HomeMy WebLinkAboutBuilding Permit #1068-15 - 700 MIDDLETON STREET 6/17/2015 (2) L BUILDING PERMIT NORTH Q��.TtEv IhO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �9SS ArED Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no s: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial C ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic D Well (I Floodplain ❑Wetlands ❑ Water,shetl 'District Water/S.ewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: .Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp: Date. 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 4 Building Permit Application Workers Comp Affidavit 4 Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4. Copy of Contract Floor Plan Or Proposed Interior Work Engineering ineerin Affidavits for Engineered products OTE: 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 4, Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4, Mass check Energy Compliance Report (If Applicable) � Engineering Affidavits for Engineered products IS OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 J Plans Submitted ❑ {Tans Waived ❑ Certified Plot Plan ❑ 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 m U FORM 4 j PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS -Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Z 4 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Drivewav Permit `.DPW Town Engineer: Signature: FIDE DEP Located 384 Osgood Street � 1 rnp Dum�pster�onsite . yes , no ILo tedat 1P24.Main Street * .h ar'+ *��" t a Fire De a a� �"°6 em nt K." atur COMMENR Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of 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) i ❑ Notified for pickup Call Email Date Time Contact Name E I Doc.Building Permit Revised 2014 Location No. I/toDate • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ a Building/Frame Permit Fee $--,4— Foundation —Foundation Permit Fee $ Other Permit Fee $ �`- TOTAL $ Check# �' 2894 r �Bwlding Inspector NORTH Town Of 2 j EAndover O ��... - 0 No. C, h ver, Mass, COC NIC Nf WtC R"��� �d A�RATEO S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System Qi'f�'y �/`.e���- BUILDING INSPECTOR THIS CERTIFIES THAT ............................................................................................................................ �C �/i f6, T Foundation has permission to erect .......................... buildings on ..7......................................�.................................... / ,,s J Rough to be occupied as ............�.1...... .°..`f../:. fl::./�G.G ,C G��. ....S....................................... Chimney provided that the person accepting this permit shall 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. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT N TARTS Rough Service ff�weLl ....... ........ .✓ .. ...................... Final BUILDING INSPECTOR GAS INSPECTOR 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 Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET, SALEM, MA 01970 ENITIMUME Telephone:(978) 741-0424 Fax: (978) 741-2012 Contractor Registration No. 101609 Construction Supervisor No.CS057733 Federal EIN: 04-3090162 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buers) Name ` Date of Contract n Buyer(s) Street Address,City,State and Zip Code A&,�a(C-A-OVRA , r Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address q M, 693-36111 The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement"),and Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.("Contractor"),hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sale of goods and services.The Buyers) agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. �/ (� Purchase Price: Est.Starting Date: ! J l 51�gt - "'7 k 1 1'7 Down Payment:diY !19,01 Wi Est.Completion Date: 0 Cash Amount Due on Start of Job: ff, Check Credit Card Amount Due on of Completion: No. Amount Due on of Completion Expiration Date: Balance Due on Upon Completion:= CVC Code: It is agreed and understood by and between the parties that this Agreement,front and back and any addendum, constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement.Buyer(s) hereby acknowledge that Buyer(s)has read the front and the reverse of this agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms,on the date first written above.Buyer(s)also(i)acknowledge that they were orally informed of their right to cancel this transaction;and(ii)request that they be contacted via their telephone numbers or email,as listed