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H rt OD I J I & I 09 I 001 0 I w 1 I (] 1 r r I H I m I W I W I O I -1-1 I I I I I I 1 1 I I I I •� 1 H rt N 1 N 1 r I H I H I W N H I I m I (D IP IQ N I I w I UIP I I I I 1 I z (D (D (D r I N I W I r I 1p m1 I y I (D I I 1 I I 1 1 I W rt I I 1 I I I I I H I a I I 1 I I I I I d I :3 r IP I N I W I N I N I H I ON W I I I Q. & I W I N I W I W 1 N N I I I I OJ I OD I H I O 1 O I N rt I H I I (D A IP I W 1 OD I O 1 O I H I l0 I I 1 (D W UUI m J I I W 1 1 I r I IP I 1 1 n I 1 I 1 I I 1 I O lQ I I I 1 I I I I G) 1 a I 1 I I I I I I ;a I En 1 1 I I I I I I ro I z p 1{ 1 1 I I I I I I I rt I 1 I I I I I I m I •::r I I I I i i I I W I I I I I 1 I jQ ' •fY 3 X I 3 z d I z I I I H H H I H H tj I y 1 y I I k Q I O 0 C 1 I 1 d I I I I Di I (D I 1 I I I I 1 I Fj •Jy 1 I 1 I 1 I I I r 1 3 i 1 tj z q C4 I ftj I 1 t o occca �000 r� o� dl rm � p p 1 m m m m m I m T� z z I M z 1 Pa z I o I ;V r t" I H ro ro I H r 1 r r H H H H 1 H r [j lj 1 DC H I H H I o n I m cj I M m m 1 G] [ j [] I GJ [] [] I [j [1] H H H H I m Q m m 1 H O I O I Ib I kK I zKK 1 ?�kk ?�kk 1 kkzzzz I () 1 I I I I I I tj i m 1 I I U) HVj I H Ln I H w 1 H > w 1 •�1� l0 I x .11 1 I n I z I M H 1 tj H I H I I r I H 1 O ro 1 m 1 A , ro 1 I x1 , () , Di m r 10ro ro r W I m I H r I H r I r 1 OO I I z I H 1 I m IA i z I z Lj 1 [j I & I I H 1 10I z I �i to 0 1 0 to I '�' i n i H i ?i z P m m m a H 3 I 1 I 1 I I tj I z 1 I I I I I I H I 1 m I m 1 m I I m I I I H I H I H I I I 1 I I I I I I r I r I H 13 1 I I I 1 � I y I y I I � H I I I I I 1 I I H I I I 1 Ul I U1 I Ul Mc � M ; mro I U3 10 10 1 m ro bb��'7 1 [jm[roj I H o ff 1 1 Hm I ml -3 1 cpHt. c 10 cnHttl I aiHZG�z0 wtt. � tH- t. � z � zz co Di I �J D7 [j m z Di I [j [j M I H i m H I I I 4 I z •�- M W I m m m I 1 le I I G] H I z z H m m I I •ri i xi xi 1 x % I x �J�i I x P5 I i 1 H I I Z r rj E I I I I I i m I I I I I i I I I I I I I 1 H I I H 0 0 i �� i H 0 PO z0 1 1 I I I I I I I I z z p I I I I I I 1 I w z I m H H" I I i I I I z H Z1 m 'ii:' rt I I I I I I I I I I I 1 I I MiH I 1 I I 1 I O co po I I I I 1•� I 1 I I I 1 I z w z (� 1 I I I 1 1 I 1 I I 1 10 m I H�O (D IQ I 1 I 1 I I I 3 5 I 1 I I I I z z I OD m I 1 I I I I 1 y ri I O W OD H m I 1 I I I I I I IP I I I I I I 1 I I H r I N 1 r I r I N 1 UI I H I I I w I O I N I N W I O I N I o I N O I I O I I G) G) ` I G1 G) G) o z 1 H H m I H H H o I H H H o I H H H o113 H H H H H o I H H H H O I H H o 1H ch 000 I moo I Lj000 I [j000 I mmoooo0 1 M0000 Imoo I mo IH i r� xl rro O 1 DU PO PO 1 [ fi ?q PO o I M 0'.11- o I [j [j 511' '�' 'N' '�J o 1 (j SU' '�7 N- 1 [j S>:J O I [ j 'FJ 1 U 1 o , , , �. �. �. 0 , -- 0 m ro o I o 1 o i o 0 I I I I I I y I UiUl [j 1 I I I I I I H I I Z t I I 1 z Z r y CC7 ro H r r N I r m t7 IA �i zNo y O co z to y H ro t=] o I o ID wco co w W N H r r N w G3 O 00 O 0 r 00 z z H 3 o �kK M R] M H n N ID H H H w M 0 0 o m .ro m O 0 r H H n N H 0 0 w tJo 0 ro N M r N y 0 N y O r N 0 v r co m w co co r H 3 3 L1 H y.b H co co zKK z O H c� C=i n z ro H 4 r W 0 0 H H H O t] 000 w ,ro xo O 0 ro r r N 1 r m N y 0 o H r 0 0 UlLn r ID w m m r N r w En O H H n 4 H r W 0 0 y y y O [7000 M ,ro m O 0 M 0 0 m m 'A r 0 H H H O [700o CJ Sa 'o O O I I y I H 0 (7] rn M M n I O I ZOa��i M�iw rD z N mnz�vlCm y I X 1-3 I-3 n[] k H Pa U I b� xy w tj t '�'3 z y 0 tyd H[n�t7b0 t7 roMMxx KJ I H I • • W 1< zjjjj�yyy Enad w I py O r• W y h� Y+y Y ro ro ro tt" M (D U r aim SD m C W Q [t] � 0 � y rr i I~-' w cn m v y rr z m m y (p r rr H C7 w p r a P. 