Loading...
HomeMy WebLinkAboutBuilding Permit #1075 - 960 JOHNSON STREET 6/19/2015 ,l f tAORTM q BUILDING PERMIT �.r�°R`,eD TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit NO: 0 Date Received �•9 Ar so Date Issue SSACHUS j ORTANT: Applicant must complete all items on this page LOCATION -�/ /�7//.=�G/S Print PROPERTY OWNER Print MAP NO:��PAIeAjv RCE�ZONING DISTRICT: Historic District yes tom/ Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resig@ntial Non- Residential ❑ New Building vone family ❑ Addition ❑ Two or more family ❑ Industrial ❑ ration No. of units: ❑ Commercial P,fRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic G Well 1 Floodplain Ci Wetlands I; Watershed District ❑ Water/Spwer Identification Please -Type or Print Clearly) 9 OWNER: Name: '��'� /`���/.[ � Phone: " Address: CONTRACTOR Name: Phone: g?�• 7 Sl-7'� ,, Address: ' Supervisor's Construction Licen�-lu Exp. Date: � �I r Home Improvement License: ` ► Exp. Date: ARCHITECT/ENGINEER i(J Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CAST BASED ON$125.00 PER S.F. Total Project Cost: $ ' ® FEE: Check No.: I Receipt No.: NOTE: Persons conlrWeRtAg with unregistered contractors do not have ac soh guaranty fund r Signature of Agent/Ovv_ner Signature of contrac#o Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewerg ` ❑ Tanning/Massage/Sody Art ❑ Swunmin Pools ❑ � ❑ f Well El 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 i PLANNING & DEVELOPMENT Reviewed On Signature_ I COMMENTS { CONSERVATION Reviewed on Signature I i +I COMMENTS i w i HTALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments f Water & Sewer Connection/Signature& Date Driveway Permit J)PW Town Engineer: Signature: . Locatedsgoo Street _ 4FIIREDEPARATMENTT,temp-Dumpster,onsite eyes- nog _ Lim- d at;124 Maiu tmw; F�retDepartmentE+signature/date. ___.._._.� _ 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 i DANCER 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 r 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 :aF 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. p All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4 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 must be submitted with the building application Doe:Building Permit Revised 2014 Location O!t a-,S0II7 S77 No. Date • - TOWN OF NORTH ANDOVER • �% ��b r646 • • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ChJS# �" `� O Building Inspector tAORTI1 own of E I� ndover No. d -o * r _ - -_ to° h ver, Mass, KI CCCNICHIWIC. y1. s � BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .. ..., ........ .......�, BUILDING INSPECTOR ................ r Proposal • 8 1 HIC#174377 Zo10 2015 Damph ouse- 1 _ Roofing LLP • years • A trusted name since 1938 Roofing • Siding •Windows 87 Belmont Street • North Andover, MA 01845 P: 978-683-4588 • : 978-685-7446 NAME OF OWNER t5 ADRESS OF JOB I Ze6i�4 TELA 7— DATE: We will remove all roof shingles off total roof area, layer. Replace any boards or sheathing at additional cost. A new 8" white aluminum drip edge applied on all edges. Approx. 6ft of ice and water membrane applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing and sidewall junctions. Existing step flashings to remain. A new base sheet applied. Architectural roof shingle installed with a limited lifetime warranty. Install new ventpipe boot flashings. Waterproof existing chimney flashing and remove debris. Shingle Color:? Ridge Vent Upgrade Wood Sheathing Repair$3.50 per ft. /J- We Propose herby to furnish material and labor-complete in accordance with above specifications,for the sum of: ® � 4 dollars($ y ). Payment made as follows cl- s '6D vvv � el Authorized Signature---,.-am, NOTE:This proposal may be withdrawn by us if not accepte th in days Acceptance of Propos - The above prices, specifications and conditions are satisfactory and are herby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. J i/� Signature Date of Acceptance. Signature HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(M.G.L.142A) 1.WORK:Provided the Homeowner performs under this agreement,the Contractor shall perform the work on the Property as specified Proposal,attached incorporated herein.The work does not include extraordinary conditions of which the Contractor could not reasonably be aware.If such conditions are encountered,this shall be an additional cost to the Homeowner.Materials selected by Homeowner may have to be ordered or custom made,which items are specified in the Proposal.The Contractor is not obligated to agree to any modifications,extras or change orders unless such items are agreed to in writing by the Contractor.All extras and changes shall be at an additional cost to the Homeowner.Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract.Lawn or Driveway may be damaged by dumpster or equipment. Due to material shortages Contractor may substitute materials of equivalent grade. 2. PERMITS:If a building permit is required for the work,the Contractor shall obtain same as Homeowner's agent.Contractor is not responsible for any other permits that may be required for the Work,and Homeowner is responsible to determine whether any zoning,planning or wetland related permits or approvals are necessary.Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund. 3. COMMENCEMENT AND COMPLETION:Homeowner acknowledges the commencement date of the work is fluid,and is subject to numerous factors such as scheduling other contractors,delivery of materials and weather.Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same.The Work shall be substantially completed within 7 days of commencement,except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal,and subject to delays for circumstances beyond Contractor's control.Notwithstanding,the commencement date and substantial completion date may be extended,and the Contractor will not be liable for delays caused by,labor or material shortages,delays in delivery of items selected by the Homeowner,governmental action, and unforeseen events beyond the Contractor's control,including but not limited to weather,strikes,war,the acts of third persons or the acts of the Homeowner.The Homeowner recognizes that the corrnnencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS:Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the Proposal.Thirty percent(30%)of the total is to be paid as a deposit with the signing of this contract.Upon cancellation prior to commencement of the Work,any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel.Final payment shall be due upon completion of the Work and Homeowner agrees it may not hold any retainage.Late fees may be applied for late payments.Homeowner shall pay Contractor's reasonable costs of collection,including attorney's fees and costs.Time is of the essence hereof. 5. WARRANTY:For a period of 2 years after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing-up or extraordinary weather events,including blizzards,tornadoes,hurricanes or storms of greater than a twenty-five year duration or intensity.Contractor gives no warranties with reference to any materials or equipment installed in the Premises,passes any such warranties directly to Homeowner,and Homeowner agrees to look only to the manufacturer with reference thereto.This limited warranty extends to the Homeowner only and is not transferable to succeeding Homeowners.This Limited Warranty specifically excludes(i)all consequential and incidental damages;(ii) damage due to ordinary wear and tear,abusive use,misuse,or lack of proper maintenance;(iii)defects which are the result of characteristics common to materials used;(iv)defects in items installed or supplied by anyone other than Contractor;(v)work done by anyone other than by Contractor;and(vi)loss or injury due to the elements.There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT:This contract and all documents referenced herein constitute the complete and final agreement between the parties.In the event that any of the provisions of this contract shall be held to be invalid,the remainder of the provisions of this contract shall remain in full force and effect.Two identical copies of this contract have been completed and signed.Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION:In accordance with M.G.L.c. 142 A,§9,Contractor is registered with the Bureau of Building Regulations and Standards Reeistration No: 174377.Homeowner may verify by contacting the Director at(617)727-3200,ext.25205.A Homeowner's rights under the Home Improvement Law(M.G.L.c. 142A)and other consumer protection laws may not be waived in any way.Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A,and which are available online at www.mass.gov.Questions may be directed to the Consumer Information Hotline,(617)727-7780. 8. ARBITRATION: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_L.c. 142A.No lien or security interest is imposed on the Property as a consequence of this contract,but Contractor has the right to record this contract or a notice of this contract,or seek a lien if the Homeowner breaches this Contract. 9. HOMEOWNER COVENANTS:The Homeowner agrees,represents and warrants that(a)the Homeowner grants permission to the Contractor to enter the Property to perform the work as covered by this contract;(b)the Homeowner has funds available to make full payment under this contract to the Contractor upon completion;(c)the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition,and agrees not to enter portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed;(d)Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and(e)that code requirements may result in roofing nails penetrating through roof decking and will be visible on the underside of some surfaces.The Homeowner indemnifies,exonerates and holds harmless the Contractor from any loss,damage,claim,liability or expense(including reasonable attorney's fees,deposition costs and court costs)resulting from a breach of this provision.Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10.CANCELLATION:Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third business day following the signing of this agreement. HOMEOWNER: DATE:_ Shingle: DEPOSIT: v The Commonwealth of Massachusetts F Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 �t www mass.gov/dia VVorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE RILED WITH THE PERMITTING AUTHORI'T'Y. Please Print Le 'bl A ' licant Information ac/ Name(Business/Organization/Individual): IL111-t / ,I Address: �- �tz— Phone#: City/State/Zip: .<. Are you an employer?Check the propriate box: Type of project(required): / em to ees full and/or part-time).* 7. ElNeiv'donstr6dion 1,1 ij,l am a employer with P Y 2.Q I ain a sole proprietor or partnership and have no employees working for me in 8. ElRemodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.FJ I am a homeowner doing all work myscl£[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical airs or additions ensure that all contractors either have workers'compensation insurance or are sole rep proprietors with no employees. 12T[]Plumbing repairs or additions 5.❑lam a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•.VRo epairs /JThese sub-contractorshave employees and have workers'comp.insurance.$ 14 l/�ii�(Jet 6.❑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'comp.insurance required] *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 flee 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. rs'compensation insurance for my employees. Below is the policy and job site X am an employer that is providing workei information. Insurance Company Name: ALE 63 �1 - Expiration Date_ �.. Policy#or Self-vns.Lic.#: 4q � � n � City/State/Zi/. Z4 Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a foie up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. c v hereby certify and thepains and lties ofpeijury that the information pr'ovided�above is truand correct. Date: Si afore: Phone A. J C� 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 Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empl6yees. 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 tmste6 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(1)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of Us 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=contractor(s)name(s),address(es)and phone number(s)along with their certificates)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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 4/ 12 /2015 10 : 29 : 02 AM 8790 m 02/02 �AC R 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) • 04/17/2015 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 00474-001 NAOMTCT Doherty Insurance Agency Inc (AlCNtJe.Ezt: (978)475-0260 (A/C.No.: PO Box 1985Ao� Ess: Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC f INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED Darnphousse Roofing LLP SURER INSURERC' 87 Belmont Street North Andover, MA 01845 INSURERO: NSU ERE: NSU ERF: 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 INSURANCE ADSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INR VWD MMIDD/YYYY M/DDNYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV IN.,URY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP(OP AGG $ OLICY CT OC AUTOMOBILE LIABILITY ODt 1NED SINGLE LIMIT $ Ea acdlen[ ANY AUTO BODILY IN URY(Per person) $ ALL Or SCHEDULED BODILY INJURY Per acc dent $ AUTOS AUTOS ( ) HIREDAUTOS F - $ NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ OED RETENTIONNN $ $ AND EMPLOYOERS LIABILITY X TORY LIMITS OR ANY PROPRIETOR/PARTNRlEXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000.00 /\ OFF ICE E�D77 ] NIA AWC-400-7028774-2015A 4/17/2015 4/17/2016 (Mandatory mmin NH) E.L.DISEASE-EA EMPLOYEE $ 500,000.00 D SCRIPT10,0dOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) No partners are covered by the workers compensation policy. 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 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 6893 Client#:14415 DAMPHOUSSE ACORD- CERTIFICATE OF LIABILITY INSURANCEEIZOA�TE(MM1001YYyy) PRODUCER Doherty Insurance Agency,Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THISCERTIFICAT ED ES NOT MEND,EXTEND OR 21 Elm Street ALTER THE C VERAGE AFFORDED BY THE POLICIES BELOW. Andover,MA 01810 INSURERS AFFO DING COVERAGE NAIL� INSURED i Damphousse Roofing LLP INSURER A: Westefrt Worid 87 Belmont St INSURER 8: North Andover,MA 01845 INSURER C: INSURER 0: COVERAGES INSURER E: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT t0 WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION A GENERALLIABILITY NPP8202847 LIMITS 04/12/15 04/12/16 EACH OCCURRENCE S1 100 000 X COMMERCIAL GENERAL LIABILITY M= 70 RENTED CLAIMS MADE Q OCCUR $100000 MED EXP(Any one person) $5,000 PERSONAL d ADV IWURY S_11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52 000 000 X POLICY PRO LOC PRODUCTS•COMP'OP AGG S2 OOO 0Oo AUTOMOBILE LIABILITY ANY AUTO (COMBINED SINGLE LIMIT $ ALL OWNED AUTOS ED ) SCHEDULED AUTOS 4ETSE: HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE iPeracci0em) S q4GARIAGE LIABILITY ANY AUTO AUTO ONLY•Fel ACCIDENT S OTHER THAN EA ACC $ AUTO ONLY: AGG 5 SSAIMBLIABILITY OCCUR EACH OCCURRENCE S CLAIMS MADE AGGREGATE S DEDUCTIBLE $ RETENTION g 5 WORKERS COMPENSATION AND _ S EMPLOYERS'LIABILITY WC STATU DTH• ANY PROPRIETCR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDE07 S S es,de ribePRO ISIOr E.L.DISEASE-EA EMPLOYEE S SPECIAL PROVISIONS below OTHER E.L.DISEASE•POLICY LIMIT I S DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RE ESE TRIE ACORD 25(2001/08)1 of 2 #531837/AA31835 DML 0 AC CORPORATION 1988 CS-067560 si-LaUI\T M T"'OSTTEY 61 P ATROIT ST N ANDOVER VL A 0181-1-5 -or � 10/25/2015 :-.._._ CS-05 5105 -. DOUGLAS J LEGARE _---- _-- 79 GARY AvE H.kti-ERIffLL 111 01830 C Jam• 0910212016 --- _-_—✓rte�o����� � �%:,ter Office of Consumer Affairs&B s►ness Regulation HOME IMPROVEMENT CONTRACTOR 1=L' Type: l•I_ ;a) Registration: 174377 Expiration: .2!4/2017 LLP D�CMPHOUSSE ROOFING LLP SHAUN TWOMEY 87 BELMONT ST N.ANDOVER,MA 018467 -'' _- Undersecretary