HomeMy WebLinkAboutBuilding Permit # 9/25/2015 NORTH
BUILDING IT
TOWN F NORTH AV °
{{ APPLICATION FOR PLAN EXAMINATION ®y
Permit NO: "" t. Date ReceivedArea
gc Hus����
Date Issued:
IMPORTANT: Applicant must complete all items on this page
r r
,.. rrr, r: r/,
r 1
rr/. � r, /lr/,. r ,r,,.�r�r r r, Jr...,,../
r Ar.r r / ,. rr /r /
r / 9 /
/ / l.r/ /r / r
rrr 1 / rf
f rr /. r //.r//f / .r.r•f, rrr. I 1.. � r.. ,"oa
% /,( ,,. ( ./� r / �,
/r /
I � / .il 0 r J
rr ,r./ l / 1
r /
/l r /,
rad r r
,r � r r
o,/ r/
r ,
/,.
�,./( 1. �
I /l, �,l r, y, a �.r. r � r ,✓/ .r, l./ + ,r,.. .r rfi,.r�,
/ /
r/ >%,+/// 1 r�� rl/ l „ I' i, fu l �, ,r r 7/ r, r�� r� ,, r, ./ ri,/✓l,rJ si , !//,r/ rrr r, ,{ - � (�rrr,,.
ira� ��✓�%a�, �,�� , f,✓ � 1 ' Y/G/, /� /, � �//„/,d r � r ,l i r/J/r /f ,/ /, ✓, / , /rl /
✓.,,,2� r��/r /,.//,ly,���. ,.I,,.f )( � r1,/. �.,, ,��/'�� l r r�rr ,! ,.r,✓�J/r,i,//,!l z�,r ,�/r orr,f� .1 S�t
! r/ � ,(�, ,/ r, , � rjrl „r 0 rZ, r� r r, <, +l G/ � r I• frra(u��, 6.�,
I r '/ �i %y U' Y 7 I rl�f, rl ✓.. � I '{' � , �r7r ff�/„
�
� r Y ,� � rr / •„,�fi, �,If�/i(a �„1,,,,1NI! ���� ,� 1����r�,/,� f �, /, irt,"�r{ o/,,,
���Jil�,�,rJJ�
r, rrr r. ✓�, f .r , r
r ,
r r a r r r � IN
/
! rr� ✓ Pry { r l� �rr ) r �r !a<✓,, ,i,
t r+ ,; <,:✓, ,f� w r r r ,, IUh//fir, �� / /f � 1r ,ra, i,���,,J� t/. �tr,l�'G/ 1 r ,��,
/ 1r
d r✓r,r / v, r lb a�
.,, ,,,,,.,: /, .I /�- I„ 1, / � ', ;,..,../ {/lir% •r r� ,r, ;. �. r/,/,/,,„l
e,/
rr/
1,
e
r ,,.r. r�,..</, r,. r, � r rU r rri r r ,,, r ,:, 1 ,✓(,'/�Y% ,.Ir /�D /J l !, �` r /v+..
r r/
ra
�„ � /i �r I r I ,�l, �,�/� //�/', ,.!%/�L r�� ,1/�'„��(/rr /iI,I/1��/r/, l„ � �,I/tel✓///���.rr rriii,//r r,�rr,i�,Il+tl r��..,,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ] One family
❑Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
ii Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
/.
,d r.
e,y
7, / �',.,rr - r r ei r,r ”, U , � t ..,f /,r•...
r / r !„ /,I r •l, !/ n ra e, e L M” l I r /c
�r r r 1 re
r„
, / !
r
r r /
/,.r
F!,/ ,r
r / r r/r„/„ J/, , ✓, c r
it ,., ,.�, / /, � r lr/ ,r /,� l// l /, .r!/ ,,.., / / ✓. �. ., / .r / /,.,, r
<•e. r/ ,.� J/1
// 1. / 1 ✓ / / r,- /1. /
,r.//� r ../. � r "r ., r O/./� /rr,/ir.r, rl .✓�/ �I/ill ri, .,,r,J,/„ .,,.�r..�l.
9rrir/!J//lillr,ori/�In/�/,i�i//�%I/Ir/„i,/,�,,,////i
i
Identification Please Type or Print Clearly)
OWNER: Name: 011 01 Q Phone: M"-6)r) 11- (r)1
Address:
r N �r r r r , ✓
r, r/✓ r F/ / / / r l r , � ( ! ( r/
/ iJ // r r /l 1, I 6 r G � �' ✓ ,
r , /l r if r �>✓ r
r ,. J, „ / /� /r�, r ,I � r , , U�!”ii r✓r, ,,,r, , l! �,� , /r/f���� I r ✓„r
/ 1f /! 1, I /. .� �0 ✓ !, .,/ , D r /
1 rrr /'� „1 r / i. /, r r / r.l, r, r 1 ) / ✓,,, r
r/ U yr v /, / 1, 1 r r„ / ✓ l///
r, �/ / / r / I // ,O /i .e �/, r�r rr/ / � ,J/ J r✓
/
11 r�,rrai'lrr0I r_a1�/�/1 (,, ��,
�rt,.��•r�r.d�J,/�,r/I/Y
l/
�1 r
r/1rr�r/
/
/rfi,.r„r/rrp
I�„rJ!rJ
r
,
r,r
rr, r � rrl r lr
/ / rr /,/ e ✓/r / / /rr r r l i /( / / l /
/// l,,�w,�/////,y r /,1 ✓ „ (,/ r r( I r//, 1 I�` / /,l / l/ �, � r,,, r/ /1 r � r % r
/,//,M 1 /� / / ,,,, /Y6 r � // h /1 r/, //J r, / f r /G r r,� J r✓
/� // / '{ ,/, / /, �/ f J � r l l%� {,l rf/ /�r'„ ✓ ''` / ,/, irk / rf
o, / ,,i��l �J lir, Ar f �� ,rrr J r� �9 r'/ r �i � � ,y✓/
r, r
l r iJ
YY/ rI/r/�• r r r � �1/ !V' I ' / � r 1 I 1/�� i � „ri
I '
r, J
/
r 1r � r it
r
/ r, i, � / .• ",v. I�� r/ r � .,J , rrr /,ri r,ll{r, r , / r/ r�
/rr rr ,/rrr",:r:'.i ri'rr�..6,.;Ir+'� r✓ -'rr'i% l� � �� //� ,/; / �rlJ/ f`, � r ,/ /', r"(q ! � J,'� /���/F
°dJ, ( ,/ �r/� 1 r r. r r�/ 1 / (/l/ +' f, Gtr � 1 ,�(,/l� •✓ � r ,/ " ,( r�, /rrY � ,�,,. j,, l i � ,1,r,,
ARCHITECT/ENGINEER Phone: 011
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: $ � FEE: $ °
Check No.:c -� Receipt No.: 1" 1
NOTE: Persons contracting with unregistered contractors do not have access to gu ranty fund
J /
it r 1 r
S� nature'of,A ent/ r r,,r,,,r ;;,,,„ 1, , %r,r,ag,ntulrero + tracor
gib,r,, ,r �6,r, ri
tkORT H
Town of Andover
® r 0%
g �. 2
® LAKE 4��h ver, ass, �-
COCMICHEWiCx �1•
� U
BOARD OF HEALTH
AN
Food/Kitchen
PEINMMMIIF T LD Septic System
THIS CERTIFIES THAT ........ BUILDING INSPECTOR
. ............... ....... . ........................................... .............................
Foundation
has permission to erect .......................... buildings on
....�iAl.... . .. Q��:....... .. ...eek-.................
Rough
tobe occupied as ........ .. . ......... ....ce.�C . .......................................................................... 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
EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT Rough
Service
......... '........ ,ya':...............'.`'v:•vw. ..........................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Buildin 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 Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
30,
/� / /fes
A A SERVICES, INC.
11 Y��/ 115 NORTH STREET, SALEM, AIA 01970
Rolm Telephone:(978) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu er(s Name Date of Contract
sly , /S-
Buyer(s) Street Address, City,State and Zip Code m/
Daytime Telephone Number Evening Telephone Number Mobile Tele hone Number E-Mail Address
—?ra _G�0 --�i1,7
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance
with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement"),and Buyer(s)have requested
that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.('Contractor"),hereby agrees to install or cause to be installed
the products or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sale of goods and services.The Buyer(s)
agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their
purchase. !!�'.
Purchase ice:4C r ,� /
��= v'°7"- ./7/�-<z"a-lnx Est.Starting Date:0,4
Down Paym nt: Est.Completion Date0
11 Cash
Amount Due on Start of,Job: 11 Check '.
Amount Due on of Completion: t Credit Card
No.
Amount Due on of Completion: Expiration Date:
Balance Due on Upon Completi n: j CVC Code: '..
