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HomeMy WebLinkAboutBuilding Permit #184-16 - Stacy Drive 8/10/2015 / Ol µORTN L P I� Oftt�•D �a9'b0 I BUILDING PERMIT 3r ,f ,•. • ' o� TOWN OF NORTH ANDOVER /� APPLICATION FOR PLAN EXAMINATION Permit N0: 7 A Date Received Arco t� Date Issued: �9SSACHUS IMPORTANT:Applicant must complete all items on this page LOCATION V(II�� e (047d o Print Agar,0rr PROPERTY OWNER l�'r�S'fv��Ul Ikcy2 ('f��.t o are Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ti ❑ New Building ❑ 0 e family 11 Addition ?Wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Q,Pepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer -(//—� �Q its/ � ohV(,i�•G✓ �' 1 /7� E� Identification Please Type or Print Clearly) OWNER: Name: c�-yl �!�n'` 31"rex •-l-i rin Phone: 9 7 —175-Y Address: CONTRACTOR Name: Phone: a3�o23S- uap .�N AW 1 �� Address: 9,� Supervisor's Construction License: GExp. Date: 09 - 1 � _ z v l S- OS��'C?�-� (10 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: t 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: $ 9 06 FEE: $ Check No.: ti Receipt No.: l NOTE: Persons contracting with unregistered contractors do not have access to the gua and Signature of AgenUOwner Signature of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 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 Conservation Decision: Comments G Water& Sewer Con vection/si gnature& Date Driveway Permit DPW Town Engineer: Signature: Loc 9 Located 384 Osgood Street _ FIRE�DEPAR�TMENT �emgDumpster onisite eyes_ Locatedlaf 12;4tMain«Streef Fire Depaffinerit:signature/d:ate COMMENTS. . 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 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 Pennit 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 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 4 Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses ,rE 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) 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 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 No. L/ Date / . - TOWN OF NORTH ANDOVER • LED 164a` . .. Certificate of Occupancy $ Building/Frame Permit Fee $�Q - Foundation Permit Fee $ Other Permit Fee $ -.. TOTAL $ ' t % Check# a .' r O Efuilding inspector North Andover MIMAP August 10,2015 091.0-0024 18 STACY DR 091.0-0022 091.0-0021 01.0-0020 091.0-0025�\ r 17 STACY DR ' 911.Q 00\23 091.0-0019 \91. 091.0-0026081.0=005700�-0027 X091.0-0�� 056 Q8-l:o,�0'��/ 091.0-0031 091.0-0033 `^ 5 STACY DR 140 PRESCOTT S 091.0-003,26 STACY DR, 091.0-0034,, STACY DR ' ` 092.0-0008 ,STACY DR091.0-0030" 9 STACY DR ,/ 091.0-0035 4 STACY DR N 1 092.0-0012 3 STACY DR 4 to 092.0-0013 2 STACY DR 092.0-0006 1 STACY DR 1. 082.0-0008 092.0-0014 118 PRESCOTT ST 126 PRESCOTT ST 116 PRESCOTT ST 151 PRESCOTT S eet Presto 092.0-0001 141 PRESCOTT ST 092.0-0011 092.0-0009 092.0-0005 082.0-0011 127 PRESCOTT ST [Q MVPC Bo 13 Municipal Boundary Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line Meters Data Sources:The data for this map was produced by Menimack Interstates 110RTM Valley Planning Commission(MVPC)using data provided by the Town of —I Gf i,,so r•q� North Andover.Additional data provided by the Executive Office of —SR ♦ �6 O OEnvironmental Affairs/MassGIS.The information depicted on this map is Roads 3? ~ L for planning purposes only.It may not be adequate for legal boundary O -- -— 111111, definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER {j Easements �•• 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑Parcels 1t — ♦ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 'F i ^ ; OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Trailso♦q _ • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF [j Hydrographic Features o♦�-��-f•"taj THIS INFORMATION --Streams 1SSACHUS�t Wetlands C[Exempt