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HomeMy WebLinkAboutBuilding Permit #763 - 95 LEANNE DRIVE 5/15/2013TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ne famil dBUilding ition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic well " Floodplain wetlands Watershed District ;- ` aterfSewer sdn, cam' " !vim d e � A2 v4 ,e-19 7 AaU.S,e- 0l3 �-7� Identification Please Type or Print Clearly) OWNER: Name: � 6T zi --I ivLo e P4 acvj n Phone: Address: e Qrt 6%/�t- – ,Idnjvtl-ed— CO NTRACTOR R.NampeL. ,d . _..► z ... G _ e p , _- Address: Supervisor's Constrtrotit n'66 Home. Improv eme t tiirense- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BUL DING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON 5925.00 PER S.F. 1� 1 Total Project Cost: $ Ic37 y FEE: $ _ � �. Check No.: IOLR3 Receipt No.: NOTE: Persons contractingwi ed actors do not hmw ac ss to : rantst, qui 9 ..t stature f. ge iOwn,.Y., S grtature ,Of cor�ra t r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received I Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Old Structure yes rno MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family b ❑ Addition ❑ Two or more family ❑ Industrial + ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ' ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Adr] rPcc- CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: 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: $, EE: $ 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 _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Star--!- 6 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APP OVED PLANNING & DEVELOPMENT ❑ �S GI I 2L COMMENTS CONSERVATION Reviewed on �`� �3 Sianature'-"-L �% �0� COMMENTS N G 4-� wA', t,- k n& ;) ; ,ja�—"L HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow;;- ]Engineer: Signature: Located 384 Osqood Street FIRE DEPARTMENT -Temp Dumpster on site yes no. Located at 124 Main Street Fire Departinert signatureldate 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) Doc.Building Permit Revised 2010 bj p q- L� k VA 1� ® Notified for pickup - Date Doc.Building Permit Revised 2010 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 o 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 Surveyed Plot Plan LD Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/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 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 o 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 o 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 app:.al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2012 Locationq�— 1&qz2ae, No.� Date l ! Check 44-013 26393 TOWN OF NORTH ANDOVER Certificate of Occupancy $�/�� Building/Frame Permit Fee Foundation Permit Fee �$ Other Permit Fee TOTAL $ Building Inspector Great Northern Construction Management Company 3 Longridge Lane Ipswich, Ma.01938 781-910-0252 FEDERAL TAX ID # 043421789 CONTRACTORS REG. #111940 CONSTRUCTION LICENSE # 033139 Mr. and Mrs. Zimmerman 95 Leanne Drive North Andover Ma.01845 Phone: home 978-258-4648 cell 978-835-3663 Rear Deck: Approximate size, 23 feet x 19 feet 6 inches 1) Dig and pour 6 concrete footings. 2) Remove siding as needed and install a 2" x 8" pressure treated ledger board lagged to the house. 3) Install commercial grade flashing to the wall of the house and over the new ledger. J%4) Install a triple 2" x 10" pressure treated support beam. 5) Install 2" x 8" pressure treated deck joists attached to the ledger board with galvanized joist hangers. 6) Install GAF composite Dura Life Brazilian Cherry decking. The first two deck boards will be installed to picture frame the deck. 7) Install full length stairs on both 19' 6" deck sides. The stairs will be set on concrete pads. 8) Install stair treads to the stairs. Treads to be same material as the decking. There will be two treads and three risers. -49) Install PVC risers to the stairs and below the slider. Install siding as needed and paint new siding blending into the existing as close as possible. 10) Frame the open end of the deck with pressure treated framing. Install square PVC privacy lattice to this area. Install PVC trim boards and skirt boards to finish off below the deck area and open stair end. �' x J wa Z LLZ D C o m I ED N a O1 N O Z 0 1 m O CO 7 O d' a+ O L U v` O N Z Z m 2 d CLO O O �' c0 O LL O N W J W _Z�--7A U V) �' x J wa Z LLZ D C o m N Y 'O O LL ED N a O1 N O Z 0 1 m O C 7 O L.L. CO 7 O d' a+ O L U — (O C LL O N Z Z m 2 d CLO O O �' c0 O LL O N W J W to 7 O K U V) C LL O V °Ja N Z y Q L = O K N C `LL i W cr a w 0 w O' LL E � m Z r-+ OOl { j a1 o Y -'O 'e (n : LL >� Q V n.5 LU a z o : p Q7 4 C�' O coO 0 'C� . V � r N � J CD > O Cl)Cc d L W Lb. o a– y cul > — -a N mQ o o =m E c oCL tm Cl) V H 0 o to T •o QC W Mn 0 c W J CL 4IL ) m =o m .o •N Q1 0 c Q L m �a 0 ~ 0 N��m uiW r -0 . O o ff' o a' m o ' .= ; 0 W L 0 V C O d �+ co N -' C; a O F- 2 CL 0(.) > 12 w S E O O Z N O IM � 0 � N •� m m CL C Q d v O a CL Q O _ v_ J Cc.CLO,0 U) Z � O V cc cc N LLI U) LLI- U) W LLI 12 W U) Great Northern Construction Management Company 11) Clean up and dispose of all work related debris. 12) Supply building permit and inspections. 