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HomeMy WebLinkAboutBuilding Permit #408-2011 - 630 TURNPIKE STREET 11/15/2010 NO R TII BUILDING PERMIT °*<tLED 6gtio 2 h6,.rr, .•?n,�6 C TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION � n / V Ra Permit NO: Date Received �,S RATED rQP R`� SACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page Pnnt - - yi �� `r PROPERTYOWNER 54i . .. GIVt- 3 'MAR-21 0 y PARCEL ZONING DISTRIC Histone Distnct yes. no Machine Sliof?.Villageyes no 'TYPE OF IMPROVEMENT PROPOSED USE E Residential Non- Residentia ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial, , Alteration No. of units: - Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other =. Septic [7 We11 0 Floodplain ' ` D Wetlands tershed Distric#_ a Water/Sewer. DESCRIPTION OF WORK TO BE PERFORMED: i Tentifi Please Type or Print Clearly) RI Phone: i 78OWNER: Name- � 8icLb^ ►?h'� h Address: e otJ2 CONTRCT AOR Nai-ne: Vhi "Pho\n'e: .T 0 3N.- ©L�� Address:' Qc0 �oX 17' c Nwi. �1i� :-.03073 .4d 4 - /. •�--s -` Supervisor s,Construction License: V �'(� Exp: Dater �/ a /- Home Improvement License: �. Exp. Date: ARCHITECT/ENGINEER Phone: '111-'-7'51-'7lfo4 II Address: Dr•'kJkX i;si 13-0 W0,Ys3r- SAtlWL-', 01gyLReg. No. Z41-21, FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Oo Total-Project Cost: $ 663 FEE: $ ' Check No.: Receipt No.. 3 NOTE: Persons contracting wit re iste ed c tractors do not have access to the guaranty fund Si nature of contractor Signature of Agent/Owner g Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS DV HEA i' LTH Reviewed on - ' . ;Si nature - - g COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ,` Planning Board Decision: Comments + - ►= i Conservation Decision: Comments Water& Sewer Connection/Signature ®ate Driveway Permit i DPW'gown Engineer: Signature: Located 384 Osgood Street [FIRE DEPARTMENT - Temp Dumpster on site yes nocated at 124 Main Street ire Department signature/elate OMMENTS.. ` --- - -_=— -- I 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 4 and G min.$10041000 fine - - NOTES and DATA– (For department use r r-740 Notified for pickup - Date Doc.Building Permit Revised 2010/October s ._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 CP om Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ -COPY of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products MOTE: 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 ❑ Flo or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Phew Construction (Single and Two Family) a 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Perrnit- Yn 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 anust be submitted with the building application Doc:Building Permit Revised 2008 Location No. �/U� G// Date "Q"'" ALI TOWN OF NORTH ANDOVER O F R 9 + Certificate of Occupancy $ Building/Frame Permit Fee $ �7 s�CIN _ ;y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #23693 wilding Inspector ORTH Town of Aitid®ver 1L . LAKE -o over, Mass., COCHICHEWICK V RATED P �y BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System 46� BUILDING INSPECTOR T 1 IS CERTIFIES THAT.................................................:............................................................................................................. Foundation he permission to erect.................:...................... buildings on ...................... .......f.........`.5 ...................... Rough to be occupied as...... !�! ./� ! .Cl... �'... � �`C � `l*SSQGI.