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HomeMy WebLinkAboutBuilding Permit #1104-15 - 99 HAY MEADOW ROAD 6/25/2015 DocuSign Envelope ID:72F4C4C9-5E8C-42A3-99BD-09727544DAA4 f FORTH A BUILDING PERMIT �2o�R<Uto TOWN OF NORTH ANDOVER ° oL{,( 1, APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received '� 9,.,>z....,: . M�SSacHUs�i�y Date Issued: 1 PORTANT:Applicant must complete all items on this page aLOGATIQN'>99 Hay Mea�ow�Rd Nort­,J ndover„ MA 01845 3 r n rX s y ���.♦}R �� y=,h m � S'i t Aa'S'"� e i 7't,.r -�C� r: � �,.CfI•I(�t,C �a �i�� k t � •t e�C� � ^e..3r*i .� ��f�r 4F�vt� �.�..F .s.nom Robert Moverman `� . ; x PRQPER7 Y OWNEr .y i tk-� � � ��` 4Af.,, a f�.v N C'•` Y i �° -'Print ..� •, „r ,,.w 7'� arFt '�}`r Av �, � € '`'- d ?* � MAP NOy V xFPARCEL 'ZONINGrDISTRiCT a x Histone District, ye t" r no �i n•. `�`x 2 -'rt;,+s� �, r �a�3r � ��Lf� x y 3 $ -.�"rG rr«,,tis r �, ' Machlner$hop;VlllageY�e- TYPE OF IMPROVEMENT PROPOSED USE _ Residential Non- Residential r! New Building DOne family ❑Addition 0 Two or more family 0 Industrial SAlteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg Cl Others: 0 Demolition 0 Other #� 6p 6d,t a�Welt`"" ,; >F,li �t; A Y loo*dpla ny 1 Wetlands p :I Wate4sh6d, istrlct, ; Jb,Water/.Sewer. ' :rpa .,#{ < ` ,.� >' r, •r a : . a This project consists of the installation of 27 Photo-Volatic modules and one string inverter on the existing residential composite shingle roof top,and the system will produce 7.02 KW I I Identification Please Type or Print Clearly) OWNER: Name: Robert Moverman Phone: Address: 99 Hay Meadow Rd, North Andover, MA 01845 CONI RAGTOR Name tti ,t h` Halll Aslari Phone !'':.. , eit� v a✓ s f:. t f� =n !` � Address P riP �, u ✓, fitr J� s .g ar a ks S ;77V>nalMSt_,.Dracut,t,MA, 0.1826 SU p rV � I501f'S'COnStrUCtlOflk L1C211Sf' t es �t { �r ;x wx 'w w t i� � � Exp Date t � � � F rs*,r's, ^t TF .S ,>< .! _.. t" -.f .�.f 1+ib� �i..f y y .✓ri +, S r 1�ij3 Lt i Nome Improvemen �� 1 69749 a ARCHITECT/ENGINEER 4Phone:g���y 0_9 Address: Reg. No. FEE SCHEDULE:SULDINNG PERMIT:$12.00 PFR$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost: $_ 26/ FEE: $ �3Z0 Check No.: ' Receipt No.: NO'T'E: Persons cof r cti g with dyjLr aft Bred contractors do not have accIes o the gra•ars v fond A41S ,111,A ignature of Agent/Owner Signature of:contractor dj TV- 6CFEB862ADSB438... -- C L 1 m.1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ElStamped Plans El. i TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑ jwell ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ i COMMEN`T'S I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ` Planning Board Decision: Comments i Conservation Decision: Comments Water& Sewer Connection/SDriveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street F,I�RE D�EP1�R"'&-k �r m �Dumpste���)ijjsite yesaa � tiLpocated at124 Main Stree° t .'� ` " �+ t ,�� t !�, FjrelDepartment ignature/date COMMENTS` _ _ 3 '' r•.- Q.., � . .flr,,.f -4? +, ®imens►on Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, avast 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) i ® 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 4. Workers Comp Affidavit 4-1 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 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) A6 Building Permit Application 41 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 e 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 �s..-aw �rc-:i*R' `:+'IAPG:�TAl�als�=•►..w°r+c§i._'�1ii1K:..^�" Location qq .�• i No. ©ate 1 i . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ � TOTAL $ j :3 Check# U j i 28976 Building Inspector r - NRTH O - - _ . wn . 2 E ,, . Zc ve' _ 0 0 No. - _ h ver, Mass, (A-X2q JC COCNIC"NWKK �ie ADR�TED PPp��� S U BOARD OF HEALTH Food/Kitchen PER LD Septic System ITTHIS CERTIFIES THAT „V�«� ., , BUILDING INSPECTOR ......................................... .. ............. ....................................... has permission to erect .......................... buildings on . Q Foundation ...... ... ............ ....... ........ ...jj.�.. ................. pi .....I�7Y. 544* � .-020��........ Chimney Rough tobe occupied as ............. ........... ................... .... .. ... ...ee...� ..... provided that the person accepting this permit shall in every respect conform to ire 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. Quotation&Contract NuWatt Energy,LLC 14 Ellyson Ave East Hampstead,NH 03826 Phone(781)995-2331 Customer Satisfaction cs@nuwattenergy.com QUOTATION & CONTRACT FOR A SOLAR ENERGY POWER SYSTEM CLIENT: Mr.Robert Moverman Site Address: Mailing Address: 99 Hay Meadow Rd 99 Hay Meadow Rd North Andover,MA 01845 North Andover,MA 01845 PROJECT DESCRIPTION AND MAJOR COMPONENTS A 7.020 kW PV System with turnkey installation at customer's site address stated above. - 27x JA Solar JAPE 260 Watt Power Solar Modules 1x SolarFdge Inverter MOUNTING TYPE: Roof Mounting STANDARD COMPONENTS: Racking and mounting components per Uniform Building Code. AC and DC disconnects per National Electric Code and Utility Wiring,conduit,and overcurrent protection per National Electric Code NuWatt Energy,LLC Page 1 of 6 1/3/2015 Quotation&Contract a . ADDITIONAL COMPONENTS: - Line-side tap MONITORING: Production Meter SolarLog S135Q Revenue Grade monitoring with 5 year subscription. STANDARD LABOR: - Design system and secure basic building or electrical permit - Install specified system in good workman like manner - Complete and submit utility interconnection documents - Coordinate building,electrical and utility inspections ADDITIONAL WORK: - None CONDITIONS Installation site is expected be accessible and mowed (il'applicable) prior to performing work NuWatt assumes that no additional electrical work or roof reinforcements are needed PV project will comply with all Commonwealth Solar it requirements,including but not limited to MassCEC Minimum Insurance and Minimum Technical Requirements .ALLOWANCES: The following items or specific prices as indicated are included in the contract price as allowances.The contract price shall be adjusted based upon actual amounts rather than estimated amounts herein: None NuWatt Energy,LLC Page 2 of 6 1/3/201.5 Quotation&Contract G TENTATIVE EVENTS & MILESTONE PAYMENTS SCHEDULE: EVENT APPROXIMATE AMOUNT DATE .......................... .......... Initial D osit 6(611015$3,000.001 Before 0rderin of MaterialsV11/1�0......................... _?�QJ2015 1 $15,389.40 .......... 6/ U on Uehvery of Materials tothelobsite 3000 7/11/-2015 1 $7,102.80 I.Jpon Conirnissioning(Municipal Building/Electrical Inspection) 8/1/2015 $1,183.80 $26,676:0::0j Total Price TIME FOR COMPLETION: The work to be performed by Contractor pursuant to this Agreement shall be corni-nenced within 7 days of delivery of materials and shall be Substantially completed within 21 days from the commencement date. ENTIRE AGREEMENT The parties represent that there are no oral agreements affecting this Agreement and that this Agreement contains the entire,full and integrated Agreement of the parties and that this Agreement supersedes and cancels any and all previous negotiations,arrangements,letters of intent,proposals,brochures,agreements,representations,promises,warranties and understandings between the parties as stated by,including but not limited to,any ol'parties' agent(s)and/or employee(s). No alteration,amendment,change or addition to this Agreement shall be binding upon either party unless reduced to writing and signed by each party. ADDITIONAL CONTRACT PROVISIONS: All milestone payments are due Net.10 days. 1%interest per month carrying charge. This quotation price is valid for 14 days front the obove date;quoted schedule is valid1br3 days. Client shall ensure payment in the ffirni of-a bank check,certified bank chock or batik wire transfer is produced at each delivery to the jobsite(modules