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HomeMy WebLinkAboutBuilding Permit #024-207 - 95 COLGATE DRIVE 7/7/2016 0*� VkORTH AT* BUILDING PERMIT 3? y�.ct��0r"�ti0� TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �9SSACHU`��t�� Date Issued: PORTANT:Applicant must complete all items on this page LOCATION 95 COLGATE DRIVE NORTH ANDOVER,MA 01845 Print PROPERTY OWNER BOB CHALMERS Print MAP NO: 074.0 PARCEL: 0018 ZONING DISTRICT: R4 Historic District y no Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer REPLACE 4 DOORS-NO STRUCTURAL CHANGE Identification Please Type or Print Clearly) OWNER: Name: BOB CHALMERS Phone: 978-390-1727 Address: 95 COLGATE DRIVE NORTH ANDOVER,MA 01845 CONTRACTOR Name: Phone: 508-351-2214 RENEWAL BY ANDERSEN Address: 30 FORBES ROAD NORTHBOROUGH, MA 01532 Supervisor's Construction License: Exp. Date: 90125 10-06-16 Home Improvement License: 170810 Exp. Date: 12-23-17 " 0 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 C2ft: $ 16,486.00 FEE: $ Check No.: !I Cp 11 Receipt No.:� NOTE: Persons contracting with unregistered co tractors do not have access a uaranty fund Signature of Agent/Owner�e � Signature of contractor r . � � � 9 BUILDING PERMIT o��1O or"A+ TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 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: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor wnw-"-+ %&ORTH q o N� BUILDING PERMIT Fr��•.:,r. • .e �� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * i a Permit N0: Date Received Date Issued: �SSACHU PORTANT: Applicant must complete all items on this pag2 �IrUCAT1QN k 9 CC2L4AE 1RIVE `�JORTH ANDOVER;MA 01845 PRbPERTY OVINER tbS Gii4LMERS P iaw PArxt P u }+ MAP N0 074 0 , PAtCELOb18LONINO131StR1CT `R1g >at�rt�[ istL 4'rlGt y no hr MachmeShop.Uillage y's no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other js5�p*i �I WWII 3 a, rQlootlpl�in z b:1111etlarads > Watershed District - t REPLACE 4 DOORS- NO STRUCTURAL CHANGE Identification Please Type or Print Clearly) OWNER: Name: BOB CHALMERS Phone: 978-390-1727 Address: 95 COLGATE DRIVE NORTH ANDOVER,MA 01845 CONTRACTOf Name ° -,t Phone 508-351'2214 t , RENE111lAL BY ANDERSEN` f w :A'diress' MBrSR�tJG}{�IV A`01532 , x' j; 30 FO�t�E$ROA[ `NORT> # - SupesoX's rwConstru0tton Llcense� Expl,' 90125 Home}lmpl'ovement License 170810 Epp rDate -23-1,7 12 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 CQ t: $ 16,486.00 FEE: $ Check No.: I P6 bq 11 Receipt No.: NOTE: Persons contracting with unregistered co tractors do not have access a uarantyfund Signature,of Age6V Wner ` . Signature of contractor.. Location �tt No. l�� ` t i Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# —i Building Inspector 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 Dempster 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 i 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 Dumpster on site yes no� Located,at 124 Main Street Fire Department 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application ,r~ 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 4. 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 in ust be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of ) O - 4 to No. - - - 62�- 2a � T o�h , ver, Mass( ':za Ile COC MIc"awick U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System -6 THIS CERTIFIES THAT C�wl.� ,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR .................. .... .. ........ ... has permission to erect .......................... buildin son ....... 1 Foundation ....... ....... ��.. ... ...... . ..... _. Rough to be occupied as ......... ... .... ... ....... .�.�ol s..�.. .. ...� ... • Chimney provided that the person accepting this permit shall in eve respect conform to the terms of the licatio p p p g p every p pp 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 CONST CTIO Rough Service . . .. aB� .... ..P. 0 ... FinaUIL INR 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. Ren eWal Agreement Document and Payment Terms Me ri' Aw Etme.rd 6v.jindtrssa of Bertao Bo'b Ghalemars and Ittlfg JS..-mac '3 C-Ai.:1e Dnve J 1;rR81t5 ,, ,. hntlnwr,h10.4i9�3 37 F ft' Paa,] N332 Flrvz- IT_ 1=.';"'Z ° 4Eosiort[ recallc~,^tea° 'tY�•[�rF,_cnm �7&ta t17-18�� f umurttrr s) fdaattL- Bob Chalmers and Kellyr dimes t )ftract Mrc 06/22116 C-ixantz,-(s)Stmet Addr.w 95 Colgate Drive, Norttar Andover, MA 01845 nix=vTelephuyl&Xumbn` Scsxar::�tryTtItplttate Number`(781)302-1696 Pku=..y Entail_: rVC350y►40040m nAi:y final: 5:.::4trts)hereby jointly a:td st r-rr-tly wets_to pascham-Lhe prc dum and/or stroft s ad Renewal by Ander,—i.,LLC d&6 Renm al b:. t�aulcncr.,efl'13arstc+t}�"� r_ts teu' ,in accordanex,aifu tlz tujm mrd conditrers eELcr. ed in t9r.is r1;tL�eftt�.i Document and l}ay mztt Trsmt, htn:iice of Canerl'atimi.ir+rrn rrxx Ovkr kc;cwt.Tcrn-and Condifloi f rmrUr.Owner or Ewtrilefmir^agr lm.ags•Imap. Iraagr.,and mw other document artzcbtd to diis Agrcrment DoctL-'Sitni,the terms of wh7ch.--v aft agreed to by clic t..-:r*_`t rmd incorporated}tr ir-b�, rric- m m frndlecth cl4, the'Urcrmznt 1_Btn�W brrehy-zgt=to sign a come.Wi=czrtiSmu after C..anwz,=T has completed al:v.iWz nnArr ti:tis Agreement. Tat;Jul)!mount: S1.6,+486 By 3igr�r'ri�ag>�ment,,Tu-z-.k tv'".;dgc that.the Flo'a-ur Dur,and the fano nt Fn-=V4 mint bre iu;ol�tq-x,,m"-, t cask.b-iuk tl1t.'.cT4it said,or";h, �1it i�a:ci�►�cd: so " �mcr.Due: 676..+86 FstimarLal Starr- EntintutjCC1sii'.etirru: AM011nt PrtataetA S16.486 '" creeks 1-2 lags MLYhrad Of payscent: Firiarlcirlg We st:l`-cdtde ins;allatiors btscd on&--date of the siegted cenirccr and so-ondadly on thr d=v in%46ch eve mrriplete the irrhair21 measurements-16 rnsr2l6tion ante th= 1206 greensky w r errpitx:r�iing at this time is c*an mimatc.We%A curse in;Calc an officia"daie 11.3 deposit and ti, 0—1 a I-ter date. Rairt=4 csucme w slier arc cn:z mus: Lumtaun caust-s firs 113 start 113 icompletion Rj`rnts)af;rest and undt!un6- dj_KL this Aymntcr_rc:arsi rutcs the M61C.U:tL; rYctllrV E►e vecn the paides and.drat there'are r,-.zi 1 t 14r--stanciin 'changing or madging ani ufthe torus cifthis:Agreement.No al-r=iona to or deviarians from this Agremcnt vbA)x trs:Ld V,-tbrxia rbc iipcd,wriacn ccm tnt of borh the RL��V rnd C:ona=ior,leu}e=1sl be_*zck-rtow�cdFp ELLI U:: rr{s) I)has tract.lilts r' rrattrttt..ttnr3rr;r4n41%thzterns of this Agra mitt,amd h;is rt3cstiti)rxi a cnsrsp",els n-d, oriel ti-m d cury nftkis rltvxmcnt,indce—�rrg rlt'�a �ttac ted: to co otic of rtrcllmioat,oil the dare hast%rixtcrr a4au� atxi Z"tz s s tall}'infortncef L�f Ilu t yi sec: this h�rantnc. NOTICE 10 OWNEP- Do,tuft ilgirr this contract if 1!