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HomeMy WebLinkAboutBuilding Permit #867-14 - 89 OLD VILLAGE LANE 6/2/2014v. s,�,. ,6.�.._4d BUILDING PERMIT ("R TOWN OF NORTH ANDOVER .6 APPLICATION FOR PLAN EXAMINATIONPermit NO: VVV7.�/L�/i Date Received Date Issued: TANT: Applicant must complete all items on this LOCATION O9 o l d V,16e%� 2 PROPERTY OWNER J7aVi 0 rint MAP NO: PARCEL:, 0(P)dr/ZONING DISTRICT: Historic District Machine Shop Vill yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial @(Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands 0 Watershed District 0 Water/Sewer x'rt are.S 2. D F l oor %4 \A A0 vis w J ,\eLJ. H o f Identification Please Type or Print Clearly) OWNER: Name: Address: 0 13 X& K/ FONTRACTOR Name: Ne�cu5 _ Se v%CBS I" ,� .4 % -t 1 _ - Vo AzuywV/ WAF-- oto V 5 _Phone: % S 1 7 2,03 0 Address: ? 0 Soy 2E23 \4 66)s-(\ NW 01 Eil' Supervisor's Construction License: a 73gF1 Exp. Date: -�l 7 1 6 Home Improvement License: I 2_q1 q -77 Exp. Date: —71 1 01 If ARCHITECT/ENGINEER 'V 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: $ 21 61+0 -, FEE: $ ID 60 Check No.: Receipt No.: NOTE: Persons contracting wo un;:ejisfered contractors do not have access to the guaranty fund ature of Agent/Owner `— Signature of contractor e Plans Submitted ❑ Plans Waived ❑..: ""...Certified Plot Plan ❑ Stamped Plans ❑ TI'PE_O> ;SEWERAGEDISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ .....Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc._ Pdrmandint Dempster on Site THE_FOLLOWING SECTIONS FOROFFICE USE ONLY _ INTERDEPARTMENTAL SIGN _OFF - U FORM `PLANNING&. DEVELOPMENT` COMMENTS < DATE. REJECTED:, DATE:APPROVED ::❑ _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 4 Water & Sewer Connection/Signature &.Date Driveway Permit DPW Tow;-, Engiweer: Signature: -- Located 384 Os ood Street FIRE-DEPARTM,E-`NT :- Temp Dumpster on site . yes . no Located at:124 Mair Street _Fire Departure►iftsigr�ature/date h - ; . .COMMENTS Dimension Number of Stories: .Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of. Meter lo.catFon,;mast -or service drop requires approval of Electricallnspector Yes No DANGER ZONE LITERATURE: -Yes No MGL -.Chapter. 166. Section 21X F and G min.$100-$1000.fine Doe.Building Permit Revised 2010 Building Department -` °rhe foh�owing is a list of the:required.forms to be filled out for:the appropriate permit to .be obtained. Roofhl g, Siding, Interior Rehabilitation Permits U . B.iailding Permit Application ❑ Workers Comp Affidavit Li Photo Copy Of H.I.C. And/0r 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 Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases .if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apu;�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doe: Doc.Building Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 21,640.00 m $ - $ 259.68 Plumbing Fee $ 32.46 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 32.46 Total fees collected $ 424.60 89 Old Village Lane 867-14 on 6/2/2014 Bath Remodel Page 1 of 5 Nexus II Carpentry and Construction Design P.O. Box 2823 Woburn, MA 01888 781760 2031 Fax 978 9751263 nexuscarpentry(a,aol.com Contract This is a contract between Nancy and David Phillips of 89 Old Village Lane, North Andover MA 01845 (Hereafter referred to as the "owners") and Nexus II Services (hereafter referred to as "Nexus") dated May 15th 2014. GENERAL SCOPE OF WORK DESCRIPTION WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated below to Master Bathroom and windows to 2nd floor Scope of work: General details ♦ Meet with local building official and apply for permits ♦ All work will be in accordance with local building code regulations and will be inspected by local officials prior to continuing with the next phase — Nexus will be responsible for arranging and being available for all inspections ♦ Nexus will contact "Dig Safe" prior to commencing any excavation work for their clearance ♦ All work will be coordinated directly between "owners" and Nexus ♦ Nexus confirms that it is fully licensed, insured and ensures any sub -contractors utilized on this site will have the appropriate insurance coverage ♦ Nexus will be responsible for the safe storage of all its property and any materials to be used on the site ♦ Owner is responsible for removal and return of all items of the house in the areas that will be affected and their safe storage prior to our work commencing SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 2 of 5 ♦ Owner will then be responsible for returning all items to these areas of the home after completion of the scope of work ♦ Remove and trash into Nexus supplied dumpster all trash associated with this project NOTE: appliances are not allowed to be put in dumpsters without additional costs "owners" are responsible for removal from site Scope of Work — Master Bath _ NOTE: The new window will be Andersen_ 200 series with the same grill pattern as the. existing windows with grills between the glass and pre -finished WHITE interior and clad exterior for all windows ♦ Remove and trash existing vanity, medicine cabinet, shower stall and toilet, window, flooring, then all walls and ceiling to studs ♦ Remove existing baseboard heat cover and trash ♦ Re -frame window opening in bathroom to prepare for installation of new window under this scope of work ♦ Furnish and install framing to create new walk in shower NOTE: to be as wide as the "wet wall for plumbing etc. will allow NOTE 2: depth to be similar to the existing but adding an inch or 2 if possible based upon the framing under the existing sheetrock ♦ Furnish and install and opening for the installation of a built in medicine cabinet provided by you ♦ Furnish and install rough electrics to code and add feeds for new ceiling fan/light (fixture to be supplied by "Nexus"), also outlets to code and your wall sconce over vanity - switches to be WHITE NOTE: Create "vent" to exterior for new ceiling fan ♦ Furnish and install new Symmonds tub/shower valve and shower head to a new height of 70" from top of tub ♦ Furnish and install plumbing to code for new vanity, sink, faucet, shower drain and toilet ♦ Furnish and install rubber pan to sub floor of new shower ♦ Furnish and install sheetrock with smooth plaster finish to walls and ceilings ♦ Furnish and install cement sub floor to prep for tile installation NOTE: this may create a small height increase compared to existing floor and depending upon what we find when we expose the sub floor ♦ Furnish and install cement wall board to 3 sides of shower to prepare for tile installation ♦ Install tile and grout (both supplied by "owner") to floor and walls of shower stall — assumes ceramic tile as other tiles cost more for installation. NOTE: Tile height to be approximately 6' from floor of shower ♦ Install toilet, vanity and faucet (all supplied by "owner") and to existing layout ♦ Furnish and install new Andersen 200 series window (pre -finished WHITE interior) to opening in bathroom ♦ Furnish and install new paint grade trim to door, window and baseboard in bathroom NOTE: trim to match as closely as possible to trim in girls bathroom ♦ Furnish and install new white baseboard heat cover I Window PROJECT MANAGEMENT Page 3 of 5 NOTE: The new windows will be Andersen 200 series with the same grill pattern as the existing windows with grills between the glass and pre -finished WHITE interior and clad exterior for all windows NOTE: In the future the interior trim in all bedrooms and office will also go "WHITE" to match these new windows and new trim Remove and trash 2 x windows in master bedroom Remove and trash 3 windows in Maggie's bedroom ♦ Remove and trash 2 x windows in Office ♦ Remove and trash 4 x windows in Sydney/Quinn's bedroom ♦ Re -frame openings in all 4 rooms noted, to prepare for installation of new windows under this scope of work — total 11 windows ♦ Furnish and install new Andersen 200 series window x 11 (pre -finished WHITE interior and clad exterior) to opening in all 4 rooms Furnish and install new paint grade trim to 11 x windows in all 4 rooms NOTE: trim to match as closely as possible to existing trim in girls bathroom Work not included in this contract Building department fees Engineering or architect costs Permit costs Unseen conditions Painting or staining work Customer supplied electrical fixtures - wall sconce x 1 — Mirror or medicine cabinet Customer supplied items as noted above Bathroom toilet, cabinets, countertops, faucet and sink Tile and grout as noted PERMITS "Nexus" will accept responsibility to obtain the necessary building permits. "Nexus" will act as a GC and work in accordance with fair and reasonable practices, and cooperate fully and under the guidance of the "Owners" and authorized parties. Nexus will pass the cost of the permit directly on to the "Owners" once advised by the Building department. Standard Exclusions: Unless specifically included in the "General Scope of Work" section above, this agreement does not include labor or materials for the following work (any Exclusions in this paragraph which have been lined out and initialed by the parties do not apply to this Agreement): Removal and disposal of any materials containing asbestos or any other hazardous material as defined by the EPA. Custom milling of any wood for use in project. Moving "Owners" property around the site. Labor or materials required repairing or replacing any "Owners" - supplied materials. Repair of concealed underground utilities not located on prints or physically staked out by "Owners", which are damaged during construction. Surveying that may be required to establish accurate property boundaries for