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Home My WebLink AboutBuilding Permit # 4/22/2015 TOWN OF NORTH ANDOVER , WOPLICATION FOR PLAN EXAMINATION ,; Permit N6:A Date Received Date Issued: ' ' IMPORTANT:Applicant must complete all items on this page n //, .,. ,, r ,✓ / ./ � / /. .�„//r/,//, / /r,�L/// rr� /..,.r�i�j��irr,.//,.,J/,..�/ c/ rr r ,r / � / �� /r �/ // / 1, / ./ � � �/ ✓ /r / �RIJPERTyYiOWNERr1�r�/�,� � rr///rr , � / / / r / /�/ / /,! r/ rz/, r / r / cru r // / lr ✓ / /r/ /,/ 1,, r/ J, /� / �Ir f r / / •' r / ,,// � /�,, ,;/% ✓.,. �,, /ri/��/, /�i� S,tOrICr�ISTrICt�/rf/��/r/% eS r nQ /i TYPE OF IMPROVEMENT- PROPOSED USE Resid ial Non- Residential ❑ New Building Rdne family ❑Addition ❑Two or more family ❑ Industrial ❑Alt ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑'Septic ❑Well ❑°Floodplain Y//❑/Wetlands/ / / ❑/1/1(atershed Distract r ' r /// �/�/,f / /o�, / /// / / �/ // /////j ;, ,❑�1l ater/Sewer,, 1;,, //// / ,,y, ;,,,. ,,,,�� /� , „/ i„ii, /¢✓2�,,,.,,//, /i,/,,i/,fi,, //„ ,,,,,< DESCRIPTION OF WORK TO BE PERFORMED: �1 A �C, Al S Identification le se4ype or Print Clearly) OWNER: Name: � S a Phone: Sr Address: , ,!, / r":: / -"..,.r , /c/,✓ / y ./ „/ ,.r,,,. /../// ., / r// // i/,rrf/,l rel ri r .,, /Add reSS/d/ /, / r r / �// /�/�/if//i/� t°16d�1�/ rl, �' ////i/rr �%f oi%///%�/rl/�/1///�irr/� /�/a rr r / /a�/ //✓/ r / r / r / Jr /. / / r r ✓. r / r /r i / / rr / r /. it r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ AID FEE: $ - Check No.: Ogt ci Receipt No.: NOTE: Persons contracting C-threFre tractorsct®rs lo not have acla rantyf dcesstu MOO? Signature of Agent/Owner Igi ature of contractor Plans Submitted [Ag' Plans Waived ❑ Certified Plot Plan_ Stamped Plans ❑ tjO T Town of Andover , " 0 No "My. , ' * I `1. LAKE . Vel°' Mass, AD9.1 S � IMF— BOARD OF HEALTH Food/Kitchen P t 'WT T fa Septic System sk L D THIS CERTIFIES THAT ............. . ... .. ........ . ..................... ,........................................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ...14t3.... .. .... e............... Rough to be occupied as ® kw. e ............. Chimne y \ provided that the person accepting this permit shall in every respect confo to the terms of thea plication Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTORJIM Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES I 6 MONTr1lS ELECTRICAL INSPECTOR tzgvm��UNLESS CONSTRUCT T S Rough Service ............. ........................................................ Final BUILDINGS INSPECTOR GAS INSPECTOR ccu u cE Permit Required to Occupy Buildini Rough Final Display in a Conspicuous Place on the Premises — Do Not Remover No Lathing or Dry Wall To Be Done FIRE DEPARTMENT til Ins ee aUnd and Approvedthe Building Inspector. Burner Street No. Smoke Det. ,aa0zaten ettsRmlme T71 - : ; .; -Im &. C" This form satisfies 0) z 111"'guaga to Contra 'ect, prolectlo 1�1'aqvlmiwj' .USoFjha1'j,j Men 1 11 J,,, -- - ''! bnii til Int Car tualts Consam ""Is-'5-kjvw ad I .!p fill.orca a 1104 5'not dudMloandard rMs and - cimprolmmen I d Home can er vd.-an residence,you 01 acopy.F-A Oil no i-Roll'abot -8787\amaar I by-mlingtho, q93 839i737 arolaurnebsite �ontracfnrinfarmsttian Sint�d3(donor 1afinId t Con OaFsaj - CIEI atsn Slut Zip Cad—— - 1L . 