HomeMy WebLinkAboutBuilding Permit # 7/27/2015 BUILDING PERMIT 0 %AOF?T#1
0
TOWN OF NORTH ANDOVER 0
,APPLICATION FOR PLAN EXAMINATION
04
Permit No#: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
7,915 sale s4 .
Print
PROPERTY OWNER
Print 100 Year Structure yes no
')&4 Historic District
s; no
MAP PARCEL: 3 ZONING DISTRICT: ye
c
Machine Shop Village ye no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building [I One family
0 Addition [i Two or more family [I Industrial
11 Alteration No. of units: [I Commercial
[I Repair, replacement [I Assessory Bldg [I Others:
El Demolition [I Other
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SCRIPTION FORMED:
i�l l,� 1i,,1�t i r�} b.er,r� n 1/�rr �f,/
A."e PF WORK TO BA PE? #�NC -
')( /1, e 0�4e - -4
e�c�.'ek<S _ _S e� -m
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QQVIA I A Ll- A IS a-f 12 A,,e. hAk&r-i AEC-1 L* 4 7Vilhhec
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Identification- Please Type or Print Clearly
OWNER: Name: )-6SL\ F4 kez-5 Phone: '778-V
Address:
Contractor Name: ,S�e-o AVepA C.� ccbq,(\ Phone: R 77
Email: .,rqnn�
Address: 115 Cwflcrst ovegs
Supervisor's Construction License: C 5 FA - 4 13 9 Exp. Date: T lo-k-7 IAO
Home Improvement License: -Exp. Date:
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: $ / 7,7 FEE:
Check No.: Receipt No.: Clel7l
NOTE: Persons contracting with unregistered contractors do not have access to th g ay rnty, and
Signature of/A nlO�Nner, , ,, FilU (J[
'7
J
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL II
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumning Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF ® D FORINT
PLANK & DEVELOPMENT Reviewed On Signature—
CO
i nature_CO ENT
®NSERVATION Reviewed on Signature l
COMMENTS � `� (, /(
HEALTH Reviewed on ;� �'� Si nature „, . .._
COMMENTS ,)
�f
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
1
is
Planning Board Decision: Comments
Conservation Decision: Comments
to
Water & Sewer Connection/signature& Date Driveway Permit t
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE,DEI?ARTIVIENT Temp,pumpsteran;site yes ro; ii,t
.v m r
NORTH
Town of �_E ndover
0 Y
No.
� Z b
T O LAH! h ver, Mass,
COCNICMl WICK y7'
X1,9 A°a�reo ►`P�,��S
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
L
THIS CERTIFIES THAT Q.jIA�,,,.,. !.04614 .... BUILDING INSPECTOR
............... .......................................................
....... ........ Foundation
has permission to erect .......................... buildings on ...� ..... .....
................................................................. Rough
to be occupied as ........�. ..�br.......... -1 ..{L,. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application 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 INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
az> PERMIT EXPIRES IN 6 ONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT T Rough
Service
.......... ..... ..... .......... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
Massachusetts Dome Improvement Sample Contract
This form satisfies all basic requirements of the state's Ilome Improvement Contractor Law(MGL chapter 142A),but does not include standard
language to protect homeowners. Seek legal advice if necessary. Any person planning liome improvements should first obtain a copy of"A
Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
Name A Company Name
L.,jL
Street Address(do not use a Post Office Box Tess) Contractor/ alesp rson/DWlter Name
S(I (e S� M o1 yqS
City/Town State 'Lip Code Business Address(must include a street address)
Daytime Phone Evening Phone City/rorwl State 'Lip Coda ',...
Mailing Address(It different from above) Business Phone Federal Employer 115 or S.S.Number '..
nar�jmproe /y)�7cfor ftcg Number Pphacion dmc
r.P.e"luill
.1.1 tbnt most home VXVX Z/VO/
imp�rovemenl<onlreelors have !! 7 (J
ns Ild nginrelinn number
The Contractor agrees to do the following work for the Homeowner: �+ v 2
(Describe in detail the work to completed,specifying the type,brand,and-grade of materials to be used,use additional sheets if necessary.)
'P-64-v Ow ,ew%A co v% .fkc tnvl o Or,tL 10X \t da.c.:�A Xl& Y,4 rA.+'S�17n�,
bv,c Sek Op S�a�'S a.vta ka,\A .w�,�v�5ka.l�ty« �R,�er -60oFv c�5 �acc se-1-A �
ZD4- k ..} .
Q,#"A
Required Permits-The following building permits are required Proposed Start and Coniple8 n Schedule-TIG following schedule will
and will be secured by the contracEir as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their aVo o-mits will he
excluded from the Guaranty Ifund provisions of ' J Date when contractor will begin contracted work.
MGL chapter 142A.)
Date when contracted work will be substantially completed.
