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HomeMy WebLinkAboutBuilding Permit #451-14 - 987 OSGOOD STREET 11/20/2013 f BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received . ATRO Date Issued: �ss�c IMPORTANT:Applicant must complete all items on this page /LOCATION g S S-r Print PROPERTY OWNER ��ro L-LG Print MAP NO: PARCE ZONING DISTRICT: Historic District yes no w ,� Machine Shop Villa a yes no 1' TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building ❑One family ❑ dition ❑Two or more family ❑ Industrial Alteration No. of units: 1�Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑peptic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District E(Water/Sewer Identification Please Type or Print Clearly) ✓ OWNER: Name: :?—A-TO 1. Lr-, Phone: 0(-4SS-"'(0 A40 Address: -A 4;;- � �P�n 0 l q CONTRACTOR Name: Phone: 5b ,btw15 A►an IM 4- t''QCx-W-eT- bDAt Address: 232- a,, >',4c::!tj lN4Ass 02n65 Supervisor's Construction License: Exp. Date: _C;S I-Z�o-ls Home Improvement License: Exp. Date: ARCH ITECT/E�NGINEER �FAewogl?. Phone: Address: yfw-1D1rn A56ec, 10A&1ASr7IMEbroP- WA- 02As5Reg. No. 8333 FEE SCHEDULE:BOLDING PERMIT:512.00 PER 0000.00 OF THE TOTAL ESTIMATED COST BASED ON 025.00 PER S.F. Total Project Cost: $ 3A -45A FEE: $ Check No.: Receipt No.: 1�/ N TE: Persons contracting with unregistered contractors do not have access to t g ara fund iFgnature of Agent/Own mature of contractor 4 II � a a- 1�14 Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DISP07 Public Sewer I_JTanning/MassageBody 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 APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Con nection/sianature&Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no i Located at 124 Main Street Fire Department signature/date o COMMENTS i =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 MGLChapter-166 Section.21A,-F and G min.$100-$1000.fine NOTES and DATA— (For department use U Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The folEowing is-a Ii'st of the requtred.forms to be-filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits a- 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 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 o , 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) ❑ 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 apo,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Buil,ding Permit Revised 2012 Location No. 9 r— Date oZC? // • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ ;&� ,b•Od Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 27125 wilding Inspector Location No. � l Date I TOWN OF NORTH ANDOVER Certificate of Occupancy $ 1C 1C Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check;2 ell) (2, 2,7413 Building Inspector s 3=.•*.. MOL . s."19 3S�cxusft CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 451-14 on 11/20/2013 Date: April 4, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 987 Osgood Street MAY BE OCCUPIED AS a dentist's office IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: PATO,LLC 145 Garden Street West Newbury,MA 01985 y Building Inspector Fee: $100.00 Receipt: 27413 Cheek : 24199 Town ­ of.-. ? � ove r o - ..: 0 No. ioh. ver; Mass, COC NICHTWIC. a• f o..�/� i 7d S OffATED AP�`,`�y • BOARD OF HEALTH Food/Kitchen PERMITT. LD Septic System THIS CERTIFIES THAT ,...,.,� ................... BUILDING INSPECTOR ...............................................................................,......... Foundation has permission to erect .......................... buildings on ...........r....... ..:.:......:..:..:.................................. Rough to be occupied as .... ......::.......... :..:........::...:..........::........................::...........::.:..................: .::..::........ Chimne.' I provided that thersrson accepting this permit shall in every respect conform to the terms of the application final � " on file in this o Iffice and to the rovisions of the Codes and By-Laws relatin to In p y g the spectlon,Alteration and Construction,of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough ��( �+ PERMIT EXPIRES IN 6 MONTHS r.,: ELECTRICAL INSPECTOR 1 Z-% r �v. UNLESS CONSTRUCTION STARTS R�o�ugh /- / 6� . ............................... Final ©h -3�j�P/g BUILDING INSPECTOR �► - ° GAS INSPECTOR Occupancy Permit Required to Occupy Buitdin Rough - Display in'a Conspicuous Place on the Premises — Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT 0� Until Inspected and Approved by the Building Inspector. Burner s 10 Street No. Smoke Det. ;T \ . a SEE REVERSE SIDE ' ,,,.•� Town ofl ,,, �., over ver,`Mass, LAN* �} coc"IcN*Wlc. v 7q A�R!1'TE D C) s � BOARD OF HEALTH PER MIT Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR Foundation has permission to erect.......................... buildings on ...........i.......:.:,::..:.:.............................................. to be occupied as ... 4, ....... ...: - .:...::....... Rough ................. 1, � ......................................................................:. c himney. provided that the�on accepting this permit shall in every respect conform to the terms of the application 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 , Z/Hj,Joe j PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough J�. , ' � Penrice`• ��- 3._�,k�J-����, ' .................. .........................:................................... l y BUILDING INSPECTOR Finaoh � 14 P/R 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 t lie Street No. Smoke Det. � — SEE REVERSE SIDE ' :�._ i Final Construction Control Document W d To be submitted at completion of construction by a ' d Registered Design Professional for work per the 8t'edition of the Massachusetts State Building Code, 780 CMR, Section 107 $VII--Di960- Project Title: NeW VENTA-t— e P-H GES Date: Permit No. Property Address: Project: Check one or both as applicable: X New construction ❑ Existing Construction Project description: 13V I I •VOUT OF REWTAi— 04:,9CE.S fivF ,, tom- ?WW%JaAv PEAS D UPON t�S WAEzE.D r>Y Y-4W& P"(GN AS90G1ATE-S, :NC-., I %V1 D A! MA Registration Number: Expiration date: 8 -31" �� , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other: for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: ' -A � Phone number: �18tJ 3p3 Email: 1Vft2rio�3@�ctvt.�da V1e Building Official Use Only ilding Official Name: Permit No.: Date: ,106112013 �l o ' Final Construction Control Document u To be submitted at completion of construction by a d Registered Design Professional for work per the 8u'edition of the bV v -Massachusetts State Building Code, 780 CMR, Section 107 $V I L-DI 9 cv, Project Title: New 'PENTkL- or-H C-ES Date: Permit No. Property Address: Project: Check one or both as applicable: X New construction ❑ Existing Construction Project description: 5V I L•POUT Of VEA,1TA --. (D-f-VCE-S fipg,, C2- JES 2WL l%JfEA ! PS D OFC3W FLAWS, WAFtED PAY r-4W4. M&(GN I Y)kyi D A i fwL. 'l e4r, MA Registration Number: PW3'z) Expiration date: B '^�Jt" I4 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other: for the above named project. 1, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. B RED Ate f J6 °9 Enter in the space to the right a"wet"or electronic signature and seal: Phone number: lei) ' Email: yIT"etio'r-�7(W!44s 0 we+, Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Enter construction cost for fee cal- North Andover Fee Cakulatlon Construction Cost 0,4 • 00 m $ - $ 3,725.45 Plumbing Fee $ 465.68 Gas Fee 100 comm. E$ 001Q0] Electrical Fee $ 4.65.68 Total fees collected $ 4,756.81 987 Osgood Street 451-14 on 11/20/2013 Tenant Fit Out Dentist Office { pORTH Town of tAndover O ti, y, 0 h , ver, Mass, /i`szvZ1.3 COC NIC Mt wICN y1' TEO I'Pa,`'�5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...11.��74 0..... C' BUILDING INSPECTOR ............................................................................................. Foundation has permission to erect.......................... buildings on .., .. .. .... .............................................. Rough / � / F ....... .....G..'�..`E.f...'.. %.`./ i4... Chimney be occupied as ........................................... provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ....... .... ................................... Final BUILDING INSPECTOR 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. SEE REVERSE SIDE CONSTRUCTION CONTROL PROJECT NAME: Buildout of New Dental Offices for Dr. Charles Beliveau PROJECT OWNER: Dr. Charles Beliveau PROJECT LOCATION: 987 Osgood Street ARCHITECT:DAVID A.FARMER OF KONG DESIGN ASSOC. INC.10 HIGH ST MEDFORD MA 02155 IN ACCORDANCE WITH SECTION 107.6 OF THE MASSACHUSETTS STATE BUILDING CODE, EIGHTH EDITION I,DAVID A.FARMER REGISTRATION NO.8333 BEING A REGISTERED PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT XX ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER(Specify) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF KNOWLEDGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE PROVISIONS OF THE MASSACUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 107.6: 1.Review,for conformance to the design concept, shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2.Review and approval of the quality procedures for all code-required controlled material. 3.Be present at intervals appropriate to the stage of construction to become,generally familiar with the progress and quality of the work and to determine,in general,if the work being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 107.6.4.,I SHALL SUBMIT PERIODICALLY A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE North Antloyt-r BUILDING COMMISSIONER. UPON COMPLETION OF THE WORK,I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. 4F U R,^ cows, "'1 DAVID A.FARMER PERSONALLY APPEARED BEFORE ME AND PROVED TO ME THROUGH SATISFACTORY EVIDENCE OF IDENTIFICATION WHICH IS HIS MASSACHUSETTS DRIVER'S LICENSE TO BE THE PERSON WHOSE NAME IS SIGNED ABOVE IN MY PRESENCE. SUBSCRIBED AND SWORN TO BEFORE ME THIS 19 th DAY OF August, 2013 N JE EY P. NQ NOTARY PUBLIC COMMONWEALTH OF MASSACHUSETTS My Comm.Expires Feb.13,2020 DOYLE AND MATTHESON, INC. CONSTRUCTION CONTRACT Agreement between Owner and Contractor Date: 9-12-13 Owner: Dr.Charles Beliveau Contractor: Doyle and Mattheson Inc., 232 Rock Island Road,Quincy,MA 02169 Project: Dental Office Construction Location: 987 Osgood ST.North Andover,MA Architect: King Design Associates 1) The.Owner and Contractor shall execute the Work listed below.Any work not listed below or in subsequent change orders signed by both parties,shall be the responsibility of others. The date of commencement to be within 10 days of building permit issuance. Unless due to causes beyond its control,the contractor shall achieve Substantial Completion of the work within 16 weeks from the start date. Henceforth, Contractor shall notify Owner of any substantial delay caused by Owner or by Owner's agent(s),if any such substantial delay shall automatically act to postpone the date of Substantial Completion. 2)The Work: A. See Attachment(Description and Values) B. According to Plans provided for By: Patterson Dental Co 3 Contract Sum: $310 454. 232 Rock Island Road Quincy, MA 02169 • Tei. (617) 405-4951 • Fax(617) 302 B DOYLE AND MATTHESON, INC. (4)Payments: A)Doyle and Mattheson Inc.will invoice once per month based on percentage of completion. B) Retainage: We accept 10%held on all labor and materials. C)We agree to submit change orders in writing prior to doing the work. D)Final payment due within 5 days of issuance of occupancy permit. E)Payments for requisitions will be payable to: Doyle and Mattheson,Inc. (5)The Contractor shall perform the Work in a good, safe and workmanlike manner, subject to all applicable codes,laws and regulations and using materials of good qty. The Contractor throughout the execution of the Work shall maintain Liability, Property,Builders Risk and Workers Compensation Insurance in appropriate amounts with the companies authorized to do business in the Commonwealth of Massachusetts All work includes a one year warranty from the date of substantial completion. (6)Doyle and Mattheson, Inc.will guarantee payments to its subcontractors. Dr.is not responsible for paying Doyle and Mattheson's subcontractors nor can Doyle and Mattheson's subcontractors obtain payment directly from the Dr. This Construction Contract is entered into as of the day and year first written above and is executed in two original copies,of which one is to be held by the Owner and the other held by the Contractor. C trac r. Owner: Z.P. J ` Doyle and M heson,Inc Dr.Charles Beliveau 232 Rock Island Road Quincy, MA 02169 Tel. (617) 405-4951 Fax (617) 302-44 43 DOYLE AND MATTHESON INC. Building Dental Offices For More Than A Quarter Century September 12,2013 Dr.Charles Beliveau: Description and Values Line Item Pricin g Acoustical Ceilings $ 4,875.00 Cabinetry $ 32,048.00 Carpentry and General Contracting $ 89,900.00 Blocking and Bracings Doors and Hardware Windows Lead Dumpst&s Labor Project Management Supervision Miscellaneous Materials Bathroom Accessories Electrical $ 31,300.00 Fire Alarm $ 3,805.00 Flooring $ 12,705.00 Heat/Air Conditioning $ 16,400.00 Metal Stud and Drywall $ 20,180.00 Painting $ 7,490.00 Plumbing $ 36,500.00 Sprinkler $ 6,230.00 Stereo $ 3,325.00 Tele/Data $ 4,410.00 2 Rock Island Road Quincy, MA 02169 . Tel. (617) 405-4951 . Fax (617) 302-4443 32 ocy, n �1 II I DOYLE AND MATTHESON INC. Building Dental Offices For More Than A Quarter Century Fire Extinquishers and Cabinets $ 790.00 Subtotal $ 269,958.00 Overhead 10% $ 26,996.00 Profit 5% $ 13,498.00 TOTAL $ 310,452.00 *We have not included: r. 1.Concrete Floor 2. Exterior wall insulation 3.Sound insulation between floors 4. Power and disconnect supplied by building owner. Owner will run pipe for electrical service to our space, but our electrician includes power feeders from building disconnect to our space. S.We also have not included mop sink or drinking fountain. They{nay be required after review by town. 6.Permit Fee will be additional and invoiced at cost. 7.Any additiorjal Engineering or Architectural that may be required will be additional 232 Rock Island Road . Quincy, MA 02169 . Tel. (617) 405-4951 Fax (617) 302-4444 10/30/2013 9:48 AM FROM: Journeay Insurance Journeay Insurance Agency TO: 1-978-687-5999 PAGE: 002 OF 002 AcoRo0/301207e CERTIFICATE OF LIABILITY INSURANCE DATE I01201YYYY)3 1 THIS CERTIFICATE IS ISSUED AS AMATTER 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 Phone- 978-346-8761 Fax 978-346-9620 CCOONNTACT Joumeay Insurance Agency Inc JOURNEAY INSURANCE AGENCY INC PHONE 978-346-8761 FAX 978-346-9620 8 WEST MAIN STREET AC No EXI: AIC NOV E-MAIL MERRIMAC MA 01860 ADDRESS INSURER(S)AFFORDING COVERAGE NAIC III INSURERA Peerless Insurance 24198 INSURED INSURER El Peerless Insurance 24198 DOYLE&MATTHESON INC 232 ROCK ISLAND ROAD INSURER : Technology Insurance Company QUINCY MA 02169 INSURER 9. Travelers INSURER E NSURER F COVERAGES CERTIFICATE NUMBER: 9537 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. /NSR TYPE OF INSURANCE AODL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WND MMIODNYYY MM/DD/YYYY . A GENERAL LIABILITY GL1050582 05111/13 05/11114 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY a4IMGE TI RENTED $ 50,000 PREMISES Ea accurence CLAIMS-MADE 1XI OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYX JET LOC $ WED D AUTOMOBILE LIABILITY BA-1D760042-13 06/01/13 06/01/14 OOMeddent) °LELuni $ 1,000,000 (Ea accitlem) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ Ix HIREDAUTOS X NON,OWNED PROPERTY DAMAGE $ AUTOS (per acddent) B X UMBRELLA LIAR X OCCUR CUB901178 05/11/13 05/11/14 EACH OCCURRENCE $ 5,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X RETENTION$ 10,000 $ C WORKERS COMPENSATION TWC3313763 05/11/13 05/11/14 XTORY csTA-r-, ER $ AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y� E.L.EACH ACCIDENT $ 500,000 OFFIC ER/MEMBER EXCLUDED? N/A E.L.DISEASE-FA EMPLOYEE $ 500,000 (Mandatory in NH) Dyes,describeE.L.DISEASE-POLICY LIMIT $ 500,000 O ef DESCRIPTION OFFOPERATIONS CteIWT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Hall THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN North Andover,Ma. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �--,_9_ Attention: fx:978-6875999 Derek Journeay ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-040515 �J:I ROBERT A DOYU - %. 232 ROCK ISLAM RD QUINCY MA 02f69 �S cJ � fj A Expiration Commissioner 07/26/2015