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HomeMy WebLinkAboutMiscellaneous - 26 MAIN STREET 4/30/2018 (4)I" � / 10 Date ... �A.('b .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that..0.C"Apj"' �—JP o A' Seip % . ........................................................................................................... has permission to perfo'm�..Q..—)- , -'"--5'0' ....... .. ........ A� .................................................................. wiring in the building, of ... �.r ... 1P ........................................................................... . ........... .. .... ... .... at ....... 2(p MA,�- -' -7 ................................................................. Jr ... N AAndover, M ss. ........... Fee .... ...... .......... ........... Lic. NoL.!�U:�,t Mb ELEc-m rAz SPEcroR Check # 6'5 - -s Commonwealth of Massachusetts o Department of Fire Services a BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. i l LHJ Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: I 6 v /3 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) (2 A /a' AJ /7 r Owner or Tenant J Owner's Address 160Y 60.2 Is this permit in conjunction with a building permit? Telephone No. Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Amps - Existing Service / Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Volts No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f%/V / /^e- n &k l ' `7"o �✓ ('mmplctinn nftha fnUnwinv tahle may be waived by the Inspector of Fires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans Tr s Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lig ting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No. of Detection and No. of Switches No. of Gas Burners InitiatingDevices No. of Ranges No. of Air Cond. TotTons No. of Alerting Devices Heat Pump Number Tons W. No. of Self -Contained No. of Waste Disposers p Totals: Detection/AlertingDevices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal El Other Connection No. of Dryers Y Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring No. of Devices or Equivalent OTHER: Attach additional detail f destred, or as regidrea oy me tnspecior ql krArea. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability ins nce including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover ,Xe'is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, lander the p ins an enalties of per ury, that the information on this application is true and complete. FIRM NAME: f //ta , er- )"Ai r, e � „J i.' v/ est'6 LIC. NO.: / 11 S Licensee: pn,►lei' I- C��/e�ignature (If applicable, a er "exe t" in the license umber line. / Bus. Tel. No -1 /b 1V L /I Address: �/ 10 a l nhl ✓1� �� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-6f, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ 3 O� Signature Telephone No. S U 3 )j A 3. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the v permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: 3 — 7 ROUGH PECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: —7 — FINAL INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments. Inspectors Signature: V Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com 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 Applicant Information Please Print Legibly Name (Business/Organizati6n/Individual): City/State/Zip:, Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Dontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site :formation. isurance Company N olicy # or Self -ins. Lic. #: Expiration Date: :)b Site Address: City/State/Zip: Atach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby cert under the pains and pena1des,ofperjury that the information provided above is true and correct 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): l I. 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 cavy workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be 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. Anew 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 021.11 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE .evised 5-26-05 Fax # 617-727-7749 wvvw.mass.Pov/dia + - .'�• •�f'" Lw X31 n0.'