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HomeMy WebLinkAboutBuilding Permit #713-2017 - 63 HERRICK ROAD 1/12/2017NORTH (� 1� BUILDING PERMIT O� c�`ED. quo 2 yE r. 6 1 TOWN OF NORTH ANDOVER J0 APPLICATION FOR PLAN EXAMINATION �j� D.pq <oewK ewKw y1 Permit No#: ` ' �� Date Received DRTED 45 gSS�iCHUS Date Issued: I Iz��1 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER rent/, Print 100 Year Structure yes no MAP —PARCEL: a— ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition ❑ Septic ❑ Well ❑ Water/Sewer PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg — ❑ Other ❑Floodplain ❑ Wetlands Non- Residential ❑ Industrial ❑ Commercial IF Others: w-rgX,rf�,2A; %a &t ❑ Watershed District DESCRIPTION OF WORK TO BE PERFORMED: r (;&A LTilrz,', d Identification - Please Type or Print Clearly 15 _ Y'02 OWNER: Name: t,- d : n � C kM,4 Y Phone: G li - s - Address 63 IN *1 Contractor Name: peter L Phone: Email 2 East Pi>np strp Address: na • 978.-44 7e763g �o Exp Supervisor's Construction 10 / �_ Home rovement License: ARCHITECT/ENGINEER Address: IIS Date: y == � Ir _y Exp. Date: �) –J - Phone: FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 3106-00 FEE: $ 02 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce to eguaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic; tank, etc. ❑ Tanaing/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dmnpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature, Reviewed on Signature Reviewed on Signature i )ning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: JIFIREDEP�AR E ;T Temp to xf Locateds 3 4 Osgood Street p. ,ump r onsi lyes ff ggcatedjaf 12`4iMafntStl et• tSte ` x__= nog Y _._ �_ _ �� Fire De artment .�.. c COMMENTS, t 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 Doc.Building Pennit 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 ,4. 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 OTE: 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 4, 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 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 2012 I ECC Energy code 4, Engineering Affidavits for Engineered products 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 Location (6:4) - A e R "'-� ��- ~�''• No. 11 �— 7 o q Date ik � l TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ` Check # 1 ! Building Inspector m m ic q X cn Z C) ic Z 2 C Z Q Z O �•. D --I O Z 0 0 N CQ O 7 CD to C 0 M y CD 0 � % 0 "0 14L A _ N < C N CDCL , CD n CD n rtrtCL0 a m o= W -�1 0 0 -CL 0m 0. CD r -4L U) 0 —i S. m 2 CL a)CDD O OtoO N' O w � rt n r► CD �D � O CD � O O 6 co LA. O' O 0 cn - h Z O 0 LT D CD :O 0- 0Q 0 <N 3 O < dwo CD rN `D y � � O rt S.O c 0 rt O S =r C �D C _ CD Cn O CD 0 CD N O rt - � S DCD CD -0 as � O rt O OC3 CL O 3 77 m --s (D (D(D z C C 7 °—' O r oo °—' (D n p c o 3 T °—' m o S T °—' ii 3 7 (D Z7 (M S T 3 Q Ol N = n N T Q \ s v D m0 z N ( m m n N m -� 0 C 00G z M N m 0 C z G1 ( n 0 3 W z p O S S O. ^ f&v -' T— r) R Federal ID Al 05-0405629 RISE Enginee ring RI Contractor Registration No SIBS MAContractor Registration No 120979 CT Contractor Registration No620120 60Shaw•mut Road,Canton, NIA02021 RISE CONTRACT 339.502-6335 FAX339-502-6345 Page 1 PROGRAM CMA -LIES 9NsaseaR�INGANNOWCCUa9 FORwNORx Aa neseRaaeo DEM CUSIDWR PHONE DAM CLIENT/ WORNORDER Kevin: Odatcy (617)515-8017 12/22/2016 444671 2-1%2 SERVICE STREET 61WNa SVEET 63 Hetrick Road 63 Herrick Road SERVICE 'Cay, SUIT ZP iuwma cat,aWTE,aP i �..} '..:_! t ` a "" • ! �,j North Andover. MA 01845 North Andover, MA 01845 L,17 ri DESCR lVA.1 f ,,J A.�,�... f 2017 17 . BARRIER: A Blower Door Tcst.%vill not be conducted at your home, due to the presensc of asbestos. 