13) Install handrail on the house side of the deck if required. Price $18, 745.00 e Grading by others. The following schedule will be adhered to unless circumstances beyond the contractor's control arise Work Schedule To Begin To be determined Expected Date Of Completion one to two weeks from start TOTAL CONTRACT PRICE AND PAYMENT SCHUDULE The Contractor agrees to perform the work, furnish the material and labor specified above for the sum of Eighteen Thousand Seven Hundred and Forty Five Dollars Payment schedule: $6,248.00 upon delivery of materials and start $12,487.00 upon completion Total $18,745.00 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CONTRACTOR SIGNATURE DATE X HOMEOWNER SIGNATURE DATE You May Cancel If It Has Been Signed By A Party Thereto At A Place Other Than An Address -Of Seller, Which May Be His Main Office Or Branch Thereof, Provide That You Notify The Seller In Writing At Great Northern Construction Management Company His Main Office Or Branch By Ordinary Mail Posted, By Telegram Sent Or By Delivery, Not Later Than Midnight Of The Third Business Day Following The Signing Of The Agreement. See Attached Notice Of Cancellation For An Explanation Of These Rights REQUIRED PERMITS The following building permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent. Demo Permit, Construction Permit, Electrical Permit, Plumbing Permit. Smoke and carbon monoxide permit detectors Contractor will schedule all inspections and secure all sign signoffs Note: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL.c.142A. Is an EXPRESS WARRANTY being provided by the contractor. NO YES X All terms of the warranty must be attached to the contract* There is a 1 -year warranty on labor and material supplied by Great Northern Home Improvement Company. NOTE: All home improvements contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to Director, Home Improvements Contractor Registration One Ashburton Place Room 1301 Boston, MA 02108 617-727 —8598 Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service, which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M..G.I. c.142A. Contractor Date (--;; Homeowner Xl��_ Date 5 NOTICE: THE SIGNATURE OF HE P IES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO AL E ATIVE DISPUTE SETTLEMENT INITIATED BY CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE Great Northern Construction Management Company PARTIES ACCELERATION OF PAYMENT Homeowner's Financial Insecurity- A contractor may not demand payments in advance of the dated specified on the payment schedule in cases where the homeowners deems him/herself to be financially insecure. Contractor's Financial Insecurity- In instances where a contractor deems him/herself to be Financially insecure the contractor may require that the balance of funds not yet due be placed in a Joint escrow account as prerequisite to continuing the contracted work. Withdrawal from said Account would require the signatures ob both parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES —`11 e--�\ \ TURE CONTRACTORS SIGNATURE NOTICE OF CANCELLATION DATE DATE You may cancel the transaction without any penalty or obligation within three business days of the above date. If you cancel any property traded in, any payments made by you under the contract or sale, and any negotiations instruments executed by you will be returned within ten business days following receipt by the seller of you cancellation notice and any security interest arising out of the transaction will be cancelled. If you cancel, You must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. -�)'I^J'tIttas_3 S - 30— 91 `1 V\A AJS �e.V" LEANNE DRIVE Nth' 25"W 127.11' 32.1' I . .96V r 7�{ �M„SZ,62.tzN 1. Y 22.6' Ex. Foundation T.F. Elev.=243.20 U v r 0� c>s CL (AO m O to r'P Y' A - 'iN. 'o r S Ql a��'", 341,18855S.S.F. '0. 0.78 Ac. /y �1 & Q .EXISITNO DRAINAGE EASEMENT ExISITNO NO CUT EASEMENT - — 17, 97' N 25'34'20"W 119.93 1 42.52' I�3'Q9'W 137.90' ?A DF `. N25 `50"W $4-31' 10 W Q l 2'g'3 "w STEPHEN � N25 lr 4W i WE HEREBY CERTIFY THAT WE HAVE EXAMINED Nn clAq THE PREMISES ANIS THE DWELLING IS LOCATED * THIS PLAN IS♦ FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY, IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED, ALSO, ACCORDING TO THE i WITF! THE STRUCTURES SHOWN LOCATED F.E.M.A./H_U.O. FLOOD INSURANCE RATE MAP. BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANEL NO.2$0098 0005 C SHOULD NOT BE USED FOR PROPERTY DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. CERTIFIED PLOT PLAN LOT 7 HERITAGE ESTATES MARCHIONDA + ASSOG.,LP. NORTH ANDOVER, MASSACHUSETTS ENGINEERING AND PLANNING CONSULTANTS 0RAwN FOR B2 MONTVALE AVE. SUITE I BR00KMEW COUNTRY HOMES, INC. STONEHAM. MA, 02184 P.O. Box 631 I (781) 438-6121 NORTH ANDOVER, MASSACHUSETTS fl DATE: 1214/01 SCALE: 1"-40' I0'd bS96 8£b tSL sp.Lvx3ossvvvamolH3aVW Wt1 —o;oT Tgez-©T-'3a The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Blectricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): Address: AI -e City/State/Zip: 7 6XZ?&hone #: o-an employer? Check the appropriate box: APf-'am Type of project (required): 1. a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # �• E] Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its g, ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 10.❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this 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 their workers' comp. policy information. 