and inverters). Neither delivery will be offloaded until NLIWZltt has received the proper payn-ient, If the deliveries offloaded because proper payment is not received,Client shall be responsible for all additional costs incurred by NuWatt, including but not limited to,storage costs,additional transportation costs,interest,additional labor, penalties,etc. Client shall pay all additional costs to NuWatt prior to Z111V subsequent deliveries. NuWatt Energy,LLC Page 3 of 6 Quotation&Contract The.milestone payments and commissioning payment(payment due upon final electrical and municipal inspections'are due within five(5)business days of verbal notification by NuWatt that the work is complete. Payments not made in accordance with the preceding terms,at the option of NuWatt,shall constitute a default and breach of this Agreement. Cl i ent agrees that upon any declared default and/or breach, among other remedies:(1)NuWatt shall be entitled to halt work and/or disconnect the.system,(2) NuWatt shall be entitled to assess interest on all past due amounts at the rate of two percent(2.011/0) per month(24%peryear),and(3)Client shall pay NuWatt for all of NuWatt's collection fees and costs,including but not limited to administrative costs and reasonable attorney's fees and court. costs. Client is to cooperate fully in completing iiecessai-ydt-.ici.imetit,.itioii to expedite the financing institutions release of funds. Client shall beat-all risk of casualty loss to the system during the ori-site construction period,and shall insure the system during such period to its full insurable value. A copy of the insurance covermve shall be nrovided to NuWatt prhQr to module delivery. Client is not responsible for any loss to the system incurred prior to or during the transfer phase. Client agrees to allow NuWatt and all delivery vehicles access to the Property over any existing driveways. In the,event,adjoining land must be crossed to enable delivery,Client agrees to obtain written permission from the applicable adjoining landowners. Client iccepts responsibility for any 0 damage to existing driveways and/oradjoining land during delivery. Neither NuWatt nor the manufacturer shall be responsible for any delay Cause by action of'a governmental entity,strike,riot,or other civil disturbances,shortage of materials,war,disaster,or- other rother natural Or Unforeseeable calamity. Except when caused by the negligence of NuWatt,its agents,servants,or employees,Client shall indemnify and hold harmless NuWatt from all liability,loss or other damage claims for obligations resulting fl-0111 any injuries or losses,including reasonable attorneys'fees and court costs incurred by NuWatt in defending any such claims. Client Shall further indemnify NuWatt for any damage to the property,premises,person,personal property or fixtures of the property owner or property owner's employees,agents,invitees or guests. Client also agrees to indemnify,defend and hold harmless NuWatt from and against all claims, expenses(including attorneys'fees),and liability of whatever nal-ure(i)arisinf;from any do fault,act, omission,or negligence of Client Client's contractors,licensees,agents,servants,employees,or customers;or anyone claiming by,through,or under Client,(ii)arising from the existence of hazardous substances,wastes or materials at the property,or(iii)arising directly or indirectly from any breach,default or omission on the part of the Client hereunder. The foregoing shall include indemnity against all costs,expenses,and liabilities incurred in connection with any such claim (including,withotit limitation,attorneys'fees)or proceedings brought:thereon,and the defense thereof with counsel acceptable to NuWatt or counsel selected by an insurance company that has accepted liability for any Such claim. NuWatt Energy, LLC Page 4 of 6 1/3/2015 4 Quotation &Contract This Agreement shall be binding U11011 and inure to the benefit of the parties