�frEs' Chimney provided that the person accepting this permit shall in every r spect conform to the terms of the application on file in Final 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough .......................... . "`"_"` Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the-Premises - Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner' DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. NO FD 7577 Date TOWN OF NORTH ANDOVER RECEIPT HU This certifies that..A,- ..111111,V0,,t-t1-1..... C................... haspaid....15- �........................................................................ for.... Received by.",-,D �. Department............. ........................................................... WHITE: Applicant CANARY:Department PINK:Treasurer Si The Commonwealth of -Massachusetts Department-of Fire SeMGeS Office of the State Fire Marshal P.0.Box 1025 State'.Road,.Stow,MA 01775 PERMIT ' Date: North Andover -Pernift No (CityofTown) (If Applicable) DigSafeNum er • In accordancd.with the provisions of NLGI,.l 4 8 Chapter_jjo asprovided insection—i=—EMR 34 Stmt Date This Pe'rnut is granted to:. I -t-e .41,1 Full name of person,Firm or Corporation Permission to locate dumpster - f or construction/renovation/demolition of building Comments:' dumP' ster. must be , 25 ' from structure if unable to place with required Restrictions: clearance.nce dumps-ter must be covered with plywood or tarp end of 'work day .at Give[=don by street and o.,or des.6b7.h manner o*rovie;d adequate identificadon of Qation as t Fee Paids 50.00 • Fire Chief This Permit will expire- (Siatureof6fficatgantingpermit) Offical granting permit Title T Massachusetts-Department of Public Sufeh Board of Building Regulations and Standards Construction Supervisor License License: CS 56710 TIMOTHY J FRAHM PO BOX 336. N SALEM, NHNWOM J �r Expiration: 11/7/2012 ('onunissiuurr Tr#: 6234 The Commonwealth of Massachusetts Department of Industrial,Acciclents Office of Investigations 600 Washington Street Boston,MA 02111 �.. 5�•` www.mass.gov/clic Workers' Compensation Insurance Affidavit: Builders/Contractors/�lectrase Print Legibly ers Applicant Information Please Print Leibl Name(Business/Organization/Individual): Address: Q 0 , 17 City/State/Zip: Aa e n W%% 03073 Phone#:( 60,31 cf 3 ' .0973 Are you an employer?Check the appropriate box: Type of project(required): 1.Dg I am a employer with 3 4. [A I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet.? 7. E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance S. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.El am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.0 Roof repairs insurance d.re uireemployees.[No workers' required.] � 13.® Other:;:VnNeA�4, comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this 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 workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name 7� �7_ C)LALK1C_C_V\\AExpiration Date: 2— Policy#or Self-ins.Lic.#: Cc,2)0,7-9y; 1C-)y Job Site Address: iuRh � P `q City/State/Zip: , MOSIQ-9, tQ-, 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 nder a ai andpenalties ofperjury that the information provided above is true and correct. Si ature: Date: 1 a Phone#: (Do 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: °RTM OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER '•; CONSTRUCTION CONTROL - �ssxwN' PROJECT NUMBER: PROJECT TITLE: 0 C e memv-,%(i hLS PROJECT LOCATION: NAME OF BUILDING: NATURE OF PROJECT: Cgl� (L--:P1Zi Tsl.-C�ii� tE�.��tG � IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, CC,Wliktd REGISTRATION NO.24,I z2 T BEING A REGISTERED PROFESSIONAL ENGINEER/AF HEREBY CERTIFY THAT 1 HAVE R ALL DESIGN PLANS, COMPUTATIONSAND SPECIFICATIONS CONCERNING: -6yiawe.D ENTIRE PROJECT ARCHITECTURAL 0 STRUCTURAL 0 MECHANICAL 0 i FIRE PROTECTION 0 ELECTRICAL -0 OTHER(SPECIFY) FOR-THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO.THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY.. 1 SIGNATURE N SWPSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 10'H.V Q,r x'00 I� NOTARY PUBLIC MY COMMISSION EXPIRES31 1)6 MASSACHUSETTS SIGNATURE WITNESSING Gov.Exec.Ord.