3A . Me0 w rIi1In1ePhLn8 , ��t��rv?77 Mvn "NWnSAdd.n(hdj Suitt A RUM cAm") zip Cade 7: ThL Conrl'actoragiv =�..nat>*tweu_-nAct--o®r Ape r4e�cribefndatallttaaaad,tR omqltfaUAtvxnanorkfarthenomeonalfin. g 14� and 1%111 basecturdbyth,con X, MIC(orasmehomeo ...... .................... (t3tt Ai A'Upt 5 art I I i I I "; ;.................. r-"Who secure th 1: 1 millelft I I ;j!!jj l�il 11, eXcluded-, fillrovaperj. -049, to laden 1:iu�! I 101,6io F0.111 dzcwnstancesb*.011d;a Cal, zschedulej,.ju the CultrayllY.Fund provislons 13talcloesconvolmis. IUCL chaPtey"142A.) Total Contractpdc 0 The Contlactoragre E H,5:11 edale. Date'**h"WIltmicled -Itill be finhstfia thILLY-omple,,j M to Patform the"".0114 rumw "Ingtifil and laborspecified pfi�17aenls"ill be Made accordin rothefitnovin �the 8 otleFortheroallsuallop 9 schedule; s-7—CP S �upon sLmlkg ccalmact(not to I-VIceed JG,oftlyclanal Contract Price Z the caito upon completion or Completion or OC upon completion OF 7lierollottinzaAw'Fav 'be c0atmcL(Lawrathf6dent tutrga OlVdImAlb-cf-0ml- hquipjager Must b,speL.,fil necant"'d b asin rfs compj to both p satisraction) torle.-fthac"fee 131k em - P ansrhedulgL(a-) Claim to b6paid for JI r7mncecirsrscs(=)Lam uIrds that Am- 'thill It or JAM. "'I"chmurlbespeckjoweadi.., OrtheloWcm- p t2ficommett 'act kear al I - . AACQatf'"1(r.-b1rCr4"','. 3bacontele- LW Con offi,," fS.71 rA=1 Subtantmetors-L • avide h,,th,, cla�?13 n r"all 1-ft'Grmiieawrd. u IntLach aatha ,." r contact shall not irrtol this documentbacomesa bbrdtn on-adr@,p esaFjh&actfansarstblero470etstoaUsal.thlrd otmelors for noted%%!thin this d cu° Can't bement;yhe -�kkasuret le contm c subcontractor "McyorC8dfindfb)1Tuvde�slavd1L Ask-quesd ratMy C, .e-11tilo b 0 AA T"Alitingto e rat 10 and see 8 cop}.1.ofarho a Kno%v;�u Isand acumen Guide to III Read 10 F1Y yoi p vemenj on Ctor oU mat,cancel thisQ copy orrhe Consam" cantr2 itnrin I bas boo sjUl 'i 1, "-fdhff a I h islh L, I 111allid,1111141 I ------- 1frd bilstne.- �-In.16.orb 1 11111 �econnacw; 0 Clayfallollin2thasr - Much so I — Raw offcabr -- . onuflar Mallpo' 'a Sted.b ew-PaIlided V 7?0u ry DO a IM amegment.Seethe ytelegymn 0119(illoacool- Sen t ork-delimartA not late;than mida, TllaiotiRrtbe lft_: Ivor SIGN T icoptual.a. us F5 0, _CT Planation ofthis ARE A nb L f SPA ry 01fieunnarg Infia ntrt {r ,A Ca- -. G'r,�' �' 9 naeror sStmmnare data an arbitration aCtiOn IRS Contractor Arbitradon rolilieshomeolmm Milli the rieltio Initiate, gedT%,armrded to a art -fne dome Itonrovement ContractorT-avrP mute ,Ia,,contractor.-Me same net Is 1..T la"Iorn7' . .: 'Unless afte r.ladve to�ourt ac 11 o ri)if Vau-v b av a a di an",dispute helshe has N14ft a homao"Vner 111 cow, Con'traclori bou�aver. he coatruatorwuld,6ve to resolve . jausamovid.dvetbe coiMtOrtht same'*t 10 oBtioDfil cjws4 proded bel 1 -O ,11L T WS is ffbidtd to Vat)TAIMP-ONNS"by The BOMD IMPMVeniert Contr armee in advance,that in the eve the contractor has a dispute -fhe contractor and the hoineMnerli0reby mu ' doitration&mt%-bfch has been oiproved by concerninf-ly's Contract.the con"ctorjn;V submitihe dispute to aprivate and the cousumershallbe rqqtfired F an6-Business Remilatiou the SecMIREY of the (JOUSUmer Md