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Home My WebLink AboutMiscellaneous - 284 APPLETON STREET 4/30/2018 (2)0 0 m 0 z m m 2012 Mqssachusetts Electrical Code Amendments 527 CMR12,00 § Rule 8: laaccordance-withth�provisionsofM.CT.L.c.143, 3L, the permit application forin to provide notice ofinstallation ofwiring sh all be uniform throughoutthe Commonwealth, and applications shall be filed - on the prescribed form. After a permit application has been accepted by an Inspector of Wires ap' pointed pursuant to M. GI c. 166, § 32, an. electrical permit shall he issued to the person, firm or corporation stated on the. permit application, Such entity shall be responsible for the notification ofcompletion ofthe -work as required in.M.a.L. c. 143, § 3L. Permits shLbe limited as to the time of.ongoing construction activity, and may bedeemed-by-the Jnspector-of-W.ires abandoned-arid-irivalid-if-he- or she has determined tl�at the authorized worl� has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion ofwork shall be permitted for reasonable cause. A permit shall be terminated upon the written request ofelther the owner or the installing entity stated on fhe� permit application. I El The Permit Extension Act was created by Section 173 of Clia*r 240 of the Arts of 2010 and extended by Sections.74 and 75 of Chaptfr 238 of I the Acts of 2012. The purpose of this act is to promote7job,growth and long-term economic recovery and the Permit Extension Act ftuthers this purpose by establishing an automatic four-year extension to certain7permits -and licenses concerning theiise or development of real property� With limited exceptions, the Act automatically dxtends, for four years beyond its otherwise applicable expiration date, any permit or approval thdt was "in effect or existence" during the qu'alifying period beginning on August 15,2008.and extend-ing'through August 15,2012. 8—Permit/Da.te Closed: 0 Permit Extension Act — Permit[Date Closed: Note:.Reapply for new permit-g�— 8 b 3 Date .... ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................. .............................................................. has permission to perform ............... I t 55 4 t,.. a .. f 7 -/-/ ..... ................... wiring in the building of ....... .......................................... at)....,) ....... 5./ ............. North Andover, Mass. ...... Lic. N ............ .. ................ . ... ........ Fee ..... 0_41��_" . ................ �*�� ........ .. ....... 7-` E cmcAL 1 Check #33-116-)_5 00-1c ial Use nl%- On Permit No. 7 Occupancv and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 107 deze blank) --- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All %%ork to he perflormed inaccordance `irll [Ile,\ Id--huselts Eleciric�d COde f NIEC 1. 5-1- CNIR I I oo (PL EASE PRIXT [VIN'K OR TYPE .4 LL vp ) L-1 T!( ).-N D ate: Citv or Town of*: 1�_,/-Y7 B% this appli' 1he cation tile undersigned notice ot his or her inten,1011 to perforill tile electricil work describcd helo\�. Location (Street & Number.) Q?,? q O�s ner or Tenant ONs n er's Acid ress ;ILL— Telephone No.&z0__399_ ecls-5 Is this permit in conjunction v6ith a buildin,2 permit., es F7 N o �2 (Check Appropriate Box) Purpose of Buildin2 L tilit" Authorization No. Exisrin2 Ser% ice Amps Volts O%erfiead L nd!!rd No. of:�leters Neiv Sen -ice Amps Volts 0 N er h ea d 7 — 1. ndard \0. of �Ieters -Number of Feeders and AmpacirN Lo - cation and Nature of Proposed Electrical IVork: V 01� ta�le Ira, e .No. of Recessed Luminaires N Insj�),cror at Wirey. 0- Of Ceil.-Susp. (Paddle) F:ins Total N - o. of Luminaire Itlets No. of Hot Tubs I Jr-ansformers KVA lGenerarors KVA No. of Luminaires Is"immin- Pool n — — — 1____7_o —5F 11 ! llergencv 12nimLy I 2,rid. urrid. L-� !Batten* Unit -s No. of Receptacle outlets I— — No. of Switches INO. of Oil Burners IFIRE ALAR:�IS No4 of Zones INO. of Gas Burners :,to- or Detection and No. of Rancres I Initi-Iting, Devices Total INO. ofAir Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Nu ber NO. of �Clz_%_Unlalnea Totals: No. of Dishwashers Detection/Alerting Devices Space/Area Heating KW Local C] Municipal 0 Other Connection No. of Dryers Heating Appliances Security S Stems-,� KW No. of Water o.'Of bevice� or Eouivalent Heaters KW 0.0 No. of Data Wiring: Signs Ballasts No. of Devices or E ivalent No. Hvdromassace Bathtubs I elecommunications Wi , No. of Motors Total HP N70. Of De ices or Eg ring OTHER: ---------------- V uivalent J .4ttach a �onal detad if dezired. or as "equired bY the Inspector of JIVires. Estimated Value of Elec al Work: XV (When required by municipal policy.) Work to Start: 16C I -TQ$ A A -_ Inspections to be requested in accordance with NIEC Rule 10, and upon completion. INS URANCE COVERAGE: Unless waived by the owner, no Permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "Completed operation" coverage or its substantial equiv'alent. The undersiened certifies that such coverage is in force, and h -as exhibited proof of same to the permit issuing office. CHECK ON1E:,flNSURANCE [Z BOND C] OTHER 0 (Specify:) Self insu-red a picaio, I certify, under the pains and penalties Ofperjury, that th ormation, Of' this application istrueandcomplete. FIRMNAME: ADT Security Ser -vices LIC. NO.: Licensee: MC`Lr�< A. 3roz)hv Sianature 7— LIC. NO.: C-45 (11'qqolicable, enter e,Tenipt " in the license number 11 -) I Address: 18 Clintcri Drive Hol . li's , DTH Bus. Tel. No.: 60-' -594 -5928. Alt. Tel. No.: *Per NI.G.L. c. 147, s. 57-61, Security work requires Department of Public Safety .. S- Lice'nse: 009S3 Lic. No. ON�`NEWS INSURANCE WAIVER: I am aware that the License- doesnot have tile liabilit-v insurance coverage normally required by law. By my signature below, I hereby waive this requirement. T am the (check one) [J o% Owner/Agent vntr [I owner7s agent. Signature — . Telephone No. PERIVITFF-E: S eG t claim # '13 7" Adjuster A4vantage 2100,Lakeview Ave, Dracut, tdA sualty Los S -Building Form of NO ti ce of- Ca 3B under Ka 5,5. Gen, LaWst Ch',, . 1 39 et TO: Buildi ng'�:O=nisqioner orl/ inspec��91� of B-tli-j,ci-ings Bo.ard of Health or Board Of 'SeleCtm9n Town Hall addres$ 17WAI eP18'7J Re: ln� ured: 6.-L)Kok lol�,4KRsR.. Propert-y. address 4 1010AF-7-,0 A'l IS7-'. Policy # 0?3 17" Y r a a Q f - File or Claim No, Cla-im has be . e . n Made involving 10,93 i dama ge Qr.destruction of the- above yf which ma� either exceed $1400--00-0r Cau" 9-0t.ioned propert plicable, X.f any Gen, Lawo,_Chalpter-143f—Sectionj to be aP . ec. 33 is apprQpr�ate. please notice under fdaa.s Gen Laws,—Ch 1.3.9—S Wt:te— ion of �h—e writer—and inaludg a refere�noe to the direct it to the . nt location, policy number, date of�- 19,90 and Qlaim' or captioned insured, file number, C, 6/v Te on this date, I Ca .. used copies of thiq notice to be sent to the persons named at the addresses indicated above by first Cl-aq,9 mail, Signature and date Claim Adjuster Adv�ntaqe Cla. .21-00 Lakeview Ave, Dracut, Kk 018-26 L; 0 -15uilding of Notice Qf--Casualty Q85 Sec, 35 under Kass', Gen, LaIN51 Ch',. 139i Board Of Heal-th To; Building'COMMj,ssioner Or f3Qard of SeleQtmen lnspec�Qi Of Buildings address Rall Town Hall KRS Property, addrass c� /0 policy #:o?3'7"- �Oqs of: /0/";? 'File or Claim NO, Cla-im has be . e . n Made inVolving 11 loss.i dama ge:Qr destructiQii of the- above au$e qw.ioned propertyr which ma� either exceed �Itoo-01.00-Qr C -f any Gen, _Laws, _Qbapter-1 4 3, -Section - 6 to be apP�IcablO, Ch, 13g Sec. 33 is appropriate. please notice under Mass-(3en-Law3t- - - - direct it to the attention Of the writer and inaludo a:-refere�nce to the captioned insured, location, policy nuirberr date of..- IP.9s and Qlaim'Q'r file number, C, TC Qn this da to, I QaU0 ed Copies of this notice `t6 be sent to the persons named at the addresses indicated above bY first class Mail, 7 signature and date Location No. g -z- Date 40RTN TOWN OF NORTH ANDOVER Certificate of Occulpancy $ MU Building/Frame Permit Fee $ t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Ll 23678 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: LWORTANT: LOCATION Date Received must complete all items on this Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 Addition 11 Alteration P(One family 0 Two or more family No. of units: 0 Industrial 0 Commercial KRepair, replacern E)nt El Demolition 0 Assessory Bldg El Other El Others: eptft Mililoogn) :d: t -r t4 M NX1,1,274 DESCRIPT10N OF WORK T 0 B PERFORMED: 6RFILD , JD,,�-My� <- - OWNER: N Address: CONTRACTOR Name: Identification Please Type or Print Clearly) Address: �— S4 -u � Rne L ALA) PLI�19rltA) / )WIP Supervisor's Construction License: <fS 47-777 3 Exp. Date: Home Improvement License: / 46 �Z r7 / 3 Exp. Date: ARCH ITECUENGINEER Phone: Address: Reg. No. Phone: ApLe) // - / lap/ / FEESCHEDULE.- BULDING PERMIT -7$1200 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ �5 FEE: $ 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 u 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 ci Photo CopVof H.I.C.And C.S.L. Licenses 0 Copy Of Contract u Flo or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) - u Engineering Affidavits for Engineered/products NOTE: All dumpster permits require sign off fro,m,/Fire Department prior to issuance of Bldg Permit New Construction (Single and Two/Family) • Building Permit Application/ • Certified Proposed Plot Pla/n • 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 u Mass check Energy Compliance Report ci Engineering Affidavits for Engineered.-p-roducts 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals bat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc -Building Permit Revised 2008mi 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 WNE LITE RATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DA U Notified for pickup - Date Doc:.Building Permit Revised 2008 I Plans Submitted El 01a'ns Waived El Certified Plot Plan 11. Stamped Plans El TYPE OF SEWERAGE DISPOSAL Public Sewer El Tanning/massage/Body Art El Swimming Pools Well El Tobacco Sales 0 Food Pacl�aging/Sales El Private (septic tank, etc. El Permanent Dumpster on Site n THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATEAPPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH COMM, ENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes L Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Ternp Dumpster on site yes --no. - Located at 124 Main Street Fire Dep"ent signature/date COMMENTS I CN 0�) U) c C'J 0 LO . > x ti. LLI CL C/) Oc U OD W Cl) ir C� L) Lu 0 Ir 3 LL CY U - w Lr) 0- I 104 E 9 rA rA 94 0 �2 C/) Or - C2 C=o CD COD C2 U) —Cd Ll� CD 0 ci, r. ZW P -W W4 r 6 V) 0 C/) CD :.S2 C.3 rL CL= C cc c CO Cc co Co= E cc CF W.2 1: :40 CL ca E.S W* CD 40 ts cD CID. m CC, s J= cc C13 C4) co CD C L2 L4 ca CD C:D .00 CS M03 cc ca Cl CD CL.- cl CO) 0- CD a LLJ g. -0 A) MD cc CO) CL= —W L) C3 4D A C3, C.3 CD =. c CO2 CL C3 :6 CO mm (a = C2 Co : CD L- :a C=o = 0... CL4- E M) C2 co CM ccl f CD I'M C2 CD C/) z 0 C/) P-4 U W, C/) z 0 Cf) C/) WE 0 4low 40.9 rl%i u 0 IOR �21 4-) 2 1�3 co ui C3 E co C2 CD :.S2 C.3 rL CL= C cc c CO Cc co Co= E cc CF W.2 1: :40 CL ca E.S W* CD 40 ts cD CID. m CC, s J= cc C13 C4) co CD C L2 L4 ca CD C:D .00 CS M03 cc ca Cl CD CL.- cl CO) 0- CD a LLJ g. -0 A) MD cc CO) CL= —W L) C3 4D A C3, C.3 CD =. c CO2 CL C3 :6 CO mm (a = C2 Co : CD L- :a C=o = 0... CL4- E M) C2 co CM ccl f CD I'M C2 CD C/) z 0 C/) P-4 U W, C/) z 0 Cf) C/) WE 0 4low 40.9 rl%i u 0 IOR �21 4-) 2 1�3 co C3 E co C2 C=o CD COD CM CO) CD w cD Cc Co co L- CL Q co �— = *.a C 0 —ca > cm CD Ca Cc CD CL ca Cc Cc CJ -J .0 EL, a G3 .0" CO2 C3 Q Ca. cc CL CO3 LU LLI to V9 ul LU 19 LLI ul to Contract Torrey Painting and Contracting 603-382-8431 office 5 Squirrel Run Road 603-234-8898 cell Plaistow,, NH 03865 MA CSL # CS 93973 MA FRC # 162713 Fed Tax Id # 04-2908762 Name: &k�)L ®R Address: �,4q L/ ) (Yfv 5P'b�-7- Town/State/Zip Code: V 'AA a; h fiAV17 U�),( Daytime Phone:q7;e. M 11 - 62 S- S 11 Evening Phone: 40110,5KAl I agree to do the following work for the homeowner: See Estimate. I agree to secure all required building permits and act as the homeowner's agent. Proposed Start and Completion Schedule: ii/i, . date when work will begin. date when work will be substantially completed. Total Contract Price: ou, Payment Schedule: 1/3 due at start of work. Balance due upon completion. Special order items must be paid in advance: $ for— Ale Notes: NM Law states that any down payment required by the contractor can not exceed 1/3 of the total cost of the job, or the total cost of special ordered items. I agree to be responsible for completion of the work described in the estimate. I agree to be responsible for all payments to subcontractors and suppliers. Warranty: No (�;) Terms: Contract Acceptance: Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract does not imply that any lien has been placed on the residence. Please read and understand all terms of this contract before signing. Please verify that the contractor has a valid Home Improvement Contractors Registration. Please verify that the contractor has the proper insurance to perform the work. Know your rights and responsibilities. Read the information on the following pages. You may cancel this agreement provided that you contact me in writing, no later than midnight of the third business day following the signing of this contract. DO NOT SIGN 1"S 'CONTRACT IF TIIERJ,,� ANY BLANK SPACES. k k \ 1 \ k 0 aate - // -4/ 112 �40 � r ' .J . , i � ' _ . � 4 � �.� t .� � r' � r _ 1 � 1 1 � `` � � .. _ r - � � Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause_provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the coniractor has a dispute concerning this contract, the contractor may submit the dispute to a pri-�ate arbitration firm which has been approved by the Secretary of the Executive Office of Congumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A. Homeowner's Signature Contractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the parties to alt6inative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute iesolution even where this section is not separately signed by the parties. Homeowner's Rights A hom'66wner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consu m-er rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below). Execution of Contract The contract must be executed in dur)licate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sip the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day recission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Consumer Guide to the Home Improvement Contractor Law," contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787 or 1-(888) 2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place, Room 13 0 1, Boston, MA 02108 (617) 727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section / Office of the Attorney General (617) 727-8400 and/or the Better Business Bureau (508) 652-4800 (508) 755-2548. TORREY PAINTING & CONTRACTING Jeff Torrey 5 Squirrel Run Rd. PLAISTOW, NH 03865 Office: (603) 382-8431 Cell: (603) 234-8898 To D 6 # 4 5H 7-p �t5T T AI& JOB DESCRIPTION: ot, 0, 0� cli-r REM P5 R il e:oO�7�k'?,TIPIV TA,��4� A �E'th-trz--- /) r -v ----- - - ------ - - ----------- ----- --- .................. . . ---------- ... ......... .......... -- . ... . ...... ........................................................ ........... ---------- ---------------- ptep�lxoz�b - ................... ............. --- -- ............. .............................................................................................................. 5s ............ ... ........ ---------------- ............................................... ----------------------- .......................................................................................... A THIS ESTIMATE IS FOR COMPLETING THE JOB AS DESCRIBED ABOVE. ESTIMATED < IT IS BASED ON OUR EVALUATION AND DOES NOT INCLUDE MATERIAL JOB COST PRICE INCREASES OR ADDITIONAL LABOR AND MATERIALS WHICH MAY BE REQUIRED SHOULD UNFORESEEN PROBLEMS OR ADVERSE ESTIMATED WEATHER CONDITIONS ARISE AFTER THE WORK HAS STARTED. BY , IE!?�ORD" CERTIFICATE OF LIABILITY INSURANCE OP ID ST 7E (MM/DD1YYYY) 1 1/08/10 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 TMAU1 NAME: THE JOSEPH S. HILLS AGENCY INC PHONE -FAA a, No, Ext): IAJC, No): U_ ADDRESS: 129 MAIN STREET, PO BOX 300 PRODUCER CUSTOMERID#: TORDBA1 PLAISTOW NH 03865-0300 INSURER(S) AFFORDING COVERAGE NAIC # Phone:603-382-9211 Fax:603-382-3387 INSURED INSURERA: NGM Insurance Company 14788 Jeffrey Torrey dba Torrey Painting & Decorating INSURER B: INSURER C: 5 Squirrel Run Plaistow NH 03865 INSURER D: INSURER E: MED EXP (Any one person) $ 10,000 INSURER F: CLAIMS -MADE FX-] OCCUR COVERAGES CERTIFICATE NUMBER: 10-002 REVISIONNUMBER: 001 THIS IS I'D 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 AUL11. INSR bUmi, WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY hAF (MM/DDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) s 500,000 A X COMMERCIAL GENERAL LIABILITY MPJ37725 06101110 06101111 MED EXP (Any one person) $ 10,000 CLAIMS -MADE FX-] OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s 2,000,000 RO r_1 POLICY 7X JPEC� 7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ — ANY AUTO BODILY INJURY (Per person) $ — ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) NON -OWNED AUTOS $ $ UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB HOCCUR CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE[yy] OFFICER/MEMBER EXCLUC (Mandatory In NH) q/A WCJ37725 06/01/10 06/01/11 WC STATU- H- I TORY LIMITS OETR E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYEE $100000 UIf es, describe under SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PAINTING Sole Proprietor exclusion applies on the workers compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PRAIKASH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dr. Prakash ACCORDANCE WITH THE POLICY PROVISIONS. 284 Appleton Street North Andover MA 01845 AUTHORIZED REPRESENTATIVE (9) 1988-2009 ACORD CORPORATION. All riahts reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD i LAW ---JAN . WI Wk,, gA rd N'", m m I f�It I 31� Illy VIC ilk , wa TA R(T lilt 1111141 Rik fill, of At _R 6k All"' The-Comm6mbalth of- Mas'sach us etts; 0 Department. of Fire Services - o* f the State. Fire Marshal. Office- atmRoad, Sto�v- MA 01775. ?1 0. Box.1025 SU APPLICATION FOR PERMIT Date: -dover N An. ..PermitWo (Cityor.Town.). (1fApplicab.1e) La accordance -with thdprayisiobs-cf MG -L. Chapter - 10 as pr ovidedin&:ction 527 CMR 34 -_application is-herieby made by, (Full name of' irm ar Corporation) Address Iq I) S))I�k5t�7- S ta cle , te -,I- /V . Dig Safe StartDatc purpose for (Street DC F.0. Box City or Tow4 which pcqmt is-requc�tcd For p��sioa to locate dumpster-for c o n s t ru t 1 an r Pn n v a t i n n H Pm n I j t -j -n n of building- C9ni�nciats.-_ d umpster must be 25' from str"ucture or 'covered' �rheTi n -ht j -n T,,;e at Give location by street and no., or descri c in such manner aa to -provied adequate idcadficatioz oflocatica) Narae of competent'operator Cert'No. - (TfAppLic�bl,) Date Issued-rej*eCtr-d. (Signature of -Applicant) Date of expiration F=S 50-00 Paid Due 51— The. -Cbmmonwealth of 'Massa.Gh"usetts P.O. Box 1025 State'Road, -Stow, MAO 1775 - -of Fire Se'rviGe.�3 Department Office of the State Fire Marshal North Andover Permit No -(C4of Town) (IfApplicabl�T In accordancimith the provisions of Nf G -La 4 8 Chapter 10 as provided in section - 3 4 TILis Permit is granted to-*. Date: Dig Safe N Cr StartDate Full name of person, Firm or Corporation locate dumpster-for' construct*'on Permission to I /renovation/ demolition of buildin.g. 001muents:' dumpster. must be. 25 ' from structure if unable to i)lace wi�h requi'red Restrictions: cleara . nce dumps -ter must be covered with plywood or tarp end of 'work da7 at (Give location by street and no., or dcscri`bciSuFh Ma 5 to provied adequate idcnOcation.of l6cation FeePaidS 50.00 ------------ Vire Chief 1011 This Permit Nvill expim 5 ignaTEYreZ-offical griii—fing pcni�it 'i )ffical gran t :-T L