•L G P co �. cu N U Fp15F Z O Q y (Y m W N 3 W Ko W : - • o > • � o � P m Q J1 N ' M. � • , p Q o ?. of Lo W 86003 f i N J • t 1 • f - f/ + i FEB -21-2013 13:01 PAUL DAVIES ASSOCIATES RAVON A - AW Powil D3viies Azar—Amffleclts February 14, 2013 L Mr. Gerald Brown, Inspector of Buildings 1600 Osgood St. - North Andover, MA 01845 978 654 5135 P.01i01 Re: Project 3127 Jeffco, Inc Eight Unit Condominium 26 Main St. North Andover, MA Dear Mr. Brown; The developer of the above referenced project would like to relocate the second means of egress of each unit from the second level deck to a rear 2'-8" door. This complies with the 81h Edition of the Massachusetts State Building Code, Section R311 Means of Egress. If you have any questions please call All; PnrYarc .Ct 11nit A 1 nwP11. MA 01852 978-459-2154 TOTAL P.01 181 Date. ! l/3........ . TOWN OF NORTH ANDOVER o ...,. a • PERMIT FOR MECHANICAL INSTALLATION This certifies that �.! !!.`.r.! ,�?..��! has permission for mechanical installation .. ...... .:..........1'�?l in the buildings of at -�.``�?^ ''?� !^;, , 1,— , North Andover, Mass. Fee.��c.. Lic. No�a�13V ..... �! ............ ! ..... . (�. ( J 2 '? ?, o GAS INSPECTOR r WHITE: Applicant CANARY: Building Dept. ' PINK: Treasurer r Yet Commonwealth of Massachusetts Shecd Metal Permit Date: j�l� 13_-- Permit# / d' Estimated Job Cost: $ a0 U U Permit Fee: `h Plans Submitted: 'YES NO Plans Reviewed: 'YES NO Business License # 69 Applicant License /1 — � 3 ( _ Business Information:Property Owner /Job Location Information; Name: ,itis ("fp Nx'1nn rto-n S� a'�i �� Name: , Street s s w � S _ Street: J -k -Q M�� City/Town:w ICS �c�r City/Town: k oc���`�`��� Telephone: ����� �S (- �{ d(telephone: -- Photo LD, required /Copy of Photo f.D. attached: YES NO sr,;rrt;��rt;;i unrestricted licet,Se � J-2 / M-2-restrictecl to dwellings 3 -stories or less and commercial up to 10,000 sq, ft. / 2 -stories or less Residential: 1-2 family Mu(ti-farnily __. Condo / "townhouses Othcr Commercial: Office Retail Industrial Educational Institutional Other Square .Footage: unCier 10,000 sq. ft:. over 10,000 sq. ft. Number of Stories: 3 Sheet metal work to be completed: New Work: Renovation: HVAC � Metal Watershed Rooting . Kitchen Exhaust System Metal Chimney / Vents Air Balancing I Provide detailed description of work to be done: ✓ II_ I Lr`S �l rrt� W�r� 0-;T (�qkr c w�1� A[c �1�`S2w„rfi i A -U a C r u 5 S �¢ C �� 0 04 Ij c �c�t _ �r alt K_ CI)_ I INSURANCE COVERAGE: I have a current liability insurance policy or its equivalentwhich meets the requirements of M.G.L. Ch. 112 Yes rdNo ❑ If YOU have checked Yes, indicate the type of coverage by checking the appropriate box below; A liability insurance policy E Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives. this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box , 1 horoby certify that all of the dotalls and Information I have submlttod (or entered) regarding this application aro true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with ail pertinent provision of the Massachusetts Qullding Code and Chapter 1.12 of the General Laws. Duct inspection required prior to Insulation Installation: YES NO Datc Date T'�l-eys Inspections Conlincrits Final 111s lection Inspector Signature of Permit Approval Signature of Licensee License Number: 5 3 Check at www.mass,ciov_/clpl Type of License: By ❑ Master Title ❑ Master -Restricted City/Town Joirrneyperson Permit # ❑Journeyperson-Restricled Fee $ ❑ Inspector Signature of Permit Approval Signature of Licensee License Number: 5 3 Check at www.mass,ciov_/clpl Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations e/ Duct work sized per manual "D" calculations ✓ Bath / shower rooms contain mechanical exhaust fan vented outdoors V— Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct nuns installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers �— Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) lu The Commonwealth of Massachusetts on Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): �x1i/ j `6N 06A Address: SS 5 w Al-(- S� City/State/Zip:, --7;-w 14swt AA 0 V%-) G Phone #: (5),i) -s 5 1-,-(4 i5 3 sire you an employer? Check the appropriate box: EY am a employer with 4 U 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their E] I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.0 Plumbing repairs or additions 12. F1 Roof repairs 13.[x.Other 14VAL- iy applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. rrt im employer that is providing workers' compensation insurance for my employees. Below is the policy and job site brmation. urance Company Name: 9X -P. ( & 5 5 icy # or Self -ins. Lic. #: �`� h 0,0 Expiration Date: Cv 1 3 of) Site Address:_ - ,s ( U_ 'l c6 City/State/Zip: :ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a '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 tp to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. hereby certify under thg pahm andpenalties of perjatry that the information provided above is trate and correct. nature: Date: )fflcial rise only. Do not write in this area, to be completed by city or town official. :ity or Town: Permit/License # ssuing Authority (circle one): . Board of Health 2. Building Department 3. City/To-tvn Clerk 4. Electrical Inspector 5. Plumbing Inspector Other HEATING SERVICE Load Short Form Job: Date: Jan 16, 2013 Entire mouse By: mfh Franks Heating Service 555 Woburn St, Tewksbury, MA 0,1876 Phl,ne: 978-851-4403 Fax: 978-851-0398 oec's�Pt m��rInforaon p .• h , For: ,A1 ,Main st north andover. HEATING EQUIPMENT Make Trade Model AHRI ref Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80 AFUE 0 Btuh 0 Btuh Htg Clg Infiltration Outside db (°F) 1 88 Method Simplified Inside db (°F) 70 75 Construction quality Tight Design TD (°F) 69 13 Fireplaces 1 (Tight) Daily range - M Inside humidity (%) 30 50 Moisture difference (gr/Ib) 28 28 usm HEATING EQUIPMENT Make Trade Model AHRI ref Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80 AFUE 0 Btuh 0 Btuh 0 °F 766 cfm 0.035 cfm/Btuh 0.50 in H2O COOLING EQUIPMENT Make Trade Cond Coil AHRI ref Efficiency Sensible cooling Latent cooling Total cooling Actual air flow Air flow factor Static pressure Load sensible heat ratio 0 SEER Area (ft2) 0 Btuh 0 Btuh 0 Btuh 766 cfm 0.050 cfm/Btuh 0.50 in H2O 0.90 2190 ROOM NAME Area (ft2) Htg load (Btuh) Clg load (Btuh) Htg AVF (cfm) Clg AVF (cfm) ent 128 2525 812 89 41 din kit 200 3071 2190 108 109 lav 46 698 947 25 47 liv 298 3728 4127 131 206 bed2 174 1374 710 48 35 wic 33 696 100 24 5 bath 55 853 968 30 48 bed1 158 2701 2467 95 123 hall 123 642 539 23 27 wic') 91 1385 281 49 14 m bath 56 591 615 21 31 3509 1576 11)3 7a mas 373 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2013 -Jan -16 13:11:41 -�- wrightsoft' Right -Suite® Universal 2012 12.0.09 RSU10062 Page 1 fiCCa, F:\Wrightsoft HVAC2\Project\24 Main st north andover end unit.rup Calc = MJ8 Front Door faces: /7 A Entire House d 1734 21774 15332 766 766 Other equip loads 0 0 Equip. @ 1.00 RSM 15332 Latent cooling 1646 TOTALS 1734 21774 16978 766 766 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 41 wri htsoft° 2013-Jan-1613:age } Right -Suite® Universal 2012 12.0.09 RSU10062 Page 2 10C -K F:\Wrightsoft HVAC2\Project\24 Main st north andover end unit.rup Calc = MJ8 Front Door faces: I Cf) 0 0 `N 0= o CA r CM Cl) M ;U --j z M z U) M > > m m • -< 10-4m > < m > M> w o ;or - 3 m < cn* m 00 0 In > z m, ;a g > Z CA Cl) co m ZM --4 ;P;o U) ):p U4 MG) 0 Ln (.4 M to -4 4 .Ln -4 (D Cl) 00, P -el 41 Signature i. Client#: 53676 HILLISFRAN2 ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TYPE OF INSURANCE 1 1/18/2013 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: nee.certificates@hubinternatio HUB International New England PHONE 978 657-5100 F 866-475-7959 AIC No Ext : A1C Nol: 299 Ballardvale St E-MAIL Wilmington, MA 01887 ADDRESS: PERSONAL & ADV INJURY $1,000,000 INSURER(S) AFFORDING COVERAGE NAIC a 978 657-5100 INSURER A: Peerless Insurance Co 24198 INSURED INSURER B: Atlantic Charter 44326 Hillis Corp LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS DBA Frank's Heating Service INSURER C BA1059735 555 Woburn St INSURER D: COMBINED SINGLE LIMIT Ea accident $1,000,000 Tewksbury, MA 01876 INSURER E: PROPERTY DAMAGE $ Per acddent INSURER F: COVERAGES 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 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDDIYY POLICY EXP MM/DDlYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR X Blnkt Add Ins: Prod] X X CBP1059734 Compl Ops:as per 6/30/2012 executed 06/3012013 contract EEAACHq�OECCCUR��RENCE $1,000,000 RENTED 000,000 PREMISES Ea OOO MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X jE � LOC PRODUCTS - COMP/OP AGG s2,0001000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X BA1059735 6/30/2012 06/30/201 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per acddent A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE X CU8917751 6/30/2012 0613012013 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000 DED ION$10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIV'E YIN OFF?CER/MEMBER EXCLUDED? � (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCA00514205 6!30/2012 06/30/201 WC STATU- OTH- X E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 81_121« Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street, Bldg 20 ACCORDANCE WITH THE POLICY PROVISIONS. Suite 2-36 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©19$8-2010 ACORD CORPORATION. All rights reserved.