00 14AZARP BARRIER: We have identified that there are recessed lights present in your home. unless the recessed lights arc certified as IC -rated (Insulation Contact Rated) %w "ill create a 3' clearance space around the fixture by using fiberglass blanket insulation as a damming material, no insulation mill be installed across the top and closed cavities Which contain recessed lights %till not be insulated.' $0.00 AIR SEALING: Provide labor and materials to seal areas of your home against mastcfad, excess air leakage. This work ttiill be performs i in concert with the use of special toolsand diagnostic Icsts to assure that your home,01 be left with a healthful level of air acchan'gge 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 gavages and other unheated areas (windows arc not generally addressed.) This %%ill reore(12) vwrking hours. A reduction in cubic feet per minute (cfm) of air infiltration trill occur, but the actual numberof cfm isnot guaranteed. At the completion of theweatheriration mark, and at no additional cost to the homeowner, a final blotter door and/or combustion safety analysis trill be conducted by the sub -contractor to ensure the safety of the.indoor air quality. $1.,020.00 AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This vturk will be performed io concert with the use of special tools and diagnostic tests to assure that yourhome ttiill be left with a healthful levci 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. basement s. attached gamgcs and other unheated areas(Wrldo%vs are not generally addressed.) This will require (2),wrMnghours. A reduction in cubic feet per minter(cfm) of air inIll rat ion will occas, but the actual number of cfm is not guaranteed. At the completion of the ttcatherization work, and at no additional cost to the homeov%ncr, a final blo%wr door and/or combustion Safety analysis, 11 be conducted by the sub -contractor to ensure the safety of the indoor air quality. $170.00 KNEEWALI S: Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to (370) square feel of kneewall area.% NOTE: THl51NCLUD) S2 BUILT 1N&.,C0NTRACfOR DISCRGATION, 51;124.50 STORAGE BARRIER: Homeot%ner is responsible for the removal of the stored items blockingthe installation of wmilicrization mark in the krecuall arcus. Removal must occur prior to the scheduled work start. (initials) i $O.OU Federal ID S 06-0406629 RISE EngineeAug RI Contractor Registration No 8186 % MA Contractor Registration No 920979 � RISEi CT Contractor Registration No620920 60SitawntutRoad,Can ton,MA0202] ENGINEERING` CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM CMA-HES EEMMERIRDIU�7DtNCUSUERFOR WORK AS MOrdRED BELOW CUSVAER PhIm D11E. CUERTS WORKORDER Kevin0 tstey (617)515-8017 12/22/2016 444671 23902 SERVICE $SREET BIUUND STREET 63 Herrick Road 63 NeiTick Road . SERVICE CM, SUM, EP - wwNo Cnr. SAE, ZP North Andover, MA 01845 North Andover, MA 01843 . JOB DESCRWnON ATTIC ACCESS: Provide labor and materials to insulate (2) back ofthc kncc%%ull hatch pith rigid board at R-10 or greater Faith the required ire rating, and seal the edge of the hatch aitlt Awatherstripping. $120.00 ATTIC ACCESS Provide labor and materials to make (2) temporary access to an attic area. The opening still be closed Wth mat criils ✓;imliar to Ihose existing. Finish sanding and paint ing:is not included. $170.0.0 13ASEMC-NT CEILING: Provide labor and materials to install (40) square feet of R-19 encapsulated .fiberglass insulation to the basement ceiling There will be some exposed fiberglass fibers %~here the contractor kill have cut the end of the butts during installation Your signature on this contract is your ackno%%Icdgcmcnt and agreement that this installation is not ftdly encapstdated.. NOTE: T1iISiSRIM J0157, $88.00 BASEMENT I)0t)R: Provide labor and materials to insulate the back of the basement door leading to the btilkhead %lith rigid board at R-10 or ,greater ►pith the requiredfire rating that meets the sections R-316.5.4 and 316.6 requirements of building code. Seat all edges and seams,.rith VSK tape. $110.00 R1SE.Enginecring «ill apply all applicable, eliuible incentives to this contract. You w11 only be billed the Net amount. Currently, for eligible m,casttres, Columbia Gas offers 73%incent ive, not to exceed $2.000 per calendar year, and an incept ive of 100°/4 for thcAir.Scalingmeastresup to the first $680 and an additional $340 if savings are justified by the auditor. ror the safety and health ofyour home's indoor air quality. %w will be conduct inga No= door diagnost is of the available air flow in your home both before the %wrk is begun. and after the ucatherization mork is