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HomeMy WebLinkAboutBuilding Permit #472-14 - 684 SALEM STREET 12/3/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: � �/ IIORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER e Print` 100 -Year Old Stru PARCEL:0 _ MAP:NO:Q ,�_-- _.ZONING DISTRICT. Historic District Machine Shop yes, no_ -no TYPE OF IMPROVEMENT. PROPOSED USE , Exp. Date: / -c9/' -46 Residential Non- Residential ❑ New Building I One family Date; ❑ Addition ❑ Two or more family D Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other o'Septic DWell ElFloodplain ❑Wetlands: ❑ Watershed District= 0 Water/Sewer. DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: pre -L -J tLL2 S G Phone: 97d .59o— 6919 Address: 6 8 CONTRACTOR- Name:©11 e:�l�YUGo- Address ;l1 d IOJn /� //11 . Supervisor's Construction License: d y�� _ _ .,,_ , Exp. Date: / -c9/' -46 Home Improvement License: 1'1-7 .L'`7 d __.. _ Exp. Date; ARCHITECT/ENGINEER IWITST 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: $ o FEE: $ �n Check No.:Receipt No.:� NOTE: Persons contracting with unregistered contractors do not have access to,the guaranty fund Sign,atur_e otrAgent/Uvvner t'G� Y Slgnature�or�contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Building Department The folbwing is -a list of the required forms to be filled out for the appropriate. permit to .be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Biailding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or G.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/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 apn.,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 U Plans Submitted ❑ PlansWaived-[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF-:SEWERAGE-DiSP-OSAL 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' u DATE REJECTED DATE.APPROVED PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Conservation Decision: Comments :Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW 'Tow;. Engineer: Signature: Located 384 Osgood Street ' FIRE .DEPA"RTOl feNT `= Temp Dumpster on site yes no Located at 124,Mair .Street FireDeparta. ,m::. l ent signature/date ", .,-".'`•• ',� ;� F,;. °-�>,..�aa, ;.:��.<.:�' COMMENTS Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: -movement of Meter location, mast or service crop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No - MGL -Chapter -166 Section 21A -F and G min.$10041000.fine imu I t5 ana UA I A — (yor department use Q Notified for pickup - Date Doc.Building Permit Revised 2010 Location '— Check #1),()(V t 27145 Date (� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ (Y9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector U) m m m X N v m 10 e0•F Z CD O CL r SU = ? CL > cc . o" v CD a. � � sv CD O co c°flv r O CC Cl) 0 VOLO LW. N �G O _ CA CD y� CD U) iv z c� 0 CD 0 0- O c' _ vii ='_ C N O c° O CD nCL '® 5: T 0 N• -�_-I :3v+ �'. o o 5 Q. = ME N Go 96J S. "• � v 1 CL .+ CD CD 0 p O O � C=n =� z' (D U) fl. n N O 0Q 0 _ U) : ud CD o f O „< FL y: Wyt CD 0 Cl a t C co :r .► C i■ * CDCD A x Co <D Co 0 00 4` nom' C ci �y o a CL v: o fD m ^ (n ^ OZ C m m> v "V m .Zi T °1 ;VL T z 2 f) (D X S m m D H m n rn A w S C W ,? r" rn n 3 (3D x 000 T = N 0• U N � N ro . T n 27 T CD WO D 0v x i n OM zX inrn o rn o � e� z ti � v z rn 0 0- O c' _ vii ='_ C N O c° O CD nCL '® 5: T 0 N• -�_-I :3v+ �'. o o 5 Q. = ME N Go 96J S. "• � v 1 CL .+ CD CD 0 p O O � C=n =� z' (D U) fl. n N O 0Q 0 _ U) : ud CD o f O „< FL y: Wyt CD 0 Cl a t C co :r .► C i■ * CDCD A x Co <D Co 0 00 4` nom' C ci �y o a CL v: o fD m ^ (n ^ OZ co � m m> v "V m .Zi T °1 ;VL T Z m O 2 f) (D X S m m D H m n T °� A w S C W ,? r" T °—' n 3 (3D x 000 T = N 0• C p Z G1 W m 0 N � N ro . T n 27 T CD WO D 0v x i r s �I I /) — wowt���� Office of Consumer Affairs and B sines Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration 4 Registration: 117870 (T- -# Type: Private Corporation i "� �2_ Expiration: 12/12/2014 Tr# 234343 GEORGOULIS CONSTRUCTION, INC SCOTT GEORGOULIS- 96 ARLINGTON AVE` - DRACUT, MA 01826 X "'Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card. SCA 1 Co 20M-05/11 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuPenisor :..� License: CS-058498ra ``` SCOTT C GEORGODUS`- 96 ARLINGTON AVE DRACUT MA 01$26 I � 954— JJ/e y 141 Expiration Commissioner 10/21/2015 ISEI1010-6955849 UCSanDie E cion American A satycounig INTERNATIONAL SAFETY EDUCATION INSTITUTE (ISEI)"' f I{` �h�scar-d certlfiies than SCOTT GEORGOULIS has completed a',10 -Hour OSHA Hazari Recognition Training f Or th'e Construction. Industry. 