Lands 1"=66 ft '�` North Andover Board of Assessors Public Access Page 1 of 1 NORTH North Andover e! Boaf ofAssessors Of,<•�o �1ti0 O A MATCHING PARCELS SS"CH° Click on a column title to sort data by that column Click Seal To Return 25 items found,displaying all items.l Fiscal Year Parcel ID StNo. Street Owner Name 2015 210/092.0-0014-0000.0 1 STACY DRIVE QUINN,NANCY, Search for Parcels 2015 210/092.0-0013-0000.0 2 STACY DRIVE MACLEAN,MARJORIE,A., 2015 210/092.0-0012-0000.0 3 STACY DRIVE GUNTHER,BRENDA,C/O RYAN Search for Sales IRASTELLO 2015 210/091.0-0035-0000.0 4 STACY DRIVE 4 STACY DRIVE NOMINEE TRUST,GERALD STABILE,TRUSTEE 2015 210/091.0-0034-0000.0 5 STACY DRIVE WYLLIE,JOHN K,CLAUDIA L WYLLIE 2015 210/091.0-0033-0000.0 6 STACY DRIVE DAVID AND JOANNE CATALANO,DAVID AND JOANNE CATALANO,TRUS 2015 210/091.0-0032-0000.0 7 STACY DRIVE KRIEBLE,ELIZABETH,G., 2015 210/091.0-0031-0000.0 8 STACY DRIVE JOHNSTON JR,DAVID E,LINDA A JOHNSTON 2015 210/091.0-0030-0000.0 9 STACY DRIVE LAMBERS,WILLIAM K,M K LAMBERS& W H INGLEHART 2015 210/081.0-0053-0000.0 10 STACY DRIVE BENNETT,JUDITH, 2015 210/081.0-0055-0000.0 11STACY DRIVE COSA NOMINEE TRUST,PETER&RITA COCO,TRS 2015 210/081.0-0056-0000.0 12 STACY DRIVE CLEMENT,GERALD,F.,CLEMENT, CYNTHUA 2015 210/081.0-0057-0000.0 13 STACY DRIVE FINN,JAMES T,C/O J&G FINN FAMILY REVOCABLETRUST MC GRAVEY,JOHN M,ANNE V MC X10/081.0-0058-0000.0 14 STACY DRIVE 2015 GRAVEY 2015 210/091.0-0029-0000.0 15 STACY DRIVE SCALIA,KELLY,C/O CATHERINE L. HUTCHINS 2015 210/091.0-0028-0000.0 16 STACY DRIVE BERRY,LISA,L, 2015 210/091.0-0027-0000.0 17 STACY DRIVE BOUTIN,PAULINE A, 2015 210/091.0-0026-0000.0 18 STACY DRIVE HRINIAK,WALTER J,KAREN E HRINIAK 2015 210/091.0-0025-0000.0 19 STACY DRIVE MB REALTY TRUST,MARILYN BURKE, TRUSTEE 2015 210/091.0-0024-0000.0 20 STACY DRIVE MCHENRY,JANE B., 2015 210/091.0-0023-0000.0 21 STACY DRIVE XIAOLI,CAI,XIAOLI,GUAN 2015 210/091.0-0022-0000.0 22 STACY DRIVE KATSCHKER,MURIEL J, 2015 210/091.0-0021-0000.0 23 STACY DRIVE ROSEANN HOULE 2012 REVOCABLE RST,ROSEANN HOULE,TRUSTEE 2015 210/091.0-0020-0000.0 4 STACY DRIVE JOHNSTON,ANDREA,L., 2015 210/091.0-0019-0000.0 25 STACY DRIVE MUI,JPHN, 25 items found,displaying all items.1 http://csc-ma.us/PROPAPP/newSearch.do?town=NandoverPubAcc&from=NewSearch 8/10/2015 Chris Howlett Subject: FW: Requested Bid From: James Finn (mailto:jimfinn130yahoo.comi Sent: Monday, August 10, 2015 10:07 AM To: Chris Howlett Subject: Re: Requested Bid Chris, This is to confirm that the Prescott Village Board of Trustees has selected Diamond Hill to do various repair work during the summer of 2015. James T. Finn Vice-President and Treasurer Prescott Board of Trustees i Price Breakdown Unit 8 Window Repairs $ 360.00 Unit 12 Pent roof gable repairs $ 775.00 Unit 11. 17. 18,22 Window Repair/touch ups $ 295.00 Unit 14 Pent Roof Repairs $ 49060.00 Unit 11 Rotted trim Replacement $ 250.00 Unit 12 Rotted trim Replacement $ 350.00 Unit 16 Rotted trim Replacement $ 675.00 Unit 19 Remove and replace the rotted siding $ 29675.00 Unit 22 Inspect and repair trim as needed.Allowance $ 285.00 Unit 24 Prep and Paint the siding and trim as needed $ 250.00 Comments: Please note that this price is based on the work requested. Please note that any hidden damages are subject to a change order. Please note that this price includes materials, labor. WARRANTY CONTRACTOR WARRANTS that all materials, facilities, workmanship, and equipment will be free of defects, and of specified quality, and will function properly for a period of 1 year(s),from the date first written above. Contractor will assign and deliver to owner all guarantees, warranties, and operating instructions of any Subcontractors, Manufacturers, or Suppliers that are applicable to any portions of the work.Within ten (10)days of first knowledge of any defect, or failure to function