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HomeMy WebLinkAboutBuilding Permit #292-2017 - 64 EMPIRE DRIVE 9/19/2016 L BUILDING PERMIT TOWN OF NORTH ANDOVER O APPLICATION FOR PLAN EXAMINATION _ Permit No#: All Date Received9 A�RITED `� I SSAC14U`�� Date Issued: IL I PORTANT: Applicant must complete all items on this page j LOCATION 6 tl fP t� Print PROPERTY OWNER t4a( a'3'��(— Print 100 Year Structure yesrno, MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family CeAddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: r, ❑ Demolition ❑ Other D Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: l�ls I llf�C�a� h vh�c6"1 marc by V,1�4 ca 5!�n 21� Identification- Please Type or Print Clearly OWNER: Name: d e& W-0. 1a yr- Phone: qct T-13clW05- Address: Contractor Name: 7417 Ccc lfG Phone: U7 F 9z1 Fc;(16/ Email: '4- Address: ,JV Supervisor's Construction License: 05 fC 6653 Exp. Date: 05-061 ' Home Improvement License: � ��'� . _ Exp. Date: ARCHITECT/ENGINEER CPhone: Address: CGU k(171111 411/7jW!7`o VyP /;4,r Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 13( Total Project Cost: $ 3-1 CY der gip' FEE: $ e, Check No.: 5b 5–� Receipt No.: �1Z, NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �� `Signature of contractor i Location nn,n', Y1�►V�- No. ! -off �� i Date t • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f Check# Building Inspector /` J 1 }i ON Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped]Plans ❑ TYPE OF SEWERAGE DISPOS 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 LANNING & DEVELOPMENT Reviewed Onq ) zooSignature_ P_.,'q P COMMENTS a p CONSERVATION Reviewed on / Co Signature COMMENTS �JJZ';, �� i�S v�Q ::ae2 L CA HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 0 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp.Dumpster on,�site yes no Located,at 124 Main Street Fire Department signature/date COMMENTS 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 s Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$100o fine NOTES and DATA— (For department use) l ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department I 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 i ❑ 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 j 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) o 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 i In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then 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 Enter construction cost for fee cal - North Andover Fee Cakulation $ 30,486.00 m $ - $ 365.83 Plumbing Fee $ 45.73 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 45.73 Total fees collected $ 557.29 64 Empire Drive 292-2017 on 9/19/16 three season room on deck Plans Submitted ❑ Plans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM CANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS N p\ CONSERVATION Reviewed on� / CA Signature " COMMENTS Q. HEALTH Reviewed on Signature COMMENTSert (— 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: F E AR=TM_EN� rt _ F _ RLocated _._ -F _ ._ 84 T Temp u- M-10 om situ ye_s, oca a Osgood Street IAgg7 tetl at 1'24'Main:Street -- j °Fire Department signatur..eldate_a _ ��COMIVIENTS __� NORT1i Town of : _¢ a.. ndover 0 No. soh ver, Mass,LAK q COC MICINIWKK 1' A�R�'rep S U BOARD OF HEALTH Food/Kitchen Sept'PE c System THIS CERTIFIES THAT MIT BUILDING INSPECTOR ........ Foundation has permission to erect .......................... buildings on �+ Rough to be occupied as ... r'1 ...i� .��� .,.,, ; ;�,�„ , Chimney provided that the person accepting this permit shall in every respect conform to the terms of the a lication Final on file in this office, and to the provisions of the Codes and By-Laws relating tot Inspe tion,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS k T Rough Service .. ... ..... ZING04 .. ......... Final I ECTO GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. �' �."