Total Contract Price and Payment Seitedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: M
Payments will be made according to the following,teoxdute:
i
$7,dT upon signing contract(riot to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater)
$ 1 jQ00 by_L—!n—or upon completion of (�Q a rAn 6N c
l
$ by or upon completion of
$g,9 7 upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special $ / to be paid for
ordered before the contracted work begins in order
to meet the completion schedule.(**) to be paid for
NOTES:(t)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may
not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule/
Exprass warranty-Is an express warranty beim provided by the contractors No❑Yes fall terms of the warranty must he attached to lite contract)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this agreement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract.'rake time to read and fully understand it. Ask questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757.
• Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a"proof of insurance"document.
• IGiow your rights and responsibilities. Read the Important Information on the reverse side ofthis form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place ofbusiness,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following the signing of this agreement. See the attached notice ofeancellation form for an explanation of this right-
DO
ightDO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
M'rwo id e ca opie of die rnntncl must be completed and signed..Onc copy should go tA�,acl.r
ther copy,hoWd be kept by the conlrmctor.
Homeowner' Signature ulre
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North Andover MIMAP July 27, 2015
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Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
—I Meters Data Sources:The data for this map was produced by Merrimack
—SR p,ORTH Valley Planning Commission(MVPC)using data provided by the Town of
Roads O e�+�tu ra qyQ North Andover.Additional data provided by the Executive Office of
Y'c Easements 2. • +e O Environmental Affairs/MassGIS.The information depicted on this map Is
Parcels .1t' L for planning purposes only.It may not be adequate for legal boundary
�O ;.—• A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
THE ACCURACY,
COMPLETENESS,RELIABILITY,OR SUITABILITY
♦i ^ .{ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
�sSACHUs�j��
1"=45 ft .
North Andover MIMAP July 20,2015
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295 WEBSTER WOODS
106.8-x183
Rail Line "=`:Wetlands Zoning '..
Interstates ;1.Exempt Lands Busine 51 District
—I �Bus1 s 2 District Hort—tal Datum:MA Stateplane Coordinate System,Datum NAD83,
—SR IS Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack
R Busine s 4 District ppRTN Valley Planning Commission(MVPC)using data provided by the Town of
Roads E Gene. Business District Qf t4a c rb qN North Andover.Additional data provided by the Executive Office of
q'a Easements 12 Planne Commercial Dev � bei t6 0 Environmental Affairs/MassGIS.The information depicted on this map Is
t Corrido Development Dist ,�. / for planning purposesonly.It may not be adequate for legal boundary
MVPC Boundary MJi Corrido Development Dist O -- '_, M definition or regulatoryinterpretation.THE TOWN OF NORTH ANDOVER
Municipal Boundary a Corrido Development Dist F^ p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
Industn I 1 District THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
13 Zoning Overlay tF
!. Industri 2 District
Adult Entertainment IF `4 ^ � OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
01Industri 13 District o
Downtown Overlay District * o w � M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
R Industri S District9q
0 Historic District Water Protection Residel ce 1 District 0THIS INFORMATION
Reside ce 2 Distdc
El Parcels ,g:Reside ce 3 Distric: CHllS
d Hydrographic Features de ce 4 District
1"=139 fttde ce5 Distdc
Streams t
YYY de ce 6 District
m,.ge esidential District
The Commonwealth of Massachusetts
. ' . Department oflndustrialAccidents
1 Congress Street,Suite 100
Boston,H4 02114-2017
• ^�.•...yJ.4't www.rnass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le 'bl
Narne (Business/Organization/Individual): 6,6)A 0
Address: °aL ° ,
City/State/Zip: oigWS Phone#:
A7yon employer?Check the appropriate box: Type project(1'equired):
1. a employer with . : employees(full and/or part-time).* 7. I"J New construction
2.[]lam a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t
10 FJ Building addition
4.[I I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.F1 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.Q We are a corporation and its officers have exercised their right of exemption per MGI,c.
14.[,Other
152,§1(4),and we have nq.employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit'this affidavit indicating they are 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 of the sub-contractors and state whether or not those entities have
employees. If the sub-con1racf6rs have employees,tliey must provide their workeis'comp.policy number.'
I am an employer that is providing workers'compensation insurance for•my employees.'Below is thepolicy and job site
information. .-
Insurance Company Name:— (-a ee, ' —
Policy#or Self-ins.Lic.#: L 1 S Expiration Date: J I
f
Job Site Address: ,, 6, tC�l City/State/Zip: 0J-�V A C"UV(
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certi u d thepains andpenalties ofperjury that the informationpi•ovirled ab ve is fru and correct.
Si nature: " ..._ Date:
Phone# � 7q' __ a
Official use only. Do not write in this area,to be completed by city or town official._
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
:4 4 pagf' Z'
DATE(MMIDOPMY)
Ac"R10 CERTIFICATE OF LIABILITY INSURANCE
711 5�20 15
THIS CERTIFICATE IS ISSUED AS A MATTER or 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 encloirsement(s).
PRODUCER MTM INSURANCE ASSOCIATES LLC NAM:
NAME:
1320 OSGOOD STREET PHONE AX
NORTH ANDOVER, MA 01845
L-MAIL
ADDRESS'
INSURER(S)-AFFORDING COVERAGE NAIL 9
INSURER A Ll'A Insurance Corporation 33600
INSURED INSURER U
STEP AHEAD CONSTRUCTION LLC
18 CUTLER STREET -INSURER
LAWRENCE MA 01843 INSURERD____
Ids URI-RE
—1—1 J
COVERAGES CERTIFICATE NUMBER: 25593234 REVISION NUMBER;
THUSISTO CERTIFY THAT THE POLICIES OF(IJSURAIJGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA10ED ABOVE FOR T14E POLICY PERIOD
NDICATED, NOTWITHSTANDING ANY RIEOUIREVENT, TERV OR (3,011DIT10ii)OF ANY CONTRACT OR OTHER DOCIPOENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR VAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIOI,qSA14DC0,14DITIONSOFStJ(',HPOLIC,IE,c3 LIVITS SHOWN MAY HAVE BEE 4 REDUCED BY PAID CLAIMS,
ILTR INA-DoL S-U,—BR Pi rifF '_PQL_JfY E_P_
TYPE OF INSURANCE ......POLICY NUMBER iMAND
�1D YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
FACti CCCJJRPENC--
r
CIAMS IAArF CCCUR P
L4ED FXP fN,V WC romc') S
PERSONAL&ACV iN.URY S
GENT A CC RE GATE L,MT A Fn,E S PER GENERAL ALec_RFGATFF 5
PCL CIF—]'C'C"T F-1 t C
PRCrUCTCC?ARr"_f'ACU
OTHER
7
, , S
AUTOMOBIU LIABILITY cl "I
ANY Atn`0 POril-Y INJURY iPu
AI_L CWNFir,' sCHFI)OLED BOOTY INJURY{Pein,"LLIked)
A JTCS AIJTCf--.
-CV;NF0
HIRED AUTOs AUTOS PFRT11 S
NON PROY DAMAGE
UMBRELLA UAB OCA"Up TACH CCCUPPENCE
EXCESS LIAR ACCREGATE S
CFC T, t
A WORKERS COMPENSATION WC5-31 S-608612-015 1/1012015 j 1/10/2016PER OTH
AND EMPLOYERS'LIABILITY y N '/ I-STATUTE I__I FR_
AN I PROPA FTGIRVARTNl RFX FL FAGHACCPFNT S 100000
01 P,CERIV-r MEER FXCIJUDED F_N NIA
Mandatory in NH) F I n19FA!�F FA ErTI't OyFd T, 100000
Jo's
FL (319FASE-PCL Cy L T 500000
DESCRIPTION OF OPERATIONS t LOCATIONS i VEHICLES ACORD 101,Addilkmiil R.i Slin,id,,W,may be bPN NW, d)
This cartifcatio cancels and supersedes all previously issued certircates,Only as they relate to wor,(nrs compensation Coverage.
ftirkers compt-ri on insurancin coverage applies only to the worrors cOrnpensaton laws of the state of i
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1600 OSGOOD STREET
NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPREqENTATNE
LM Insurance Corporat on
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
®R®® DATE(MMIDDYYYY)CERTIFICATE OF LIABILITY
7/14/2015
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 Lisa London
NAME:
MTM Insurance Associates PHONENo, (978)681-5700 A/C No:(978)681-5777
1320 Osgood Street ADORess:lisal@mtminsure.com
INSURERS AFFORDING COVERAGE NAIC#
North Andover MA 01845 INSURER ANorthland Insurance Company
INSURED INSURER B:
Step Ahead Construction LLC INSURERC:
18 Cutler St. INSURERD:
INSURER E:
Lawrence MA 01843 INSURER F:
COVERAGES CERTIFICATE NUMBER:15-16 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 100,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $
A CLAIMS-MADE 1XIOCCUR WS225440 1/9/2015 1/9/2016 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
X POLICY PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea acddent _
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N L
IMIER
ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? F—] N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
This certificate of insurance represents coverage currently in effect and may or may not be in compliance
with any written contract.
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 St.
N Andover, MA 01845 AUTHORIZED REPRESENTATIVE
Mike Traverso/STEPH
Massachusetts Department of.P 3blic Safsty.
Board of-Building Regulations and Standards
Construction Su ervisor 1 &2 Family
License: CSFA-106138
NICHOLAS LUSSAR
18 CUTLER STREE I 3
Lawrence MA 0143 S �
Expiration.
08127/2018
Commissioner
77
Offict oL ouper tfaL65 2 --is�lat�i 10i
;HOME IMPR01/EMENT COKTRACTO.R
'Registration 180870 TYpe
�Expiratibn 1/2312017 LLC
ro.
S_� AHEAD CONS RUCT�OtZ t�C.
3 is V �'
NICHOLAS At
LUSSi1 R 3-� ? 3
a18 CUTTER STREET��a� �
iLAWRENCE MA 0:1843
Underse-ret art' ��