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HomeMy WebLinkAboutBuilding Permit #561-2017 - Fernview 5-7 11/23/2016 RTil lei, BUILDING PERMIT �o.:"��°� I TOWN OF NORTH ANDOVER0 to APPLICATION FOR PLAN EXAMINATION ��o� Permit NO: Date Received 11—�3 _�0!6 9 ���,<».�. Date Issued: IL, - a0 110 �4SSACHUS IMPORTANT:Applicant must complete all items on this page LOCATION 9 f�k( Yr tw a r ,(� �&ALl' e n PROPERTY OWNER N , nCYLQ �c Prin MAP NO: I/ PARCELD ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ fle family ❑Addition B'Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Well Floodplain Wetlands Watershed District Water/Sewer r (� IdentificationPlease Type or Print Clearly) 2 OWNER: Name: �t hone: J/) 9f�- Address: ?2 &Lr Fa�-Vjvodju - J CONTRACTOR Name:Lt O n Cm S —VA-149 .hone: 7 a Address: 00 ra •1 t (4 �- Supervisor's Construction License:Gs'�� ,.� p xp. Date: Home Improvement License: 1-5 n 01 ) Exp. Date: ARCHITECT/ENGINEERIU A Phone: � Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $18,168, FEE: $ aa,�- Check No.: SS77 Receipt No.: 3 12- NOTE: Persons contractin ith registere co tr tors d n v acce to the guarantyfund Signature of Agent/Owne /�( i u o' contractor q. BUILDING PERMIT OF o Dr 6 sti TOWN OF NORTH ANDOVER 32 h ''` -_J�-=8 APPLICATION FOR PLAN EXAMINATION ~ _ Permit No#: Date Received ,] " ^J ArEO . �SSgcHus�� Date Issued: IlVIPORTANT: Applicant must complete all items on this page 3 P.R®PERT*YWNERE Pnntc10D�Year Structure }yes ,nod l MAPS _ 1PARCEL�- __ ZONINGI®1STRICT _ His_tonct®i'stncti eyes rio'�= vk a1 1 la no y ,� r r ;M e S p�Vil ge • TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic '' Well '� ~° '�'� dFloodplain Wetl`an'ds u �'1Nate�Shed District;' - - _ 7. Water/Sewer "�` �'°'' `' t1 '- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor`Name " '" _ Phorie; _ z• , .� •. !-. .X Adtlress �,_ , 5 .- ---.-. - -- - --• ate" Superviso�'sa 7tionsfruction License v Exp Date Homellrnprove�meritLicense � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. "-,.Total Project Cost: $ FEE: $ Check No.: Receipt No.,.- NOTE: o,_NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund Signatua, of_AgentT canerSignature of contractor; i } Location — 7 relujUI r w . No. 5(DI— t'7 Date J1-�3•0�l!!�� o i I 1 • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ '. Building/Frame Permit Fee Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check# d, Building Inspector i i ti 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124.Main Street Fire Department signature/date COMMENTS limension 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 ®ANGER 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 ate Time Contact Name Doc.Building Permit Revised 2014 i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. F, . Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 VOTE: 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 Doc:Building Permit Revised 2014 I r 1 tkORT1y ^� ve" . 0 No. * _T h ver, Mass, o JAW& CO[MICN.wt[M 7 7.AS R'�TED PP�`��5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT &M.N..! OV0 a BUILDING INSPECTOR c has permission to erect .......................... buildings on ..... Foundation ..... ..... ' � .,,,...,,,,,,,....., Rough C �,�r tobe occupied as ........... .. .�...�.......... ......... ................................................................. Chimney 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 CONSTRUCTIO,: ST TSRough Service ............ ..et Final BUILDING INSPECTOR { GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. i Nov 21 2016 08;01 PM HP FaxHuitage Green 19786850521 page 2 L. E. MORGAN CONSTRUCTION INC. 86 BILLERICA AVE., N. BILLERICA, MA 01862 PH: 978-670-4747 / Fax: 978-670-6477 PROPOSAL Submitted To: Afflnity Realty Management Date: 10-28-16 Address: 39 Rear Farrwood Rd.,(Clubhouse) N.Andover, MA 01845 Cell/Fax: 978-376-9687/978-685-0521 Job Site: Heritage Green Condominiums 5-7 Ferrnview Rd.,N.Andover, MA,Approx.5,279 SQ FT WE HEREBY submit our proposal for the following scope of work; 1. Remove the existing shingles down to the wood deck and dispose of off-site. 2. Install V of ice&water shield at the leading edges and 3'in all valleys. 