setback purposes (fences and old stakes may not be located on actual property lines). Final construction cleaning ("Nexus" will leave site in "broom swept" condition). Landscaping and irrigation work of any kind. Temporary sanitation, power, or fencing. Removal of soils under house in order to obtain 18 inches (or code -required height) of clear space between bottom of joists and soil. Removal of filled ground or rock or SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 4 of 5 any other materials not removable by ordinary hand tools (unless heavy equipment is specified in scope of work section above), correction of existing out -of -plumb or out -of -level conditions in existing structure. Correction of concealed substandard framing. Removal and replacement of existing rot or insect infestation. Construction of a continuously level foundation around structure (if lot is sloped more than 6 inches from front to back or side to side, "Nexus" step the foundation in accordance with the slope of the lot). Exact matching of existing finishes. Repair of damage to roadways, sidewalks, or driveways that could occur when construction equipment and vehicles are being used in the normal course of construction. The "Owner" is to enter into contracts for all of the above-mentioned services and provide direct payment to "Nexus" for all of the services we are to provide. "Nexus" will be responsible for removing all components and all construction materials relevant to the "scope of work" in this contract. Dumpsters, trailers and signs "Nexus" will provide as included in the cost of this project, a dumpster for the sole purpose of the removal of trash associated with this project. This dumpster should not be used by any persons for any other waste items or for any purpose outside of the specific use under the scope of work, unless authorization is received from "Nexus". Nexus may have on site for part, or the whole of the project, a trailer containing materials and tools belonging to "Nexus". This trailer will be parked in a position agreed to in coordination with the "Owners" and will be covered under the insurances of "Nexus" at all times. "Nexus" will have on site, a sign, with our contact details, in the event that anyone has a need to contact us directly. Photographs "Nexus" reserves the right to, from time to time, take photographs of the contracted work for use in its general marketing or for production on its web site. At no time will "Nexus" share any personal contact details of the "owner" for any photographs that it may use without seeking authorization from the "owner" Warranties All the components supplied by "Nexus" as part of the original order are covered under the warranty exercised by "Nexus" and supported by the vendors. All labor and materials purchased from other suppliers to achieve completion of contract are warranted (1) one year from completion of the construction. Expiration of this Agreement: This Agreement will expire 30 days after the date at the top of page one of this agreement if not accepted in writing by "Owners" and returned to "Nexus" along with the necessary deposits within that time frame. Changes in the Work: During the course of the project, "Owners" may order changes in the work (both additions and deletions). "Nexus" will determine the cost of these changes and the cost of this additional work will be added to "Nexus" profit and overhead. People Authorized to Sign Change Orders: The following people are authorized to sign Change Orders: 5igL_ "Nexus' Mark Gotobed or Ged White "Client": Nancy or David Phillips Concealed Conditions: SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 5 of 5 This Agreement is based solely on the observations "Nexus" was able to make with the area in its current condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once work has commenced which were not visible at the time this proposal was bid, "Nexus" will stop work and point out these unforeseen Concealed Conditions to "Owners" so that "Owners" and "Nexus" can execute a Change Order for any Additional Work. Schedule of work It is agreed by both parties that this work will be coordinated with the "Owners" and "Nexus" to be undertaken in various stages to avoid complete disruption of the home environment. "Nexus" will give "Owners" no less than 2 days notice prior to arriving on site for commencement of any of the agreed stages of work to allow "Owners" to prepare. "Owners" commits to have sites identified for construction work available for start at the beginning of the scheduled day so as to avoid any unnecessary delays. Contract Cost and Payment Schedule: Total cost of work description and materials included in the proposal (except materials/work stated) - $21, 640.00 (Twenty one thousand six hundred and forty dollars and zero cents) PAYMENT SCHEDULE 1st Pavment due upon signing this contract TOTAL $7,214.00 2nd Pavment due upon completion of 1st week of work TOTAL $5, 000.00 3rd Pavment due upon completion of 2nd week of work TOTAL $4, 000.00 4th Pavment due upon completion of 3rd week of work TOTAL $4, 000.00 Final payment due upon completion of scope of work TOTAL $1, 426.00 Amount due upon signing this contract - 0,21-4-.06 I have read and understand, and I agree to, all the terms and conditions contained in the proposal above. Date...q... ..... "Nexus" Authorization............ ..................... "Client" Authorization...............' Date........................ Date ............................... "Client" Authorization...................................................... SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT 0 rl Eq—* = LLZ p m C NW t Y \ O LL E T N U O_ V) U CL W H z Z co C ++ "a 7 LL L 7 d' T C U LL O W N Z z m J d L 7 O W CL N ? Q W W L 7 U i {n Cto LL O U a Ln Z L K LL z W cc w c uiV LL N C Co ON Z QJ `1 N i 0 u O Vl Q0.h C a H J CL� oo� > N•- � �a a : a Na 0 o 2 o �= T = o .N �1• a� 0 0 � CJ m 0 cc 0y a� 0 c c Q Lcco ® = G1 Q Gj N O cn 2 m as N w W y o 70 O O uj LL ' 2D t/1 C O O- m O w E 0-o r- 0 0_ W L 0 a)' i t� a�N a N �oy'0 OJ t . CLov > Z G co z LU x LUH W CL o V W Z Z C3 m U CO Z 0 U Z 0 U) J w ti 5 E 4.+ Z 0, AyA' 'VW L 0 V ^tea 1.i U) V U rm1 t0 O. R C. 0 V 9; CL uD to += +-� - 0 O o N 0 L CL w 0 Q0.h C a H J CL� oo� > N•- � �a a : a Na 0 o 2 o �= T = o .N �1• a� 0 0 � CJ m 0 cc 0y a� 0 c c Q Lcco ® = G1 Q Gj N O cn 2 m as N w W y o 70 O O uj LL ' 2D t/1 C O O- m O w E 0-o r- 0 0_ W L 0 a)' i t� a�N a N �oy'0 OJ t . CLov > Z G co z LU x LUH W CL o V W Z Z C3 m U CO Z 0 U Z 0 U) J w ti 5 E 4.+ Z 0, AyA' 'VW L 0 V ^tea 1.i U) V U rm1 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �XVlS S pfd CeS Address:? 0 30X 2F23 /State/Zip: W O D w- (\ M4 Phone #: % Are you an employer? Check the appropriate box: I . ❑ I am a employer with 4.h am a general contractor and I employees (full and/or part-time).* ave hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 5. ❑ 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comm insurance required.l -76u 2030 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F] Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 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. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/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 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 and 01 X30 - G that the information provided above is true and correct wk l Fe- Official e Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 1 .w SMassachusetts - Department of Public Safety Board of Building Regulations and Standards Con%truction Supervisor License: CS -073991 ; GERALD WHITE = ; 23 GLENDALE DR JM DANVERS MA 01923, Expiration 04107!2016 Commissioner Office of Consumer Affairs & Business Regulation j. OME IMPROVEMENT CONTRACTOR ;RType: 129177 Expiration: 7/19/2015 Individual Gerald White Gerald White 23 Glendale Dr Danvers, MA 01923 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 � 2 '-- Not valid without signature ACORff CERTIFICATE OF LIABILITY INSURANCE DADD/YYYY) 3/226/26/2014 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 endorsement(s). PRODUCER Cross Insurance -Peabody 139 Lynnfield Street Peabody MA 01960 CONTACT Lauren Goldman PHONE , (978) 532-5445 FAXIAIC. Nok (978)532-2217 ADDRIEs :lgoldman@crossagency.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Western World Ins. Co. INSURED Nexus II Services LLC P.O. Box 2823 Woburn MA 01888 INSURERB:Safety Indemnity 3618 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER-CL142602352 RFVIAInN NI urtrR- 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. INSRLTR TYPE OF INSURANCE ADDL S B POLICY NUMBER MM/DDY EFF MMIDD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR Timothy Tramonte/MDI �isY6i d NPP8183741 8/12/2013 /12/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PIECT RI LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWA TOSNED X SHEAUTOULED NON -OWNED HIRED AUTOS X AUTOS 116632 1/10/2013 1/10/2019 COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ 500,000 BODILY INJURY $ 500,000 Pe'a cid RPERTntDAMAGE $ 100 000 Medical Pavments $ 5,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Refer to policy for exclusionary endorsements and special provisions. CERTIFICATE HOLDER CANCFLLATIAN ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David and Nancy Phillips ACCORDANCE WITH THE POLICY PROVISIONS. 89 Old Village Lane AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Timothy Tramonte/MDI �isY6i d ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. Location S�j' No. Date 11 L Check # 64q-1) 2 89 �- -15/ TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Building Inspector,