It is agreed and understood by and between the parties that this Agreement, front and back and any addendum, constitute the entire
understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Agreement.Buyer(s)
hereby acknowledge that Buyer(s)has read the front and the reverse of this agreement and has received a completed,signed and dated copy of this
Agreement,including the two attached Notice of Cancellation forms,on the date first written above.Buyer(s)also(i)acknowledge that they were orally
informed of their right to cancel this transaction;and(it)request that they be contacted via their telephone numbers or email,as listed above,in the event
Contractor believes Buyer(s)would be interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES. '...
A&A wices'I/c, Buyer(s)
By: (✓�.� ���
Signature
Signature
Print Name LL,n �ea�e'
Print am)e
Signature —
Print Name
You,the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction. See the following Notice of Cancellation form for an explanation of this right.
ARBITRATION:The contractor and the homeowner hereby mutually agree in advance that in the event either party has a dispute conceming this contract,either party may subout such dispute to a
private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affaipnd Business Regulations and the other party shall be required to submit to such
arbitration as proved in M.G.L 042A.
Cnmmctnr initials:4:" �`" My e,Iniki
Da1c: Date: /: /v-.
NOTICE OF CANCELLATION NOTICE OF CANCELLATION '..
Date of Transaction�r_�'y—f y y penal or Date of Transaction
.You nm cancel this transaction,without an penalty .You may cancel This transaction,without any penalty or
obligation,within three business days from the above date.If you cancel,any property traded in, obligation,within three business days from the above date.If you cancel,any property traded in,
any payments made by you under the Contract or Sale,and any negotiable instrument executed any payments made by you under the Contract or Sale,and any negotiable instrument executed
by you will be returned within 10 days following receipt by the Seller of your cancellation notice, by you will be returned within 10 days following receipt by the Seller of your cancellation notice,
and any security interest arising out of the transaction will be cancelled.If you cancel,you most and any security interest arising out of the transaction will be cancelled.If you cancel,you must
make available to the Seller at your residence,and substantially in as good condition as when make available to the Seiler at your residence,and substantially in as good condition as when
received,any goods delivered to you under this Contract or Sale;or you may,if you wish,cornply received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply
with the instructions of the Seller regarding the return shipment of the goods at the Seller's with the instructions of the Seller regarding the return shipment of the goods at the Seller's
expense and risk.If you do make the goods available to the Seller and the Seller does not pick expense and risk.if you do make the goods available to the Seller and the Seller does not pick
them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of
goods without any further obligation.If you fail to make the goods available to the Seller,or if you the goods without any further obligation.If you fall to make the goods available to the Seller,or if
agree to return the goods to the Seller and fail to do so,then you remain liable for performance of you agree to return the goods to the Seiler and fail to do so,then you remain liable for performance
all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated of all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated
copy of the cancellation notice or any other written notice,or send a let ram,to A&A services, copy of the cancellation notice or any other written notice,or send a tea m,to A8A Services,
115 North Street,Salem MA 01970,NOT LATER THAN N41DNIGHT OF�9-17 `/S 115 North Street,Salem MA 01970,NOT LATER THAN MIDNIGHT OF' /
mater male)
I HEREBY CANCELTHIS TRANSACTION I HEREBY CANCELTHIS TRANSACTION '..
Cwsum r s Signature Dale: Consumsr's Signature Data:
Phone: 978-741-0424
140, A Grade Fax: 978-741-2012
Above
Since 1982 www.a-aservices,com
115 North Street
KEERM . . 5 Salem, MA 01970
Date:
Work Specifications for Roofing Project
Name: ��L�b, �'�� e,
Address: /o y7 ,�<,,� e_.�
City:/V 4,4o�, State: f < , Zip Code: tis- s--
Areas to Be Re-Roofed:
Roof Areas Excluded from Re-Roofing:
NPull Permit with Community as Required.
Waste disposal is included using either dump truck or dumpster. If dumpster is utilized (site location:
as agreed to by the home owner), it will have plank stock put under dumpster as
\— property protection.
`F.1 Tarp house from fascia board to ground and beyond to protect house from falling roof shingles. A&A
Services makes every attempt to protect home, decks, driveways, landscaping, and shrubs. Due to the
heavy weight of roofing shingles coming off the home we cannot be responsible for damage to
landscaping and shrubs.
Strip roof of_layers of roofing shingles.
"R Inspect roof deck after removal of shingles for any rotted wood. If any replacement is needed, the first 32
sq.ft. is included. For any other repairs: 48 sheets of plywood removal and replacement will be billed at
$ per sheet. The charge for resheathing deck with 1/2" of plywood (go over existing roof deck), if
needed will be $ per sheet. Planking replacement is billed at $ per linear ft., and carpentry
repairs at $ per hour.