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L r n x M ty H y n O H H H H ZQ4H r �U) H U) 0k A x r k m M u t4 r n PO tLj t7 H H n O H H 0 4 I 1 y 1 H d Q (n ;0m n 0 z w�yL7m 0 tj I 1 w n N- zIHz-1 1 Pd U I K 0 x � k �] I n l-3 1 y[] to TI m 0 [d I ro I d d I yftj I • �y11 �% P7 Q r- ro Ear 1 y H H O ili I I Flt' M (D 0 r y m>imm U) d m m I Q r- y rr on r 3 b H rt p7 r ri I 7•., I (D (D H (D Fl rt H QI ca a Y• r (D rr I I (p n p 0 (Q 1 Fj fp �] w I � I ((1 ro z Q C I I CT I � I [i] I 0 I I H 0 I W 1 I [%7 n i N I I Ff JY I �-I I I r I ty I O d H 3 U M V y 1 K C7 H [] (J] w M I H I i y H 0 [+] z I 1 I I 1 1 1 t I 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I 0 I OA I �Hf O m z O z En y (C m H H i n z mG K rt y h] H ro• O m ro Iz �Hx 1 1 w z m x o H r 1 0 I Q i•7 I r •V (D (� I n I-jI r M I z I r ,oo I I z Z zZ I N O I W v] I I-3 N o (n H M I W m I I •• 1 � I 1 r I 1 I n I Q 1 Z U H {? I by I O V) ro I O I H I (J1 I Q I I z I (jl I I (P I 1 I I r 1 I 1 0 1 I I 1 I I I 1 I I I r I I I N I 1 I 1 co 1 N I 1 N N I N 1 N ? 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I I I I I I I 1 I y A I O (P H I I H 1 H I H I I I 1 I M I w OD I I N I Lrl UI I W I 1 I I 1 I I I I 1 I I 1 I H H I H I N I I I J 1 OD I I H 1 I W 1 1 H I I UI 1 OD I I W A I I I O I O :-as a G1 1 0 ,A o 1 s s A Cii `J � 6] : G] s ` z HHo I HH I HHHHm 1 HH HH 1 yyo 1 '1'3H1 -3a, I H I HHo 1 to 1 t]00 1 m0 1 tj000w 1 til0 100 I w 0 0 I [0000 1 0 I NOO I H 1 m 0 tj I O til ro O I I W I I I O O W (I�j I I I I I I I I I y I i v I I I I I I I I I H I (j I I I I 1 I I 1 I z I W I 1 I I 1 I I I I Ol I I I I 1 I I I 1 I I 1 1 I 1 I I I 1 I I I I 1 I I✓� O � O p t. 71 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 665 Date: i lv 10,_2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 0 Pleasant Street MAY BE OCCUPIED AS Town Bathing House — Stevens Pond IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: The Town of No.And+ 120 Main Street North Andover MA 01845 p Building Inspector m m m m VI m mm C2 C � � CV 10 O CD Z CO) CLO �. C Q. CO) �C) cp O 0 CD cs CL Q rC d CD CCD O CCD wwa C CD CO) CD C :L O y CO CD S v H O CD Z o CD O C CD 5 rRI N v C/) O zcn� cn C 2 0 � z0 cn z cn cn O —• N < O' N CD CO) CD C2 CO CS m O NmaC W Z =-= Vi --i O w X O N. z1 CL Mn O.••r d CA CD �O,O y O =' ? m m CD N : -1 a N ; m m--ft o O % O N n W � O O C =r co n aom o a ,� ... O O O N to C")=m d H a ;V C7 V ccl CL. c_ CO)CL mto; ,•,► m N N W n0—r H 3 om: 000 00: � A o CD � s: .% N 7 o Cc, dd ate• C-) � 0 �; Fs � �o �q Cn Cn a1 O 71 'JC7 O r1 O P.0 O O d 00 d o n r o•� � N M O ® r n y 0 0 c GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame,- Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip.footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipe/stone/fabric filter/cover and outlet connection. FRAME: Fireblock - over girts/plates between floor joist. . Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. a Windbrace corners and center bearing partitions: Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations '/ " air space at sides in.foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). �► Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. '/ of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5" on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. \ Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stair's. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. t Re -inspection fee - $30.00 (Be Ready). Certificate of occupancy required prior to occupying structure. D. Robert Nicetta, Building Commissioner TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978)688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 1, Kaffee Kang ,HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 12 Stevens Street, North Andover, MA DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS . k , k A A G1 NO. 5287 AUTHORIZED SIGNATURE: REGISTRATION: DATE: July 9, 2008 Massachusetts Registered Architect #5287 NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Fonn revised 11. 