08/23/2013 Director: Scott MacKay Trainer: Taytor Sikes Grad_ Date: P The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 UV. www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information` Please Print Legibly Name (Business/Organization/fndividual): eB v) Address: City/State/Zip:— Phone #: %f Are you an employer? Check the appropriate box: Type of project (required): I am a employer with b � 4. ❑ I am a general contractor and I 6. El New construction employees (full and/or pa time).* 2. ❑ I am a sole proprietor or partner- have Hired the sub -contractors listed on the attached sheet. 7. ❑ Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. FJ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.[3 Roof repairs - insurance ] ired. re q u 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. i -Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that checkthis 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: p (� _n Policy # or Self -ins. Lie. #:� ��� 7 �� Expiration Date: Job Site Address:City/State/Zip: n Ql"'/"f1 zefnLc,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. I do hereby certV under the pains and penalties of perjury that the information provided above is true and correct. 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 ofhire,• express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two ox 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 maybe 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 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 Musachusetts Department ofladustrial Accidents offtce of Investigations 600 Washington Street Boston, MA 02111 TeX, # 617-727_4900 eyt 406 ox 1-877:MASSAAFE Revised 5-26-05 Fax, # 617-727-7749 c WW-Mass,goV1dxa GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Arlington Ave. Dracut, MA 01826 Al Greene - Estimator 1-978-453-4242 Office 1-978-888-1700 Cell georgouli s 14 1(&,aol.com Drew Buttress 684 Salem St. N. Andover, MA 1-978-208-7675 - 1TV-$10',(.31 f cell dbuttress@comcast.net Scope of Work: CONTRACT 11/22/13 Job Location: 684 Salem St. N. Andover, MA Remove all layers of roofing down to wood deck on all shingled roofs of the house. Install 6' GAF Weatherwatch icetwater shield across all eaves, in valleys, and 3, up rakes at all roof to wall locations. Install GAF Shinglemate felt paper over remaining exposed roof deck. Install 8" .025 gauge heavy duty white aluminum drip edge on entire roof perimeters. Install GAF Timberline HD Lifetime Architectural shingles with Timbertex caps on roof. Install new Coravent V-400 ridgevent on main ridges. Remove all job related debris from property on a daily basis and at jobs completion. $2.50 Per Lineal Foot Extra Cost to replace any damaged plank board decking (if needed). $7.00 Per Lineal Foot Extra Cost to replace any damaged facial, rake, or shadow trim boards (if needed). Entire job includes GAF Systems Plus Warranty. First 50 Yrs. Is non -prorated, fill labor and material coverage from GAF, against any material defect cause. WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the sum of. Dc�•Pa:d s3000,00 C -s(, Five Thousand Seven Hundred Eighty Dollars $5,780.00 s 3000.eo PAYMENT TO BE MADE AS FOLLOWS: s 2'4$0.00 '2,489.99 PAID IN ADVANCE FOR MATERIAL COST S3-000-08 PAID IN FULL WHEN JOB IS COMPLETELY FINISHED ACCORDING TO THE ABOVE LISTED PROPOSAL. All material is guaranteed to be as specified. All work to be completed in a substantial workman like manner according to specifications submitted per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Our workers are fully covered by workers compensation insurapee.. Georgoulis Authorized Signature JA, 11A, This proposal may be withdrawn by us if not accepted within 30 da Color Acceptance of Proposal- The above prices, specifications are satisfactory and are hereby accepted You are authorized to.do the work as specified. Payment will be made as outlined above. �Signature Date of acceptance The following is part of this contract: Contractor Registration All home improvement contractors must be registered with the Commonwealth of Massachusetts. Contractor Registration # 117870 and Construction Supervisor License #058498. Inquires about registration should be made to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Better Business Bureau, Inc. Georgoulis Construction, Inc. member ID# 35522. Contact the Better Business Bureau (508) 652-4888 or at memberservices(a,bosbbb.org. General All outside work areas will be left rake clean. Roofing may result in dust or debris falling into the attic. This contract does not include clean up or protection of the contents in the attic. In the event a satellite dish should have to be removed to complete project, Georgoulis Construction, Inc. will not be responsible for repositioning after re -installation, should it be necessary. In addition, the Roofing contractor will not be liable for any damage, whether incidental or accidental, that may occur to any A/C, electrical or plumbing equipment that is installed or located in a place that interferes