complete. We %611 also conduct a fudt assessment of the combustion safctyofyour heating system and eater heater. This has a value of $90 and is at no cost to you Total alloaahic acatherization incentive is $3.110. The Permit N%ill be secured by the insulation contractor, at no additional cost. it is the homcov-nces responsibility to close out this permit by contacting their municipality at the completion RLUAM Federal 10 0 05-0405629 RISE Engineering RI Contractor Registration No 0186 �f MAContractor Registration No 120976 1 S E � CT Contractor Registration No820120 ENGINEERING' G0 ShaWrnot Road, Can too, NIA 02021 339-501.6335 FAX339-502-6345 C4 ,VIV I , tRNT Page 3 PROGRAM 10 CORMACTIe ENIEREO IN10 SIMEEN RISE CMA-HES EBA1N EC1SMMFORWORKAS DEaDB Q cwV ER PHONE DAE CUENT9 WORKCRDER. Kevin Ortmey (617)515-8017 112J2016 44671 23902 SERVICE 11i11ET OWNO SHEET 63 Herrick Road 63 I4enick Road SERYICEG1Y.atAE,aP _. - BIWIKSCrrf.aux. aP North Andover, MA 09845 North Andover, MA 01845 JOB DESGRII' WON Total: $3,192.50 Program Incentive: $2,663.07 Customer Total $529.42 WE AGREE HEREBY TO FURNISH SERVICES- COAAK.ETEIN ACCORDANCE W RH ABOVE SPECIFICAT ION& FOR TME SUM OF **''.Five Hundred Twenty-Nine & 421100 ars $529.42 WONFIRALMSPECION ANDAPPR ALBY 8188 ENOMEERINO. CUSIOMER AGREES ID RE4fiANOtB7TDUE H WFRESTOF I% BE CHARGED MONSLLY ON ANY UNPAID-BALANCE AFER JO DAYS. E REVERSE FOR Il1PORD{Hrg1FORMA1pN ON GtMRANEES. RRSNID IE KK89HE CONRACIOR RECUIRAIM 00 NOTSIGN THIS CONTRACT IF THERE ANY SP E AVSH0091EDSl RIS ring CUS OCE CE t 2 2!0/ HOSE. 1000HIRA WNBYUSIFNOMEWEDWYHIN DAECFACCEPIXNCE ACCEMNCE CF COHRACT.jW ABOVE PIUCEe SPECInCA100 AND L'ONDMONS ARE . 30 aAYB AASSSPECMEO.PYM""°NTW�Kt AaDBEASOULIIDE.D AUSftORA3D1D00HEWORK n9l ti I` RISE ENGINEERING -"fk e;;CyEne.pin . 60 Shawmut Road, Unit2 # Canton, MA 020211339-502-6335 www.RISSongineering.com OWNER AUTHORIZATION FORM owner of the property located at: hereby authorize (Property Address) (Subcontractor) an authorized subcontractor for RISE Engineering, 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. The Permit will be secured by the ins responsibility to close out this permit Date ', at no additional cost. It is the homeowner's it municipality at the completion of this work. 6.2016 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: POLAR BEAR INSULA11M PO BOX 958 AND01/ER, MA 01810 City/State/Z'ip: Phone #: 57 Are you an employer? Check the appropriate box: Type of project (required): 1. (l I am a employer with 4. ❑ I am a general contractor and I _6 employees -.(full and/or part-time).* have hired the sub -contractors 6. E] New construction 2. ❑ 1 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. E] Building addition [No workers' comp. insurance required.] comp. insurance. 5. ❑ We are a corporation and its 10. El 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 'workers' 13. ❑ Other employees. [No comm. insurance reauired.l *Any applicant that checks box #I 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. nn Insurance Company Name: v r M A t - 7"'A v f 4 We Cc twt Y4 to Policy # or Self -ins. Lic. #: 7o w y 03 6 Expiration Date: a 2o 1.' Job Site Address: c Q� City/State/Zip: �_ �}dl d✓rl p rX 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 thea. and penalties of perjury that the information provided above is true and correct. Phone #: �1 %� �% dim ;> o ip 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 #: 11312017 Insurance Services AC4::)RV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYM TYPE OF INSURANCE 01(0312017 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 pollcy(les) must 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 NAME: Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard Roseland, NJ 07068 PHONE A No Ext): E MC, A tR INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: NorGUARD Insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURER B INSURER C PO BOX 958 INSURER D: Andover, MA 01810 INSURER E : INSURER F: THIS IS 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. ... 