above,in the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contractor.DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Serviecs,Inc. Buyers Signature Signature k, Lydd y �� Sscy2 Print Name Print Nam Signature Print Name You,the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION:The contractor and the homeowner hereby mutually agree in advance that in the event either party has a dispute concerning this contract,either party may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Bysiness Regulations and the other party shall be required to submit to such arbitration as proved in M.G.L c.142A. Cammttor initis Buyers InituL: NOTICE OF CANCELLATION NOTICE OF CANCELLA?ION Date of Transaction t You may cancel this transaction,without any penalty or Date of TransactionW�.s4.ys .You may cancel this transaction,without any penalty or obligation,within three bu ness ays from the above date.If you cancel,any property traded in, obligation,within threeit, from the above date.I1 you cancel,any property traded in, any payments made by u under the Contract or Sale,and any negotiable instrument executed any payments made bthe Contract or Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice, by you will be returned within 10 days following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled.If you cancel,you must and any security interest arising out of the transaction will be cancelled.If you cancel,you must make available to the Seller at your residence,and substantially in as good condition as when make available to the Seller at your residence,and substantially in as good condition as when received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick expense and risk.If you do make the goods available to the Seller and the Seller tices not pick them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the them up within 20 days of the date of your Notice of Cancellation.you may retain or dispose of g000s without any further obligation.If you fail to make the goods available to the Seller,or if you the goods without any further obligation.If you fail to make the goods available to the Seller,or if agree to return the goods to the Seller and fail to do so,then you remain liable for performance of you agree to return the goods to the Seller and fail to do so,then you remain liable for performance all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated of all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated r copy of the cancellation notice or any other written notice,or send a telegram,a A&A copy of the cancellation notice or any other written notice,or send a telegram to A A Services, 115 Norh Street,Salem MA 01970,NOT LATER THAN MIDNIGHT OF f'� 115 North Street,Salem MA 01970,NOT LATER THAN MION IGHT OF ,� ref ✓ r I t 1 HEREBY CANCELTHIS TRANSAC?ION I H-.REBY CANCELTHIS TRANSACTION Consumer's Signature Date: Consumer's Signatwe Date: ADDITIONAL TERMS AND CONDITIONS Contractor Responsibility.The Contractor will issue its formal warranty upon full payment,which shall constitute the Contractor's warranty for the labor and materials provided to the Buyer.Contractor agrees that all work done pursuant to this contract shall be of a workmanlike manner using professional quality materials and supplies.Warranties are available for inspection at the time of signing of the contract.Contractor accepts no responsibility for any damage resulting from structural or other defects in the property at which the installation is carried out.Buyer acknowledges Contractor's products do not correct or cure structural problems.Contractor shall not be responsible for(a)any damages arising in whole or in part from strikes,fires,accidents,floods,governmental actions or any other causes beyond control of Contractor or(b)any damages including without limitation,lost profits or reduction in value of Buyer's property,arising from Contractor's delay in performing under this Agreement or due to its breach of this Agreement. Condensation/Mold:The contractor is not responsible for conditions beyond its control,such as condensation which may form on or within a window or between windows resulting from pre-existing conditions in the Buyer's home and external temperatures.Some condensation may also form on the frame or portions of the roof.Reducing the humidity in your home will often remedy any condensation problems.The Contractor is also not responsible for existing or developing spore or mold growth.Mold may be due to condensation which may form on or within