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HomeMy WebLinkAboutBuilding Permit #742-2017 - 65 BEAR HILL ROAD 1/27/2017,* n I o��- 4 � U�- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO Permit No##: 7� _ 9-0 /-7 Date Received NORTly O��-rLED ,6i 7,q �R17ED �,FF' SSAC"u TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family P"A'ddition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -Septic Well D. Floodplain n Wetlands- 6 D 1Naterslied D►stN6 ❑_Water/S .-. DESCRIPTION OF WORK Tc.s 13k PhKI-L)KIVIUK 42,k-//,PoV -w A e/,�e— oleo& o.,,) kAcc% ra'f- ho �t >IVf 0� . Identification - Please Type or Print Clearly' OWNER: Name:_ .4 iA/6 A/ -i 74e/ L- Phone: D1) Address: 65 6e 41L-6 r`%( /2c• G), &JO /�-�►- _ _ 7,e - .. Phone:.._ �.. (2�y ��/.� _ �'s = r- (:.X- Vj Supervisors Consfruct�ori`License:-,� .. e ,J• Hnma lrririrnvPmPht i PnsPa . / � � k - - Exp: ARCHITECT/ENGINEER Phone: Address: Reg. FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. ___,Total Project Cost: $ .3 5l/�D, o FEE: Check No.: Receipt No,, NOTE: Persons con wtzng 1w 2 u registered contractors coo not have: access to the guaxCanty f�d Location V� i 6pt, s� {� � ) pd, No. '-142 — 2 (, Il Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $4(O— Foundation Permit Fee $ Other Permit Fee $ ;� TOTAL $ Check # lU�i � Building inspector "� "' e Plans Submitted Plans Waived El Certified Plot Plan 2/ 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 PLANNING & DEVELOPMENT Reviewed On 1 �� ZOl Signature_ P—VLAL-,� . COMMENTS W4J� _' mA riYi-llI e. niCJI �AIN a LA CONSERVATION Reviewed on 7 Si nature COMMENTS � /,���� �� HEALTH Reviewed on Signature COMMENTS M Q A A Zoning Board of Appeals: Variance, Petition N Planning Board Decision: Comments Conservation Decision: Comments Hv' Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date DrivewaV Permit DPW Town Engineer: Signature: FIRE DEPARTMENT" -.Temp Dumpster on site yes Located at 124 Main Street Fire Department signatureldate Located 384 Osgood Street no 0 iimension 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 clrop..requires proval of Electrical Inspector lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$10041000 fine Doc.Building Permit 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.1. C. And/Or C. S. L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products VOTE: 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 o CCon I I aet ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of BIdg. 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 Doe: BuiIdingPermitRevised 2014 w O—q _* �/ J w 2 LL Dz O CO C: L \ O LL E +O + T N U O. N N ? z_ C J m O O a+ "O 7 LL t K ? C U 0 LL O H Z m Jcu d t to K N LL O Q U V W W L j CL' U, i V) IA.. V a z a (7 S OO K LL z LLJ H a W W LL i Co O z Ol V7 �-: O u O1 0 N O � •C L c �O 41100. y 0 ► a. ' w O •F+ J E 7 ` O Q L T >M _ d y G1 O O,0 — 'a cu q o CD z CL_� NO t 'V, _ 3 � CL a) : � mew � � c w v��Em ujN -0, O O LL '� d 1;U) = V V W E V Q 0-0 O N 0 E d IL H t co cn _ m 000 O _ .O N m t O z O Q J O O LLI CL cnz Z CO Z co W ~ Cl) aZ w0 W LLJ0- z ES January 26, 2017 Joe Donovan 43 Acropolis Road Lowell, MA 01854 CONSERVATION DEPARTMENT Community Development Division 65 Bear Hill Road, North Andover Addition on Sonotubes Conservation Conditions of Approval, NACC #182 Pursuant to section 4.4.2 (L) of the North Andover Wetlands Protection Regulations, applicants Joe Donovan (contractor), filed for a small project for work proposed at 65 Bear Hill Road, North Andover. The proposed work includes construction of a 14' x 14' addition on sonotubes within the footprint of an existing deck and over an existing patio. All work is outside of the 50' No -Build Zone and 25' No -Disturb Zone. During the January 25, 2017 public meeting, the NACC voted unanimously to approve this project. All work shall conform to the following: RECORD DOCUMENTS: Small Project Filing Including: Application Checklist, Joe Donovan Construction Company proposal, Construction Drawings, Lot 5A Bear Hill Road plot plan, Aerial Photo with distance to wetland resource area Filing received: January 17, 2017. The following conditions are hereby mandated: CONDITIONS: 1. Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the small project permit and is aware of the wetland resource area and the limits of the proposed work. 2. Excess construction material shall be properly disposed of offsite and accepted engineering and construction standards and procedures shall be followed in the completion of the project. There shall be no stockpiling of material within 100' of wetland resource areas. . - 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.northandoverma.gov Wetland markers shall be installed at the 25' No -Disturbance Zone, and can be placed on existing trees. Conservation Department staff can assist with wetland marker placement locations if needed. Wetland markers are available at the Conservation office ($2 round/$3 square). 4. A biodegradable (no plastic netting) straw wattle or trenched siltation fence shall be installed between the work area and the wetland resource area. 5..Once erosion control and wetland markers are installed the applicant shall schedule a preconstruction meeting with the Conservation Department. 6. Upon completion of the approved project and site stabilization, please contact the Conservation Department for a final inspection. 7. This Permit shall expire six months from the date of issuance. Should you have any question or comments regarding the contents of this letter, please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience. Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER ONSERVATION DEPARTMENT tinifer Hug s onseryVo ation Administrator 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.northandoverma.gov o -JOE DONOVAN CONSTRUCTION COMPANY 43 Ampolis Road, LoweO, MA 01854 (978) 453-6209 . (978) 804-8415 Quality Custom Carpentry Roofs Additions • Remodeling DATE I DESCRIPTION I AMOUNT �Lemc:.�. �,c�:s11�i/✓�' j�lx �y �c��- �N ��cl; -t'2F1/►'+"t. 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U-01-11 09 470..EAWHILL'RD �.ov J 064.0-0100 ,.� rr'�29 BEAR HILL-ARD � rr 037,8-0024 / - r Zz' , 064:0-0134 064:0-0098. ��., 6- EJYr ' 41',BEAR HYLL RD_ 0640'-0101 . /$064.0=0078 0376-0064OF +r 205 DALE ST ' 06 .0-01 '%� 56fBEAR'HILL�RD 53 064:0-007 r.� Cp �r 064.0 0096 4/ y=—BEARaHYLLrRD R1 ff 064.0-008a �! f 130 APPLETON ST='�_� �::: � f 037.8-0029 064.0=0095 100-BEARoHIL 7RD i 77 BEAR HILL RD .' 064.0-0081 1 064.0-0094 _lig.::: 89 BEAR HILL RD ...._: it _::::_- c:064:0 0.082 • 268 _ . � ,... ' : '.atltt....,y'•-. ISS, .,, .t, "alk 99 BEAR HILL RD 064.0-0083 037.8-0028 f. = 172 APPLETON ST Q1, 064.0-0128 111 BEAR HILL RD 064.0-0084 _. 064.0-0129 C au 064.0-0130 064.0-0085 37..B-'0058 di '�:,. _=:_ =- 064.0-0131 Q MVPC Bo Zoning Overlay Zoning Municipal Boundary © Adult Entertainment Distdc Busine Machine Shop Village Ove U Busine — Rail Line 0 Watershed Protection Dist O Busine Interstates 0 Historic Mill Area 0 Busine s 1 District s 2 District s 3 District s 4 District AORT1y - Horimntal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of = Interstate ® Medical Marijuana ® Gene — Major Road Downtown Overiay District d Planne 0 Historic District: Corrid Roads Osgood Smart Growth (40 1! Corrid t r Easements C O Cordd Business District Of t `i ° , q,4 Commercial Dev ? bit • •s 00 Development Dist 3' G - Devebpment Dist O --• - A Development Dist F p North Andover. Additional data provided by the Executive Once of Environmental Affaim/MassGIS. The information depicted on this map is for tannin purposes only. It may not be adequate for legal planning p y y g boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER Hydrographic Features Indust ❑Parcels Streams Indust 1 District 12 Disrict * ♦ s ' y MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR DOES OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT NOT Wetlands 0 Industn Q Indust Q Exempt Lands Reside 3 District i o �� ♦ I S Di ism ce 1 Distract 'll pO+�r�o-i.���v.�7 ,S$ACMUSEt ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION Reside 13 R—idei ce 2 District ce 3 District dei 1" = 137 ftede de ce 4 District ce 5 Distct ce 6 District ,a a esidential District �S,00 �N•TS.) UTI L.iTr ES �43�ltSF. Pool. 1 �l7.00 1 THE LOCATION OF PROPERTY LINES SHOWN HEREON IS BASED ON PLANS BY OTHERS AND ON INFORMA11ON FROIA VARIOUS SOURCES AND IS TO BE USED FOR MORTGAGE PURPOSES ONLY AND NOT FOR ESTABLISHING LOT LINES, LOCATION OF FENCES, DRIVEWAYS ETC.—AN T05TRUMEN-T-SMVEY HAS NOT BEEN PERFORMED. AN INSiRUM.ENT SURVEY IS ADVISABLE IF STRUCTURES ARE LOCATED WITHIN ONE FOOT OF A LOT LINE OR ZONING SETBACK LINE. CAIAEROIN—BISHOP ENGINEERING CORP 90 MONTVALE AVE, STONEHAM 02180 (817) �, E X14 ne Ho. 1573 scAE -art c" 1545 PACE Z3-mlPw, lF9z crno+s(sD 1?obeet: � }�PQgPzP �rlLLs-ER ponczs !n5 BEAQ Li�IL Rp N Ae+Do�GP� o :rMTERAZ£ NAT 1. MTC,• CDeZp Aro M E 21WRMS. IASED ON MY KNONLEDGE, INFORMATION AND BELIEF, I CERTIFY THAT: — THE BUILDING CONFORMS TO THE FRONT. SIDE AND REAR YARD SETBACK REQUIREMENTS AND THE LOT CONFORMS.TO THE AREA AND FRONTAGE REQUIREMENTS OF THE ZONING BY—LAWS OF 111E TO%T4 OF V.401 WERE 114 EFFECT AT TILL TIME OF CONSTRUCTION. The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations IN 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): bt- .Jah/OUIW 60N5_�, Address: 4/3 A c"yo City/State/Zip: Lome M,14- 095-V Phone #: l 7 20e an employer? Check the appropriate box: ArI 1.m a employer with cN-- 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and' have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. �Kilding addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. / X Ay �e4 S �i� Policy # or Self -ins. Lic. #: (offu6 40'90f �3 /(,, U Expiration Date: LVd- Job Site Address: (P.S Be AiLk l/ IL<( . City/State/Zip: A) . /i -4ve L Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. 1 do hereby certify under thepains a d penalties ofperjury that the information provided above is true and correct. Signature: Date: /-3—/7 Phone #: 9 If- 0 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. 'Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial .Accidents Office of Investigations 604 Washington Street Boston, M.A. 0.2111 `1~e1, # 617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fay, # 617-727-7749 wwwanass,gov1dia ��C)R� CERTIFICATE OF LIABILITY INSURANCE °��`"�'°°"f"'"' 1 4 i7 THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFSRS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD9b BY THE! POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holdera an , tlTe polloypas) must be endorse ATION 18 WAIVED; sub eat to the terms and conditions of the policy, certain policies may require en endorsement. A statement on this cartificate does not confer rights to the certificate holder In Ileu of such endorasmenga), PRODUCER Daniel. N. O'Rourke Inauranca 429 High street Medford, MA 02155 20JIT MAgTy 7 1 396-92Q4 . (781)1391-2973 sales ORourkelnaurance.net i INSLIFEB(Ill AFFORDING COVELIA91 NAICq INSURIVtA I COMMOrCS GENERAL AGGREGATE a 21000,0P.0 INS UR ED PRODUCTS - COMPIOPAGO 6 11000 JOSEPH DONOVAN CONSTRUCTION 43 ACROPOLIS RD LOWELL, MA 01854-1301 INSURER0 r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAND14G 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 16 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. j VrO,R TYPGOFINSURANC6 1NAR WAD POUCYNUM13ER BCDZZQ 8/9/16 8/9/17 LIMITS I EACH OCCURRENCF 1 A GENERALLIAMUTY X COM1IPv1ERCIALGENERALLIABILITY CLAIMS -MADE E OCCUR ,1,1000,000 ETORENTED 9 11 MEP EW(Ariyona penal) 6 PERSONAL&ADV INJURY 8 11000 000 GENERAL AGGREGATE a 21000,0P.0 OEN'LAWIREGATELMITAPPLIES PER; 17 POLICY Tcoi Ll LOC PRODUCTS - COMPIOPAGO 6 11000 6 AUTOMOBILE LIABILITY ANYAUTO ALOSN:D UTBULEDO A NON•OWNEDP HIRED AUTOS _ AUTOS a.denINGLELIMIT 11 BODILYINJURY (Par paieon) 6 j BODILY INJURY (Per eooleni) bAJTi areal ernAMkGE a 6 i UMBRELLA LIAR EXCESSLIAB OCCUR CLAIMS -MADE EACH OCCURRENCfi 8 i AGGREGATE $ DED RETENTION S I WORKERS COMPENSATIONC AND EMPLOYERS' LIABILITY YINTORYLIMI.1I ANY PROPRIEn7R/PARTNEWEXECUTWE OFFICEP IIn NMR EXCLLIDED9 ( If ges dworlbeunder IP O 0- N I A STATU• OTA, ' H ACCI DE NT I -EA EMPLOY al I E.L. DIS EASE - POLICY LIMIT a i, UG&CRIPTION OF OPriulnONS I LOCATIONS / VEHICLE$ (Attach ACORD 101, Additional Remtirk,o Wedule, If more optica to requl rad) I CERTIFICATE HOLDER CANCELLATION \® 1988-2D10ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mall: SHOULD ANY OP THE ABOVC DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELIVERED M ACCORDANCE WITH THE POLICY PROVISIONS, I . ATTN: PAUL HUTCHINS i AUTHORIZED REPRESENT I \® 1988-2D10ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mall: AC<>R0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOMrYY) 01/0412017 THIS CERTIFICATE 18 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), ALITIjORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If 8UBROGATION 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 rlglits to the certificate holder In lieu of such andoreemenl e , PRODUCER DANIEL N. O'ROURKE INSURANCE AGENCY, INC.s1 428 HIGH ST. MEDFORD MA 02155 ACT Martin 111de10 Jr I 396-8244 PAC oR Salas orourkeinsurance.net INGURERISI AFFORDINGCOVERAOE i NAICN INSURER A, TRAVELERS INDEMNITY CO OF AMERICA 125666 INSURED DONOVAN JOSEPH DBA JOSEPH DONOVAN CONSTRUCTION 43 ACROPOLIS RD LOWELL MA 01864 INSURER 2: INSURER c, IN URPR 0 i I INSURER 6: ! ljNjURER r II COVERAGES CERTIFICATE NUMBER: 115558 REVISION NUMBER: THIS 16 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, 10-11 ep TYPEOPINSURANCEAIJIJL WON I Y MBAR P LI pmp LIMITS COMMERCIAL GENERAL LIABILITY I EACHOCCURRENC6 6LA CLAIMS -MADE F7 OCCUR P 6 I MED EXP (Any ono Anon) 6 PERSONAL 6 ADI/ INJURY I NIA GEN'L AGGREGATE LIMIT APPUt$ PER: POLICY j r7LOG OENGRALAGOREOATE i I PRODUCTS -COMP/DPA00 11 I WHOM AUTOMOEILRIJAEILITY r,l S BODILY INJURY (Per parson) 6 ANY AUTO BODILY INJURY (Per eceldenl) s ! AUTOS ED ACTEOSULED HIREDAUT06 AUT09WNED N/A P 6 (Per accidenil s � UMBRELIALIABOCCUR HCLAIMS-MADE EACH OCCURRENCE 6 I AGOREOATfi 6 EXCESSUAa NIA RETENTION I A WORKlRSCOMPCNSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNCRIFXECUTIVII V f N OFFICE R/MEMBEREXCLUDI NIA (Mandatory In NHI NIA NIA 6HUB4890P83A15 10121/2016 10/21/2017 X A ER - _ E.L EACH ACCIDENT s 100,000 E.L. DISWE . EA EMPLOYEE S 100,000 E.LDISEASE- POLICY LIMIT I 500,000 ifea deeuihe under D@eGtRIPYO O O N/A I i i DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLXS (ACORD 101, Addltloeal Remark& Schedule, may be attached If more spat:• Ie required) Workers' Compensation beneAts will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 00 e, no authorization Is given to pay claims for benefite to employees In states Other then Massachusetts if the Insured hires, or has hired. those employees outside of Massachusetts, i This certlfiate of Insurance shows the policy In force on the date that this certificate wee Issued (unless the expiration date on the above polity recedes the issue eats of this certificate of Insurance). The status of this coverage can be monitored dally by accessing the Proof of Coverage - Coverage Verification Search tool at www.mese.govflwdlworkers-compensatlonf nvestigatlone/. Sole proprietor has not elected coverage. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B@FORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITMTME POLICY PROVISIONS. 2 CYPRESS TERRACE AUTHORIZEDREPRESENTATNE NORTH ANDOVER MA 01846 �"' L`� M. Cr y, CPCU, Vice President— Residual Merkel—vvcR18MA 01988.2014 ACORD CORPORATION. All rleht3i reserved. ACORD 25 (2014/01) The ACCRD name and logo Bre registered marks of ACORD yy "'M assa:h U s e ­u S a 02-'r m a r t Oi : tU u',[C S a:-' . :I7 Board of Sunding ; equia icris and g'iandards License CS -002604 _ • ��ii JOSEPH E DONOVAN 43 ACROPOLIS RD LOWELL MA 01854 :-I; irnI,_--sic 05/23/2018 _Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 155879 Type: -Expiration: -5/15/2017 DBA JOE DONOVAN CONSTRUCTION JOSEPH DONOVAN 43 ACROPOLIS RD. LOWELL, MA 01854 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 _ Not valid without signature -JOE DONOVAN CONSTRUCTION COMPANY 43 Acropolis Road, Lowell, MA 01854 (978) 40-6209 e (978) 80443415 Quality Custom Carpentry Roaft * Addidont - Remodeling DATE DESCRU31WN- Aelf'L /V 'Y Av-,"k. ce"23, AvIvi --floo"t- e- 'S 'Ul ,9 -r -e 9-S A ffecr;e, d iub- ,wer_-15 &)WIS- duaAe-, do4f-ve14 . J 7 gem_wc qAJ ee-locAle- e—ei, /�;V�" c4c ',v4v. vei,) /U."M _f - 51cle- :(i t'4! 1w '4,vd rum ed ..v _bd A -A,4-1 5 4 (4 // P^A/:O' ou �e,4�L.-ak_ IV eje,> - ,-/, 4dct n' 04C 0 C Jo wA C. C e Cf -1,16 &1 Je 4-,u _:5;4j le- ,t. ?I Ze ywAd IA)01 "POA� 'q, 3yo. OLo ky-K-4 AMOUNT rj 4 - ,3V.100- TOTAL 13 yt'/vv , �0