L7 Install GAF storm guard leak barrier 6' up roof from edge of fascia board (code calls for 3'). A&A Services
is dedicated to using extra ice dam protection in our unpredictable New England weather. GAF storm
guard leak barrier/ice dam protection material is a flexible membrane that sticks to the roof deck to prevent
it from moving when shingles are installed over it. This membrane self-seals when nails are driven through
so water cannot leak through it.
'-9 Install GAF storm guard leak barrier 18" in from edge of rake (eave areas of the home). This prevents
wind-driven rain from penetrating the edge of your roof and causing leaks.
Buyer Initials: Date:
Z:\A&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan.2015(2).docx
Phone: 978-741-0424
A Grade
Above Fax: 978-741-2012
Since 1982 wlmv.a-aservices.com
A&A SERVICES 115 North Street
• • Salem, MA 01970
Install GAF Roof Shingles Style: 7;;y,����;, //,0 Color:
Nail locations vary by shingle and roof slope. It is critical to fasten the shingle in the proper locations in
order to achieve desired performance and meet warranty requirements.
• All nails that will be used on your roof will be barbed or rough-shanked nails and will be resistant to
corrosion.
• In most applications, shingles will receive 6 nails and all nails will be long enough to penetrate min.
3/4" into the roofing deck. (Using 6 nails per shingle and utilizing ProStarter shingles at rakes and
soffits upgrades the wind rating of your roof to 130 mph.
❑ Install GAF Timbertex premium ridge cap shingles with approximately 8" exposure. These shingles add
the finishing touch to the peak and/or ridges of your home. They are also designed to handle some of the
toughest areas of roof protection. TimberTex ridge cap shingles are much thicker and have self-sealing
adhesive that seals each shingle tightly and helps reduce the risk of blow-off.
Install GAF Seal-a-Ridge Cap Shingles with approximately 5" exposure to ridges.
Clean off roof with blower to remove any debris. Clean out gutters of any roofing debris. Rake clean all
work areas. Leaf-Blow the perimeter of work areas. Go over grounds with magnetic rake to pick up any
loose nails. Please note: you may want to cover your attic belongings due to roofing debris sometimes
\ falling through the gaps in the roof deck. That cleanup is not included.
�0 This is a safety equipment project. We value our help and are concerned for your liability.
Supply owner with partial leftover bundle of shingles to have in the future if needed.
10 A&A Services is a certified GAF installer. We follow all Massachusetts building codes and GAF
manufacturer's installation requirements. By doing so, your roof qualifies for a 50 year non-prorated
warranty from GAF. See warranty for more details.
Massachusetts Law requires contractors to warranty their work for 1 year against installation defects. A&A
Services offers warranties for their roofing work for 10 years against installation defects. If any problems
occur at any time, A&A Services will come out free of charge to evaluate and help our customer through
any manufacturer's warranty claim.
❑ Miscellaneous: 1.y�cle-
buyer Signature Salesman Signa ure
Dau)D20 n,y� Date: 9-/q-15 Date:
Buyer Print Salesman Print
Z:\A&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan.2015(2).docx
3 0 Phone: 978-741-0424
1
�1,982-20,� Fax: 978-741-2012
1C �n mma-aservices.com
JUA NERV115 North Street
- Salem, MA 01970
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building
Permit Number is that the debris resulting from this work shall be
disposed of in a property licensed facility as defined by M.G.L.c. 111, Sec. 150a.
The debris will be disposed at:
Republic of Boston, Dumpster Service
at
115 North Street
Salem, MA 01970
sl ,
/ /-;
�/
Signature of P4rmit Applicant
Christopher Zorzy, President
Name of Permit Applicant
- as= ps
Date
Lam•.
The Conunomvealth of/Massachusetts
17eparttnent of Industrial Accidents
� Office oflnugstigations
600 {l ashiii ton St7•eet, 7`I' Floor
_ . Boston, Mass. 02111
1Vorkers' Compensation Insurance Affidavit: Builtlitta�/Plumbing/Elech•ical Contractors
-aDPlicant information: Please PRINT IeQibly
name• �,.t(� �� ����L..,��' �C`�s�f.
address: /5 l n�1—,7 er�t
CIt1' I-e state: lVI A 71h' ��� '71/ phUnZ# �1� � / �'�� �c L! rl• !l
work site location(full address)' I Y "lp "5-+ ,••)
❑ I atm a hon)eowner performing all work myself. Project Type: ❑New Construction []Remodel
❑ I am a sole proprietor ane.d have no onworking in any capacity• ❑ I3uildinu Addition
r
Q 1 am an employer providing workers' compensation for my employees working on this jab.
company name: /_ /-� r _ `j 'Y_v I`L-_75, F' ,'`
address: ( / J^ ✓i /�n .�`j
� --7 �y� /
City: �ri!T !1 l i i���l— �l / 5'- 7 -(J l c
phone#
,r. T.
insurance co. T��_ ! Cl+✓- r )' 1 policy#
❑ I am a sole proprietor, general contractor, or homeowtur(circle one)and have hired the contractors listed helort who have
the following workers' compensation polices:
compaury name:
address;
city: hone#:
insurance Co. oliev#
company name:
address:
city:
phone#•
insurance Co. olicy#
:attach additional sheet if necessary
Failure to secure coverage as required untlerSection 35:1 of NIGI. 153 can lead to the imposition oferiminal penalties ora line up to sl,5oo.00 and/or
one yea's'imprisonment as well as civil penalties in the form ora STOP WORK ORDER and a ane ol•SIII0.00 it day against nae. I understand that a
copy of this statement may be rorwarcled to the (lice of Investigations of the DIA for coverage verification,
I do ltereGv cerfify tutde thC�prrias enc!p nnllies of petjurP t/tett!Le information provider/above is hoc nnr/correct.
C
Signature/ � �/ Date (' �As ` J
Print name l / I Cs I . U y"- Phone# C 0&--7L/ /—O f�_
official use only do not write in this area to be completed by city or town official
city or torso: permit/license it ❑Building Department
❑Licensing Board
❑check if immediate response is required
❑Selectmen's Office
❑llealth Department
contact person: phone H; ❑Other
(revised sept '_On;)
�'�" CERTIFICATE OF LIABILITY INSURANCE Ef!
9/15/015
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
RELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
11viPORTANT: 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
NAME:
The John M.Sullivan Insurance Agen PHONE 781-449-9330 FAX781 449-3511
P.O. Box 920047 Malo Ext: (AJC,No
Needham,MA 02492 ADDRESS: sullivan.insadv@verizon.net
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:The Travelers Indemnity Co 11347
INSURED INSURER 8:
A&A Services, Inc
INSURERC:
115 North Street
INSURER D
Salem,MA 01970 INSURER E:
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 INSR WVD SUER POLICY NUMBER MFF POLICY
MIDDLICY/YYYY) (MMIDDIYYYEXP
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $
CLAIMS-MADE 1:1 OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
POLICY PRO- LOC $
4UTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITYY/N 9/13/2015 9/13/2016 T LIMITS ER
ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000
A OFFICER/MEMBER EXCLUDED? F--1NIA 6KUB-0243M81-5-15
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 600,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1600 Osgood Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
g ACCORDANCE WITH THE POLICY PROVISIONS.
'ding 20, Suite 2035
th Andover, MA 01845 AUTHORIZED REPRES5NX&7E
@ 1988-201 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
Certificate No: A044298
I
THE COMMONWEALTH OF MASSACHUSETTS
t EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
,i =} DEPARTMENT OF LABOR STANDARDS
19 STANIFORD STREET BOSTON,MASSACHUSETTS 02114
I
DELEADER CONTRACTOR LICENSE
A&A SERVICES, INC.
115 NORTH STREET
SALEM MA 01970
i
I
LICENSE: DC000440 EXPIRES: Saturday,June 25,2016
IN ACCORDANCE WITH M.G.L.CH. 111, § 197B(b)AND 454 CMR 22.03,THIS LICENSE IS ISSUED BY r
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF I
ENTERING INTO OR ENGAGING IN DELEADING WORK.
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L.CH. 111 § 197B(b)(2)AND 454 CMR 22.03.
I
WILLIAM D.WKINNEY,DIRECTOR
Massachusetts -Department of Public Safety
��--�---Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards
T1 �1DOME IMPROVEMENT CONTRACTOR �r,iiSti Uz rr, Saperri:.,r �.
li2egistration: 101609 Type* License: CS-057733
�Expiration: 6/26/2016 Private Corporatio �"�
CHRISTOPHER�
pie AAA SERVICES,INC A 115 NORTH ST
a Salem MA 019707 f
Christopher Zorzy
115 North Street
Salem,MA 01970 Undersecretary �-'�^'� " Expiration
Commissioner 05/26/2017
A&A SERVICES,INC.
115 NORTH STREET I `
SALEM,MA 01970
E