tw-ej jqgss�achuse Gen %ter 142.4- jm sp to submit to such MOntion:03 - jq : p, -ef' , Contractor's S%miabze r��obit?on inid;ited bti=the contractor. Tne l�omeoc��nzr may inifiaie altzrriative dispute rzsolulion even tvher anis RID-inedivnees Rights ctor La%y g, -umer ovmees rights wderthe.RomeImprovernent Contra dGL chapter 142A)and other cons Ahome V, %,Ed in any.va,&even by agreement. HONW.er;.homeoWnerS protection law(1-f-1 MM chapter 93A)Mav not be — , - - tered as prescribed bY ifthe,contractor the-Y Cho ose.is not PIPPErIv re ms a--41 Giiarmty-Fund pro-040-Ds 03 e-.,ciude -from, be.excluded from i. Romeo-,Vaerss who sewe their awribwIdlingpermlis me automalsca%, Si O_ ContractorLaw. !he contractor is responsible legal iontractor the. ome TmDrov I the vinent er may be eatitlea 10 Other SPecifip- tftn ,and-w;rlmadike manner- Home F ton to 01afantees Or'%N'4 M' d-s orlyo- -%v ,-Mwsbip or mmeflais. Ih addif ParanteusorproNridesaneXPress aaa* Mchusetts Carryan impliedwaiiartlY Of Tftcrdwl�bft"end fitness fbr provided by the contractor_6gootissoldliniva nicht nich the homeovraerand contractorlal-MILIMY Agearnzybe particular pulp Dse- An enumeration.of othermatters on me ,n e es b as!c co Usu In er 691115--Ify 0 a h av a ,a as they do not det a added to the terms ofthe contract as Iono- sr contactrest1le consuraerhO Information Hotline(listed below) quezdans about3rour consurner/homeMe= rrig� ENecutan 01,contrapt'ecut d a duplicate andshorildnotbesi-McdUntil aca'AYof all exbV'tgandrffFerended lie contract L 'mustbee% ve mtuatil a blanksections haxa been also advised notto sixth documt, .ebeexiattacbed. Parties are OPv of-the contract-vAth attachments is to documents have OneOril#nalsi-medc the ,contrar filled in orrallik modificaon to the be given to the O'Vner and the otherlePtbY &61 both ptiarties ThavereceWd RNIVwxecuted COPM.of SUdgmed lo,by both pardes.Coutracted.,vaTkma3r:icv�Lbgg�a. 1hr 'On period has eXIANCei.p,contract and thethree day resclISS1 A.ccalerated,Payments inadvance of the dates speclifiedonthapayment schedule in cases vyhera the A contraotor may nol�demand pqrrients- ly insecure.Holge,.wr in kistanoes where a contradtor deem him/herself homeo'N'ner deems him/berself to be,finandial cr L firianci ma%,reouke that the balance Offinds notyat due beplaced in ajoint es ON-' IaUy insemoz the contractor acC0untv;oaarcqo1re the to be to contioulag the contracted wofl,�V-jthdra,.�,g of funds from MO. account as a pre raqdsite siulatthres of both parties. ne ' Additional information addition inibrluiitiba ab Out the Homelmprmtement Contractor!A%v or Of if you have general que!rdtms or need i ivlassachusetts Consumer Glida to Home Improvemene'r co t Is arner k--k!k,o r i f yolt-vvj sh to ab Win a Re 5 COPY. contact: c.onsumarTriformation Haire 0 ffic p,Of Consumer AffdrS and Business Re-Dilation 10 parj-pla7,,,L Ro am 5 17 Oz B OStiOnz,MIA 02116 RWebsiteVLh -1 617 973-8757,888283757 or1sk11DOCAB - all 'a contractor orilr,�you Neemestions or need additional Y pntContraDtorLpe,�cdntacL .ezistratioa component oftheROMO RD aboUttilecontracto Director Of Rome It ConmtorRq�-Stradon office of Consumer A:ffajrs and Business Re�gati()U io Parkplam Room 51-1 Q.BOSIOE6 MA 02116 �t h-.t r,� -.x--�-.-IN%m 888-283-37ST orAsit the EUC tivebiLe a Go online to view the status of a Some I I-OPOvement Contractor's Registration: For assistance math informalmediationof disputes orto rester formal.complaints against a busin a-St Gon,smr, ' er Complaint Section offit Attome-v General ANVOR 50$-5524800,508-755-2548 ot-4137,34-3114 r,Z, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 w;vw.tnass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E4 lectricians/Plumbers Applicant Information Please Print Legibly Name(BusineWOrganizatioii/Individual): Adofic Wcather"on,LLC 61 R JefltMn ' -nue Address: 0-1 out MA 01970 City/State/Zip: Phone M 7�JYY- 9114 Are you_an employer?Check the appropriate box: Type of project(required): 1.C21rarn a employer with 4. n I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.0 7- C]Remodeling I am a sole proprietor or partner- listed on the attached sheet.I ship and have no employees These sub-contractors have S. E]Demolition working for me in any capacity. workers'comp.insurance, 9. 0 Building addition [No workers'comp,insurance S. El We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.El I am a homeowner doing all work right of exemption per MGL I L El Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.E]Rgofrepairs insurance required.]t employees.[No workers' comp.insurance required.] _J *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 arc doing all work and Then hire outside contractors must submit a new affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name oftlic subcontractors and their workers'comp.policy information. lam an employer^flint is providing workers'cotnperrsation insurance for my einployees. Below isthe policy mrd job site information. Insurance Company Name: Z(A 1-1,–cl Policy#or Self-ins.Lie.#.-- 56 970/Z I Expiration Date: Job Site Address: /Y83 �/,C-0-7 City/State/Zip: 9:z�zdOV4,1_ thA, 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 MOL 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 coverage verification. I do hereby cerdAzinder the pa. d Ift-T ofPciptry that the ii(formadon provided above is true and correct. Vol 7"`7�, 4 1 Signature: Date: Phone ft: (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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACCORLI kl.� CERTIFICATE OF LIABILITY DATE(MMIDD/YYYY) 3/x/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Construction NAME: Eastern Insurance Group LLC PHONEFAX (800)333-7234 233 West Central. St E-MAIL c Nol: ODES: INSURERS AFFORDING COVERAGE NAfC ftNatick MA 01760 INSURERA:Arbella Protection Ins. CO. 41360 INSURED INSURER B-.Nautilus Insurance Co Atlantic TnTeatherizatiC+n INSURERC: 61 Rear Jefferson Avenue INSURER D: INSURER E Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER MASTER 2015 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. INSRN eR LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PX COMMERCIAL GENERAL LIABILITY AMA E T R TED PEMISESEa occurrence $ 50,000 A CLAIMS-MADE ®OCCUR 8500042816 /20/2015 /20/2016 MED EXP(Any one person $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 PRO POLICY X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT-- $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 020015871 /20/2015 /20/2016 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS AUTOS NED PROPERTY DAMAGE AUTOS Peraccdent $ PIP-Basic $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ 4600058654 /20/2015 /20/2016 $ WORKERS COMPENSATION STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? F—] N/A E.L EACH ACCIDENT $ (Mandatory in NH) --- If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B POLLUTION LIABILITY CPL200378613 10/1/2014 10/1/2015 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS t LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE John Roegel/PMA ACORD 26(2010/05) 071988-2010 ACORD CORPORATION. All rights reserved. INSn25t5,ninns)ni 'rho 4!lr1Rr1 names anrd Innn aro raniatarod marlra of Aflnpn Rightfax 142-1 3/10/2015 10 :11 :37 AM PAGE 7/013 rax z)UrVcr DATE 03-10.2015 ACCORO CERTIFICATE OF LIABILITY INSURANC E CERTIFICATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERSEENIDHOR ALTERTS UPON COVERAGE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, 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 policWlss)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). CONTACT PRODUCER NAME: FAX EASTERN INS GROUP LLC PHONE A1C No: No Ext 233 W CENTRAL STREET E-MAIL NATICK,MA 01760 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURER B INSURED ATLANTIC WEATHERIZATION LLC INSURER C: 61 REAR JEFFERSON AVE INSURER D: SALEM, MA 01970 INSURER E WSURER F: ''. COVERAGET u B R O R: THIS IS TO CERTIFY THAT THE POLICIES OF IN 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. ADDL SUB POLICYEFF POLICY EXP LIMITS INSR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DO1YYYY MM/ODIYYVY LTR EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY p jSES(EA occ:urren cc) _, CLAIMS-MADE n OCCUR MED EXP(Any onepetson) _, '....................... PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE PRODUCTS-COMPIOP AGO S GENL AGGREGATE LIMIT APPLIES PER: S PRO• LOC POLICY JEC7 OMBINED SINGLE LIMIT $, AUTOMOBILE LIAR IUTY a aLY I u BODILY INJURY(Per person) $ ANY AUTO $ ccident) ALL OWNED SCHEDULED BODILY INJURY(Pet a AUTOS MAGE AUTOS NON-OWNED eOaE Y A $ HIRED AUTOS AUTOS $ EACH OCCURRENCE UMBRELLA LIAR OCCUR AGGREGATE $ EXCESS UAB CLAIMS-MADE $ DED RETENTION X WCSTATU- OTH- WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETORtPARTNER/EXECUTIV YIN E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? NIA A 6ZZUB 03-20-2015 03-20.2016 E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) 58270121 II yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 10111,Additional Remarks Schedule,H more space is required) Aviva ET 1 ODE O TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 1600 OSGOOD S7 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N. 0 OSGOOD S 01845 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD leCt��J+`.•ekb1zeS�m�'`w7.r^33�✓ Ch.1 iL�N.Y t'w�ll1 �4d d4Lr f� V�P CWP d TON ST i Salem WA 01976-- CC rVU!!?SS i(3 qe.* 019716=CCrVU!!#SSicsge. 04/23/2016 vlre�ornnrournerrlf��G�eltr,8,itt�«1nffJ Office of Consumer Aftirs&Business Regulation ME-1MPROVPMENT CONMCTOR gistrntion: 14mg Type piratian: 3112/2816 Ltd Liability Corpo= ATLANTIC WEATHERiZATION L:L.C, ERIC PALM SIR JEFFERSON AVE' SALEM,MA 01970. -Undersecretary i.