walls or other surfaces resulting from[pre-existing conditions in the Buyer's home and internal or external temperatures.Buyer indemnifies and holds Contractor and its employees,authorized contractors and their subcontractors from any claims as to the identification,detection,abatement,encapsulation or removal of mold,asbestos,lead based products or other hazardous substances inside or outside of the structure being improved. Permits:In Massachusetts,the Contractor is responsible for applying for and obtaining any and all necessary permitting.Homeowners who secure their own permits will be excluded from the guaranty fund provisions of Massachusetts law. Delay/Unknown Conditions:Events beyond the control of the Contractor,such as Acts of God,labor strikes, inclement weather,material shortages,Buyer's inability to qualify or obtain financing,delays by local government authorities in issuing or otherwise approving inspections,permitting or other required authorizations for the job,or other events resulting in delays in performance of this agreement do not constitute abandonment and are not included in calculating time frames for performance by Contractor.In the event the Contractor determines that this Agreement cannot be performed as intended by the parties due,for example,to incorrect pricing,unforeseen structural defects or pre-existing conditions to the Buyer's property,the Contractor may cancel this Agreement within 30 days of its execution,notify the Buyer of such a cancellation in writing and return all monies paid by the Buyer.The Contractor and the Buyer(s)have determined that a definite completion date is not of the essence to this Agreement.Contractor will not be responsible for any work not specifically listed in this Agreement or the Addendum. Late Cancellation,Late Payment/Default:If Buyer attempts to cancel this Agreement at any time subsequent to midnight of the third business day after the date of the Agreement,as more fully described on the Notice of Right to Cancel form,and Contractor accepts such late cancellation,then Buyer agrees to pay Contractor a cancellation fee equal to(i)15%of the Agreement's purchase price to offset Contractor's incurred labor,administrative fees and material costs;plus(ii)the Contractor's costs for any specialty orders or any custom manufactured items.Buyer agrees to pay 1 %%per month on all amounts due and owing from the buyer to the Contractor accruing from the date due and running to the date the payment is made.If Buyer is in default of this Agreement,Buyer agrees to pay Contractor's attorney fees equal to 15%of the defaulted amount or as otherwise allowed by applicable law.Buyer also agrees to pay any other costs or expenses of repossession,collection,or realization on any security including court costs,to the extent not prohibited by law. Security Interest:This contract may result in a lien on or security interest on your residence.Buyer grants Contractor a security interest under the Uniform Commercial Code and other applicable law governing,security interests in the property purchased pursuant to this Agreement,including a security interest in any proceeds from the sale of such property.Buyer agrees that the property purchased under this Agreement is,and will remain,personal property, regardless of the fact that said personal property may become attached to Buyer's real property. No Set-Offs or Retentions.Upon substantial completion of the Contractor's performance,Buyer shall pay all amounts due under this Agreement in accordance with its terms without any right of set-off or retention.Substantial completion is defined as the job being materially completed,functional as intended,and a final inspection,permit or occupancy certificate,as the case may be,having been obtained.If after making full payment,the Buyer alleges that the work is defective in any respect,the Contractor,without waiving any of its rights,shall cause an inspection of the premises and perform any remedial work to the extent the Buyer is entitled thereto under this Agreement or the Contractor's warranty at no cost to the Buyer. Buyer's Representations:Buyer represents and warrants that(a)any credit information furnished by Buyer in connection with this transaction is true and complete;(b)no person has promised or offered to pay,credit,or allow to Buyer any compensation or reward for the procurement of an Agreement with others as an inducement to enter into this Agreement;(c)no person has offered,delivered,paid,credited,or allowed to Buyer any gift,bonus,award,money, merchandise,trading stamps,or cash loan as an inducement to entering into this Agreement;(d)Buyer is the owner of the property where the goods and services are being provided. Miscellaneous:Problems and inquiries can be directed to the Contractor,who may be reached at the telephone y number on the front of this Agreement.In construing this Agreement,the gender and number of words used may be changed to meet the context.Any part of this Agreement contrary to law of this State shall not invalidate other parts of this Agreement.This Agreement is to be governed by the laws of the State in which it is performed.All contractors and subcontractors must be registered by the administrator of the Massachusetts Board of Building Regulations and Standards and any inquiries about a contractor or subcontractor relating to a registration should be directed to the Director,Home Improvement Contractor Registration One Ashburton Place Room 1301,Boston,MA 02108 Tel:(617)727-8598.This Agreement and any accompanying documents represent the entire agreement between the parties and there are no prior or contemporaneous oral or written agreements or representations on which either party is relying.Any modifications to this Agreement shall not be effective unless in writing,signed by the Buyer(s)and a President or Vice President of Contractor.The section headings contained in this Agreement are inserted for convenience only and shall not affect in any way the meaning or interpretation of this Agreement. AGrade Above 5m.1952- A & A SERVICES, INC. NORTH)T� FE18701970 ASASERICES Telephone: 0424 9741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyer(s)Name Date of Contract MACEn - U Sal Buyer(s)Street Address,City,State and Zip Code F- '7oo m ick bw P,� Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 1-7 The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a part. WINDOW REPLACEMENT �/ �ipsi J Remove and dispose of# �VCS- existing windows. 5A�'�'-bvmSSS Vp Install # "-11N21 Ut2-' new 'S'(4 Y2 ri 50..- windows:Gmyl f Wood (Manufacturer) Options: Style V 'o tkw Grid pattern �c - - Color Interior W�"AColor Exterior k.-lk• _ Glass Type aw'e(-17 Wrap exterior trim with aluminum: Style Color �G� L-Din/ l/ All windows will be installed according to the installation procedures in the portfolios— Dec, ✓�. Caulk all interior and exterior edges. ��J// r- giv-,r C6-PInsulate where possible around new units. / Insulate window weight pockets if exist,and around new window units where possible. Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. wilding permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS t Create new window opening by cutting through existing home and framing in opening. T Remove and dispose of existing unit(s)in its entirety. Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with. t Install window(s)into opening(s). Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible) or tie into existing soffit system. 4 Bay t Bow t Casement t Other window(s)to include new interior style trim and new exterior style trim and head flashing as needed. 67 Note: Painting and staining not included. STORM PRODUCTS Remove and dispose of# existing storm window(s). t Install new storm windows# Manufacturer Style Color Option t Remove and dispose of# existing storm door(s). 1, Install new storm doors# Manufacturer Style Color Type: t Aluminum t Solid Core SPECIAL INSTRUCTIONS: ' r +;a I ;J 41( Q.J 21 d — Itis agreed and understood by,and between.the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms.This contract may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and the Contractor. Buyer(s)hereby acknowledge that Buyer(s) has read this Specification.Sheet. Contractor Initials: s�- Date: S d f Buver's Initials: 14� Date: ' CIf 5 ` = The Commonwealth of Massachusetts � �.____ -.