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HomeMy WebLinkAboutBuilding Permit #Exception - 75 JOHNSON CIRCLE 5/1/2018 t BUILDING PERMIT o`"o oT"gtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION so i Permit No#: Date Receivedrev �gSSACHus���y 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 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: r i Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email:— Address: mailAddress: _ 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 signature of Agent/Owner Signature of contra( .' y\� Plans Submitted ❑ Plans 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 - U FORM 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp lDumpster on site. yes Ld-ated at 124Vain..Street _ o Fire Department signatureldate . COMMENTS T -- i 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) ❑ Notified for pickup Call Email Date Time Contact Name 3 Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.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 Li Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) Li 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 ❑ Certified Proposed Plot Plan Li 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) Ll Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) ��'-.�-j 5-5-3^/ -s-3 q l 116 /Get,re s �1,b License Number / Expi ation bate C111- N f CSolder List CSL Type(see below) 21 �(�cwk /i6111 Ad 191141yQi T Description r U Unrestricted(up to 35,000 Cu.Ft. Signature <57 R Restricted 1&2 Family Dwelling t'7 _ �S M Masonry Only RC Residential Roofing Covering Telephon r C WS Residential Window and Siding ey►r� t L e p / �([�1�LEic�, C rGI SF Residential Solid Fuel BurningAppliance Installation E-mail Address ✓ D Residential Demolition 5.2 Registered I�ome.I pro m_nt Contractor(HIC) �t �2 Gda! le HIC Company Na e or I-l Zgistr�}t Name Registration Number s3 15Dw B �(J' /��d'� i U4 01 ` 6 � 2 �� 117 xaAd7, O(� -4 0 -277/ E piratio Date Signature ./ Telephone E-mail Addres SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuanc of the building permit. Signed Affidavit Attached? Yes .......... No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWN 'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ..Stye Cdrti� as Owner of the subject property hereby authorise to act on my behalf, in all matters relative to work authorized by this building permit application. Sienature of Owner Dat SECTION 7�b,: �O/WNEW OR AUTHORIZED AGENT DECLARATION as Authorized Agent hereby declare that s "the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Sienature of Owner or Authorized Age Date (Signed under the pains and penalties o perjury) NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 10.86 and l 10.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) C� (including garage, finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Ze-z,�,�i Habitable room count Number of fireplaces t-� �,,. Number of bedrooms Number of bathrooms Number of half/baths Typc of heating system Number of decks/porches C,G�,• p Type of cooling system Enclosed Open LJ r , NORTH E 1 aver O No. b h ver, Mass, t( - �,9 COCNICHtW1CH �1• pDR�ITED I'P���S s � BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............tel.. .. ......... . .... .1.!:!:................... ......... ....... ........ ...H-- has permission to erect . g Foundation ......................... buildings .......5.....��.v%j b�.....C�.�z.�.� �� Rough to be occupied as ..... *1.....13�i ...�..... L....��... 1!r/.. ,�r�..�!'''�.... ?................ 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 0 TARTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. L(978 GODDARD'S Painting •Contracting•Constr3 Bow Street,North Reading,MA 01864 goddardpainting@comcast.net ) 664-2274 Fax: (978) 664-2539 JACKIE BLINT / PAUL ACTIS 75 JOHNSON CIRCLE NO.ANDOVER,MA 978-457-9416 CONTRUCTION CONTRACT *** ILL is �j� 17rc7�ejtm �A RESEARCH HEAT SITUATION PRIOR TO CONSTRUCTION WORK NOT INCLUDED 1OAse r7 caN f i-uMr>eg's r-rNDtrj& FULL BATH ) PROVIDE AND INSTALL LOUVRE DOOR ON MECHNICAL ROOM/NEW BATHROOM DOOR /BUILD RECCESSED CLOSET INTO MECHANICAL ROOM )REMOVE EXISITNG FIBERGLASS BATH TUB / BUILD SHOWER /ONE GLASS WALL/ GLASS DOOR/MIXING VALAVE ON LEFT SIDE /GLASS BY OTHER )INSTALL PROVIDED VANITY/TOILET/HEATED WALL UNIT IF RECOMMENDED BY PLUMBER INSTALL PROVIDED TILE IN SHOWER INCLUDING CEILING/TILE FLOOR INSTALL ALL PROVIDED ACCESSORIES /LIGHT FIXTURES/VENT/ALL PAINTING HALF BATH ) BUILD WALL PARTITIONS AROUND OIL TANK WITH ACCESS PANELS /STORAGE CLOSET OVER TOP OF TANK / INSTALL PROVIDED TILE FOR FLOOR ) INSTALL PLUMBING FOR TOILET TO BE CENTERED IN AREA WHERE EXISTING WASHER AND DRYER ARE /INSTALL PROVIDED VANITY ON OPPOSITE WALL MUDD ROOM INSTALL NECESSARY PLUMBING FOR WASHER /SLOP SINK/DRYER ALONG NOTED WALL / BUILD WALL PARTITION AS DISCUSSED FOR UNITS / PAINT UP MOVE EXISTING GARAGE DOOR THREE FEET TO THE RIGHT INSTALL NEW DOOR TO ELECTRICAL ROOM /ALTER EXISTING CLOSET Fv1, - 134 TH ��oo1Z- PLS � Y 5 h GODDARD'S �7 Painting• Contracting• Construction 3 Bow Street,North Reading,MA 01864 goddardpainting@comcast.net F:](978) 664-2274 Fax: (978) 664-2539 i OWNERS TO PROVIDE: ALL TILE& GROUT/TOILETS/VANITIES/SINKS/FAUCETTS ALL LIGHTING, GLASS AND ACCESSORIES CONTRACTOR TO PROVIDE: ALL BUILDING MATERIALS, ELECTRICAL& PLUMBING CONTRACTORS,ALL NECESSARY PERMITS AND INSPECTIONS CONTRACT PRICE $24,000.00 TWENTY FOUR THOUSANDS PAYMENT TERMS $2500 UPON SIGNING CONTRACTS UPON DAY OF START $4000 THREE PAYMENTS OF $5000 BALANCE ON SATISFACTORY COMPLETION $2500 ACCEPTED ............:........ ... ................ .........................DATE........ ..... .......... ACCEPTED .............. ....... . . ... . ......................................DATE.....j�..L.,1. .. CONTRACTOR ...............................................................................DATE........................... UoslW14pe i I VIA ILItylc J r V IVIE6j e�—A y.o ci r L `Tc.s 8 -Ac::> SI?a 4� �►-� C 7( /V eco -72e/4 t r /°yJ r.''D , w GODDARD'S Painting Contracting Construction 3 Bow Street, North Reading, MA 01864 978- 664-2274 Richards odg dard&comcast.net Date: PROPOSAL 9 Y« Owner's Name -1- ?,411 & iS Telephone/FAX 9 - ys` 7 - e7�4/6 We hereby propose to furnish all material and equipment and perform all labor necessary to complete the following work: 5 e-e- -e at vs The contracting agents full name is Richard S.Goddard.Richard is a state registered contractor in good standing with the Commonwealth of MA. This information has been made available in accordance with MA general law. All material is guaranteed to be as specified.All work is to be performed in accordance with the drawings and specifications submitted. Any changes involving extra costs will be executed in writing upon signed mutual agreement by both parties with additional charges noted.All agreements are contingent upon strikes,accidents,schedule or shipping delays beyond our control. Richard is insured for liability and workers compensation as required by law,copies of certificates available upon request. Owner to carry all other necessary insurance.All canceled material orders are subject to a 10%restocking charge.All special orders are a non-refundable final sale.Manufacturer's material warranties are the contractors warranty.All work to be completed in a substantial workmanlike manner for the sum of With payments t be made as follows: ���s You,the buyer,may cancel this transaction at any time prior to midnight of the third business day.After the window for cancellation by the buyer has passed said cancellation shall be deemed a material breach of this contract which entitles the contractor to 20%of the total contract price.Cancellation without lawful excuse is a violation of the law.It is the obligation of the contractor to obtain all permits,the cost of which has not been included in the above noted price.The building inspection shall be called for by the contractor upon receipt of final payment.Homeowners that secure their own permits or deal with unregistered contractors shall be excluded from the guaranty fund provisions of chapter 142A of Massachusetts General Law.All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be direct . to: Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston 021.18 (617)973- 0. CONTRACTOR: This proposal may be withdrawn if not accepted within 10 days. ACCEPTANCE You are hereby authorized to furnish all material,equipment and labor to complete the work described in the above proposal,for which 1,we,the undersigned agree to pay the amount stated in said proposal in accordance with the terms thereof. Any change involving extra cost of labor or materials will be executed only after submission and acceptance of a written change order. By signing this contract the signatory acknowledges that they are authorized to do so and assume all fiduciary responsibilities for this contracted agreement. OWNER/ Date AGENT Date �Y- Z— ZQ!� Goddard's Painting Contracting Construction 3 Bow Street, North Reading, MA 01864 978-664-2274 Richards goddard&comcast.net Pursuant to MGL c 142A and/or contract # '7 y1ro namely: 09 ei,,/i , dated: // - 2 - 2-d i S' For the purpose of this document the "Buyer" as noted below is the signatory power of the"above noted contract"baring the above written number. (Said contract hereinafter referred to as the ANC). The below noted signatures concur that these statements are both truthful and binding by both parties. • There are currently no liens or security interests on this or any other owned residence by this party as a consequence of this or any previous contract. • Richard S. Goddard (hereinafter referred to as RSG)uses and assumes all manufacturer's material warranties as the sole and only warranty for materials used. All labor comes with a one year warranty unless otherwise stated in writing. • Buyer understands and agrees that RSG is not responsible for any work not specified in the scope of work pertaining to the ANC. • Signatory for the buyer acknowledges that he/she is hereby authorized to execute this agreement and the ANC. • Customer agrees to refrain from sharing or leaving accessible this or the ANC with any of RSG's agents, subcontractors or staff and that any questions they may have regarding these agreements must be directed to RSG by the concerned party. • Any materials purchased by RSG to perform work regarding the ANC are part of the customer's deposit payment. Some or the entire purchase price for these items may be non-refundable should the customer cancel the job after the date of the"right to rescind"has passed. • Buyer holds harmless and fully indemnifies RSG and/or his agents for any damage to any electronics in the customer's possession moved or handles by RSG and/or any of his agents during the course of job performance. • Buyer acknowledges that the buyer relies on no other statement of representation by RSG and/or any of his agents other than those statements contained in this agreement and the ANC. • Buyer agrees to refrain from additional work negotiations with any of the labor force of RSG and/or any of his agents and that any such requests/demands shall be brought solely to RSG's attention. • During winter months RSG reserves the right to cancel or postpone work without recourse or consequence in the event of inclement weather. • In the event the buyer does not adhere to the noted payment agreement as outlined and agreed to in the ANC a charge of 2%per month may be added to the Buyers total for each calendar month or part thereof in which the above amount is not paid. • In the event collection is necessary, Buyer agrees to pay all costs of collection including reasonable attorney fees. • The contractor and the buyer hereby mutually agree in'advance that in the event that the contractor has a dispute concerning the ANC, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the buyer shall be required to submit to such arbitration as provided in MGL c142A. r • p • Buyer(s) I • Contractor Xupervisor chard S Goddard • NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. • Any homeowner who deals with unregistered contractors shall be excluded from access to the Guarantee Fund;MGL cI42A :{ The Commonwealth of Massachusetts Print form Department of Industrial Accidents '_ ---°' Office of Investigations 600 Washington Street Boston,MA 02-111 www mass govA a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address:.2, iWr S ;v-ijl a rl 1. City/State/Zip: &����e ®f.� Phone#: 9,78 -_' '- Z Z7y Are pwan employer?Check the appropriate box: Type of project(required): 1.R I am a employer with�_ 4. ❑ I am a general contractor and 1 6. 0 New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp•insurance.: required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]f c. 152, §1(4),and we have no 13.0 Other employees.[No workers' comp. insurance required.] *Any applicant that checks box#tl 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 providing workers'compensation insurance for my employees. Below is the policy and job site information. f Y� Insurance Company Name: Z, 1�r/ "� Policy#or Self-ins.Lic. 33 Expiration Date' d hen Job Site Address;- 7 T (.,v t4x&it 6cy t City/State/Zip: 6� 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains at .naltiec o rju that the information provided above is true and correct. signafire: ' Date: ff Phone#• e9 7 .K_..��� t/3 , 7 Oficial use only. Do not write in this area,to be completed by city or town gfficiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AC40� CERTIFICATE Off' L1 DATMMI,DDIr" �,,,,,� ABILITY INSURANCE 10/15/2015 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 AMEN% EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CE RTIFMTE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cerd ficate 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 CONTACT Barbara McDonough Gilbert Insurance Agency, Inc. (781)942-2225 FAX No (781)942-2226 137 Main Street ADDRESS:bmcdonough@gilbertinsurance.com INSU AF Nwg Reading MA 01867-3922 INSURER A:.Safety Insurance CoMany 39454 INSURED vas mi;t a la Mutual Ins. Co. 0034 A & R Goddard Corp. INSURER C: 3 Bow Street HrStIROt D INSURER E: North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 MASTER REVISION NUMBER:- THIS UMBER: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,TERN!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. t7§RR TYPE OF INSURANCE POLICY EFF POLICY EXP POUCY NUMBER iIMM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F-1 OCCUR DAMAGETO;ENTED PREkR4SES ocu¢rence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY n jECT F]LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LMBi>J7Y idOMBI F�SIN LIMIT $ 500,000 a ) A ANY AUTO BODILY INJURY(Per person) $ AUTOS AUTHO COM 6229448 7/10/2015 7/10/2016 BODILY RIURY(Per aaWwrt) $ $ HIRED AUTOS X NON-OWNED PROPERTY DAMAGEAUT $ Per ac cadent Medical Payments $ 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAO CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSAI ION AND EMPLOYERS'LIABILITYY f N ATUTE 7 1 I€R ANYCEPJMEMHER EXCLUDED.PROPRIETORIPARTNER/EXECUTIVE O N r A El,EACH ACCIDENT $ 100,000 (Mandatory in NH) WC2313311865045 9/19/2015 9/19/2026 EL.DISEASE•TEA O $ 100,000 If yqs,desaibe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedut,may he attached H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROOF OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/LINDSE ©1988.2014 ACORD CORPORATION. A11 rights reserved. ACORD 26(2014101) The ACORD name and logo am registered marks of ACORD INS025 i9m4 wI Office of Consumer Affairs.and 7usiness Regulation 10 Park Plaza.- Suite 5170 Boston, Massac ,isetts 02116 Home Improvement C for Registration -� Registration: 168420 Type. Cort�or-dtioA tA+„ ' Expiration: 2/15/2017 Tr# 262031 A& R GODDARD CORP. RICHARD GODDARD3 BOW ST f } NO. READING, MA 01864 � =” v Update Address and return card.Mark reason for change. s F] Address ❑ Renewal ❑ Employment Fj Lost Card DFS-erkt a- W-04104-61M6 ., office R% am fla i-Al�s�.`"�is-3ioa License or registration vafor iudividul use only - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Re9�on.:;. pwo Type: Office of Consumer Affairs and Busing Regulation = Expiration: 017 Corporafton 10 Park Plaza-Suite 5270 Boston,MA 02116 A GOD DARDiC C RICHARD GODDAfR 3 BOW ST :;:. _._..:�,_•;_. _; � � -Q� NO.READING,MA :::z% Undersecretary Not valid hoot signature 1 Massachusetts -Departrnent of Pub Ic sa e,,s Board Of uuii'din g aicgulations and� cicasziu5 License. CS-055395 RICHARD M D"GIUO._. 12 PING AVE M U DLIKION MA 0190' r Commissioner IIA41M16