E v+i l onve-Tied C-Irci ,. '"1 -'�I.id I)r •1SY:9 S"f;<.,)f(:JY[1-•'J+- t c:. -. � i i : : IL: JJl I I I W D '1t''p.+rYv: . J y { 1 Prep I EXIT I r! ; I� t , ' .9 I. t L'ob 7 Tfec, i 31 A P' f'; 'yttr;tef r r .. , E K I _ e y 1 I Q aE E 3 - j bub E E C SBA 2, 1- _,.........._S ;1 ......." rAB, ij M. ... .. j ?vin.. n k 1 J .... -. .. - _ i € t ,.:..,�. ;rhEd ...y._ x-a,Y'. - f Y f t 1�J Y I 5 J I .._.�_..,._.i Y r j I f r E s I, y _ t bi XY 137717 � `.. u CII I hh, Is �t ° t)MC ...,..._ (� f li (,.- ...�..".-._ II�� d ----_- _..-_ ...•.-.w.•. ,. E.:r f r r y , I (qp{qpy E I� ...... I 1 ( iL ..•,UGI'S `:�, 9 :.lit. T -j Iwo_ i � J n_.. ... I : ..I .. El !7 .... - .... .,. _. iJ. , � }3Eii Ey f ! � I EXIT I i , i r n ---- _-- • THE DG'IN CHEMICAL COMPANY i E ADVANCED MATERIALS WILLOW'Ii. NOR—i i,ANDOVER 01 S451i ._........_..... TF ',7 9. ':JS I A.X 9%$..`;51'. i �>' A c TE i - E ji ��Rn�R{E1A8Y A?tQ CilNfitJENsi.'aL i G_K;._,_._.__;.-..,7............. ! North Andover Facility Map,JB s%a '0E5 .-....,.....V ................. ..........._ -._.._._._.____..._...._._._-_-' tXX(xX/XyvX _-------- .........__--.........._..........._.. - - P­ --------- xxx V_ _- c1rE: c:,^l�, lScsrrf c XXX E ty r .i.-i"al `a_.i sC'.li?!fru: i.-tJ rt�z '.`,i Y- s ,-.» ° .. i_ ..-. ----------_. ."....._ .__ r - r ,t y North, } f_/r �; (-:(Iti..ii)tl<�..�3 •'t "-1, .J:i_�? W f A ...:J- .l iV!., ._ .... .... -.,... - r C. ,r i. .� IN UQ NOT, C.RAVVI,G ..... ... ... _......,._ .... ......... .............._..... ."---"........ .., _ .___ �_....._............. ................. .._ -'---._.- ”—.____...__...... _ .................... .._._-_. ...................__... _"...,...". ---.._ .. ..__.. _.._.,__._.. _...._..... ..-....._......__.-..... , : P 4 3 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information ) Please Print Legibly Name(Business/Organization/Individual): / Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): l,R]pm a employer with(employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L Q Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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 art employer tl:at is providing worlcers'compensation insurance fog'my employees. Below is the policy and job site information. Insurance Company Name: rr I�� Policy#or Self-ins.Lie.#: l a /!?� �a tDy Expiration Date: ( , Job Site Address:_(' (,e�l'l1�w r�e�- City/State/Zip; V14 P Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and enalties of peijuty that the information provided above is true and correct. Signature: Date: 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/6/2017 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 Robert Poulin NAME: Sennott Insurance Agency PHO E. o (978)887-4900 AC No: (978)887-2404 16 South Main Street E-MAIL robe=tpoulin@sennottinsurance.com ADDRESS: _ P. 0. BOX 457 INSURER(S)AFFORDING COVERAGE NAIC# Topsfield MA 01983 INSURERA:The Travelers Indemnity Co.x INSURED INSURERB:Travelers Indetunity Co 25658 Pimentel Construction Co Inc INSURERC:Travelers Property Casualty Ins CO 38130 231 Andover Street INSURERD:Travelers Indemnity Co of CT 25682 INSURER E: Wilmington MA 01887 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1612694090 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 ADD_SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YY LIMITS X COMMERCIAL GENERAL LIABILITY 1,000 000 EACH OCCURRENCE $ r DAMAGE TO RENTED A CLAIMS-MADE X OCCUR 300,000 PREMISESSEa occurrence) $ CO 4G944425 12/12/2016 12/12/2017�MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 POLICY D PE� F-1LOC ( PRODUCTS__COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 BANY AUTO BODILY INJURY(Per person) $ ALL OWNED Ix SCHEDULED BA 46911480 12/12/2016 12/12/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DEO I j I RETENTION$ I CUP 4G944425 12/12/2016 12/12/2017 $ WORKERS COMPENSATION X STATUTE ETH AND EMPLOYERS'LIABILITY Y/N — ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 11000_000 OFFICEWMEMBER EXCLUDED? U N/A ---------------- - -- D (Mandatory In NH) UB 6G290457 12/12/2016 12/12/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Robert Sennott/RP2 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) i i C • Massachusetts - Department of Public Safety 3oara of Budd.mr P.egulat,ans and Stan-lar-J-, r..ui�i Fii�ii«.i cw irr�.i♦«ai �. ... License CS-092345 MATT PEMNTEI; 27 Boutwell Rd 9 4 Andover MA 01840 Expiration . Commissioner 05/04/2017