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HomeMy WebLinkAboutBuilding Permit #402-2017 - 80 OSGOOD STREET 10/14/2016 pORTy BUILDING PERMIT - -a'6 P TOWN OF NORTH ANDOVER ':` APPLICATION FOR PLAN EXAMINATION Permit No#: e Date Received �Rq�RATED 9SSAC HU5�4 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 0 OS�Oo d $ Print PROPERTY OWNER �4 v C Print 100 Year Structure yes no MAP PARCEL: l ZONING DISTRICT: Historic District s 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 JQ Others: ❑ Demolition ❑ Other El Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: �if 5�4 ���4 f'xTY �rbd— oaf/ ,�n4u/gI-idv� i,Q.��S ti!� �r�/�IiSt C (a4 hh�r�d5 Identification- Please Type or Print Clearly OWNER: Name: ?,q v t Cr4 h e Phone: Address: 6-0o Si- Contractor Name: r l -e8 (eve- Phone: Email: Address: eg5 I'✓I e 7-0w 1'1-b/ Supervisor's Construction License: �19A0 17 Exp. Date: Home Improvement License: Exp. Date: 7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ cab• 0 D FEE: $ Check No.: Receipt No.:� �� NOTE: Persons contracts with unregistered contractors do not have access to the guaranty fund 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS IA CONSERVATION Reviewed on Signature COMMENTS f HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIREtDEPARTMEN = Located 384 Osgood Street a T, Temp.�bumpster onsite, ,yes:_ _ lno� 1 Locatedjaf 124tMainrSt�eet - -� - ,4e.D;epartinent',s,ignature/date _s COMMENTS w _ . 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 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 :r 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 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 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) Engineering Affidavits for Engineered products 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 Doe:Building Permit Revised 2014 Location Ae No. Oz- � fT Date /-/V4 + - TOWN OF NORTH ANDOVER Certificate of Occupancy $ 4-FouBuilding/Frame Permit Fee s4-9- Foundation ndation Permit Fee $ Other Permit Fee $ r TOTAL $ Check# f? U ��, Building lAfpector �� 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 Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR-OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT Reviewed On lupvdhSignature_ 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: FIRE DEPSARTMENT `« •- Located 384 Osgood Street E _ir ,,TernpDumpster�on,ste• }yes, -� , .., . �� no L6c6tetlat1�24MaintStreet Fire{Department signatur"e/date {,. �_ r. . " .V i f f` • '�' 'T`{'Z�i-t' ,f w.. y .. .e-..,.....-. ,n,,... .�. .......,',e'er _« .m..._,,. ._-- COMMENTS. NORTH own Of 6Andover O to No. a_ e , * Y _ a � � � y ,� oh ver, Mass, C OG NIG«l_'C« y1• �•4 A°R�reo S lJ BOARD OF HEALTH I Food/Kitchen PER Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............... [[T .�&.....cpw .q.......................................... 000 � has permission to erect .......................... buildings on ........ ...... $is.(�r .........* ...... Foundation Rough to be occupied as !��� � .r1Ml�... �� �Nl�............................ 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS N Rough woo Service Final BUILDING INSP OR 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. Federal 1D#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RIS�` CTContractor Registration No 620120 ENGINEERING 60ShatirittutRoad,Canton,1�3A02021 �CONTRACT(��A 339-502-5197 FAX 339-502-6345 �O Page 1 PROGRAM VUS CONTRACTIS ENIERED I IKIBEIWEEN RISE AAjI CiIN'{/ HES ENGINEERINGAND 1RE ClIUMNER FOR WORK AS , ttt;tt�(t DESCRIBED BELOW CUSTOMR PHONE DATE CLIENT# WORK ODER Paul Craney (617)797-2540 09/20/2016 428781 28604 SERVICE STREET C".! BILIolW SatEEi 80 Osgood Street 8Q Osgood Street SERVICE CIn.STADs.ZIP Q-- siumo CIT',sTATE.ZIP North Andover,MA 01845 U I North Andover,MA 01845 1�� OB ESCWTION BARRIER:The rollowing contract is not valid unless accompanied by the Pre-Weatherization Barrier incentive form,signed by your licensed electrician,Work will not proceed with this work until we receive n copy of the form. $0.00 A I R SEALING:Provide labor and materials to seal areas of y our home against wasteful,e..wess air leakam. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be lett with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primaq areas for sealing include air leakage to attics,basements,attached gtrages and other unheated areas(windows are not Lmnerally addressed.) This will require(2) working hours.A reduction in cubic fat per minute(cfrt)ofair infiltration will occur,but the actual number of efm is not guaranteed. At the completion ofthe+weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $170.00 AiR SEALING:Provide labor and materials to install Q-Ion weatherstripping and a doors+veep to(5)door(s)to restrict air leakage. $375.00 WALLS:Furnish and install blown in Class 1 Cellulose to(1617)square feet of shingle and/or clapboard exterior walls.Thebutt of the upper course ofyour wood siding is cut to drill holes into the wall sheathing behind.The holes are then plug pd and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting if needed,will be the customer's responsibility. Invoicing wilt occur upon comp lotion of installation.Homeowner has received a copy of the EPA's Renovate Ritebt Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work or},to be performed.Your signature is your acknowledgement of receipt and agreement to proceed. $2,991.45 RISE Engineeringwill apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to avecd$2,000 per calendar year,and an incentive of 100%for the Air Staling measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health ofyour home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the weather'u-ation work is complete_We will also conduct a full assessment of the combustion safety ofyour heatingsystem and water heater.This has a value of 590 and is at no cost to you. Total allowable weathcrization incentive is$3.110. $90.00 Federal ID#05-0406629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISECTContractor Registration No 620120 G' ENGINEERIN60 Shawmut Road,Canton,�1A02021 CONTRACT 339-502-5197 FAX 339-502-6345 Page 2 PROMA M CNIA-� THIS CCNTRACTIS MAND N OUSTREQ TOBETW WOR A ENOURIERUtOAN0/HE CUSFTt.£R FOR WORK AS DESCRIIIEDiTELCW CU^uTOAER PHONE DAVE CLIENTS WORK CADER Paul Craney (617)797-2540 09/20/2016 428781 28604 SERVICE STREET BILLND STREET 80 Osgood Street 80 Osgood Street SERVICE Cm.STATE.MP BILLING CITY.STATE.DP North Andover,MA 01845 North Andover.MA 01845 JOB DESCRIPTION Total: $3,626.45 Program Incentive: $2,635.00 Customer Total: $991.45 WE AGREE HEREBY TT)FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Nine Hundred Ninety-One&45/100 Dollars $991.45 UPON FINAL INSPECIM AND APPRWAL BY RISE If"UMERING,CUSTOWRAOREES TDREMTAMUNTOVE IN FULLL INTERESTOF 1%WBL SE CHARGED MONTHLY ON ANY UNPAID BALANCE AMR 30 DAYS.SEE REVERSE FOR INPORTANTINFORIMAON ON WARANTEES,MOM OF RECISION,SCHECULIN4 AND COHRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACTIF THERE A Y BLAN SC ild W_,< AUINGRQEDS TURt- EIV i19 CUSTCbE C PTANCE NOTE:TNS.CONIRACTARY BE W IHDRAWN BY US IF NOTE%ECUTED WITHIN DATE CFACCEPTANCE ACCEPTANCE OF CONTRACT.ME ABCJEREST PRICES,SPECIRCAlM AND COMMONS ARE 30 DAYS. AS SATISFACTORY PE RED AVKHTUS WILL Bit'MADE AS qnED. ED ABOVEA���OTDOOLiE WORK WV 1r ✓ —� C S C �' 60 Shawmut Road,Unit 2 Canton,MA 02021 '339-502-6335 CM RISE ENGINEERING www.RISEengineering.com o Efficiency Energized, N QC�=� L=i � O OWNER AUTHORIZATION FORM Paul Craney (Owner's Name) owner of the property located at: $0 Osgood Street, North Andover, MA (Property Address) (Property Address) hereby authorize f b rA(� (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building _ permit and to perform work on my property"7fiis form"is3i�Ty viidrvith-a ' Owner's Signature Date The Commonwealth ofMassachusetts _ ___ Deparhnent of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,JVA 02114-2017 -r www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ayolicant Information Please Print Legibly Naive(Business/Organization/Individual): t aR EAR 1- i rr ATUW Address: PO lox see A VER AAA 01810 C'iVj,/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1.9 I am a employer with _ 4. ❑ I am a general contractor and I T�pe of project(required): employees(full and/or Part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. !' i. ❑Remodeling ship and have no employees These sub-conuactors have working for me in any capacity. employees and have workers' g' El Demolition [No workers' comp.insurance comp.insurance.# I 9. ❑Building addition required.] 5. E] Vre are a corporation and its 10.n Electrical repai.'s or additions 3.❑ I am a homeowner doing all work officers have expxcised their 110 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no l 12.0 Roof repair employees.[No workers' 13. Other comp.insurance required.] *Any applicant that checks box 1�1 must also 5ll out the section below Showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contactors than check this l ux�+!Lst a?*ached an aerdi6onal sheet shcwing the rare afthe sub-cozractors--nd crate vvhethe:or nc:tho;;entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer er tha.[s prof_-j sig wot>re.�'CGlr`:IDensatl9n i'.'SeLtFf3tce fOP inV�. i(1 2es. Belo s'LS t1�e ) �•s information. '� y po.icy an_j,b si. Insurance Company Name:_ 1� 1,—(;v/ jr,)y t�4 t�l� y"t of y�y PoUcy#or Scl#ins.Lic. E p of 16� lad 1.) x iraiion Date: Job Sitc Address: �b ay j s i City/Stata'Zip: y�` Attach a sapy of the workers'compensation policy declar2tio i 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 tine up to$1,500.00 and/or one-year imprisonment,as weli as civil penalties in the form of a STOP WOM ORDER and a fine of up to$250.00 a day against the violarer. Be advised that a copy of this statement may be forwarded to ate Office of Inve-stigations of the DIA for insurance coverage verification. do herEny certify under Me airs and. enaltis:a er'u that tiro Fn or nation provided above is true and correct. Si stare: '�' '�"""'—� Date. /V Phone 11: q�� ye)— 7& 3 6 ) rlcal use only. Do not write in this area,to be completed by city or town ofjzdaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone M 6/10/2016 Preview:Certificates of Insurance A�p® CERTIFICATE OF LIABILITY INSURANCE F°Ao�siloizol's' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.if SUBROGATION IS WANED,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: PHONE Automatic Data Processing Insurance Agency,Inc. AK.No.E.l: ac.Nor 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAIC# INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER e: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 Andover,MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER. 503587 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWooNYYY) 1MIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS4AADE [—]OCCUR PREMISES(Ea rxcunence) S MED EXP(Any one person) S PERSONAL 8 ADV INJURY 5 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY F-1 PRO- ❑ LOC JECT PRODlJCTS-CCF.IPIDP AGG 5 ROTHER: S AUTOMOBILELIABILITYCOMBINED 'L S fEa occident) ANY AUTO BODILY INJURY(Per person) S ALL AUTOS NED AUTOOSIAED BODILY INJURY(Pea accident) S NON-OWNED S HIRED AUTOS AUTOS (Per aeeideni) 5 UMBRELLALIAeOCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION H. AND EMPLOYERS'LIABILITY YIN X STATUTE ER A O FICER/A1EANI P EPEXCLUDED fd;lnl� Y❑NIA N POWC772258 01/0112016 01101/2017 E.LEACHACGDENT s 1,000,000 iM-des In NH) If es.deE.L.DISEASE-EA EMPLOYE S 1,000,000 scribe ceder DESCRIPTION OF OPERATIONS bel= E-L.DISEASE-POLICY UFAIT 5 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddKbnal Remarks Schedule,may be attached 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. 1600 Osgood St.1 suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE )k-- A@ 1988-2014 k_..,-A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD https:/iadpia.adp.coni/icertcf/#/run/preview/5035971900012975 111 ACOORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD(YYYY) �i 6/10/2016 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 this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT g NAME: Linda BO daaawicz Insurance Solutions Corporation PHONE (603)382-4600 Noll:(603)382-2034 60 Westville Rd E-MAIL ADDRESS: coin INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURERA:W@stern World INSURED INSURER B:Nautilus IIISurance Group Polar Bear Insulation Company Inc INSURER C: PO BOK 958 INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1632326134 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 TYPE OF INSURANCE A L SUB POLICY EFF POLICY EXP LT POLICY NUMBER MWDD/YYY MMIDD/YY LIMITS R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑R OCCUR DAMAGETORENT11 100 PREM ISES Ea occurrence $ 100,000 NPP8274967 3/24/2016 3/24/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY PRO- ❑ LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Peraccident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 -:4DED I I RETENTION Am026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/SJAt ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 0014on WOMM4�vm� 0 wi Office of Consumer Affairs and Business Regulation 10 Park Plaza.- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA - Expiration: 7/212018 Trir 419291 POLAR BEAR INSULATION CO. " Vincent LeBlanc P.O. BOX 958 ANDOVER, MA 01810 _ Update Address and return card.Mark reason for change. sca 1 0 zoM-osrn Address [] Renewal n Employment Lost Card �fe�arrrnra�uacul(l o�G'�l�nua>�nic!(S Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to.- Registration: o:Registration: 102726 Type: Office of Consumer Affnirs and Business Regulation fi Expiration: 712%2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR iNSL1LA116N CO: Vincent LeBlanc 51 SO.CANAL ST.#5A LAWRENCE,MA 01841 Undersecretary V Not valid without signature I y Massachusetts -'Department of Public Safety Board of Building Regulations and Standards Cnmtruction Super%ilior Specialty -icense: CSSL=108017 PETER A LEBLANC ` 2 EAST PINE STREET Plaistow NH 03865 1 Expiration Commissioner 04!28/2018