HomeMy WebLinkAboutBuilding Permit #893 - 65 SPRING HILL ROAD 6/23/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received—4 P Z
Date Issued: / . • ,& 1 •
[PORTANT: Applicant must compl
all items on this naLye r
PROPERTY OWNER 1. e CkVi L AJ Ck
Print
MAP N0: a PARCEL: o��i ZONING DISTRICT: o� Histor
Machine
X -E yes no
Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
XOne family
❑ Addition
❑ Two or more family
❑ Industrial
Iteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
[Septic ,� tWell
; :►Floodplaii� ®W elandsVTT
sf,
-� a 0 Wateshed strict
DESCRIPTION
OF WORK TO Rrt -Pc{.-crnPA rr n- r
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I � to (� � e C l�( � � �V •Fcd� rr�s �.e�vK� , �e e�r,
vie w w�\AAaW., civ`C� �c e�o�
(Ydentificatipp Please Type'air Print Clearly)
OWNER: Name: e `r /�J 0,
CONTRACTOR Name:
Address:l! 4� e I' E Y c�� b ow /J H
t 9 ��.e�3 3J= 1.
Phone: 7-3 `
Q S 6i _
Supervisor's Construction License: _��3� Exp. Date: `� f
Home Improvement License: C G 0 6 ` Exp. Date:
ARCHITECT/ENGINEER / Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
.r -
Total Project Cost: $ FEE: $
—4
Check No.: 17? Receipt No.:��
NOTE: Persons contracting wingistered contractors do not have access to the . a ty fund
r–
r
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Art ❑
Swimming Pic ol,5. r7 ElTanning/Massage/Body
Well ❑
Tobacco Sales ❑'
a '4 , C
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
permanent Dumpster on Site ❑
4`THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
{
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
F
COMMENTS
t -
.�? v v
Reviewed o
cJ
Reviewed on
Sianature
I
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board*Decision:
Comments
Conservation Decision: Comments
Water & Sewer Con nection/Siglnature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEP,�ARTMENT . - Temp Dumpster on site yes no
Located at,J!g�1���
tr6
Fire Departmen sigfiAutr/date <
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. it.:
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.$10041000 fine
NOTES and DATA — (For department use)
r
J
Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
I
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
❑ 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
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/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
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ 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: Doc.Building Permit Revised 2008mi
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I
FLED CONTRACT AMOUNT
THIS AGREEMENT, Made as of April 22nd in the Year of 2011
Between the Owner: Cedric Nash
65 Spring Hill Road
North Andover, MA 01845
And the Contractor: M. Ryan Norman
Norman Properties & DeveIopment
CS 87851
9 Quaker Street
Newton, NH 03858
603-974-2874
For the Project: Sun Room Remodel c& New Deck
65 Spring Hill Road
North Andover, MA 01845
ARTICLE 1. CONTRACT DOCUMENTS
1.1 The contract documents consist of this agreement, general conditions, construction documents,
specifications, allowances, finish schedules, construction draw schedule, information disclosure
statement,'all addenda issued prior to execution of this agreement and all change orders or modifications
issued and agreed to'by both parties. All documents noted herein shall be provided to the Contractor by
the Owner.. These contract documents represent the entire agreement of both parties and supersede any
prior oral or written agreement.
ARTICLE 2. SCOPE OF WORK
2.1 The Contractor agrees to purchase and construct the above mentioned structure and fixtures
attached thereto in North Andover according to the specifications, allowances, all addenda, change
orders, modifications and specifications set forth in the specification booklet.
ARTICLE 3. TIME OF COMPLETION
3.1 The approximate commencement date of the project shall be late June 2011 or early July 2011.
The approximate completion date of the project shall be 5 weeks from the commencement date;
however any change orders and/or unusual weather might delay or otherwise affect the completion date.
ARTICLE 4. THE CONTRACT PRICE
4.1 The purchase price of the project shall be set at the sum of thirty thousand five hundred thirty
'dollars, ($30,530.00), for total renovations on property at 65 Spring Hill Road to be started in June or
Yul'' ' an4.1 ompleted; 5 "weeks thereafter, as agreed upon in this entire contract with specifications, subject
to additions and deddctions pursuant to authorized change orders and allowances.
4.2 The Owner and the Contractor acknowledge that the Owner has paid a non refundable sum of one
thousand dollars, ($1,000.00) as part of signing this contract.
ARTICLE 5. PROGRESS PAYMENTS
5.1 The Owner will make payments to the contractor pursuant to the attached construction draw
schedule as work required by said schedule is satisfactorily completed. Owner shall make draw payments
to contractor within 3 days after request by contractor. Should the owner fail to make payment,
contractor may charge a penalty of 18% annually upon the unpaid amount until paid.