�B �•�♦♦•♦♦♦ / Qom" � �'� G ' <<�off- t.\ �� .��`y♦�♦.,.�` ,,i0 ��� ®�/i• A ♦•O� c�/ `�VER � r '�- `♦♦ ♦♦♦♦ ♦♦•••iii °'r •i+i•���/� A/C UNIT- IULKHEAD lax, IC♦♦O♦O♦ O.. � � � � 'ate. • ., ,(��►r is ��@%/ O E� � � , � �S:'d.•E.'� .. • ,gym ���\ �'// �� �'4����/e.f`�y- • -� � t1?�� gyp; y17� E�.4/� / '��//�, �,-r�a,•�am�s,�s-tea= z�`mea�ms��� � � �°�. �,o���'� 1� _.�--' � Z�aaeam aes=osaa tas•,� //.G;�2 ��� SLS 1. �s�� •• r mee�7; S �� F.••:::�•.� arsr�a �'sassx • Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner In rmation Contractor Info tion Name AA Company Name 4 y e / �'IQ O�� 7G17 17 Lai f!_! Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 0( 0 9 %fin r. City1rown State Zip Code Business Address(must include a street address) r:U 041r -Pette Moe, C/ Daytime Phone Evening Phone City/rown State Zip Code Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Homermprovement Contractor Reg.Number Explatimdate Law nqurro thnt mosactt home 2m.Hd ghimlon u..rshave awndngislntion numhcr The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work e— completed specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) gns �! j�e-3 f'C��3r rt s�q!a+,n a�c t j' elnod an ee*1 (,fire-do 1 a K :QJVv/1 epi fiz llw Sh%n,�✓e ice F S/�! w�i� ,2d r s 14­ny tel' & i d,Yxv, 1,ce, Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be .�// excluded from the Guaranty Fund provisions of 046—ODa�e when contractor will begin contracted work. MGL chapter 142A.) ,/,fiGo/0 t►`�l/'")Tate when contracted work will be substantially completed. Total Contract Price and Payment Schedule 2 The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of. Payments will be made according to the following schedule: $ 16014 upon signing contract(not to exceed 1/3 of the total contract priceor the cost of special order items,whichever is greater) $�by / / or upon completion of I'101—In-'/y y-ed 04"10(01-fX-PIA ch�' $ f!���� �//�//by / / or upon completion of $ X) '7'OVupon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) Tie following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(")law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty fs an express warranty being provided by the contractors RNo❑Yes fall terns of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this aereement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted Nvithin this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Reeistration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Horne Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document • Know your rights and responsibilities. Read the Important information on the reverse side of this form and get a copy of the Consumer Guide to the Home improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractors normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business da following the signing of this agreement See the attached notice of cancellation form for an explanation of this right Y g � g DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM 1%vo identical copies of the contract must be completed and signed.One copy should go to the homeoowne/rT The other copy should be kept by the contractor. Homeowner's Signature Contractor's Signature Dae Date PARTS LEGEND FEMALE VERTICAL INSTALLERS LAYOUT SKETCH H CHANNEL CMAIE -aNctE CORNER VERIFY ALL FILL MEASUREMENTS BEFORE CUTTING � � g U4 a Ir * DBL-CHECK BOM * ° THIS JOB HAS NOT BEEN CONFIRMED. =a z v PLEASE FAX AN APPROVAL WHEN READY TO ORDER. CS 00 a•.z o �Naa RELEASE APPROVED BY r (586)314-0404 ❑BUILD SHIP IMMMIAIMY CUSTOMER: US HOME IMPROVEMENT Lo cn JOB NAME: WASSAF, H ADI 3 5/8" WALLS np 11 U 120 120 NO TRAPEZOIDAL GLASS N A o o� Z oz in GABLE(s) ROOF ROOF cn PITCH PITCH IA OF LUAY s. ' yG ] 55 C� 55 036 �] 71 .625 C s CIVIL3 3/16 o.40SO4 11 /16 120" 120" NOT TO SCALE ICC LE EVALUATION REPORT 0118 240 ^O ICC LEGACY REPORT ESR-1801APPROVAL `t FLORIDA PRODUCT APPROVAL 5505-R1 ICC EVALUATION REPORT