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 Sef-in,s. Lic. #:� ru������% �gExpiration Date: c` Job Site Address:4�egn ite bvh. 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 requiredunder Section 25A of MGL o. 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. Ido hereby cert nsenalties ofperjury that the information provided above is true and correct. t 1,,-;7=,=rnate. _�—// / O 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 - - 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 of hire, - 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 ofpublic 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 -contractors) 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 for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit 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' compensation 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: TIM Commonwealth of Massachusetts Department of Industdal .Accidents. Office ofInvestigatlons 600 Washington Street Boston, MA. 02111 Tel, # 617-727-4900 ext 406 or 1-877:M.ASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass,govfdia Rightfax C1-2 5/7/2013 5:34:37 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) TWISSERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 he terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. PHONE FAX LAURANZANO INS AGENCY 107 DODGE STREET (A/C, No, Ext): (A/C, No): E-MAIL BEVERLY, MA 01915 ADDRESS. 7242D INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED ------------- INSURER A: TRAVELERS INDEMNITY CO. GREAT NORTHERN MANAGEMENT CORP INSURER B: INSURER C: INSURER D: 11 EAGLE COURT INSURER E: IPSWICH, MA 01938 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT E POLICIESOFINSURANCE LISTEDHAVE EEN 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 LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE (MMIDDIYYYY) POLICY EXP DATE (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ EMISES (Ea occurrence) CLAIMS MADE F7OCCUR. MED EXP (Arty one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: RSONAL & ADV INJURY $ ENERAL AGGREGATE $ POLICY PROJECT LOC ODUCTS - COMP/OP AGO $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB r7 OCCUR EACH OCCURRENCE $ EXCESS LIAB M CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN UB -0466M979-12 08/012012 08/012013 X WC STATUTORY LIMITS OTHER ANY PROPER ITORJPARTNER/EXECUTIVEN OFFICER/MEMBER EXCLUDED? NIA E L. EACH ACCIDENT $ 100,000 (Mandatory In NH) EL_ DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESJRESTRICTIONS!SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 120 MAIN ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTEE NORTH ANDOVER, MA 01845 -- RATION. All rights reserved. ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (M/YYYY) 05/0M/DD 05/06/2013013 PRODUCER (978) 927-8420 Lauranzano Insurance Agency g Y 107 Dodge Street Beverly MA 01915- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Great Northern Management Corp. 11 Eagle Court Ipswich MA 01938— INSURER A: American European Ins Co. INSURER B: Travelers INSURER C: INSURER D: INSURER E: r1nVFRAf:FC 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LT ADD'L IN RD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMDD PTEXPIRATION DATE MM/DD/Y) LIMITS A GENERAL LIABILITY SRP 2000236 10 07/25/2012 07/25/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FKOCCUR / / / / DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 2,000,000 X POLICY JECT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON -OWNED AUTOS / / / / BODILY INJURY (Per accident) 5 PROPERTY DAMAGE (Per accident) 5 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ AGGREGATE $ OCCUR D CLAIMS MADE 5 DEDUCTIBLE % / / / $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY / / / / �y TORY LIMIUFS OER E.L. EACH ACCIDENT 5 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under / / / / E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT 5 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS L,cn 1 irm m 1 e nVILUer1 L:ANGtLLA I IUN (978) 688-9545 (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Town of North Andover FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Building Department INSURER ITS AGENTS OR REPRESENTATIVES. 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover MA 01845- AGUKL) 25 (2UUT/US) ®ACORD CORPORATION 1988 gTre INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (800)327-0545 Page 1 of 2 4 -W !4 0014.0 Ab 0 a Of a Of R ILS 1'r rip 4 a= _ IE 41 17-) m El N re '►(assachu etts - Department of Public Sated, AM Board Of Building Re1julations 4,0t1 Stluidartls Construction Supervisor License License: CS 33139 ROBERTS LANDERS 11 EAGLE COURT IPSWICH, MA 01938 a -- J Expiration: 11/13/2013 { immi.vt,ncr Tr#: 7864 �a ✓fie i�oorwnoozcueaf�i o��iatoe�a +-\ Office of Consumer Affairs & Business Regulation sL_ HOME IMPROVEMENT CONTRACTOR Registration: -119940 Type: } _`' Expiration: 9/2'+/2013 Private Co oratio %ua' RNORTHERN HOME IMPROVEMENTS ,OBERT LANDERS 1 Eagle Court ,pswich, MA 01938 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consu►ner Affairs and Business Regulation 10 Park Plaza - Suite 5170 n..ton, MA 02116 Not valid witi� =ut signature ',