and respective lega] representatives,successors,and assigns. A ...... Customer Acceptance Signature: Dat e: Robert Moverman NuWatt Energy,LLC Page 5 of 6 1/3/2015 ' � ~ ~ �^�0�0 ������o�� 8���0���� 0�����U��������� �����w "=°~�� Consulting =~" °��"°~~~~~= ~'� =" "~^ | 407 Rear Mystic Avenue, Unit 26, Medford, hHAU21G5 � Tel: (781) 3968747 Fax: (7Q1)B9698@2 EMail: b.andnn@momncaotnet )une16'Z015 Subiect: TheMovermao's Residence 99Hay Meadow Rd North Andover, K4A0lD45 RE� Installation o(Solar Panels onthe Roof � ToWhom |tMay[oncern� A design check for the subject residence was done on the existing roofing and framing systems forthe installation of solar panels over the roof. From a field inspection of the property,the existing roof support structures were observed asfollows: � The roof structure consists of composition shingle on roof with plywood boards that are Supported by 2x6rafters @16"o.c.The rafters have atotal projected horizontal span of15'-1O"'with aslope of35 degrees.The rafters are connected at one-third of span by 2x1O collar ties @36"O[. The existing roof framing system is judged to be adequate to withstand the loading imposed by the installation ofthe solar panels. Noreinforcement isnecessary. The spacing of the solar standoffs should be kept at 48"o.c.with a staggered pattern to ensure proper distribution ofloads. I further certify that all applicable loads required by the codes and design criteria listed below were applied to the Unirac Solarmount solar rail system and analyzed. Furthermore,the installation crews have been thoroughly trained to install the solar panels based on the specific roof installation instructions developed byUniracSo|armouo(for the racking system and Eco6astenfor the roof connections. Finally, I accept the certifications indicated by the solar panel manufacturer for the ability oythe panels towithstand high wind and snow loads. * Applicable Codes=Massachusetts Residential Code,8th Edition,ASCE 7-05, and 2005 NDS ~ Roof Dead Load= 13psf * Roof Live Load=ZOpsf * Wind Speed= l10mph, Exposure [ * Ground Snow Load=5Spsf Roof Snow Load=2Q�73paf � Sincerely MEI Consulting Engineers, Inc, . . MJavid Maiek President - ............. ...... ______-__---_ 27-PANEL SOLAR ARRAY On Exterior Wall Inverter Utility Meter Exterior Utility Production Disconnect Meter pt 7 Array is composed of 27 JA solar JAP6 260 modules. f 2 Strings of 14 and 13 modules in series to SolarEdge SE7600A Inverter I I I I ' I (2)X10 AWG USE-2/ WIG�&ddrcinEMF o I Module frames,mounting hardware and equipment enclosures grounded to main panelground orground rod. SDIarEdgeSE7600A 240 VAC Output I I I 60OVDC Built in DC Dis an SR I Minimum 48 AWG continuous or GFP ��I j irmvcrsibly splicedwre from METER11 Combiner bazto inverter Ll L2 N line Side Tap s I'— —-—-—'—'—'—'—' 1-2 1-1 I I I I Minimum f18 AWG continuous or 200AMP I irreversibly spliced wire from MAIN Inverters to dedicated ground clamp BREAKER to System Ground rod or Eufer. I I I Dedicated PV N system kWh 240V I meter (Sola dog 51-350) I PVkWh I meter 3112-Pole 60A Siemens AC Disconnect _ I I I I NuWatt Energy, LLC www.NuWattEnergy.com 99 Hay Mea ow rd. Date North Andover-MA 01 345 6/22/15 The Commonwealth of Massachusetts E-6�rint Form, Y - Department of Industrial Accidents Office of Investigations ,y 1 Congress Street,Suite 100 Boston,MA 02114-2017 3. www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Al Please Print Legibly Name(Business/Organizaiionllndividuap: l Address: 44 City/State/Zip: Phone#: Are you an employer. heck the appropriate box: Type of project(required): 4. Q I am a general contractor and I I am a employer with 6. ❑New construction employees(full and/or part-time):* have hired the sub-contractors 2.El 1 am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have g, []Demolition and have workers' working forme in any capacity. employees9. []BuiIding addition [No workers'comp.insurance comp.insurance.