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North Andover Board of Assessors Public Access
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MIProperty Record Card
Parcel ID :210/018.0-0055-0000.0 FY:2014 Community: North Andover
Location: 3840 SARGENT STREET
Owner Name: . PELICH, JOESPH M
PELICH, SUZANNE
Owner Address: 1915 GREAT POND ROAD
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 4 - 4 Land Area: 0.11 acres
Use Code: 104 -TWO -FAM -RES Total Finished Area: 1708 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 252,100 262,500
Building Value: 131,600 1.42,000
Land Value: 120,500 120,500
Market Land Value: 120,500
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=2432227&town=NandoverPubAcc 6/17/2014
Charles F. Perrault'
Steven S. Blair
"Licensed in MA, NH & ME
PERRAULT LAW GROUP, PLLC
ATTORNEYS
SM
June 17, 2014
Town of North Andover
Building Department
1600 Osgood Street
North Andover; MA 01.845
Attn: Gerald Brown, Inspector of Buildings
79 Haverhill Street
Methuen, MA 01844-4203
Tel: (978) 975-4100
Fax: (978) 975-0184
www.perraultlaw.com
SENT VIA FIRST CLASS MAIL AND
FAX (978)688-9542
RE: 38 Sargent Street, North Andover, Massachusetts
Dear Mr. Brown,
Please be advised that I represent Nancy Silvestro in regards to an incident that occurred
at 38 Sargent Street on November 24, 2011.
I want to obtain a copy of the file at the Building Department regarding 38 Sargent Street.
I am seeking any and all documents pertaining to 38 Sargent Street from October 11,
1994 until the present. Please let me know if there is a cost in obtaining these documents.
Please also let me know when these documents will be available.
Please contact me with any questions.
0 LIFE MEMBER
MILLION DOLLAR ADVOCATES FORUM
The Top Trial Lawyers in America TM
E .arafvfra 'fc�,ctd
�-_ cr
Q & F-
BOAFM OF PRE FREVaMON REGMUL iTIONS
P r 1 �IciK FOR PEPMr TO PERFORM ELECT, R1 CAL WOR
PLEASE PFMr IN [AfK CiRTYPE R[.E_ WFfi TTON Efa�r �� •� z
- Crty or Town -aft '-L To the Inspector of Wires:
By, this appricafim, the Lmdersigned gives native of his or her ir� to perform the eiecttml! work descrbed below.
Lacatiarr (Street& NLffrttrerl. -g ed -z T i
Qner ar 'erTactt ii a' C j�' z -`
(-1TAM=t 'z Srfrfrp_Cm. `72 Sf A',I f
is this permit in conjurtarr w Rh, a.. Btaldfrtg PWrdt'7
yes, 0•f No a (qherk Appraitr[a> a Box)
Purpose at•&uilding: F` � � Utility Authertation t
E)dsting Service: If—e,— AMPS J2,& f Z� et" Vofts Overhead P�- � Ci'nde und.D # of Meters_
New Serraite: .;70� _Aff W Z f z el' -/"'Volts Overhead E&--- Urtddergsaund.0 #- of Meters'_ Z
Number of Feeders and Plrctpac�%
Location and Nature of Proposed Bet#icai'Wotic A-
ftof Recessed Fomovs
NO. of CerL-Susq. (Padde) Fans
Na_ of Transfarmers 'talar KVA
(40. of Ligwm adsft I
Na of KatTub a
Geneiz= KVA.
No., af:Ltghung Fuaares
S* Fad, Aft— T-61' ¢ In Gmu is
# of EamTencyLrg dhaq Baftery Unfts
N'a_ of Receptads auftefs-
NM of air sumets
Frts Alarms # of Zanes'
# of Detecdon & fnitiafing Devfims
# of Satmdmg Devices
# of Self Cant ned
Deted oNSouttdmg Devices
Lccaf a . minicivar Connectfan a - Omer a
Na, of �,
Nor; of Gas Hrtmers 2�
Na. of Ranges
Nc. ofAr Ca uMmers =AL MMS.
-
Na. of Wasm Dfspasars f
L
Heat PmM T_ a Wr.
Ntrrt�es TatdSc KW*No.
S -Way Systems
of Devfms or Equfvalant
Na., of Distrusts
Space fA m Haa&W KW
Data WrhW Na. of Devices or Egtairarett
Na. of Dryers _
-
-Hsa&q Appriarmas' KWTele
mmmmunicatans f!V•ving NG fd Devices ar
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Na. 0twatgrKeatafs, KW
N2.. afSFgtfs #c eff
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# of Hy&a Massage Tuffs
Ka: of WWL Twef HP
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JUN -17-2014 00:12 P.01i01
PERRAULT LAW GROUP, PLLC:
A T T O R N E Y S
SM
Charles F. Perrault' 79 Haverhill Street
Steven S. Blair Methuen, MA 01844-4203
'Licensed in MA, NH & ME
June 17, 2014
Town of North Andover
Building Department.
1600 Osgood Street
North Andover, MA 01845
Attn: Gerald Brown, Inspector of Buildings
Tel, 1978) 975-4100
Fax, (978) 975-0184
www.perraultlaw.com
SENT VIA FIRST CLASS MAIL AND
FAX (978)688-9542
RE 38 Sargent Street, North Andover, Massachusetts
Dear Mr, Brown,
Please be advised that I represent Nancy Silvestro in regards to an incident that occurred
at 38 Sargent Street on November 24, 2011.
I want to obtain a copy of the file at the Building Department regarding 38 Sargent Street.
I am seeking any and all documents pertaining to 38 Sargent Street from October 11,
1994 until the present. Please let me know if there is a cost in obtaining these documents.
Please also let me know when these documents will be available.
Please contact me with any questions.
LIFE MEMBER
MILLION DOLLAR AL)YOCATM5 FORUM
The Top Trial Lawyers in Ami„ir,;i ,.
TOTAL P.01
6b
e4-�
Locatiorf�� P--r
No- Date -
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $� -
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
1 MJ 3-.,
Building Ins pe�or
`
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT !MA
RKNOVATg OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER •
IN
_ ~ DATE ISSUED:
3�
SIGNATURE:
�✓
Buildin Commissioner/I r of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
3S SsgicijN� icg,ej
1.2 Assessors Map and Parcel Number:
'O Vy SS
Map Number Parcel Number
L�
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard Rear Yard
R 'red Provide
red Provided R red Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Fafmmation: 1.8 Sewerage Disposal System:
Public ❑ private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No
2.1 Owner of Record
S�Ya� SA7anJN6
.Name ' t)
70?S ��k r � f✓op A✓c>ro!/f '
Address for Service
a
Signatu I
Telephone
2.2 Owner of Record:
Name Print
iv
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature
Telephone
00
rn
X
Z
0
v
rn
0
z
rn
90
0
e
r
M
r
r
aa_
^2
YI
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No...... 4
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑
Existing Building ❑
Repair(s) 4(
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
:.OFFI>�IATUE ONLY
1. Building
QQ
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
`✓ "1
4 Mechanical
(HVAC)
5 Fire Protection
6 Total 1+2+3+4+5
S4 U
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, -J 03 C!1 �l ���� Ch as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and beli
Print Nam
.larer�� C/
Signature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINIBERS 1 2 No3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
d
or
e NORTH
TOWN OF NORTH ANDOVER
0
OFFICE OF
A
BUILDING DEPARTMENT
400 Osgood Street
►,e �.r.o :�;�
North Andover, Massachusetts 01845
D. Robert Nicetta,
Building Commissioner
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: �%�Z6�O S
JOB LOCATION: 3 6
Number
Telephone (978) 688-95454
Fax (978)688-9542
ME I A
Map/Lot
HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the
owner acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended
to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNA
APPROVAL OF BUILDING OFFICIAL
HOARD OF APPEALS [i88-95 {1 CONSFIRVATION 688-9530 11YALI'll OSX-9540 PEANNING i .05,35
09%23/2005 08:54 7819338055 CNE DISTRIBUTING PAGE 02
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: 3k �r(v f jjr ,e is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
11, S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
1 OA.
The debris will be disposed of in:
(Location of Facility)
Signature of Permit Applicant
Fire Department Sign off:.---
Dumpster Permit
Date
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6161
Date.. 1er- '1-5—
..... 0 .................
Zer,'40RT
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .,-.a ... .................................................
has permission to perform .......... .. . ...............................................................
wiring in the building of ............................................
at..... . .................................................... ,North Andover, Mass.
—41
{Fee............`:..... Lic. No... gj�� . ..... ...... ...............
ELEcrRICAL INSP "' ;:;
Check # 4croy-
t
Lom~nwen a o/ ///ad"dumelb For Office Use Only
(Rev, 11/99) / i
r/� Permit Number.
.1JsPa.�ntsa� �.�• �.� .
Occupancy & Fee
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ✓
(ALL WORK TO BE RUORIAM Wn'H TIM M&WACHUMM ELECTRICAL CODE 527 C MX 11:00)
PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: �G Z
City or Town of: A/ �i��v �:' "L 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) . 3 S ---
Owner
Owner or Tenant: /f d C /L �t
Owners Address Z 3'
Is this permit in conjunction with a Building Permit? Yes QY No ❑ (Check Appropriate Box)
Purpose of Building: 2 �%� i �� Utility Authorization
Existing Service: /w Amps /2-11"1 Z`t'f'Volts Overhead Underground.[] • #of Meters_
New Service: ,Lo Amps /Zf Z yd Volts Overhead D---- Underground.0 # of Meters:
Number of Feeders and Ampacity:
and Nature of Proposed Electrical Work:Ile-
Location �� d '�.
No. of Recessed Fixtures
No. of Cell.-Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures 149
Swimming Pool: Above ground o In Ground o
# of Emergency Lighting Battery Units
No. of Receptacle Outlets
No. of 011 Burners
Fire Alarms # of Zones
# of Detection & Initiating Devices
# of Sounding Devices:
# of Self Contained
Detection/Sounding Devices
Local o Municipal Connection.0 Otner o
No. of Switches 2
No. of Gas Burners _ �i
No. of Ranges
No. of Air Conditioners TOTAL TONS:
No. of Waste Disposals
Heat Pump Totals:
Number. TONS: KW:
Security Systems:
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating: KW
Data Wiring, No. of Devices or Equivalent
No. of Dryers _
Heating Appliances KW
Telecommunications Wiring: No of Devices or
Equivalent
No. of Water Heaters KW
No. of Signs: # of Ballasts:
OTHER:
# of Hydro Massage Tubs
No. of Motors Total HP
INSURANCE 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 equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the peri
issuing office. CHECK ONE: INSURANCE IAS BOND O OTHER ❑ Please specify:
Estimated Value of Eiectrical Work $ (When required by municipal policy)
Work to Start �® / Z S Inspections to be requested in accordance with MEC Rule 10, and upon completion
I certify, under the pains and penalties of perjury, that the Information on this application is true and complete.
Firm Name: l% �Z/� �� n LIC. #/� -3 3�
.�, Signatu
(if applicable, enter " �pt" in the
LIC.# / 9533
% — Zl�f' AIL Tel. #
Tel # 6 p
OWN910118 INGURANGF WAIVER; I am aware that the 6ieeneoe does not have the liability insurance coverage normally reauired by Jaw. By my signaturebelow, I nereby
woiv® thia3 muiroffi t, I om tho (ahmk an®) Ownof ® OR Agont
Signature of Owner/Agent: Telephone #pggry� pg; S
-C
UomnwnwaalLh o f 11 /aAdazJLumUi For Office Use Only
(Rev. 11199)
Permit Number. [�
1Jspar�n�ra1 a�.}ira �irvicu
Occupancy & Fee
BOARD OF FIRE PREVENTION REGULATIONS
APPLICA'T'ION FOR PERMIT TO PERFORM ELECTRICAL WORK
(ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00)
PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date:
- City or Town of: , 41" . /0i, -e, r, -e -L To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perforin the electrical work described below,
Location: (Street & Number) e T�—
owner or Tenant: %/ �t
Owner's Address:_%Z S Al a / G-��� S� %t/ n- -4_z
Is this permit in conjunction with a Building Permit? Yes 0, ---No ❑ (Check Appropriate Box)
Purpose of Building: X Utility Authorization 9 --
Existing
: Existing Service: Amps q "Volts Overhead �— Underground. C . # of Meters_
New Service: '' Amps /�� 1 2 y� Volts Overhead Cl— Underground.0 # of Meters: Z -
Number of Feeders and Ampacity:
Location and Nature of Proposed Electrical Work:
No. of Recessed Fixtures
No. of Cell: Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Omdets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures 16,
Swimming Pool: Above ground o In Ground o
# of Emergency Lighting Battery Units
No. of Receptacle Outlets
No. of Oil Burners
Fire Alarms # of Zones
# of Detection & Initiating Devices
# of Sounding Devices:
# of Self Contained
DeterdioNSounding Devices
Local o Municipal Connection o Otner 3
No. of Switches
No. of Gas Burners ?�
No. of Ranges
No, of Air Conditioners TOTAL TONS:
No. of Waste Disposals
/
Heat Pump Totals:
Number. TONS: KW:
Security Systems:
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating: KW
Data Wiring, No. of Devices or Equivalent
No. of Dryers -_ _
Heating Appliances KW
Telecommunications Wiring: No of Devices or
Equivalent
No. of Water Heaters KW
No. of Signs: # of Ballasts:
OTHER;
# of Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insuance i
including *completed operation' coverage or Its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the pemml
issuing office. CHECK ONE�Y/: INSURANCE tBOND ❑ OTHER ❑ Please specify:
Estimated Value of Electrical Work $ (When required by municipal policy)
Worts to Start: f ®� / — y S Inspections to be requested in accordance with MEC Rule 10, and upon c,^,rraletior
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
Firm Name:
�► LIC. # '� 3/ ,�
Licensee:/ l.�–? /s S / s7� yr Signatu ` u, - LIC. #. 1l� -.3
Of applicable, enter "ex pt" fn the license n ber line)
Tel # ZY-7 ->lf- l Afl. Tal. #
' I
OWN9R13 INSURANCE WAIVER: ! em aware that the 6ieeneee does net have the liability insurance coverage normally reouired by law. By my signature oetow, i nereo-
woiv® ihltt foewiromiiin6 I drii int (tin9tik on@) Owner u OR Agent
Signature of Owner/Agent. Telephone #.
Date. /. ��.. e),5 . . ....
1 Nun r
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..{. --�^ ' .. f . ..................................
-,has permission for gas installation
`yin the buildings of ."-:-._.................................... .
atv-�'.- ^� ,North Andover, Mass.
l� 3i
Fee......... Lic. . .:OR
.........
GAS INSPECs1
Check #
MASSACHUSET'T'S
(Type or print)
NORTH ANDOVER, MASSA
APPUCATON FOR PFIZNff TO DO GAS FTITNG
Date % 1/0 —C6
Building Locations Permit #
Amount $
�Jf U�� %}1 }/�. Owner's Name `-�
New ❑ Renovation Replacement Plans Submitted
KY 'Ef
(Print or type Check one: Certificate Installing Company
Name Lv 1:1 Corp.
Address 2 KePartner.
Business Telephone RFirm/Co.
Name of Licensed Plumber or Gas Fitter�(1
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes E No 0
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 0 . Other type of indemnity 13 Bond 1
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 11 Agent 1
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 in;eotns p�ass
orme nder Permit Iss d for this application will be in
compliance with all pertinent provisions of the Massachate Cg and jZhapter l of the General Laws.
BY:
Title
City/Town
1APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
0 Plumber ;;:�; ?z
Gas Fitter License Number
Master
Journeyman
ACORD CERTIFICATE OF LIABILITY INSURANCE 11/14/2o 3
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
M.P. Roberts Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1060 Osgood Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North Andover MA 01845
978 683-8073
INSURED THOMAS SHANLEY
38 SARGENT STREET
NO ANDOVER, MA 01845
978-682-3414
COVERAGES
INSURERS AFFORDING COVERAGE
INSURER A: MERCHANTS INSURANCE CO
INSURERS:
INSURER C:
INSURER D:
INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRPOLICY
LTR
TYPE OF INSURANCE
POLICY NUMBER
EFFECTIVE
DATE MM/DD
POLICY EXPIRATION
DATE MMIDD
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 300,000
X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one fire) $ 100,000
CLAIMS MADE m OCCUR
MED EXP (Any one person) $ 5,000
A
TO BE ISSUED
11/14/03
11/14/04
PERSONAL &ADV INJURY $ 300,000
GENERAL AGGREGATE $ 600,000
GEN'L AGGREGATE LIMIT APPLIES PER,
PRODUCTS - COMP/OP AGG $ 600,000
17 POLICY jE a LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
(Ea accident)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per person)
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESS LIABILITY
EACH OCCURRENCE $
AGGREGATE $
OCCUR ❑ CLAIMS MADE
DEDUCTIBLE
$
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TORYWCSLIMIT LIMITOTH-
S ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE- POLICY LIMIT 1 $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
TOWN OF NORTH ANDOVER
ATTN: BUILDING/ELECTRICAL INSP
27 CHARLES STREET
NO. ANDOVER, MA 01845
ACORD 25-S (7/97)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. -
AUTHORIZED REPRESENTATIVE )A
0001, l7w/
0 ACORD CORPORATION 1988