5.2 If payment is not received by the Contractor within 5 days after delivery of payment demand for
work satisfactorily completed, contractor shall have the right to stop work or terminate the contract at his
option. Termination by Contractor under the provisions of this paragraph shall not relieve the Owner of
the obligations of payments to Contractor for that part of the work performed prior to such termination.
Termination by Owner under the provisions of this paragraph shall not relieve the Owner of the
obligations of payments to Contractor for that part of the work performed prior to such termination.
5.3
Payment Schedule and Amounts
n
1.
Si of Contract: $ 00
ming
��tizt_�
2.
3.
Window & Door er (order by early June): $5,000
Project $5,000
r --
start
Co $4,000
j ,J
4.
5.
6.
Deck ete:
Sun om oof, Windows, Doors, & Skylights Installed:
& Rough Building, Inspection Complete: $5,000
$6,000
i J
ctrical
7'`WWork Complete & Final Build Inspection: $4,530
lI3 �` `v
ARTICLE 6. DUTIES OF THE CONTRACTOR
6.1 All work shall be in accordance to the provisions of the plans and specifications. All systems
shall be in good working order.
6.2 All work shall be completed in a workman like manner, and shall comply with all applicable
national, state. and local building codes and laws.
6.3 All work shall be performed by licensed individuals to perform their said work, as outlined by
law.,
6.4 Contractor shall obtain all permits necessary for the work to be completed.
6.5 Contractor shall remove all construction debris and leave the project in a broom clean condition.
6.6 Upon satisfactory payment being made for any portion of the work performed, Contractor shall
furnish a full and unconditional release from any claim or mechanics' lien for that portion of the work for
which payment has been made.
ARTICLE 7. OWNER
7.1 The Owner shall communicate with subcontractors only through the Contractor.
7.2 The Owner will not assume any liability or responsibility, nor have control over or charge of
construction means, methods, techniques, sequences, procedures, or for safety precautions and
programs in connection with the project, since these are solely the Contractor's responsibility.
7.3 All persons working on this, i.e. sub -contractors, foremen or laborers will be notified that no
payments will be made by owners of property to them, that only Norman Properties & Development is
responsible for payments to them. All contractors shall be insured to the minimums provided as
described by Norman Properties and not the responsibility of the owner.
ARTICLE 8. CHANGE ORDERS AND FINISH SCHEDULES
8.1 A Change Order is any change to the original plans and/or specifications_ All change orders need
to be agreed upon in writing, including cost, additional time considerations, approximate dates when the
work will begin and be completed, a legal description of the location where the work will be done and
signed by both parties. 50% of the cost of each change order will be paid prior to the change, with the
final 50% paid upon completion of the change order. A 0% fee shall be added to all change orders and
overages in excess of initial allowances. Additional time needed to complete change orders shall be taken
into consideration in the project completion date.
8.2 Any delays or changes in finish selection schedules will delay the projected completion date.
ARTICLE 9. INSURANCE
9.1 The Owner will purchase and maintain property insurance to the full and insurable value of the
project, in case of a fire, vandalism, malicious mischief or other instances that may occur.
9.2 All Workers will be covered by needed Workman's Compensation and Liability insurance
coverage as required by law.
ARTICLE 10. GENERAL. PROVISIONS
10.1 If conditions are encountered at the construction site which are subsurface or otherwise concealed
physical conditions or unknown physical conditions of an unusual nature, which differ naturally from
those ordinarily found to exist and generally recognized as inherent in construction activities, the Owner
will promptly investigate such conditions and, if they differ materially and cause an increase or decrease
in the Contractor's cost of, and/or time required for, performance of any part of the work, will negotiate
with the Contractor anequitable adjustment in the contract sum, contract time or both.
ARTICLE 11. HAZARDOUS MATERIALS, WASTE AND ASBESTOS
11.1 Both parties agree that dealing with hazardous materials, waste or asbestos requires specialized
training, processes, precautions and licenses. Therefore, unless the scope of this agreement includes the
specific handling, disturbance, removal or transportation of hazardous materials, waste or asbestos, upon
discovery of such hazardous materials the Contractor shall notify the Owner immediately and allow the
Owner/Contractor to contract with a properly licensed and qualified hazardous material contractor. Any
such work shall be treated as a Change Order resulting in additional costs and time considerations.
ARTICLE 12. ARBITRATION OF DISPUTES
12.1 Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be
settled by arbitration administered by the American Arbitration Association under its Construction
Industry Arbitration Rules, and judgment on the award rendered by the arbitrator(s) may be entered in any
court having jurisdiction thereof.
ARTICLE 13. WARRANTY
13.1 At the completion of this project, Contractor shall execute an instrument to Owner warranting the
project for 1 year against defects in workmanship or materials utilized. The manufacturer's warranty will
prevail. No legal action of any kind relating to the project, project performance or this contract shall he
initiated by either party against the other party after 1,year beyond the completion of the project.
ARTICLE 14. TERMINATION OF THE CONTRACT
14.1 Should the Owner or Contractor fail to carry out this contract, with all of its provisions, the
following options and stipulations shall apply:
14.1.1 If the Owner or the Contractor shall default on the contract, the non -defaulting party may
declare the contract is in default and proceed against the defaulting party for the recovery of all
damages incurred as a result of said breach of contract, including a reasonable attorney's fee. In
the case of a defaulting Owner, the Earnest money herein mentioned shall be applied to the
legally ascertained damages.
14.1.2 In the event of a default by the Owner or Contractor, the non -defaulting party may state
his intention to comply with the contract and proceed for specific performance.
14.1.3 In the case of a defaulting Owner, the Contractor may accept, at his option the earnest
money as shown herein as liquidated damages, should earnest money not cover the expenses to
date, the Contractor may make claim to the Owner for all work executed and for proven loss with
respect to equipment, materials, tools, construction equipment and machinery, including
reasonable overhead, profit and damages applicable to the property less the earnest money.
ARTICLE 15. ATTORNEY FEES
15.1 In the event of any arbitration or litigation relating to the project, project performance or
this contract, the prevailing party shall be entitled to reasonable attorney fees, costs and expenses.
ARTICLE 16. ACCEPTANCE AND OCCUPANCY
16.1 Upon completion, the project shall be inspected by the Owner and the Contractor, and any repairs
necessary to comply with the contract documents shall be made by the Contractor.
16.2 Building inspector of North Andover, MA must issue final approval for final payment by owners
to Norman Properties & Development, for completed work at 65 Spring Hill Road.
ARTICLE 17. CONTRACT LANGUAGE REQUIRED BY THE COMMONWEALTH OF MASSACHUSETTS
17.1 All home improvement contractors and subcontractors shall be registered and that any inquiries
about a contractor relating to a registration should be directed to:
Office of Consumer Affairs and Business Regulation
Ten Park Plaza, Suite 5170
Boston, MA 02116
Phone: (617) 973-8700
17.2 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
173 PERMIT NOTICE
1. ANY AND ALL NECESSARY CONSTRUCTION RELATED PERMITS
SHALL BE THE OBLIGATION OF THE CONTRACTOR TO OBTAIN SUCH PERMITS
2. OWNERS WHO SECURE THEIR OWN CONSTRUCTION RELATED PERMITS OR DEAL WITH
0 %
UNREGISTERED CONTRACTORS SHALL BE EXCLUDED ACCESS TO THE GUARANTEE FUND
17A The contractor and the homeowner herby mutually agree in advance that in the event that the
contractor has a dispute concerning this contract, the contractor may submit such dispute to a private
arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation
and the consumer shall be required to submit to such arbitration as provided in MGL c 142A.
Witness
Contractor ' ature
Owner Signature
Witness
MZ,
Owner Signature
7
Owner Signature
The Commonwealth of Massachusetts
6 Department of Industrial.Accidents
=� u • j'f
Office of Investigations
<<:;fFf 1 600 Washington Street
a : :'lltl
,�' Boston, MA 02111
"tea`' www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansfPlumbers
Name (Business/Organization/Individual):
City/State/Zip: �tU�� iy IV Phone /#: 1 ?<6' ��?J ` 7 3
Are you ali employer? Check the appropriate box:
Type of project (required):
L ❑ I am a employer with
4. K am a general contractor and I
6. ❑ New construction
employees (full and/or part-time).*
ave hired the sub -contractors
� ❑Remodeling
2. ❑ I am, a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
8. ❑ Demolition
working for mein any capacity.
insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
9. F1 Building addition
[No workers' comp.
required.]
officers have exercised their
I0.❑Electrical repairs or additions
3. ❑ I 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 Roofrepairs
insurance required.] i
employees. [No workers'
13.❑ Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Flomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors mild 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. r
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Expiration Date:
Job Site Address: City/State/Zip:.
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 maybe forwarded to the Office of
Investigations of the DIA for insurance'coverage verification.
I do hereby certify under
of perjury that the information provided above is true and correct'
Simature: Date:
Phone #: 3,15-2 a— 7 7 3
Official use only. Do not write in_this area, to be completed by city or town offr'eial.
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 uilder 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 thanthree 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 -contractors) 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 cavy 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 pen -nit or license is being requested, not the Department of
Industrial Accidents. Should you Have any. questions regarding the law or ifyou 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 pennit/lieense number which will be used as a reference number. Irl 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 marred by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future pen -nits 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 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 AcQidents
Office of Investigations
600 Washington Street
Boston, MMA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax ## 617-727-774g
www.mass.gov/dia
04/15/2011 4:19:36 PM FRED C CHURCH INC — 978-454-1865 PAGE 2 OF 2
Ilk. [ � CERTIFICATE OF LIABILITY INSURANCE
�°°"""'
F04115M11M
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(les) 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).