* required.] 5. [� We are a corporation and its ME]Electricalrepairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions [No workers'comp. myself. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.E3Other 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 the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my emplovees. Below is the policy andJob site information. r: Insurance Company Name: ! Policy#or Self--ins.Lie.#: i^ Expiration Date: 1' Job Site Address: City/State/Zip: Ad l Attach a copy of the workers' pensation policy declaration page(showing the policy number and expiration.date). ! Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I da hereby cern under he atns nd enalties o r er u in that theormadon provided above is true and correct, _ Date �_ i Si ature: _ Phone#: QoWal use only. Do not-write in this area,to be completed by city or town official i City or Town' Permit/License## i Issuing Authority(circle one): 3 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person. Phone#• 3 DATE(MhlfDD/YY) A COM. CERTIFICATE OF LIABILITY INSURANCE 12/01/14 PRODUCER PHONE:603-964-9555 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Demers Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 553 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Rye,NH 03870 INSURERS AFFORDING COVERAGE MAIC# INSURED ._.._ NuRED Energy,LLC INSURERA: Atain Specialty `A+Carrier' 14 Ellyson Ave. INSURER a: Nationwide Insurance Co. East Hampstead,NII 03826 INSURERC: Scottsdale Ins.Co. `A+Carrier' INSURERD:The Guard Ins. Co. INSURER E: COVERAGES 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,TIIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY �S'Sa EFFECTIVE. POI.ICYEXPIRATION TYPE OPINSI/ItANC4: YOLtCY NUASBER DATE DATE(MlWDD/YY) LIMITS BIMIDDIM GENERAL LIABILITY CIP229376 11/25/14 11/25/15 EACIIOCCURRENCE $],000,000 [X]COMMERCIAL GENERAL LIABILITY [ ]CLAIMS MADE I.X]OCCURRENCE DAMAGE.TO RENTED $100,()()0 [ ] 1'RF.MISF.S F.a nccurrrnce [ ] MED EXP(Ary une.perm.) $5,000 A GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1,000,()00 [X ]POLICY [ ]PROJECT [ J LOC $C LXIDeduotrble: GENERAL AGGREGATE 2,000,000 Bodily injury/Property Damage=$1,000 PRODUCTS-COMPJOPAGG $2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT [ ]ANY AUTO (Ea aWdew) $1,000,000 [ ]ALL OWNED AUTOS BODILY INJURY B [ ]SCHEDULED AUTOS (PerPcrsan) $ [ ]HIRED AUTOS HOMILY INJURY [ ]NON-OWNED AUTOS (Per accident) $ [ ] PROPERTY DAMAGE. [ .l (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ [ ] [ ] OTIIER IIIAN FA ACC $ AUTO ONLY: AGG $ FXCESSIUMBRELLA LIABILITY XBS0045857 11/25/14 11/25/15 F.ACII000URRENCE $1,000,000 [X]OCCUR [ ]CLAIMS MADE AGGREGATE $ 1,000,000 C $ [ ]DEDUCTIBLE $ [X]RETENTION $2,500 $ WORKERS COMPENSATION AND R2WC522483 11/03/14 1.1/03/15 X YrA,vroaY Orn FMPLOYFRS'LIABILITY uMlrs rx CGvered State:Massachusetts K.L.EACH ACCIDENT $ 100,000 D ANY PROPRIETOR/PARTNER]EXECUTIVE E.I-DItiFAtiF P.A EA1PlAYEF, $1,0[],()()() OFFICER/MEMBER EXCLUDED? ITyes,describe udder E.I.DISFASE-POLICV LIMIT $500,000 SPECIAL PROVISIONS below DESCRIPTION OF 01'RW17'IONS/LOCATIONS/VF.HICI.FS/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TBI,ABOVE DESCRIBED POLICIES.BE CANCELLED IIEFORE 771E EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL.3f_I DAYS WRITTEN NOTICF. TO TRF:CERTIFICATE HOLDER NAMED TO THE LEFT',BUT FAILURE TO DO SO SHALL IMPOSE NO OBIdGATION OR LIARJLITY OF ANY KIND UPON TIIE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTDpR12ED REPRESENTATIVE ACORD 25(2001/08) 0 ACORD CORPORATION 1988 V/Lta (fJ(T77Ti7�77C(1G'U�llb G�Vl�7GdiClC/Gt!.iL'�.�:J , OME IMPROVEMENT.9Q Istfation: � '16979' ExP.1 '067/28/�15; ALAN - 7 � L 4SLAN DRACtff,MV4 01826 A c rr.T'ni�r=n nr:� - . - ....t'- - •.^.r�r.nr:r.r;r.r.r�r-.r.�- x.i i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor - License: CS-098996 tj ( HALIL ASLAN J 7 VINAL ST _ r I DRACUT MA 01$26IN < Expiration Commissioner 12/15/2015