3. Install RHINO SHIELD Synthetic Underlayment to the remainder of the wood deck. 4. install 8"white aluminum drip edge to the entire perimeter&mechanically fasten. S. Install Certainteed Swiftstart shingles as a beginning course. 6. Install Certainteed Landmark Silver Birch architectural shingles&hurricane nail. 7. Install 4 new pipe flanges, 3"-4",with neoprene collars. 8. Install new Attic Slant Vents to replace the existing on rear of the building. 9. Install new ridge vent and matching cap shingles. 10. Remove the metal siding on dormers,&install 10D%ice&water shield on the walls. 11. Install new white vinyl siding on all 3 dormers with white vinyl comers. WE propose hereby to furnish materials&labor,complete in accordance with the above specifications,for sum of; Eightee ousand Eight Hundred Twenty Dollars: $ 18,820.00 AUTHORIZED SIGNATURE Lawrence E. Morgan Jr President ACCEPTANCE of PROPOSAL:The above prices,spedfications&conditi s are satisfactory and are hereby accepted.You are aul&wrized to do the work as s 104 r.%I, �j& �4r� .,,. AUTHORIZED BUYAR SIGNATURE DATE TE THANK YOU FOR CHOOSING MORGAN C01YSTRUCTION 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 o 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 Li Certified Surveyed Plot Plan ❑ Workers Comp Affidavit a 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 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 < Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AyMicant Information Please Print Legibly Name (Business/Organization/Individual): Yn of) C -h wiAddressAM M C vafv t �� ,1 City/State/Zipy . d I(l�(. ne#. 0 Q-7 Y? Ar7yon employer?Check jhe appropriate box: Type of project(required): 1. a employer with AUC employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.[_J I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 10 E]Building addition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.FJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑R f re ails t n These sub-contractors have employees and have workers'comp,insurance.: VK) 6.n We are a corporation and its officers have exercised their right of'exemption per MGL c. 14. then 1 152,§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. tContractors 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 I ant art employer tliat is providing ivorl(ers'compensation irtsurartce for my employees. Below is the policy and job site in00 rination. ` Insurance Company Name: Policy#or Self-ins.Lic.#: 1^ Expiration Date:1'Z. l L(• i Job Site Address:5 1 Veynv1 R City/State/Zip:lV . t "C.� 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vefification. Ido Ir eb rtify tntder the pain andl,{et�{t�es ofpetju y that the information provide bove i tare and correct Si nate llr////►/eI Date: 2) ) 10 Phon #: V 7i ;( Of ial se only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#' �C R LEMORGA-01 BBOYER FCERTIFICATE OF LIABILITYINSURANCE DATE(MMIDDIYYYY) 4114/2016 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 C ONTRACT 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 endorser ient. A statement on this certificate does not confer rights to the certificate holder in Ii of such endorsement(s). PRODUCER CONTAC Welsh&Parker Insurance Agency,Inc./Hudson Office NAME: 131 Coolidge Street,Suite 100 PHONE Hudson,MA 01749 (Arc,No, xtj:(978)562-5652 FAX E-MAIL (ac,No): (978)562-7120 ADDRES INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER :Western World Insurance Company INSURER :SAFETY IND INS CO 33618 LE Morgan Construction Inc INSURER :Scottsdale Insurance PO Box 75 INSURER Billerica,MA 01821 INSURER : COVERAGESINSURER 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 AN CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY �HCED E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN RE BY PAID CLAIMS. ]NSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBEROLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY MIDDIYYYY MM/DDIYYYY LIMITS CLAIMS-MADE n OCCUR NPP8381520 DAMAGETORENTED EACH OCCURRENCE S 1,000,000 0 /13/2016 04/13!2017 PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEn LOC GENERAL AGGREGATE S 2,000,000 PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT BANYAUTO 6230688 (Ea accident) 5 1,000,000 ALL OWNED X SCHEDULED 1 /13/2015 10/1312016 BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X AUTOOSWNED PROPERTY DAMAGE Per accident S UMBRELLALIABXOCCUR S C X EXCESS LIAR DED RETENTIONS CLAIMS-MADE XLS0099346 EACH OCCURRENCE $ 5,000,000 0 /13/2016 04113/2017 AGGREGATE S 5,000,000 WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER ETR PROPRIETOR/PARTNER/EXECUTIVE YIN STATUTE ER OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT S (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYE S DESCRIPTION OF OPERATIONS beknv E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS]VEHICLES(ACORD 101,Addttlonal Remarks Schedule,may be att ached If more space is required) WORKERS COMPENSATION CERTFICATE OF LIABILITY WILL BE SENT DIRECTLY BY Th E CARRIER. CERTIFICATE HOLDER CANCELLATION SHOUL10 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street,Bldg 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZE REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILI INSURANCE DATE(MM/DDiYYYY) 19/17/2015 TilAXERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFE S NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR LTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW EN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE PR DUCER AND THE CERTIFICATE HOLDER. PORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)mt st be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsemetltt. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTAC NAME: BALDWIMWELSH PARKER INS 131 COOLIDGE ST,SUITE#100 PHONE FAX (AIC,No,Ext): (AIC,No): HUDSON,MA 01749 E-MAIL 27KLD ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED L E MORGAN CONSTRUCTION INC INSURER AMERICAN ZURICH INSURANCE COMPANY INSURER B: INSURER PO BOX 75 INSURER p: NORTH BILLERICA,MA 01862 INSURER INSURER ' COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE INSU ED NAMED ABOVE FOR THE POLICY PEROIODIINDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 111 RICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CON ITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB LTR TYPE OF INSURANCEPOLICY EFF DA POLICY EXP DATE L R POLICY NUMBER (MMIDDIYYYY) (MMfDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ACH OCCURRENCE $ CLAIMS MADE F-1 OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ POLICY 0 PROJECT❑LOC ENERAL AGGREGATE $ AUTOMOBILE LIABILITY PRODUCTS-COMP/OP AGG $ ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) SCHEDULE AUTOS BODILY INJURY $ (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DEDUCTIBLE $ RETENTION $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN UB-513738312-15 12/14/2015 12/14/2016 X LIMITSATUTORY OTHER ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ED N/A (Mandatory in NH) E.L.EACH ACCIDENT $ 1,000,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORK ERS COMP COVERAGE. ERTIFICATE HOLDER CANCEL TION TOWN OF NORTH ANDOVER SHOULD A Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET,BLDG 20,SUITE 2035 BEFORE T E EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCOR ANCE WITH THE POLICY PROVISIONS. 2�� NORTH ANDOVER,MA 01845 AUTHORIZE REPR TA ` ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts Department of Public Safety ---- Board of Building Regulations and Standards �/eom�rnon.iaea�/a �/Lcsaclerlef7 License: CS-0Office of Consumer Affairs&Business Regulation Construction Supervisor I L?� HOME IMPROVEMENT CONTRACTOR `' FJ Registration:,,_­137913 x 9 13.7913 Type: LAWRENCE E MORGAN,JR - Expiratior}_ #22117 Individual 100 IRON HORSE PARK LAWRENCE E.MORGAN-JR - NORTH BILLERICA MA 01862 LAWRENCE MORGRN ^_�_'' 100 IRON HORSE PARK l BILLERICA,MA 01862 Undersecretary Expiration: Commissioner 06/03/2017 OSHA �4nhSstxatioU" _ ll��-- - � _ - t 4 r: 'F This card aekn,,oyvtedges tha thdrecipte�iElias'suciiessfu(ty corimplEtecF a I -- 30-hour..OaZupationalSafeiyandHealth Tralnin-4 Course in i Dcn: rcnarsatet arrddear: ,,,,:,•_t;�t, , Cons tmotion Safety and Health J . LARRY MO has SuccesS(uR`,'CCMI ICtE -r; Tv P d a i0 u.G:upairpr,gl'SafE(e anJ NEaith i �(21.^tin] Construction Safety 8 peat'it t (Tratnar name—print or type) L Jt �t�� ,(course end.date) AL (Trailer) —�— — 0� ;Date) f