PRODUCER
Fred C. Church, Inc.
44 Kenrza Avea/a
Haverldl, MA 01830
(600) 2257865
CONTACT Danielle Plourde. CISi
NAME:
PHONE 978 3717172 FAX ft- EX11- UK,No : (978)454-1665
E-MAIL � h00oclrr�.Wm
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC 0
6804835R940
8/5/2010
Ace American Insurance Company 22667
INSURER A :
INSURED
John T. Cronin Corsslnlcuon LLC
INSURER B: Travelers Casually trguraice ComparuyofAmerica
INSURER C:
1 Birch Road
Newton, NH 03858
INSURER 0:
INS E:
$
INSURER F :
AUTOMOBILE LIABILITY
ANYAUTo
ALL
AUTOWNEO NODULED
NON -OWNED
HIREDAUTOS AUTOS(Per
COVERAGES CFRTIRCATF Nl1MRFR- "—' REVISION NIIMRFR
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
LTR
TYPE OF 94SURANCE
I R
VVVD
POLICYNUMBER
POLICY EFF
MM
POLICY EXP
LIMITS
B
GENERAL LIABILITY
X COMMERCIAL GENERAL LViBLITY
CLAIMS -MADE OCCUR
P ,.
6804835R940
8/5/2010
8752011
EACH OCCURRENCE $ 1,000.000
PREMISES Ea oocur nce$ 300'000
MEDEXP(Anyonaperson) $ 5.000
PERS &ADV INJURY $ 1'000.000
GENERAL AGGREGATE $ 2.000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROLOC
IECTIT
PRODUCTS-COMPNP AGG $ 2,000'000
$
AUTOMOBILE LIABILITY
ANYAUTo
ALL
AUTOWNEO NODULED
NON -OWNED
HIREDAUTOS AUTOS(Per
COMBN M
a acddent
ODDLY INJJRY (Per person) ;
BODLYINJURY (Per accident) $
PROPERTY DAMAGE $
accident)
;
BRELLA LIAR
ESS LIAR
I
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATEO
I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY
ANY PROPRIETORIPARTNER/EX=CUTIVE YIN
OFFlCEWtrEMBEREXCLUDED7
OFFICERNE BER
it yes, describe under
DESCRPTIDN OF OPERATIONS below
NIA
6S62UB4143P83511
2242011
2124r2012
X VVC STAN- OTH
E.L. EACH ACCIDENT $ 1�•
E.L. DISEASE - EA EMPLOYEE $(Manddoryi:–TO-0—.000
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional RemarksSchedulq if more space is required)
4,cRllrwr►Icnvr.ucr%
---- —
Norman Proper8e5 & Development
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10 Keleher Avenue
ACCORDANCE WITH THE POLICY PROVISIONS
Plei.how,NH 03065
AUniORIZED REPRESENTATIVE
P ,.
nen wr�►nn /NIODADATIAM All A.hln rpAaarwad-
Client 0 ---, Mst # cert HOlner IF ----
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
� o�sp
Office o onsnmer Anairs & B sines R alat�on
HOME IMPROVEMENT CONTRACTOR
Registration: ,,l 60921 Type:
Expiration: .91.10/2012 DBA
M. ORMAN PR PO E_RTIES &-DEVELOPMENT
il- Mr
MICHAEL NORMAN
10 KELLEHER
PLAISTOW, NH 038fi5 % Undersecretary
Massachusetts - Depatiment of Public Safeth
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 87851
Restricted toc 00
MICHAEL R NORMAN
10 KELLEHER AVE
Q
PLAISTOW, NH 03865
Expiration: '912312011
Commissioner Tr#' 4777
INorth Andover MIMAP May 17, 2011
Interstates
Interslale
Major Roads
Roads
Easements
C3 C3 MVPC Boundary
J Parcels
1" = 113 ft
Horizontal Datum: MA Stateplane Coordinate System, Datum NAD63,
Meters Data Sources: The data for this map was produced by Merrimack
NGRYN
Valley Planning Commission (MVPC) using data provided by the Town of
Nonh Andover. Additional data provided by the Executive Office of
Environmental Affairs/MassGIS. The information depicted on this map is
for planning purposes only. It may not be adequate for legal boundary
F
definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
>r
THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY
OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
t1%i Q -t.- ,-&
x ou�lZB�� y
/n 1//V.- 1IR•04
-.28-
t18, .2Qr
Location -55,a�� III &
Date
No.
1401tTst TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
Building/Frame Permit Fee $
Mu
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # / ) / �
2 4 6 1 4
"3 Building Inspector