#455(03-13),§5(f) Commonwealth of Massachusetts County of �(1r �. 0 ss. h _ "� On this the day of nogpw�hT - 1® , before me, Day Month Year 15r`R- �! `�Y®►�Q ffrR '4� the undersigned Notary Public, Name of Notary FlUblic personally appeared Nfime(s)of Signer(s) proved to me through satisfactory evidence of identity, which was/were �'t'ywd17® M.0- Description of Evidence of Identity to be the person(s) whose name(s) was/were signed on the preceding or attached document in my presence. Signature of Notaryublic Printed Name of Nota My Commission Expires LALRM A.AM$T1=11 9 =1 PC=: t C CO^ a Exams tU 11.231110 Place Notary Seal and/or Any Stamp Above OPTIONAL Although the information in this section is not required by law, it may prove valuable to • . .. persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Top of thumb here Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: ©2004 National Notary Association•9350 De Soto Ave., P.O.Box 2402•Chatsworth,CA 91313-2402•www.NationalNotary.org Item No.5953 Reorder:Call Toll-Free 1-800 US NOTARY(1-800-876-6827) r MJS MILLWORK, LLC November 10, 2010 Pentucket Medical Assoc. 1 Park Way Haverhill Mass Job—630 Turnpike Street Contract— For interior renovations to include moving reception walls and office walls to allow for better flow of patients. Expand doctors office, add 1 more exam room and new work station for medical assistants. New paint,new flooring in hallways and reception. New countertops and cabinets. Move electrical and data as required. Patch and replace existing ceiling as needed. Note: 80%of work is to be completed the week of Thanksgiving starting Tuesday night and going thru the weekend. The office will need to be closed on Wednesday the 24th. Flooring and final paint and touch ups etc. to be completed Monday the 291h thru December 5th. Your total investment is in the sum of $57,663.00 Mass Tax $ 251.56 1� ::d Tim Frahm Jo S o MJS Millwork LLC P n ket Medical Assoc. PO BOX 17 • North Salem New Hampshire 03073 Tel 603-893-2173 • Fax 603-890-6963 0 34 J,,I:u61.1r.hA,Jg As r., ,;._:i. IiC SATE OF LIAE3ILIT'Y NS RA 't IBB " A R�A"°""„w..~ ,®� c9RrrFrCprg DOU NOT aF«� 4@tAAT Y AHe ae I ARPIRillil ELY OR 1Vrsit�*iy�,e.1rA � 1 $7Y0 lrc�rrl�v 4'Yt?N ,, 07/) "LOYv. 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Aft rdnurkg WAW � 11YsbMtvlO. roc.'+buu FAX 603.382.2034 v W a xn I-A%.,C 1mMiuu/YYYY) Insurance'Solutions Corporation THIS CERTIFICATE IS ISSUED A 12/29/2009 60 S A We ONLY MAT Westville Y —MATTE -R 11 a Rd � AND CONFERS NO RIGHTS UPON THE OF INFORMATION ION HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Plaistow, NH 03865 ALTER THE COVERAGE AFFORDED BY TH Marialana D'Agata E POLICIES BELOW.I INSURED Uptack Plumbing INSURERS AFFORDING COVERAGE g & Heating, Inc. —�—UINSURER ---____ NAIC# 32 Rochambaul t St INSURER A: Peerless -------- Haverhill , MA 01832-1941 B: -------- 24198_ INSU ER R C �� _. I' NSURER D: _ COVERAGES INSURER THE POLICIES OFtN 1. ERM O LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISS TO ALL THE TERMS,EXCLUSIONS POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OR THE POLICY PERIOD INDICATED.NOTWITHSTANDING O WHICH THIS CERTIFICATE MAY BE ISSUED OR NSR DD' ONS AND CONDITIONS OF SUCH LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY DATE MM/DO/YYYY MM/DD/YYYY DATE CBP2266492 12/31/2009 12/31/2010 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ 1 CLAIMS MADE n OCCUR DAMAGE TOREN ED $ 11000,000 A I — PREMISES Ea occurrence $ 11000,000 -- _ MED EXP(Any one person) g --- PERSONAL 8 ADV INJURY11000,000 