=1<__ - --:=-,z Department of IndustrialAccidents Office oflnuesfigations r =ve 600 Washington Street, 7t Floor Boston,Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors Applicant information: Please PRINT Ie2ibly name: �/�✓t�S/ ,P 'r' ��1�2�/t address: �/ J VO r7% 5-fr-e,&/ city 6a I-P ft, state: M__ A zip: 0/7-70 phone# ��"-7V1—e 79 f work site location(full address): IOO IMI/ ffaj'e T//77n 99 , JV6. lqh SVree, MA D)FY 5' ❑ I am a homeowner performing all work myself. roject Type: ❑New Construction❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition [� I am an employer providing workers' compensation for my employees working on thisjob. company name: /A/0 /� t�V t f I address: [ 5 I O v�n�� 4—. (] t L city: SC?a I e (m Nl F phone#: —t 7S` 7 7 W-V T �y insurance co. f ✓>O�V-e -e r -5 olicy# V e✓ P ❑ I am a sole proprietor,general contractor,or homeowner(circle ate) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone#: insurance co. policy# company name: address: cit),: phone#: insurance co. poliev# Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of NfGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded toInallies ice of Investigations of the DIA for coverage verification. I do hereby/certify un" a th pains and p of perjury that the information provided above is true and correct. Signature),✓ Date is ` 1 Print name `-!�[.t t t Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; ❑Other (revised Sept.2003) Jun 10 1511:18a The Insurance Advisory 781-449-3511 P.1 CERTIFICATE OF LIABILITY INSURANCE DATE`MM9/22a2/014 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 BETVVEEN 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). PRODUCER CONTACT NAME: The John M.Sullivan frtsuranceAgen PHONE 7 (31-449-9330 A n: 781-449-3511 P.O.Box 920047 E-MAILR Needham,NIA 02492 SS: suflivan.insadv@verizon.net INSURER(SP AFFORDING COVERAGE NASO A INsuRER A:The Travelers Indemnity Co 11347 INSURED INSURER e A&A Services,Inc INSURER C: 115 North Street INSURER D: Salem,MA 01970 INSURER E; INSU RER 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. /NSR TYPE OF INSURANCE D SUBR POLICY NUMBER MNILDI DIYYYY MNDIYEXP LIMITS GEN RALLIABAJTY EACH OCCURRENCE_ $ DAMAGE D COMMERCIAL GENERAL LIABILITY O RENTI I PREMISES'Ea000t rens b 1 CLAWS-MADE OCCUR MED EX?(Anyone person) $ PERSONAL BAOV INJURY b GENERAL AGGREGATE S GENL AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY ` PRO- LOC S AUTOMOBILE LIABILITY COMB NED SINGLE LIMIT _LEa acddecll S ANYAUTO BODILY INJURY(Per person) 5 ALLOWNED SCHEDULED BODILY (Per accident) S AUTOS AUTOS I I 4 NON-OWNED I I PROPERTY DAMAGE HIRED AUTOS AUTOS Per aCcitlem $ 1 $ UMBRELLA LIAH _I OCGVR EACH OCCURRENCE S eEXCESS LIAB J CLAIN1S-41ADEi AGGREGATE S DED RETENTION S WORKERS COMPENSATION WC STATU- OTH- i AND EMPLOYERS'LIABIUTY Y r N 9/13/2014 9/13/2015 ANY PROPRIETORIPARTNERIEXECUTIVE I ; E.L.EACH ACCIDENT $ 500.©DO A OFFICERIMEMSEREXCLUDED? NIA SKUB-0243M81-5-14 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ 500,000 ,yyes,Oesaibe Under DESCRIPTION CF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Addillonal Remarks Schedule,If more space Is required) I CERTIFICATE HOLDER CANCELLATION Town Of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N ACCORDANCE WITH THE POLICY PROVISIONS. Building 20,Suite 2035 North Andover, MA 01845 AUTHORIZEDREPRESENIAi�IE ©1988-2010 ACORD CORPORATION. All rights reserved. ACO RD 25(2010105) The ACORD name and logo are registered marks of ACORD I I cei-tt".1-cate IN:) A04.3006 TF[E- COMM0NVv'E.ALTH OF i\IAS-)ACFFU-)ETT,S E X�ECUTIVE OFFICE o�c -o;') V,'0lZ.-KF0RCE DEVELOP.\IENT � I. DEPARTMENT OF LABOR STANDARDS 19 ST.kMFORD STREET. BOSTON, NfASSACHUSETTS 02 1 14 DELEADER CONTRACTOR LICENSE A &-, A SERVICES, INC. I 15 NORTH STREET SALEtM MA 01970 LICENSE: D0000440 EXPIRES: Sunday,June 07, 2015 1\1 ACCORDANCE V,'ITH M.G.L. CH. I 11, § 1978(b) AND 454 C[%-[R 22.03, THIS LICENSE IS ISSUED BY Tc' DEP,-,•RT\f T OF LABOR STA'r AIRDS TO THE COQ TRACTOR ABOVE FORTHE PUP-P0 c:SL-OF ENTERTNG NtTO OR ENGAG NN'G INDELEADDNG WORK. THIS LICENSE IS VALID FOR A PERJOD OF ONE YEAR. THIS LICE\ SEIUST BE i\AAf-,NTAI-\;ED, BYTHE CONTRACTOR ',VHE�! ELiGAGED F\I DELEADING VVOR-K UN1 ACCORDANCE WITH M.G.L. CH. I I I 197B(b)(2) AND 454 UAR 22.03. HEEATH:R E. Rr),,vE, 3 1. Of COUU me r A Fri ir3 &Buiindsi Re -(r•i-rilln ')uPni, r ,- 0 =HOME IMPROVEMENT CONTRACTOR S a CS057733 �1— ' R agii stration: 'Expiration: CHPJSTOPHER ZE)RZTY Pi,;VaN " 1 3.)(34 Uc 115NORTHST - A&A SERVICES, INC Salem LNL-k 01970- Christopher Zorzy I to-,North 3traet S 31em. MA 01970 05/26/2015 ,C)VL https://elicense.chs.sl:ate.ma.us/eGov/Web/PaymentResult.aspx?ans,,v. Application Submitted Your application has been submitted and all fees have been applied to your credit card. Please print this page as your proof of submission and receipt of payment. Application Information _ ((Date Submitted: Wednesday, May 06, 2015 Applicant Name: CHRISTOPHER ZORZY Pcense Number: CS-057733 (Agency: MADPS Process: Renew License process Pavment Information Authorization Code: 125004 Received Date: 5/6/2015 9:26:33 AM Received Amount: $100.00 g MAY 0 � 2015 of 1 5/6/2015 9-26 Ali