=k-You are endtlefi to atzv of Lhe col coact a:drz!Hwt~=—sign. 'k OUT,THE BU YF.R, MAY CANCEL THIS TRA�TSACMN AT ANWI ME NOT LATER THAN MIDNIGHT OF 0612512016 ORTHE THIRD BUSMSS [SAY AFrER.THE DATE OF THIS TRANSACTION, WICHEVER DATE IS LATER*SFE THE,ATTACHEU NOTICE OF CANCELLATION FOMf FOR AN sn o .ire--- . � -- � 5r,:rmtirr of Sala Nriurt Si;;t�rta '�igtfature +ill Salem Bob Chalmers Kelly Mmes :%stt I';'atne of S.drn Ntimi ptim:gate brant [+cant.- rr"*1_3r1a Faze2 ' 12 ReneWal Itemized Order Receipt hfAnderscm Jl=-ftwv-al bT Am&mn of Bcn--n M 021--ears and KCIty A--v% al by Ard�rv�,Z, Dnw 170910 Andover,MAUI M'z P i2 5:3-351-2200:FacI5C5 :7f,7-12 C 78')307-109F r; 101 Side door t*1sa "Aild :le.-.-. S 1 :7, e u o r 102 Side stufm &o,., f-'Rsu 'Add %L--,% S _m F.7 i don 103 Front storm d�, f.*Zsc: 'Add :m-,'i :--n doo 104 Front entry door !�llsc: 'Add Nevs, F%-i doo VON DO WS.0 RATIO COORS-0 SPECIALM 0 MISC:4 ToTAL 516A86 _ s• a •R t 3r r 0M, !t v ti °r'R'R• f a �S�Ch 11lrcarr-, t . ....�� � 1 l✓�1[s/1 n.ti�J i4f -11L L w.•. - jr- 59 , '_ �"'�:�F r1 x►,t T'�JS1�j':-�� 'S���"�'�j'=�l • ! *~ _'q kFn I i Y'"t+l' vmh 3 '•• Frarn gym' ` 'iPF a i006 SlYle-No LI`1 .��/JfJ >f j _ j�. �I y��Wi' .Yj^_.ir't. - � � t �-1 j PIiC'r� ?. l'•r�tw�'�-7r ;y{�. 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I .`a(;' t __ c9� r_;a,..4-•i y.-•cr.i. -:_.7 .'�'F.-;y.i.::.aly�jr�_ � a�. 1*�e�'ommant�atltk a►,�'.�assrrciifaeus - Depal-t uJi Of 1ndw-id Accidantr -� +�,ffxe at hwes igado 3110 Aliashingwn feel Boston,K4 Q'IM wrrm.tmarxgon1dia Workers' Compensation fotrance A iris-A.".Imide.s/Culatractors/ElectritlarsMumbers r.► 1) cant Int"or! ►atr J\.ame il;usiressii�r a ;;.:ationnnri act,ta;�; RENEWAL BY ANDERSEN Adjre&S: 30 FORBES ROAD City/State,=7. p-.NORTHBORO,MA 01532 Phone#: 508-351-2200— Are ou an eenplayer,Check`:iu appropriate box: - 'I w of prajevt t required): 1.tN 1 UM a atnpleyer with,__30_ 1. ❑ 1 am a gmertl ewwactor and I employees(full and,ut`paa-time.)'' havt hiretlthe jict+�contractars ii 6' ❑:yew construction ` 3.[) I am a solepruprittor irrpattner= hist-2d rtn the attached sheet, I -' fj' Remodaling ship acid have tk,omployees `11h sur-ttrrtttavlArs have S, ❑Dernolithm working. for me.itt sky capacity. 'workers,comp-insurance. 4, ❑Building addition [No ti`o'kets'comp.ina nce M e area corporation and it` ME!Electrical repairs ur additions required.] officer's!•rase ia2r coed their l am a homemner doing all woak right o'ex;L-ni►tion pet MG1., 11:0 Plumbing repairs or additions zn)self.(No workers'comp. c. 1521 49(4),and we have no 11❑Roof repairs tnstnance requO d.}'� eartplovres,[bio a orkers' _ 13 LJ rn comp,instnakce requrrt3.l L � _.,,_--- 'Anv voxvwi that�lv s bet�i;tr est a ti fdl gut tho v:,hnn tr<lea sho«,nta iifCrr v,vtt:.7s -kimatsdWrIP41cy;mR.►rmarnr am;Gvit indscatwr& a~;:doing all a�tl:tart then tttie ovtark�unsraU:n must aubmtt s tett at J,tvit.utdiiatiog a wh lCtulb,*tnrs t!t ,ne i th"1xrr must taw as mi AJMAnal Me&At-A m t the tlO&oftic eub-c mtr&mv,end tMrc R'Orkar �p (+Ntcy tela ntattJtt I am are eslp4wr that isprovh tg wor6ers'rotgpmwdon bate neeJor aur employees. Nolon i0kepvlicy o d jute sire Warmatiunr. ln,,urance Comms Narr_e: OLD REPUBLIC INS. CO. — _-- —` Policy 9.or Self-ins. Lits.n,'_.MN!r.��Q54�7_QO_.___—__..._. _ l:xpirat on iJatc;_10-01116.__._.._ —-- Job Site A&-ew;_ 95 COLGATE DRIVE GilyStGip; NORTH_ANDOVER MA 01845 Attach a copy of the wort era'compensetion pocky deciaration;rage(shooing the poi cy number and expkation datt). Failure to secure covetage as required under Section 25A of MGL c' 151 can lead to the Lrnposttion of criminal p hnalti.-,a;x fine up to S 1,11500.00 andror ant-;;ear wtprisonment,as well as crit it penattir ut the f6M orf a S IFOP WORK ORDE;R;And a fm' of tap to S:S0,00 a day against the violator. He advisee that a wpy of this staternartt may be f4vwardad ttt the Office of love-ftattons of the IMA for insurance covamge vetii?cation, I do hereby eeM, • the pains aYndperralties fif perjury that the i r.,mWwt prolided rebate it trur and correct phone&: 50 1-2200 Ofjia W rate only. Ido not write in tkis urea,to he con rkmd by ci{tt or town ofrial Cita-or Town: P+�rraiU:�icease 1a Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City!Toern C:erit 4.Electrical Inspector.S.Plumbing Inspector 6.Other Contact Person; ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY( INSURANCE FDATE(MM/DDIYYY1f) 10/112015 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 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 I CONTACT Willis Of Minnesota,Inc. PHONE Willis Certificate Center Fax Wo 26 Century Blvd AIC N E :(877 945-7578 Arc Na:(888)467-2376 P.O.Box 305191 ADORIL :Certificates willis.com Nashville,TN 37230-5191 [!!SURER(S)AFFORDING COVERAGE NAIC fl 1NSURERA:0Id Republic Insurance Company24147 INSURED INSURER B: Renewal by Andersen LLC INSURERC: 30 Forbes Road INSURER D: Northborough,MA 01532 INSURER E: 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 TYPE OF INSURANCEAVOLISUOR P LILY EFF P LICY EXP LTR INSO WVD POLICYNUMBER MM/DDIYYYY MMIDD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 0. CLAIMS-MADE 0 OCCUR MWZY 305440 10/01/2015 10/01/2016 PREMISES Me occurrence $ d4,OOO,00 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ X POLICY u JECT �LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITYEaMBINEDtSINGLE LIMIT $ 51000,000 accA X ANY AUTO MWTB305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED OPER, D AGE AUTOS Per exident $ $ UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED 11 11 RETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY YIN X STATUTE ERN A ANY OFFICERIMEMBEER EXCLUDED?ECUTiVE NIA MWC30543700 1010112015 10/01/2016 E.L.EACH ACCIDENT $ 1100010 (Mandatary In WaE.L.DISEASE-EA EMPLOYE $ 1,000,0 If yyes,dscribe under nd DESCReIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additlonsi 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 Evidence of Insurance �'✓� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD :w y MW=huoetts-Department of Public Safety Board of Building Regulations and Standards Construction Sapery jsor 15 { ' ,f LYM NA 0190"r 1 j r r Expiration ta;rar7tasaion2z 1Q/D8l�D9fi C-�'1es�.wn.mra�uaeQ:ld a�n�aaaac�/uiaelly. i ice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Registration.:. }1pgt0 - Type: Explr4,ctrf�i Supplement Card RENEWAL BY ANDl 1-J'Z- t JAIME MORIN 30 FORBES RD - .-mss.•y --- NORTHBOROLIGH,MA 09532 Undersecretary 1