10 OOO GENT AGGREGATE LIMIT APPLIES PER: $ 1,000,000 GENERAL AGGREGATE X POLICYPRO- 0ECT LOC $ 21000,000 IAUTOMOBILE LIABILITY PRODUCTS-COMP/OP AGG g 2,000,000 ANY AUTO BA2244529 12/31/2009 12/31/2010 I AL OWNED AUTOS COMBINED SINGLE LIMIT _ (Ea accident) $ _X SCHEDULED AUTOS 11000,000 X I HIRED AUTOS BODILY INJURY— —— (Per person) $ - X NON-OWNEDAUrOS BODILY INJURY -- _--_--_ (Per accident) $ PROPERTY DAMAGE GARAGE LIABILITY (Per accident) - $ ANY AUTO AUTO ONLY-EA ACCIDENT $. EXCESS/UMBRELLA LIABILITY OTHER THAN EA ACC $ CU873247,' Auro ONLY X�OCCUR 12/31/2009 12/31/2010 AGG $ CLAIMS MADE I EACH OCCURRENCE AGGREGATE _ 3 I _ATE $$ ,000'000 DEDUCTIBLE I �_ 3,000,000 X RETENTION $ 10,00 --___ $ WORKERS COMPENSATION $ ANO.F.MPLOYERS'LIABILITY — v/N WC22664901 12/31/2009 12/31/2010 $ ANY PROPRIETOR/EXCLUDED? UTIVEf--1 _ W q OFFICER/MEMBER EXCLUDED? u i TORY LIM (Mandatory in NH) ITS If yes,describe under E.L EACH ACCIDENT -- SPECIAL PROVISIONS below - $__ 500,000 OTHER E.L.DISEASE-EA EMPLOYEE $ 500,000 E.L.DISEASE-POLICY LIMIT $ 500,000 ;IPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 'IFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN MIS Mi l l WOrk 'NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL PO BOX -336 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Salem, NH 03073 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 25(2009/01) l�t RD CORPORA ION. All rights reserved. The ACORD name and logo are registered mOarks o ACORp -107 14L'u [q %.#cR ' it moo i r _IAbIL1 I Y INSUKAN(;E vA1CjMWW1xy YTY) 07/14/2010 PRODUCER 603.382.4600 FAX 603.382.20 4 THlS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Solutions Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 60 Westville Rd HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Plaistow, NH 03865 IMURERS AFFORDING COVERAGE NAIC# INSURED All Bright Systems, LLC �' Ir.-4-f;z=+, Peerless 24198 S Brookhollow Dr ;__- Netherlands Insurance 24171 Salem, NH 03079 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HA4SEE BEEN LSSt/ED TO THE MURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF A6S'Y CONTRACT OR OTHER DOCU).!'ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCtES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PALO CLAIMS- NSR ADEYLPOLICY EFFECTIVE PTE(MMODNYYYI 00U Y EXPIRATION LIMITS LTR NS TYPE OF INSURANCE I POLICY Nll�BER GENERAL LIABILITY CBP3497378 05/31/2010 05/31/2011 EACH OCCURRENCE $ 1,000,00 01 X COMMERCIAL GENERAL UkBILrry -D=Ut FO RE 5PREMISES a occurrence $ 100,00 01 CLAUS MADE OCCUR MED EXP(Any one penton) $ 15,0W A - PERSONAL E ADV INJURY $ 1,000.000 GENERAL AGGREGATE $ 21000,000 GEITL AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ 2 R 1000,000 POLICY X JECTT LOC AUTOMOBILE XAUTOABILITY BA3497374 05/31/2010 05/31/2011 BINED SINGLE LIMIT $ (Ea accident) 1.00 100 ALL OWNED AUTOS BODILY INJURY B SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAANYGE AUTO LIABILITY AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CU8778554 05/31/2010 05/31/2011 EACH OCCURRENCE $ 1,000,00 OCCUR CLAIMS MADE A AGGREGATE $ 11000,000 Fx DEDUCTIBLE $ RETENTION $ 10,000 WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC3503455 05/31/2010 05/31/2011 TORYLIMITS ER B OFFICER/MEMANY EBEERR EXCLUDED?ECUTIVE� E.L.EACH ACCIDENT $ 500,00 (Mandatory ) 500,00 In NH [fps describe under E.L.DISEASE-EA EMPLOYE $ SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 5001,000 00,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL M]S Millwork IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR PO BOX ;17 REPRESENTATIVES. North Salem, NH 03073 AUTHORIZED REPRESENTATIVE Kathleen Miller CISR, CPIW ACORD 25(2009/01) FAX; 603.890.6963 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD