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HomeMy WebLinkAboutBuilding Permit #247-15 - 65 BRIGHTWOOD AVENUE 4/1/2015 NORTh BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION -�Permit No#: Date Received �° �gSSAArea CHl1`'���y Date Issued: 7 I MPORTANT: Applicant must complete all items on this page LOCATION �o5 -G? . ._v iT 7-51 040 A, V6 P ' t PROPERTY OWNER -4yy -A4*/ y - ni c cs -4A-A-C Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Villageyes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition N-Two or more family ❑ Industrial Alteration No. of units: 2 ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well ❑Floodplain ❑Wetlands ❑ Watershed District .Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: iVIJ l coddz �it�,y�v e R�•Kcli�� , ��i.v,T zoo2�tiG, i vc �EsFIX�o�e 0&774 xr w�vo0�vs ftyL Lam/L<--v Identification- Ple se Type or Print Clearly OWNER: Name: 'AAzt:r,�zvy Flz© CGtf-t,4r-r�Lz Phone: Address: �'r tF l tic.p�.rav�cccwrs ��LSG.. Contractor Name: Phone: 779 e6 G0 �rC) Address: 32 itMt�V S?-;e-q- T S tF4.c �yfC. 0 3 0 2 CS- r� Z X40 Supervisor's Construction License: _.- 8 Exp. .Date: /2 /4 Home Improvement License: Exp. Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F_ Total Project Cost: $ 2!i ®p FEE: $ Check No.: Receipt Receipt No.: A�k NOTE: Person contracting with unregistered contractors do not have cess t he tY and Signature of Agent/Owner Signature of cqAtractor° Location Of /0 7 No. f Date . - TOWN OF NORTH ANDOVER • s D', Certificate of Occupancy $ Building/Frame Permit Fee : ,r Foundation Permit Fee I, e; a � Other Permit Fee $ TOTAL $ Check# -1 0 2 ,) � r, .r r `` O Building Ins p e�c cr—" { Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped.Plans ❑ TYPF Z F SEWERAGE DISPOSAL Phblic Sewer �{ Tanning/Massage/Body Art Swimming Pools ❑ f Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ I Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 1 COMMENTS I I I CONSERVATION Reviewed on Signature 1 COMMENTS ' I HEALTH Reviewed on Signature f COMMENTS I "9, Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes V Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP�►RTMENT -Temp pumpster on site yes no Located at 124.Main Street Fire Department signature/date-. COMMENTS 1 1 Dimension Number of Stories: 3 Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 4S-©0 i i' 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 NOTES and DATA— For department use � p ) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 1 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.I.C. And/Or C.S.L. Licenses j o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses " o Copy Of'Contract v - ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and-Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract L3 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 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 I 7 r , Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 25,000.00 m $ - $ 300.00 Plumbing Fee $ 37.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.50 Total fees collected $ 475.00 65-67 Brightwood Avenue 747-15 on 4/1/15 Second Floor bath and kitchen remodel Gut third floor NORTH t E Town of : _ Andover O .., y.. 0 No. jqh ver, Mass, 4 dig cocNrcHewrcK �1. �d A�RATEO JPa�,�S s V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......A4.40T1: J.I:,�n.1 LV ..�- BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ..�..��......� "....Ka.n-t . ....lr.-S.a+�... ...:....... Rough �U-r 32d �—(o a I ^'7� n to be occupied as .......................................�r....}....... .LW... 4`!' ..' :.. T... ...� ..MOA"� ' Chimney provided that the person accepting this permit sh�fl in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection Alteration and Construction of Buildings in the Town of North Andover. and NW L'J%Adow's t !�a () ti,-- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST Rough IL-0- , . Service ............................. ..........,.................................... Final BUILDING INSPECTOR GAS INSPECTOR j Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT j Until Inspected and Approved by the Building Inspector. Burner Street No. i Smoke Det. !I ` 4 Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: 12/18/14 (originally mailed October 24, 2014) To: Owner/Agent of Record: Property Location: Kenneth Nutter 65 Brightwood Ave. 2nd Fl 31 Corbett St. North Andover, MA 01845 Andover, MA 01810 Dear Mr.Nutter, An authorized inspection was made of your property at the above address on October 9, 2014. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below.Living conditions of these premises are in extreme disrepair.It would be inefficient to list each item specifically, as it is most likely that hidden hazards lie in areas that will be uncovered as they become exposed. Owner(s) must repair within seven days or contact a contractor for work and submit proof of contract within seven days. Corrections are to be completed within 30 days or as otherwise approved. Failure to act will result in further legal action. 105 CMR 410.000 Notes: Kitchen and Half bath ✓ Regulation# Description if conditions may Time limit for endanger or impair health,safety or compliance well-being Front common hall way; stairs worn down to raw Owner must repair within 7 wood.Not cleanable.Walls, floors and ceilings days or contact a contractor must be in good condition and free from defect for work. Completion is to Owner must maintain floors in a cleanable non be within 30 days. porous condition - Repair stairway Doorbell in disrepair,hanging out of wall on front porch. Owner must ensure it works as intended - Owner must repair .501 (B) Front door locks not operable Owner must maintain all locks and doors; - Check both front and rear door locks - Ensure proper closing, locking and that the door is in good condition Front hallway second floor;exit door to unsafe X Owner must repair within 7 Q asphalt roof over first floor entryway. Safety hazard. days or contact a contractor r' Owner must ensure all doors exiting the building for work. Completion is to are safe and comply with the building code. be within 30 days. - Secure door and remove. .500 Front room; floors walls and ceilings are worn Owner must repair within 7 down,with chipped paint,porous floors etc. days or contact a contractor Owner must maintain the premise free from defect. for work. Completion is to be within 30 days. .500 Kitchen Area under sink; cabinet base warped, signs Owner must repair within 7 of water damage,not usable. days or contact a contractor - Owner must maintain storage area surfaces; for work.Completion is to for easy cleaning,to repel moisture and in a be within 30 days. usable condition. .500 Area under sink;holes around piping; old insulation Owner must repair within 7 damaged.Unsanitary condition. days or contact a contractor - Owner must maintain walls free from holes for work. Completion is to that could allow pest entry and free from be within 30 days. dampness. Kitchen appliance provided by owner must work as Owner must repair within 7 intended; days or contact a contractor - Assess and repair for work. Completion is to be within 30 days. Kitchen floors,walls and ceilings in disrepair; Owner must repair within 7 peeling paint,porous surfaces etc. days or contact a contractor Owner must maintain in good condition; free from for work. Completion is to defect. be within 30 days. - Assess and repair Pantry walls filthy; floors disrepair; chipping paint; Owner must repair within 7 doorknobs etc days or contact a contractor - Assess and repair as necessary for work. Completion is to be within 30 days. 504 a,b Bathroom unsanitary; some areas are uncleanable Owner must repair within 7 due to age and general wear days or contact a contractor Owner must maintain walls,floors and ceilings in for work. Completion is to good condition;non-porous and all fixtures in good be within 30 days. condition - Assess and repair .501 (A) Windows throughout the apartment must be Owner must repair within 7 assessed.Must meet code for weather tightness; days or contact a contractor unbroken,caulked,open and closes easily, no cracks for work. Completion is to etc.must all have screens in good condition,without be within 30 days. defect and fit properly Owner must maintain - Assess all windows in apartment and common areas and repair or replace as necessary Windows all have chipping paint Z - Assess and repair as needed Living Room Floors,walls,baseboards etc old and Owner must repair within 7 in disrepair in many areas days or contact a contractor Owner must maintain for work. Completion is to - Assess and repair as needed be within 30 days. Laundry room area;walls, floors, ceilings etc, old Owner must repair within 7 and in disrepair in many areas;holes, open pipes days or contact a contractor Owner must maintain in cleanable non-porous for work. Completion is to condition. be within 30 days. - Assess and repair Painted areas in all rooms;corners,cabinets, Owner must repair within 7 doorways etc. Should be examined for non- days or contact a contractor cleanable,porous surfaces. for work. Completion is to be within 30 days. 410.481 No Posting of name of owner.Per code; Owner must place posting An owner of a dwelling which is rented for within 7 days. residential use,who does not reside therein and who does not employ a manager or agent for such dwelling who resides therein, shall post and maintain or cause to be posted and maintained on such dwelling adjacent to the mailboxes for such dwelling or elsewhere in the interior of such dwelling in a location visible to the residents a notice constructed or durable material,not less than 20 square inches in size,bearing his name, address and telephone number. Where the owner employs a manager or agent who does not reside in such dwelling, such manager or agent's name, address and telephone number shall also be included in the notice. (See M.G.L. c. 143, § 3S.) .500 Exterior rear porch—wobbly corner post Owner must repair within 7 - Owner must maintain structure free from days or contact a contractor defect. for work. Completion is to be within 30 days. Exterior—observed plywood over basement window. Exterior entry porches; Owner must repair within 7 Areas in disrepair; days or contact a contractor Assess and repair for work. Completion is to be within 30 days. You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations,may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date,time and place of the hearing and of their right to inspect and copy all records 4 cowernin the matter to be heard. The petitioner has the right to represented at the hearing. s awyer Galt irector List Attachments: tenant's rights doc. State delivery method to Owner: certified mail and regular mail: and email for expediency and Occupant : regular mail delivery Cc: tenant ZNb AlAti.WAy ev r wee AA 13"x i2' /S +c •z'6 '' 8&DkbD A4 A,,nwE7V 1Y X X3=6 " hvAjbny BEDReON( 5 YA-i,e s f COACH EST.1841 I 1f EI�Rbb N` 1�I1 tang � x Of Wl�- Y"' COACH EST.1941 i The Commonwealth of Massachusetts Department of IndustrialAceidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le:ribly Name(Business/Organization/Individual). St TC /M P,%pyam Ey7-.5 //1/C. Address: 3 2- AAA,,'/V ST—Xe-E77- City/State/Zip: Tie ETCity/State/Zip: SkLEM r NW 030 79 Phone#: (`17 9:5—/a3a Are you an employer?Check the appropriate box: Type of project(required): LX I am a employer with 5. . employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. M Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑4.❑I am a homeowner and willbe hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is pioviding workers'compensation insurance for my employees. Below is the policy and job site information. w ES G G Insurance Company Name: / t737/ L L 11! /NS l/R.AW-C Policy#or Self-ins.Lic.#: W w e 3 99'? Z/07 ? Expiration Date: d-7 A- /2 d /3" Job Site Address: A-a/ze- City/State/Zip: IV A/y 0 y ,M A 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 civi Pena ' s in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. c y of this statement ma be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio I do hereby cer 'y and tli pains and p vfp rju that the information provided above is true and correct. Si nature: / Date: Z/ f / j Phone#: I 7�� 6 / C 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#: I I 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia l'1 SITEI-2 OP ID:SR ACORO" DDmYY) 704/01/2015 (MM/CERTIFICATE OF LIABILITY INSURANCE (MMI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Michaud,Rowe And Ruscak Ins: ~` PNAME:HONE Lawrence R.Michaud,CIC FAX P.O.Box 188 A/c No Ext:978 688 8829 A/C No): 978 557 2130 North Andover,MA 01845 E-MAIL Lawrence R.Michaud,CIC ADDRESS:lmichaud@mrrinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Harleysville Insurance Company 26182 INSURED Site improvements,Inc. INSURER B:Hanover Insurance Company 22292 Anthony Finocchiaro INSURER C:Wesco Insurance Company P0Box 1145 Andover, MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE D DLSUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE a OCCUR SPP79814L 02/06/2015 02/06/2016 DA E PREMISES Ea occurrence $ MED EXP(Any one person) $ 100,00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT ❑ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1+000+000 B ANY AUTO ADN0749277-07 06/22/2014 06/22/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X JOCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE CMB79863L 02/06/2015 02/06/2016 AGGREGATE $ 1,000,00 DED I I RETENTION$ $ WORKERS COMPENSATION PEROH- AND EMPLOYERS'LIABILITY STATUTE ERT _ C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WWC3094079 07/11/2014 07/11/2015 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED' N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Grading of Land,Site preparation for paved areas Office CERTIFICATE HOLDER CANCELLATION NORTHA9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn.: Building Department 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD