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Home My WebLink AboutBuilding Permit #Exception - 79 JOHNSON STREET 5/1/2018 %IORTh BUILDING PERMIT OF t""D 16 TOWN OF NORTH ANDOVER o� 9a o° APPLICATION FOR PLAN EXAMINATION #_ 70 Permit No#: Date Received A�q•TEO I,PP .(� gSSACHus 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 Elwell ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer 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 guarantl, ignature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL i 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 t 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: �ILocated 384 Osgood Street - FIRE DEPARTMENT - Temp Dumpster on site, yes no Located.at 124 Main Street Firs D:-?n tment signature/date COMMENTS 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 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 ❑ Certified rt fled SurveY ed Plot Plan ❑ Workers Comp Affidavit ❑ 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 ort (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Famil � 9 Y) ❑ 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 I Doc:Building Permit Revised 2014 Location J hs.1�Ci rJ Date 1 • - TOWN OF NORTH ANDOVER 1 . � MD'I Certificate of Occupancy $ ' Building/Frame Permit Fee s2A -� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#' J 1 2 57 5- 4 Building Inspector r I NORTF� : :. .� . )ver 0__ No. _ 1 � _Y .� - _ � o o � s ver, Mass • h � ■ TA-o cOC NIC 1N11CK 01. AERATED ►4P�,`,�5 `S tJ BOARD OF HEALTH Food/Kitchen PERR T TSeptic System 6k"" BUILDING INSPECTOR THIS CERTIFIES THAT ..................... ....... ......4�.0........................ ..................... �i• b��4j. Foundation has permission to erect .......................... buildings on ........ ... •• •'"••••••••••••••••• Rough to be occupied as ............; �.......... ........................................ ............................. Chimney provided that the person accepting p eve in is permit shall in respect conform to the terms of the application Final every on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTFJS ELECTRICAL INSPECTOR UNLESS CONSTRUCT' T Rough Service ... ... ...................................... 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. Julien Du ont 1 p 24 Merrill Ave.Salem NH 03079 508-243-4191603-893-4385 H1C 17524 CSL-106330 Homeowner Information: Contractor Information Peter Calkins Julien Dupont 79 Johnson St 24 Merrill Ave North Andover Ma 01845 Salem NH 03079 The Contractor agrees to do the following-work for the homeowner: Strip all shingles off of house Install 6fh of ice and water shield on bottom edge,3ft-in valleys and roof wrap on remainder Install 8"drip edge Will re-roof using CertainTeed lifetime architectural shingles.Color:Colonial Slate Install new vent pipe boot Install new ridge vent Dispose ofall debris Required Permits-The following building permits are required and will be secured by the contractor as the homeowner's agent(Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) Proposed Start and Completion Schedule-The following schedule will be adhered to unless circumstances beyond the contractors control arise V week of december 2015:Date when contracted work will be begins contracted work 3 days after start date:Date when contracted work will be substantially completed. The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: Seventeen Thousand Dollars($17,000) Payments will be made according to the following schedule: $8,500 when job started $8,500 upon completion(Law forbids demanding full payment until contract is completed to both party's satisfaction) NOTES:(•)Including all finance charges(s')Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-is the contractor providing an express warranty?-No-Yes(all terms of the warranty must be attached to the contract)Subcontractors -The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract Don't be pressured into signing the contract.Take time to read and fully understand it.Ask questions if something is unclear. Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757 •Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of proof of insurance document Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CO CT IF THERE ARE ANY BLANK SPACES!!! Two identical a contract musted and signed.One copy should go to the homeowner.The contractor should keep the other copy. Homeowner's Signatu a�. ntractor's S' natu , Z Date � Date The Commonwealth of Massa chusetts Department of IndustrialAccidents d,a 1 Congress Street,Suite 100 =' Boston,MA.02114-2017 www mass.gov/dia sy Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE]FILED WITH THE PERI4IITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: phone Are you an employer?Check the appropriate box: Type of project()Vequired): 1.❑I am.a employer with employees(fall and/or part tune).* 7. E]New construction 2 I am a sole proprietor or partnership and have no employees working for me in 8. [J Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3..Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 l.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-coiitractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. i homeowners who stbiri if Us 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 and state whether or not,those entities have employees. If the sub-coritractors fiave employees,they must provide their workers'comp.policy number. d am an employer Mat is pioviding workers'compensation insurance for my employees. Below is the policy and job site information. ®® �-- Insurance Company Name: `!�ZIi�9c,+✓t ��+'15 Policy#or Self-ins,Lic. Expiration Date: ��- Job Site Address: 7-2 "��!, e/y�zS'/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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1'do Hereby certify unde the ins and penalties of peiYUry that the information provided above is true and correct. Si nature: - Date: —/S e- - Phone#: A 2V Official use only. Do not write in this area,to be completed by city or town offzciax. City or Town: Permit/License# Issuing Authority(circle one): i 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 b£lire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill'out the workers' compensation affidavit completely,by checking the'boxes that apply to your situation and,if necessary,supply sub-contractox(s)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affiidavit 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' compensatioii policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of IudustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617•-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia AcoR ® CERTIFICATE OF LIABILITY INSURANCE (MMID IM) 11/20/15 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 HOLIER. 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 thi s certificate does not confer rights to the certificate holder in lieu of such endorsement(s). y PRODUCER CONTACT Hasbany & Regan Insurance Agen PHONE Eric Jansen FAx 254 Pleasant Street E-MAIL 78 685-3188 N : (97e) 685-9460 Methuen, MA 01844 ADDRESS: eric@hasban .com INSURERS)AFFORDING COVERAGE MAIC# INSURER A:Northfield INSURED INSURER B:Travelers Julien Dupont INSURER C: dbaJulien Dupont Construction INSURER D: 22 May Lane Dr INSURER E: Salem, NH 03079 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPEOFINSURANCE POLICY NUMBER MMDIY WAMDIYYYY LIMITS A GENERALLIABIL17Y WS256622 7/20/15 7/20/16 EACH OCCURRENCE $ 11.000,000 X CObMERCIALGENE RAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE F—x]OCCUR MED EXP(Arryone person) $ 5,000 PERSONAL&AOVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATELIMIT APPLIES PER PRODUCTS-00 MP/OPAGG $ 2.000.000 $ POLICY PRO- T" RQ TjECT F-1 LOC $ AUTOMOBILE LIABILnY Co .JEOMBINED�SINGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERLY DAMAGE $ HIRED AUTOS AUTOS eraccident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB 17 CLAIMS-MADE AGGREGATE $ DED RETENTION B WORKERS COMPENSATION 7PJU8-2E18812-A-15 5/2/15 5/2/16 WCSTATU- I$ OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMENBEREXCLLDEDI N/A E.L.EACH ACgDENT $ 1 1000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE 1,000,000 Ifyes,RIPTIbNOFO E.L.DISEASE-POLICY LIMIT 1.000,000 der DESCRIPTION n OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Sdheduls,if more space is regU red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Emilv Crossman ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: i ACC)6 CERTIFICATE OF LIABILITY INSURANCE 7(MM/DDIYYW) 11/20/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on thi s certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ACT NAME: Eric Jansen Hasbany & Regan Insurance Agen PHONE (978 685-3188 5410 N : (978) 685-9460 254 Pleasant Street ADDRESS: eric@hasbany.com Methuen, MA 01844 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Northfield INSURED INSURER B:Pro res sive J&S Allstate Contracting INSURER c:Essex C/O Stephen Nolan INSURER D:Travlers 5 Hampshire ST INSURER E: Salem, NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDY MMIDD/YYYY LIMITS A GENERAL LIABILITY Y WS217993 5/31/15 5/31/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS.MADE Fx_1 OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2.000.000 GEMLAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 J( POLICY PRO-,ECTLOC B AUTOMOBILE LIABILITY 02376094-2 8/29/15 8/29/16 COMBINEDCSINGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS $araccident C UMBRELLALIAB $ OCCUR CUBW5223714 5/31/15 5/31/16 EACH OCCURRENCE $ 3,000,000 X EXCESS UAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED RETENTION$ 10,00 D WORKERS COMPENSATION 7pJUB-6B20508-1-15 8/30/15 8/30/16 WC ,..,T. X OTH- AND EMPLOYERS'LIABILITY Y/NFR TORANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACgDENT $ 1.000.000 OFFICERIMEMBER EXCLLOED1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1,000,000 D e-RIPTIONOFer E.L.DISEASE-POLICY LIMIT 1.,.000,000 DESCRIPTION n OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Renerks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Emily Crossman ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts Department bf Public Safety Board of Building!Regulations and Standards License:.CS406330 Construction Supervisor 4 STEPHEN NOLAN ` 16 L PHILLIP ROAD DERRY NH 03038 s xpiration: Commissioner ;07/19/2017 _, , -- ='jl�Ccitttirr-rr�rrcllf�{r�"•^_-rl(Ct.:."tro'irr._•Jl-� '" C3ftice of Consumer'Aff m&Ru;ioess 33eguladon Z ME IMPRAIqPJIENT COK t RAC IOR , TFAgr IR' tt NVL:piration: 742/2016 individual STEPHEN P.NOLAN STEPHEN NOLAN IS L PHILLIP RD DERRY.NH 03038 iJnder:ecretarp t i i k