with the roofing or re -roofing process within normal standards & practices of a typical and reasonable roofing or re -roofing installation. Pam The maximum down payment or advanced deposit allowed by Massachusetts law is limited to whichever is larger: (A) One third of the total contract or (B) the entire cost of any special order materials. Final payment is required within 15 -days of the invoice date or a late fee charge in the amount of five (5) percent of the said payment shall be assessed for every 30 -day period for said payment outstanding. If non-payment becomes a legal matter, the Homeowner will be responsible for all legal fees incurred by both parties. All Credit Card Sales over $1,000.00 are Subject to a 2.0% Convenience Fee. Work Schedule The owner agrees the scheduling date is approximate. The contractor agrees to show good faith in meeting deadlines, but are not responsible for delays caused by weather. Suppliers, subcontractors, building officials. asbestos abatement, hidden damages or conditions, accidents, acts of God or anything beyond our control. Change Orders The owner is aware that the work may contain hidden damage, defects, or conditions such as decay, insect damage, or substandard construction practices, that may require additional work not included in this contract. In this case, Georgoulis Construction, Inc. will contact the owner and agree on an additional charge to the original contract price. In the event the owner can not be contacted, and it is crucial that work continue to protect the residence from the elements, (rain, snow, ect.) photographs will be taken to document the necessity of the additional work. The owner understands that any additional work will delay the completion of the project. Warrpty The contractor, Georgoulis Construction, Inc. agrees to correct any work that fails to conform to the contract or workmanship that is defective within TEN (10) years from the substantial completion date of the project at NO CHARGE to the homeowner. The homeowner agrees to notify Georgoulis Construction, Inc. specifying the nature of any workmanship defect, immediately. No warranty is provided for ordinary wear and tear, fading, abuse, neglect or casualty, or minor cracking/shrinking of concrete or caulking. No warranty is provided for materials not directly supplied by Georgoulis Construction, Inc. or for used, re -installed materials, (including skylights not installed by Georgoulis Construction Inc) or work done by others. This warranty excluded consequential and incidental damages. Contract Acceptance Upon acceptance of the authorized parties at Georgoulis Construction, Inc. this contract and all work described herein will constitute the entire agreement between Georgoulis Construction, Inc. and the Homeowner. r ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(0, 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 certifteate holder is an ADDITIONAL INSURED, the Po6cy(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 to lieu of such endorsement(s). P Phone: (978) 263-45M Fax (978) 2S3 -143b GALLANT INSURANCE AGENCY, INC.PNO1a 199 GREAT ROAD / P O BOX 975 ACTON MA 01720 ^`T Gallant insurance Agency, Inc. (978) 20-WOFAX N : (978) 263-1438 E-MAIL PRODUCERCUyTOMrR ID: 36702 1,000,000 INSURERS) AFFORDING COVERAGE NAIC6 DAMAGE TO RENTED $ wsuREO GEORGOULIS CONSTRUCTION INC. uaarRFRA : Seneca Specialty Ins Co XISURERa : Chartis Insurance Company CIO SCOTT GEORGOULIS VaLum C 96 ARLINGTON AVENUE DRACUT MA 01826 INSURER 0: eibVRERE 1,000,000 INSURER F . . .. wvarsswt* ChKTIFICATE NUMBER: 36324 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, I G TYPE OF INSURANCE' ADM SM POLICl/ NUMBER PdilC7 EFF POLICY EXP LIMITS - A GENERAL LIABILITY SAG4001034 03/06113 0310SM4 EACHOCCURRENCE_ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 1--x1 CLAIMS t -MADE OCCUR MED. EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY PRO LOC AUTOMOBILE LNBLRY COMBINED SINGLE LIMB ANY AUTO (Ea accident) $ BODILY INJURY (Per penton) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) S NON -OWNED AUTOS $ eMeRFl,. Ellie OCCUR EACH OCCURRENCE $ AGGREGATE $ -- EXCESS lJA6 CLAIMSdNADE - DEDUCTIBLE $ $ RETENTION S 13 woRXERs couPEwAmN WC009774M 09/2SM3 09125114 X'"tiBrA'I DTH $ . r. AND EMPLOYERS' LWUUM YIN EL EACH ACCIDENT $ 100,000 ANY PROPREioBmARTHEROEXEcurrvE. OFFICERAB3IBER EXCLUDED? (Mandatory in Nte NIA E.L DISEASE -EA EMPLOYEE $ 100,000 DESCRIPTION OPOPERATtONS bekw E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAttedr ACORD tOT, Addi5orMI RemarM SdmdLd% if more space Is mqukvd) ncorc,i.��r vcr�,rwnr MALAOcrc - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Andover, MA 01845 AUTNORrZEU REPRESENTATIVE Attention: Ray Gallant, President The ACORD rwne and logo are registered marlin of ACORD �ORDD CO RATION. All n m—