ESR-1403 FLORIDA PRODUCT APPROVAL 10829-R2 120.00 �y C FLOR DA PRODUCT APPROVAL 7086•R1 D 6.0 2 FLORIDA PRODUCT APPROVAL 7082-R1 FLORIDA PRODUCT APPROVAL 12671 _� 16W3295 08/10/16 US—HOME DETAILED BY: MICHAEL RANG FLORIDAPRODUCTAPPROVAL38557-R2 lZI FASTEN ROOF PANEL TO En 0 ALUMINUM CHANNEL WITH #8 .41 z 1 /2" SCREWS AT 6" ON CENTER METAL PREFLASH AND z MOUNT TO Z—CHANNEL EXISTING WALL ui W/ f8 X 1 /2" SCREWS co �2 ;4 6 0.C. 0 "D 8 s NWAlMNlWdWAML.;lb CD 00 ROOF' 00 00 C:, 0 w W �- z Z NU 0- 0 HANGING RAIL MOUNTED WITH (2) 1 /4" X 3-1/2" SCREWS CD INTO EACH WALL STUD 0 STAGGERED TOP & BOTTOM 0 cn O 0- no w - !� Z a ul o H 0 N cc0 LIJA. 8,), ® ETAIL ' B ' (D z ES A4� — Es 6 * 0 ll. m z < lz O :5 tn U) m S.: M O O Z M a d 4Jp_G0 � 9 CL�� C;: Z T Q .-.O A B wooer a�zv � EXISTING HOME a to z Doao Allot ,0� I I I I 1 I I 10' 0" o (10 ,41. _ N I I I I I o f o co — o � Nrn o zea too t o I I I I I I Lo o = ow '� II I w 9ZaX 5(" WINDOW 55" WINDOW 6" WINDOW �6' PATIO DM rIP 20'-Q» O� 2 z 0 Z o a L UA v 4040 cS�Q N 0. o 00 LJ ��/� m W Q O -' CD z FLOOR PLAN NOTE: < wi FRAME COLOR: WHITE THE SIDE WALL ATTACHMENT = � TO HOUSE IS A NON-LOAD i FASCIA/TRIM: WHITE y Q INTERIOR KP: WHITE BEARING CONNECTION. c/) PROPERLY CAULK BOTH SIDES EXTERIOR KP: WHITE NOTE: ENCLOSURE NOT TO BE USED OF ALUMINUM EXTRUSION SKIN TYPE: 1EMKOR AS A PERMANENT LIVING AREA AT THIS CONNECTION. c c 9l/OL/80 ava Y 0m� lu ,:atr.. r• }j:tip``,,, f„�• :r,i.a•rt,• 1}sit. \\ i'• t y 4 •a er r3 \\ fy r• '.�s��t T m N ..Sadf• \ �lfi;,.v((•�d,".,'k€J.' Z'r,' r• 03 \\ t�:<<�E��• Rt i.S it .sat �`?it•�r / >t•,i t ;•r t.�+ =rn azgoD W ter- acro-m =N afTl 2 —q I to o z mO c m-1z 90n0wo0 �cpooz z 10 mypm�n00 ell p>mp� 0w n0m0C G) z z mzmmN mm n�m 0G) K0 to DEALER:US-HOME 16W3295 PH. ( ) TEMO SUNROOMS, INC. WAY ESHO, P.E. WASSAF, HADI 20400 HALL RD 20400 HALL RD. 64 EMPIRE DR CLINTON TWP, MI 48038 CH. (80 )TON 3 - 48038 66 NORTH ANDOVER, MA 01845 PHONE: 586 286-0410 PH: ESSI 344-83IN ( � PROFESSIONAL ENGINEER DRAWN BY:MICHAEL RANG ON:08/04/16 1 SCALE:NONE PAX: (586) 314-0404 MA Lic. # freddie I II SEE ATTACHMENT DETAIL '®'- 4T+EM04 TEWC ALUMINUM CLAD STRUCTURAL INSULATED ROOF PANELS FIG. I --- O H Yi U 00EXISTING z a G) 4 O Cs STRUCTURE � I co ;* 4TEM04 0 FIG. J3 8 _0., 00 t0 42 � ofoZ 01 LI 0z© X ~ NCJSf�19Q� OR C7 EXISTING WOOD DECK �,a -F WITH FOOTINGS I IA E$IHo <t CIVIL U" ROOF PANELS: 4114m,0.032, 2#. ROOF 'LOAD:45 P.S.F, � � � The Commonwealth of Massachusetts Department ofIndastrialAccidents F d X Congress Street,Suite 100 - Boston,MA OZY142017 , www mass.govldia Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plutmbers. x TO BE FEE"WITH THE PERMITTING AUTHORITY. A pl:icant Information Please Print Ilegibly Name(Business/organizationUndmdual): US YC1n e• r-/')'1AP�V9 MW�- Address: 27 144,MVJ tin /\A City/State/Zip: l?e�cl�e�el y 11'1 Q 01-16e Phone#: Are you an employer?Check&api rropriate box: Type of project(regtured : 1.[� I am a employerwifh .�9�. ! employees(fan and/or part time).* 7.. [1 New cozistruction 2.Q I am a sole proprietor or partnership and have no employees working for mein 8. El Remodeling any capacity.[No workers'comp.insurance required.] Demolition 3.FJ I am a homeowner doing all work myself[No workers'comp..insurance required.]? 9. ❑ 10 [aSuilding 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 11.[]Electrical repairs or.additions proprietors withno employees. j 12:F1 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 bade employees and have workers'comp.insurance. 6.Q We are a corporation pnd ifs officers have exercised their right of1muiption per MGL c. 14.[]Other 152,§1(4),andwehave no.,eenployees.[No workers'comp.insurancerequired.] *Any applicant that checks box 41 must also fdl out the section below showing their workers'compensation policy information. T Homeowners who submit tlmis affidavit indicating they are doing an work and then hire outside contractors must:submit a new affidavit indicating such tConiractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have '' ' e em to ees the�must rosidetheir workers'comp.policy number. employees. Ifthe sub-contractors hav p y Y P X am an employer tliat is pYovidingworkers9 compensation insurance-ormy employees'Beloiv is the policy acid job site information. Insurance Company Name: IW6F'sh�"1"G, yami W gX — Policy#or Self-ins.Lic. ayvC G y 7 3 gq ExpirationDate: 7- owl G Job Site Address:_6 cl -le City/State/Zip: 44AIler Ma- 0/Sys' 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. X do hereby certify under�thepalns�andpen _ ofperjury that the information provided above is due and correct P '} C Si afore: Date: Phone# lei-775, 3 Official use only. Do not write in this area,to he 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.Plambing Inspector 6.Other Contact Person: Phone#: 09/19/2016 12:41 7817498822 JOHN J. LAMB INS PAGE 01/01 CORDSDATE(MreroYYYY)lx CERTIFICATE OF LIABILITY INSURANCE 9 19 16 HIS 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(les) must be endorsed, If SUBROGATION 15 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 tD the certificate holder in lieu of such endorsemenke). PRODUCER NAWI ACT LTohn J. Lamb Insurance Agency PHONET81 74Q_6960 Ia4X N (781) 749-8822 24 North Street E-MAIL Hingham, MA 02043 SS: karinv@j1ambinsurance.com INSURERS)AFFORDING COVERAGE NAIC# _-....._._..._—•------._......._-.._.---•---_-----• _ __ _ _ __ __-•--•— INSURERA:SafetV Ing INSURED - John H Carroll Iwuwa;Guard Ins- Bureau • INSURER C dba U3 Home Improvement INSURERD: 27 Hamilton Rd INsuR E: Peabody, MA 01960 INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW HAVF,BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAT'6D. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WffH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAN,THE INSURANCE AFFOFOEI) BY THE POLICIES DESCRIBED HI=REIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. --- ---- ffiL e0 ---- —,----�......_._ ---- u� Pd17s:Y - -- _.... ......._._. INS LTR TYPE OF INSURANCE N POLICYNUMER MM/DD MM/DD/W1rY LINTS A GENERALUABILITY BMA0005758 6/20/16 6/20/17 EACH OCCURRENCE $ 000,000 X COMMERCIAL GENERrA�-L•�LIABILITY I�i ETO`aENTED $ 10o'000 CLAIMS-MADE L_ I OCCUR ' MED W(Ary ore Dawn _$ 10,000 PERSONAL&ADV INJURY S-11-000 000 GENERAL AGGREGATE $ 1 000 000 GEN'LAGGREGATELINT APPLIESPER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY CeMBINEDSJNG $ ANYAUTb BODILY INJURY(Per pemarl) $ ALLOVVWD AUTOS AUTOS BODILY BODILY INJURY(PQr mdderrt) $ NON-OWNED I PROPS HIREDAUTOS _AUTOS p�acp�„t ffi UMBRELLA LIAR F OCCUR EACH OCCURRENCE $ FXCESS LIAR CLAIMS-MADE I A$GREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION R2WC647329 10/7/15 10/7/76 WCSrATU- I OTH- AND EMPLOYERS'LIABILITY Y/N I MRY 1.IM ITS ANY PROPRIEIOR/PARTNERIEXECUTNE EL.EACH ACCJDENT $ '100,000 OFFICERAVEMBEREXCLUDED? N/A (Mandatory In NH) DESCRye¢s,desvbeunder EL.D{SEASE-EAEMPLOYE �00 000 RIPTMONOFOPERATIONS bB10W 61,DISFASE-POLICY LIMIT $ 500,000 MSCRIPTION OFOPPRATIONS/LOCATIONS/VENCLES (Attach ACORD 101,Ad:Honal Rena rim Schedule,if more space isKegrired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town. of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1600 Osgood Street AUTHORIZED REPRESENTATIVE Bldg 20-Ste 2035 North ver, NA 01845 lioanne R McPhail ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax. (978) 688-9542 E-Mail: Massachusetts Department of Public Safety , Board of Building Regulations and Standards t_icens.e: CS-106653 Construction Supervisor , .. JOHN H CA RROLb ` .27 HAMILTON ROAD PEABODY MA 01960 44' •.4 rr� Commissioner Expiration: 05/06/2015 cpa�n�zza�acuea��a.G��asQac�uia Office of Consumer Affairs&Busi ess Regulation t - HOME IMPROVEMENT CONTRACTOR I Registration::,"30768 Type: - Expiration: -4h8_/2048 DBA U.S.HOME IMPROVEMENT _ I JOHN CARROLL , 27 HAMILTON RD. j -C PEABODY,MA 01960 Undersecretary,-- r j i i