5K LTR TYPE OF INSURANCE (NSD WVD POLICY NUMBER POLICY EFF MWDD POLICY EXP MID LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurrence $ txAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PR JECTF LOC GENERAL AGGREGATE $ PRODUCTS - COMMOP AGG $ OTHER: AUTOMOBILE LIABILITY Eaaodden t $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMA(* Par sodden $ $ UMBREIIALNAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION$ I$ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICERAIEMBER EXCLUDED? ECUTIVE a (Mandatory in NH) Wdescribe under RIPTIONOFOPERATIONSbetow N I A N POWC840361 0110112017 01/0112018 X STATUTE ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE -EA EMPLOYE 3 1,000,000 E.L. DISEASE -POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remark. Schaduk, may be attached Vmom space B squired) Contractor License: CSL 106017 HIC 102726 Town of North Andover 120 Main st North Andover, MA 01845 At;UKU 25 (2014!01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD https:lladpia.adp.conVISExtemaIlapplindex.htnil?clientid=2037315&requestFrom=run#lhome 111 ACO �,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMOWYYY) 6/10/2016 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: H the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 endorsemen s . PRODUCER Insurance Solutions Corporation 60 Westville Rd CT Linda Bogdanowicz NAME.PHONE (603)382-4600 FAX .(603)332-2034 N:lindab@iso-insurance.com �� INSURER AFFORDING COVERAGE NAIC 4 Plaistow NH 03865 INSURED INSURER A .Metes World Polar Sear Insulation Company Inc PO Box 958 INSURER B Mautilns Insurance (iron INSURER C: INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632326134 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 MATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO Ail THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD[ RM LTR I TYPE OF INSURANCE X COMMERCIAL GENERAL UA131LITif WVD POLICY NUMBER POLICY EFF POLICY LIMITS A � CLAIMS -MADE I X l OCCUR UPP8274967 3/24/2016 3/24/2017 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES Ea o nence 5 100,000 MED EXP (Any one n S 5,000 PERSONAL BADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPLIES PER: X JECTT '❑ LOC POLICY ❑ OTHER:PRODUCTS GENERAL AGGREGATE $ 2,000,000 - COMP/OPAGG S 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SING LIMIT ..M.R $ BODILY INJURY (Per person) S BODILY INJURY (Per acaderd) S PPReOa DAMAGE ren $ $ B X UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE AN026107 3/24/2016 3/24/2017 EACH OCCURRENCE S 1,000,000 AGGREGATE $ 1 000 000 DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS, LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBEREXCLUDED? �N/A (Mandatory in NH) If nes, describe under DESCRIPTION OF OPERATIONS bebw $ PER OTH STATUTE ER E.L. EACH ACCIDENT $ EL. DISEASE - EA EMPLO $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCAT16MB VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) Town of North Andover 1600 Osgood St, Ste 2032 North Andover, MA' 01845 --VlIY LJ JAW I -Hu 1/ INS025 rmiaon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Maglia/SJA ©1988-2014 I ne Auumu name and logo are registered marks of ACORD TION. All rights reserved, Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registra6an: -= --- Type: Expiration: POLAR BEAR INSULAT[ON CO. Vincent LeBlanc ANDOVER, MA 01810 - Update Address and return card. Mark reason for change. - SCA 1 0 20M-oslii � Address [] Renewal ❑ Employment n Lost Card 102726 DBA 712120'18 Tri 419291 J1Se�a��tmantner��//r o�G%�jfi3l!/C/lr�sell3 OMce of Container Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR = Registration: ' 102726 Type: Expiration: 712i2018 DBA POLAR BEAR INSULATION CO:: . Vincent LeBlanc 51 SO. CANAL ST- ;5A LAWRENCE. MA 01841- Undersecretary License or reg'biradou valid for individual use only before the expiration date. If found return to.- Office o:Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, MA 02116 wi—x-odvaid without signature )V�' Massachusetts -*Department of Public Safety Board of Building Regulations and Standards Comtruction Super%Nor Spedulty _icense: CSSL406017 � PETER A LEBLANC ` . .• 2 EAST PINE STREET p _ Plaistow NH 0386-5 -.�..►�l1>��t�c. ` Expiration Commissioner 0412812018