15.2004 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 GOVERNOR TIMOTHY P. MURRAY LIEUTENANT GOVERNOR Commonwealth of Massachusetts OFFICE OF CONSUMER AFFAIRS DIVISION OF PROFESSIONAL LICENSURE 239 Causeway Street, Suite 400 Boston, Massachusetts 02114 September 15, 2008 Kaffee Kang 339 Boston Post Road Sudbury, MA 01776 DANIEL C. CRANE DIRECTOR, OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION GEORGE WEBER DIRECTOR, DIVISION OF PROFESSIONAL LICENSURE DEPUTY DIRECTOR FOR.ENFORCEMENT JOSEPH A. PELUSO, JR. EXECUTIVE DIRECTOR FOR THE BOARD OF THE EXAMINERS OF PLUMBERS AND GASFITTERS PAUL KENNEDY, SR. CHAIRMAN FOR THE BOARD OF THE EXAMINERS OF PLUMBERS AND GASFITTERS Re: Variance Granted — North Andover Youth Services — 12 Stevens Street, No. Andover, MA - Dear Ms. Kang: Please be advised; on August 27, 2008 the Board of State Examiners of Plumbers and Gas Fitters deliberated on, and voted unanimously in favor to grant a variance to modify the requirements of 248 CMR Section 10.10(6)(c)1 & 2.; which requires materials surrounding urinals shall be finished and non-absorbent. In addition wood and fiber boards are prohibited. Condition(s): The materials surrounding the urinals shall comply with 248 CMR 10.10(6)(c)1., except for the side shield partitions. This variance is based solely on the presentation, information and documentation submitted in the application by the Petitioner and is applicable to this site only. All other plumbing and gas fitting work, if applicable, shall comply with the rules and regulations of 248 CMR 3.00 through 10.00 and all other applicable statutes and codes. Sincerely, Hardoard Pel soJr., Exe tive Director State Examiners of Plumbers and Gas Fitters cc: North Andover Plumbing and Gas Fitting Inspector Mr. Michael Keller PHONE - 617-727-6388 FAX - 617-727-6095 WEB - http://www.mass.gov/dpl/boards/pi/ Date ... 677.2,5- e!)(F ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING that AY..:�A This certifies ....................... .... . ...... has permission to perform ................................. ...................... wiring in the building of ... ....... A ... /.. - . ....... . ......................... / 0a at ...... -.,(w ........ 4,orth Andover, Mass. -A4 Fee ... ....... Lic. No..2�.. V*.7 .............. 412 . ...... ...... /11,1Z ELE&CiCAL INSPECTOR Check # 8208, A - - ------ I-acr-ssamusetts Department of Fire Services OficialUse Permit No. I I BOARD OF FIRE PREVENTIONcy an 'e' . REGULATIONS cc and LV7110 :7 (leave blank APPLICATION FOR PERMIT TO PERFORM in ELECTRICAL U work to be performed accordance with the Massachusetts Electrical Code (MEO, -527 CMR 12.00WORK (PLEASE PRINT BVRX OR =EALL.5VF0RXfA rjojq City or TOWR of: NORTH ANDOVER Date: 4/09 By this application the undersigned gives notice of his r Lnf,�� ..To thelnspeVcr off W_2*�. � fi", +, or her mtetion to 0 -4— perform the electrical work described below. Location (Street & Number) Owner or Tenant . . .... ... Owner's Address Telephone No. Is this permit in conjunction with a building permit? -------- Purpose of Building tJo,) f2, --k— L-b�S Yes b!j No FJ (Check Appropriate Box) E3isting Service Amps Utility Authorization dgrd New StIlia Amp Volts Overhead FYV UA. 0 No. of Meters ZgL— L'P-yL.LVO1ts Overhead P' Undgrd D N .Number Of Feeders and Ampacity (1. of Meters Location and Nature of Proposed Electrical Worla- No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. Of Receptacle Outlets No. Of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers No. of water Heaters KW No. Hydromassaw ,e Bathtubs Com wietiono' the No. of Ceii-Susp. (Paddle) F., No. of Hot Tubs Swimming Poolo�yeln a 0 !!: d. No. of oil 13 U-Xmers No. of Gm Bou-ners No.. of Air Cond. otal eat ump umbTons To er Tons Space/Area Heating KW Heating Appliances 0. of No. of Si Ballasts ---------- No. of Motors . T . otal Hp wm table he waived by the IW=o may ­—To—ad Transformers KVA Transformers Generators KIVA ED 0. 0 Mergency Ig ED natte units ALARMS kT.,i Vx c NoT_ . of Zones I Of Alerting Devices of elf: Contained ctionj,ue Q Devices a EDMunicipal Connection 13 Other city Systems - In. of Devices or tn��nt whing: 10. of Devices or aivaient l —. :01nalunicatioiTs o.of Deviem nr rM.-L, Estimated Value of Electrical Work -Attach additional detail if desired oras to -(When required by municipal policy ..)required by the Inspector of Wires. Work' Start: L'Te 'ons to be requested in accordance 1NSURA-NC]f CC AVVVRI�_O_ W,"GE: Unless waived With IVMC Rule 10, and upon -completion. the licensee Provides proof of liabili - by the owner, no Permit for the Pefformance of electrical undersigned certifies that such co, !!Y insurance including "completed operation- coverage or work may issue -unless its substantial equivalent The 3 CF V, ge Is m force, and has exhibited proof of same to the Permit issuing office. B NSLMAN BONDED OTHER .(Specify. CHECK ONE: T I certify, under the pains and penaldes. ofperjury, that, the inf FIRM NAME: 111, 119 ormaijon on this aPPhL-adOn is true and complete _4Z fa) fic Licensee: LIC. NO.: (TfappLicable, enter in the amber Li LIC. No.. atnre Address: Cp *Per M.GJ, c. 147, s. 57-61, security work. Bus. Tel. No.: requires Dep ent of Public le "Sit Alt. Tel. No.: OWNER'S INSURANCE WAINER: I License; Li.c. No. am aware that the Licensee does not have the habili required by law. By my signature below, I hereby waive this requirement ty msuranc coverage normally Owner/Agent I am the (check one) ED own e Signature Telephone No D owner's a ent -�. �� \ i -Ar "9 w b t M Policy # or Self -ins. Lic p Eipirstion Date: Job Site Addross: Attach a copy ofthe .workeW cow Crfy�ta�/Lm: lv 'J `lyYn�i��a.✓ PeasatioD policy declaration page (showing the porcy Dumber and expiration date Failure to secure coverage as required under Section 25A of � � �•�� fine up to $1,500»00 and/or one-year im MGL e. 152 can feed to the imposition of criminal partaities Of up to 1250.00 a Y or. Be a vi as well tis civil penalties in the form of a STOP V�ORfC Oyu of fine gallons of tfse day violator. Be advised that a copy of this statement may be forwarded to the Office oandf investi ftmzance coverage verification. •sereoy cerci r nsfer the pouts and pessatties ofP�Jary tfim' the isrformaiio>t rot,�r� Si siure: �° above /rue and correct Dater Phone Official srsr artly, Do not ayrtte rill .this area, iv -he compler'd by efty or town of zcW City or Tows; Issuing Authority (circle one): PernawLicense # I. Board of Health 2. SuAffing De b. Other parEsuent 3. city/Town Clerk 4. Electrical Inspector 5. Plumbing laspecfar Contact Person: Phone #r • ,P Comnwftweajh ofMassachusear j , Department Of lndustrid Accidents QjrWe iNX of Investigaiions . ��a %� 600 Washinjon Sireel` Bastorx, MA 02111 aviLsgavltiia . Workers' Compensation Insurance Affidavit: A at Information Builders/Co •Resntractors0ectricians/plumbers Please Print Legibly Nalne (Business/O rganiration/individuao) rIr Address: ' City/5te/Zip;�ro�c=(�� %LAiA ?� Phone #:.`g )ti f --CrO C n employer? Check the a PPrep�te�bo= a employer with 4. ❑ I am a Type.o Pref (requir^I generalcontractor and IY o ees. {full and/or part-time).* asole proprietoror . have hiretd the sx&r,rttsactors 6Naw construction Folepartxter- have no em i ees oYThese Iisisd on the attached sheet 3 7.nd ❑Remodeling stti�-conttactots have n forme in g any capacity, comp, insru anee workers com insurance.' Q Demolitionorkers' 5.VJe are a corporation end its : • ❑ Building addition d ] homeowner doing all work •: Office= have exercised their 10.❑ Electrical ri �p or additions Of rrryseI£. END -work, rs' comp. Per MGL 11.❑ I'fumb' c .152; § 1(41•and we have no � repairs or additions rnstaartce required.] t .tmrptoye :& [No workers' 12.[]Roof repairs *Any eppiicmntthat �P• insurance required_] I3-E1.Other checks botty/ 1 must also fill out the section below showing their woricers' briinpettsatien t Homeowners who anbtttit this esti-aiavit indicating *they iCottnacton that chcok ffiis box mustattaobed an x addihm.W f — dvin all work policy infomuttion gand Then hire outside oonmu:t o must submit a new affidavit indicating etch sheershowmg the starttr of tiri n6.0.. �` sc w.s erd ti i, wow °comp. am an esnpioyer tltat.is , Policy ininnnadon. utformafioa. ';°"�uag:warkesss compeasadej, irssurauce for my. ees Below k.the policy Insurance Company Names:_ mrd job site M Policy # or Self -ins. Lic p Eipirstion Date: Job Site Addross: Attach a copy ofthe .workeW cow Crfy�ta�/Lm: lv 'J `lyYn�i��a.✓ PeasatioD policy declaration page (showing the porcy Dumber and expiration date Failure to secure coverage as required under Section 25A of � � �•�� fine up to $1,500»00 and/or one-year im MGL e. 152 can feed to the imposition of criminal partaities Of up to 1250.00 a Y or. Be a vi as well tis civil penalties in the form of a STOP V�ORfC Oyu of fine gallons of tfse day violator. Be advised that a copy of this statement may be forwarded to the Office oandf investi ftmzance coverage verification. •sereoy cerci r nsfer the pouts and pessatties ofP�Jary tfim' the isrformaiio>t rot,�r� Si siure: �° above /rue and correct Dater Phone Official srsr artly, Do not ayrtte rill .this area, iv -he compler'd by efty or town of zcW City or Tows; Issuing Authority (circle one): PernawLicense # I. Board of Health 2. SuAffing De b. Other parEsuent 3. city/Town Clerk 4. Electrical Inspector 5. Plumbing laspecfar Contact Person: Phone #r Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp.Ioyers to provide workers' compensationfor their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under arty contract of hire, express or implied, oral or written." , An ernployer is defined as "an individual, partnership, assaciafdon, corporation or other legal entity, or anytwo or more ofthelburping engaged in a joint entrprise, and including the legal representatives of a deceased employer, or the receiver or tnsste a -of an individual; partnership, association or other legal entity, employing empioyees. '1-ioweverthe owner of a dwelling house having net more thea thr= agar-tments and Who' esides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dweliinghouse or on the grounds or building appurtenant thereto shall not because of sucb employment bo deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state ora- local licensing age ney shall withhold the issuance or renewal of a license or permit to operate a business or to constmet buildings is the commonwealth for any appiicaat who has not produced acceptable evideuce.of compliance with the insurance coverage required." Additionally, MOIL chapter 152, §25C(7) 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 insraance requirements of this chapter have been presorted to the contracting authmity." Applicants Please fill out the workers' compm =60n• affidavit 00mpietely, by checking the boxes that apply to your situation and; if necessary, supply sub-corrtractor(s) n2me(s4 addrms.(es) 2md phone number(s) along with #heir certificate(s)of finer == Limited Liability Companies -(LLC) or Limited. Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cagy workers' Mampensation insurance. if an LLC. or LLP does have employees, a .policy is required. Be advised 6.= this affiriatnit.nlay be submitted to the Department of industrial Acciderm for confirmation of iron=e coverage.. Also 'be sure to sign and slate the affidavit The affidavit should be returned to the city or town that the application for the pcimit or license is being requested, not'the Department of industrial Accidents. .Sh6 d you have any questions regaz-ding the lave or if you.are required to obtain a work=! oompensat:ion policy,:piease-tail the Department at the nux-nber listed below. Self insured cc=panies should enter their self-insunance'.jieense rummer 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 pesmit/licemc nuanber which %%-i;lI be used as a reference number. in addition, an applicant that. must submit multiple. parmit/iicense applications in any given year, need only submit one affidavit indicating•currarrt policy infbm- ation (if necessary) and under "Job Site Adch-ess- the applicant should write "all locations in (city or town)." A copy ofibe affidavit that has bean officially stamped or marked by the city or town may be provided to the applicant as proof that a valid-afErdavrt is on file for fu a rft permits or licenses. A newaffidavit must be filled out' each year. When a home owner or citizen is obtaining a license or permit not related to any businrm or commercial .venture (i.e..a dog iicernsa of permit to bum leaves etc.) said person is NOT required to.camplete oris affidavit Trot Office of investigations would IDD. to thank you in advance for your cooperation and should you have any questions, please do not. hesitate to give us.a call. The Department's address,, telephone and fax number: The COMmOnwmalth of Massachusetts Departorent of Industtia( Accid=ts wee of-Iavesk-ations 600 Washington Street Boston, MA €1211-1 TeL # 617-7274900 ext 406 or 1-877-MA.SSAFE Revised 5-26-05 Fax # 617-727-7744 wwwmass.gov/dia Ut ZDate:\4 0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING . . . . . . . . . . This certifies that . .'. L.� ..... * .......... has permission to perform ......... ......... plumbing in the buildings of,./ A-�. !�9/ ..... at. North Andover, Mass. K Fee.�? ....... Lic. No. -1:7Z A6J ................ PLU,�',Bl NSPECTOR Check # 7726 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Lpcation VN5 ` 4 v; I( coo o Date 1 - % • 0 )wners Name % -Wt4 d A Rr(,06 permit # Py (7'b—�v -0Amountof Occu anc New ri' Renova Replacement "1:1 1 Plans Submitted Yes ❑ No ❑ IWWW114 (Print or type) Check one: Certificate Installing Company Name t �t>-�p I ,fl, l�} ❑Corp. Address _ % CJ !� Partner. u�iness Telephone G57 ,rT k , / 5 -Fl Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance poi Other type of indemnity F1Bond ❑ Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have sub' (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ins ations p onn der Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts to lumb' ±;�42 of the General Laws. By'igna ure o is um er Type of Plumbing License Title City/Town cense um er'�— Master ElJourneymanAPPROVED (OFFICE USE ONLY CM W_ CIO WX Architecture Interior Design 410 Boston Post Road Sudbury, MA 01776 tel. 978.443.6383 fax. 978.443.1360 em, webmail@kangarchicects.com www.kangarchitects.com June 2, 2008 Mr. Gerald Brown Inspector of Buildings Town of North Andover 1600 Osgood Street N. Andover, MA 01845 Re:, O Stevens Porid Pavilion— Dear Mr. Brown: As you suggested, I am writing this letter to confirm our telephone conversation on Friday, May 31, regarding the elevated walkway for the referenced project. With reference to the 6`h Edition of the Massachusetts Building Code (780CMR) and the Regulations of the MAAB (521 CMR), for both of which you are the enforcement agent, we agree on the following (code references are in parentheses): • A walkway that is pitched no more than 1:20 is considered a walkway and not a ramp. (780CMR 1016.5 and 521CMR 22.3) As such, handicapped railings are not required. • A walkway that is elevated above grade no more than 2'-6" is not required to have guard rails. (780CMR 1005.5) These are the conditions of our elevated walkway. It will pitch no more than 1:20 and it will not be higher than 2'-6" above grade at any point. We also discussed the possibility of adding some optional precautions for the safety of the public. Because they would be voluntarily improvements, any such precautions, such as a safety rail or a curb, do not need to meet any particular dimensional requirements from the Building Code, such as those for a guard rail. You favor adding some precautions because this is a public building, but will not require it. I trust this accurately reflects our conversation and your understanding of relevant codes. Thank you for your assistance. Yours truly, Kaffee Kang TOWN OF NORTH ANDOVER Office U the .guilding Department Community Development and. Seii ices 27 Charles Street North Andover, .Massachusetts 01845 D. Robert Nicetta, Buildirr" Coit inis5'ioll er March 12, 2003 To Whom It May Concern: Telephone (978) 658-9545 FAX (978) 688-9542. 40 At S Please be advised that upon review of the site plan prepared by Scott Giles in regard to the property located in North Andover and known as map 95 parcel 24 I have the following observation. The property is located in the R-3 zoning district, which requires 25000 square foot lot size, 30 - foot front and rear setbacks and a 20 -foot side setback with 125 feet of street frontage. It appears that the plan prepared in March of 2003 has all the required dimensions and that when all the required sign -offs from the different departments are obtained a building permit can be issued. I hope that this letter will satisfy any questions that may arise. If there are any further questions I may be reached at 978-688-9545 between the hours of 8:30 — 10:00 AM and 1:00 — 2:00 PM . Respectfully, /�uL.je AY� � — Michael McGuire Local Building Inspector t INCORPORATED Gerald 1. Brecher President / CEO 51 Middlesex Street N. Chelmsford, MA 0 1863 USA Tel 978 251 8088 Fax 978 251 8585 jerry@suturtek.com., w.ww.suturtek.com, BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 9 6 -5' Date Received Date Issued: 6-"1AAf- / V-Stteo �°i��0 °� IMPORTANT: Applicant must complete all items on this page LOCATION Rra PROPERTY OWNER d , Print .MAP NO: PARCEL: T ZONING. DISTRICT. Historic District yes Ano Machine Shop Village ves 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer OWNER: Name: Address: Azo CONTRACTOR Address. -4, Supervisor's Home Impro Ut,5�;KIF' I IUN OF WUKK TO BE PREFORMED: Identification Please Type or Print Clearly) Phone: I -a/ ��. Exp. Date: Exp. Date: --/15-. ARCHITECT/ENGINEER Phone: Address: A/o d Reg. No. FEE SCHEDULE. BOLDING PERMIT. • $12.00 PER $1000.00 OF HE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �/� , (069-- FEE: $ /V1 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t#e guaranty and ig5� nature of Agent/Owner r Sig tarp ure of co.ntcacto 06 �g 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 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 ❑ 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) I ❑ 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 2.2008 C Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL !E25 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on COMMENTS Sianature HEALTH Reviewed on v/ '/` ,v f Sianature I/V" I'�—, f COMMENTS —��- �✓'� �-c S 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: FIRE DEPARTMENT Temp Dumpster Located,at 124 Main Street FireDepartment signature/date COMMENTS Located 364 USgood Street site yes no` y 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup'- Date Doc.Building Permit Revised 2008 d - Location No. Ig Date ;12 f14�e /Q - A- 150 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee Other Permit Fee $ TOTAL Check # — Z"I - f 21 i 48 g5tuilding inspector r Q COD Z a oa TO: Jeff Vicente COMPANY: BC DATE: May 6, 2008 RE: Stevens Pond With this letter, we are sending the following: FROM: Kang Associates, Inc. 410 Boston Post Road Sudbury, MA 01776 tel: 978-443-6383 fax: 978-443-1360 em: webmail (a)kangarchitects. corn www.kangarchitects.com COPIES DATE NO. DESCRIPTION 3 stamped dwgs 1 original stamped affidavit REMARKS: COPIES TO: SIGNED: CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: DATE: May 6, 2 0.o s PROJECT TITLE: Stevens Pond Pavilion PROJECT LOCATION: 12 Stevens Street, North Andover, MA NAME OF BUILDING: SCOPE OF PROJECT: New bath house on existing foundations. IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUILDING CODE, I Ka f f e e Kang MASS. REGISTRATION NO. 5287 BEING A REGISTERED PROFESSIONAL ENGINEERJARCHITECT HEREBY CERTIFY THAT I HAVE , PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF. ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT x ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER (specify) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT. IYURTHER 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 116.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code -required controlledmaterials. 3. Special architectural or.engmeering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix B. . UPON COMPLETION OF THE W RK, I SHALL SUBMIT A FINAL REPORT AS TO THE. SATISFACY�. COMPLET�OIGAND AD S `OF PROJECT FOR OCCUPANCY. 4 iay :J Signature 's SUBSCRIBED AND SWORN TO BEFORE ME THIS `� DAY OF 200 V 9<•• U. � . �rARY P�� Y PUBLIC MY COMMISSION EXPIRES ON The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers DDlicant Information Please Print Legibl, Name (Business/Organization/Individual): Address: 3g5 City/State/Zip: a 7./� . / 24 Nei Phone .#: �l%6 - -5-C�2 Are you an employer? ChAk the appropriate box: 1._2 I am a employer with /�C 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required):, 6. ❑ New construction 7. ❑ Remodeling & ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *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. lContractors 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 employees. Below is the policy and job site information. Insurance Company Name: °Policy # or Self -ins. Lic.#: �(�yC�, y� Expiration Date: //-oi Job Site Address:_ /2 .JTGd�/Js' JY- City/State/Zip:/'VA/daytr "Om Attach a copy of the workers' compensation 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 coverag"erification. Ido hereby certif, nder th p n and pen tie of perju , tha the information provided above is true and correct. o Si nature: Date: Phone #: : ,��— I'll �40 — 4�� 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 Contact. Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. 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 trustee 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(7) 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 this 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 certificate(s) 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 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 6.17-727-4900 ext 406 or 1-877-MASSAFE Revised 11,22-06 Fax # 617-727-7749 www.mass.gov/dia ACQRQ CERTIFICATE OF LIABILITY INSURANCE DATE 1 04/04/2008) PRODUCER(860)333-7234 FAX (508)655-8853 EASTERN INSURANCE GROUP LLC 233 WEST CENTRAL STREET NATICK, MA 01760 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED B C Construction Co Inc 385 Main Street Wakefield, MA 01880 INSURERA: Harleysville Worcester Ins Co 26182 INSURERB: Guard Insurance Company INSURER C: INSURER D: - INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR DD' NRR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONI DATE iMMIDDNY) LIMITS GENERAL LIABILITY MPA8J4465 11/23/2007 11/23/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE IF_ I OCCUR DAMAGE TO RENTED $ 100,000 PRFMIRFS (Fa nccurpnrp.� MED EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY M PRO- JECT M LOC AUTOMOBILE LIABILITY ANY AUTO BA8J4465 11/23/2007 11/23/2008 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY $ (Per person) A X _T X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ i ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY BE8J4465 11/23/2007 11/23/2008 EACH OCCURRENCE $ 3,000,000 X OCCUR D CLAIMS MADE AGGREGATE $ 3,000,000 A $ DEDUCTIBLE $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC808348 - 11/21/2007 11/21/2008 1 WCSTAAU-O R E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: CONSTRUCTION OF THE STEVENS POND PAVILION TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Rosemary Ful ham/PMA '`"-a ACORD 25 (2001/08) ©ACORD CORPORATION 1988