properly, Contractor is to be notified, in writing, of same by owner or his/her agents. Contractor shall be given first opportunity to promptly repair, replace and/or correct any item found to be defective, or that fails to function properly, at no cost to owner, within, a reasonable period of time.This Warranty does not apply to any construction work that has been subject to accident, misuse and abuse, nor to any construction work that has been modified, altered, defaced and/or had repairs made or attempted by others. Under no circumstances shall Contractor be liable, by virtue of this Warranty or otherwise, for damage to any person or property whatsoever, or for any special, indirect, secondary or consequential damages, of any nature, arising out Initial--------- 2 of the use or inability to use because of the construction defect.THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESS O7-- D. � � Diamond Hill Builders, LLC -- ------------------------------------ Date------ uhnebl jiit m 8/10/2015 JamesFinn ------------------------------------------------- Date------------------ Diamond Hill Builders, LLC www.diamondhilibuilders.com Initial--------- 3 r 7 NORTH : :. .c ver No. _ J$ 4 C, h ver Mass 2615 ° 74A QCoCNICNl WICK �•9 °R�reo �p�,��(y S U BOARD OF HEALTH Food/Kitchen PER", Septic System LD THIS CERTIFIES THAT . ...b>ak..iI. 1. � ......... ..g� :. � BUILDING INSPECTOR Foundation has permission to erect .................:.:...... buildings on ... .. Rough ! 1..... ..................................21 ..... Chimney e yto be occupied aS ...........:1 w•R A. provided that the person accepting this permit shall in every res ecoconfor to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating t -he Inspection, Alteration an Constructiq�of B#jildings ' the ow of North Andover. PLUMBING INSPECTOR ,� Rough VIOLATION of the Zoning or AuildiAg ReAlatlons Void thAerml. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST RT Rough Service ........................ ......... ... ....... ... .......... Final I DING 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. Massachusetts - Department of Public Safety Board of Building Regulations and Standaras Construction Supensor License:. CS-059504 PAUL RA]BENFUS '07ow 14 IIAbW"N N9, .r lop a►� y1.. ro4w, .f. ► �� . 31' ii1 �� Expi ratlC311 i Diamond Nill Builders, L&C• 98 Portsmouth Avenue, Stratham, NH 03885 (603)580-5368 1 www.diamondhillbuilders.com Diamond Hill Builders offers complete building and remodeling services including new construction, renovations, home and business improvement needs for individuals and businesses throughout the Seacoast NH area. We are fully insured and offer the highest quality workmanship available. In addition to new home construction and remodeling we specialize in ' home additions, garages, roofing, decks, windows, doors and siding. All of fJ our work is guaranteed. Date: June 12, 2015 Job ID: NorthPoint: Prescott Village Repairs Customer Name: Prescott Village Customer Address: 1 Stacey Ln North Andover, Ma ' Job 1 - • • • Unit 8 Re-Install the garage window as needed. • Unit 12 Repair of siding on pent roof and building corner. Remove and replace as needed. • Unit 11, 17, 18, 22 Repair window sash. Prime and paint as needed. • Unit 14 Pent Roof Repairs-Roofs. • Unit 11 Repair the garage window trim and paint as needed to keep it a tight seal. • Unit 12 Remove and replace the rotted trim. • Unit 16 Remove and replace the rotted trim.Apply new paint to match the existing. • Unit 19 Remove and replace the siding that is pulling away. Paint the siding as needed. • Unit 22 Inspect he are where the caulking is hanging. Repair as needed. • Unit 24 Prep and paint the area where the bare wood is showing.Association Initial--------- 1 North Andover MIMAP August 10, 2015 qJl Q (D 0 MVPC Bo Interstates Honwntal Datum:MA Staleplane Coordinate System,Datum NAD83, —I Meters Data Sources:The data for this map was produced by Merrimack —SR NORTH Valley Planning Commission(MVPC)using data provided by the Town of -Roads Gf+tett V is qNorth Andover.Additional data provided by the Executive Office of t Easements ? �� n Environmental Affairs/MassGIS.The information depicted on this map is Parcels 3 L for planning purposes only.It may not be adequate for legal boundary F -^ 9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 41 ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY • i ^ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT �► o� v � ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �gsSAcwUs�t 1"=48ft ^�° North Andover MIMAP August 10, 2015 091.0-0016 091.0-0017 091.0-0018 "� LL 24 STACY D 091.0-0020 ...•--•'"" 20 ST 091.0-0021 091.0-0023 19 STACY DRI0024 20 STACY DR 22 STACY DR 23 STACY DR 091.0-0025 091.0-0026 18 STACY DR 091.0-0022 r 17 STACY DR 091.0-0019 091.0-0028 \091.0-0027 08-1:0-0057 091:0;00 0056 rn 081:0--00581:0-0053 08-1:0-0055 �--! 5 STACY DR .,r^"��*� •--'"092.0-0008 ,` 6 STACY DR ,�-"''�• 091.0-003'2 091.0-0034 091.0-0031 7 STACY DR 091. 0-0033. 091.0-0030 8 STACY DR 9 STACY DR 091.0-0035 L N 092.0-0006 4 STACY DR 082.0-0008 092.0-0012 MVPC Bo Municipal Boundary Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line Meters Data Sources:The data for this map was produced by Merrimack Interstates NORTH Valley Planning Commission(MVPC)using data provided by the Town of —I OE �p 'a North Andover.Additional data provided by the Executive Office of —SR =. 4`�,, r..600 Environmental AffairslMassGIS.The information depicted on this map is Roads 3' L for planning purposes only.It may not be adequate for legal boundary O to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER t,Easements ~ % MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑Parcels ♦ • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY f i ' OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT — Trails # q M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF T. Hydrographic Features q� o ��•"taj THIS INFORMATION —Streams 1SSA�NUS�t Wetlands C Exempt Lands 1"=48 ft "�` ACORU0 DATE(MM/DD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE F8/10/2015 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 CONTACT Jessica Hildreth ACSR NAME: r CROSS INSURANCE - LACONIAP4H/C No Ext (603)524-2425 AIC No:(603)524-3666 155 Court Street AIL ADDRESS:jhildret:h@crossagency.com INSURERS AFFORDING COVERAGE NAIC# Laconia NH 03246 INSURERA:Frankenmuth 13986 INSURED INSURER B Continental Indemnity Company DIAMOND HILL BUILDERS, LLC INSURERC: 98 PORTSMOUTH AVE INSURER D: INSURER E: STRATHAM NH 03885-2415 INSURER F: COVERAGES CERTIFICATE NUMBERCL1581047143 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MWDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FX OCCUR DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ BOP6165548 8/10/2015 8/10/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F JE o [X]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employment Related Practices $ 100,000 AUTOMOBILE LIABILITY CEaOMBaccident INED SINGLE LIMIT $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BA 6165548 8/10/2015 8/10/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Peraccident $ Uninsured/Underinsured Mot $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? a N/A B (Mandatory In NH) 46-843442-01-05 9/19/2014 9/19/2015 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Christopher Howlett is excluded from Workers Compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of North Andover, MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. Building 20, Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE J Hildreth, ACSR/JH5 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)