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HomeMy WebLinkAboutBuilding Permit # 10/29/2015Permit NO: - Date Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential n New Building Li Addition Alteration n One family LI Two or more family No. of units: ill Industrial A Commercial LI Repair, replacement LI Demolition LI Assessory Bldg CI Other II Others: CL ,,? 0 4, OWNER: Name: Address: Identification Please Type or Print Clearly) OA, Phone: ARCHITECT/ENGINEER 1), rf, Phone: Li Address: M400 ra„ CLi4',./ fr 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: $ /oR „ Check No.: c FEE: $ 2 2 0 — Receipt No.: Wiz, 2-614T6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of yynery?,:. U� = CD Ci r. "0 0 c� CD 0 tD • - 03 C ® ® m 0 I ) ® Co st C▪ D • (o cD 1. y 0 A., CD 0 PM - 7 CD 2 O CD naapo1paiy1 2IO133dSNI 9NIa1Il8 VIOLATION of the Zoning or Building Regulations Voids this Permit. 0° 7: C =' g O ▪ 5: 5 • a C. w- CD CD 0 a • N CO Cl• s • as CD 13 O - O • CO O N O co'O O - aDU)c O (i O �- � • Cn< O. CO '< CD r tU "CS,„ (/) CD O �- O co O CD s m py. Cfl -, CD U)n O -- Oa p Biz > CD CD -:a o gu g. D ®' 0 1VHl S31311A30 SIHl � noml it, �� u� A? Construction Company Inc. 200Sutbon Street SavvtooLhBui|ding ZUMBA TENANT Demolition Rough Carpentry Finish carpentry 500.[0 4,000.00 Both Stages 5,000.00 painting 5,500.00 K4uta|Stud/Dryvva|�A�ousbcal $ 27[5OO.OD ���I'll Mirror Barre � 9,600.[0 5,010.00 Allowance Cutting Glass Floor covering � 38�000.00 ForHVV��EHVV Doors and Frames 4,000.00 Alum Door Plumbing - � 4,500.00 � 14.000.00 12,500.00 Electrical 29,750.00 Fee $ 164.360.00 $ 20604.00 $ 184.964.00 As of 10/19/2015 CONSTRUCTION COMPANY, INC. October 19, 2015 Re: Miami Fitness Scope of work The following is based off of plans titled "Miami Fitness & Lifestyle" dated 10-13-15 drawn by DB2/Architecture. General Conditions: 1. We assume project duration of approximately 10 to 12 weeks in one phase. 2. A licensed superintendent will be assigned to this project 3. Mechanical, Electrical, Plumbing, and Fireproofing drawings not included. Continuous Work: 1. Throughout term of project, premises will be swept cleaned daily for dust control and safety. Rough Carpentry: 1. Build Wood framed stages as to Drawing A-101 2. Build Access ramps leading into Studio 1 Finish Carpentry: 1. Reception Desk CONSTRUCTION COMPANY, INC. 2. 2 - Storage Cubbies with integrated bench Doors & Hardware: 1. 3'0" x 7'0" Solid Core Wood Doors 2. ADA Hardware 3. Aluminum Glass Double Door leading into Studio 1 Gypsum Board: 1. Furnish and Install all new interior partitions (metal stud) and insulation per print as to plan A-101 in a Class III finish. To be delivered in "Ready to Paint" fashion. 2. Patch and Tape all current non finished areas, 3. Bathroom partitions to be 10' High Acoustical Ceiling: 1. Furnish and install new ceiling in "Kaplan" Area. Tile: Armstrong 769 tile Mirrors: 1. Mirrors panels to be 7' Tall adhered 2' off the floor with no cuts. Mirrors shall be placed along the perimeter of Studio 1, excluding existing brick wall and windows. 2. 12 Cuts for Mounting Brackets Flooring: 1. Furnish and install Studio 1 floor: a. 3/8" Acoustical Sound Mat CONSTRUCTION COMPANY, INC. b. 2 Layers of 3/8" Plywood with Green Glue c. 1 Later of 1" MDF Plywood d. Choice of either Armstrong Ascot Hardwood or'h" Prime Harvest Engineered Wood 2. Reception Lobby: Daltile Sandalo Ceramic Tile 3. Common Corridor, Storage, and Reception: Mohawk Mixology Carpet 4. Bathrooms, shower, and Janitorial: Armstrong Standard Excelon VCT Ballet Barre: 1. Furnish and Install 30' of Single Fixed Height Wall Mount a. Hardwood Ash (1.5" diameter) b. Metallic Silver Collared Brackets 2. Furnish and Install 24' of Single fixed floor Mount a. Hardwood Ash (1.5" diameter) b. Metallic Silver Collared Brackets c. Metallic Silver Single Fixed Height Fitness Floor Stanchion (top of barre height @ 42") Plumbing: 1. Furnish and Install a. 2 - Wall Hung Kohler toilet & Sloan #110 Flushometers b. 2 - Wall hung carriers c. 2 - Lavatories Kohler and 4" Faucet 3 V. / D -- r3-O %5` CONSTRUCTION COMPANY, INC. d. 1 - 24"x24" Mop sink and Valve e. 1 - 36"x36" Shower and valve f. 1 - ADA water cooler and glass filler g. 1 - 50 Gallon electric HW Heater set on Stand above Mop Sink h. 1 - ADA fixtures as shown on Plan. HVAC: 1. In Studio 1: Install Spiral ductwork, registers, and grill from 4 Ton Split System (Supplied by Realty) 2. Office area and Lounge: Two zone ductwork control system, grills, and registers. 3. Bathrooms: Inline bathroom exhaust fan, ductwork and registers. Electrical: 1. Furnish and install (5) type "A" lighting fixture 2. Furnish and install (16') Type "B" light track. 3. Furnish and install (7) type "C" lighting fixtures. 4. Furnish and install (6) type "D" lighting fixtures. 5. Furnish and install (9) type "E" lighting fixtures. 6. Furnish and install (7) type "X1" lighting fixtures. 7. Furnish and install (4) industrial paddle fans. 8. Furnish and install (17) duplex receptacles. 9. Furnish and install (4) single pole toggle switches. �/a 0/ice CONSTRUCTION COMPANY, INC. 10. Furnish and install (5) occupancy sensors. 11. Furnish and install (1) GFI receptacle. 12. Furnish and install (2) floor boxes. 13. Furnish and Install (2) plaster rings and pull strings for voice/data 14. Furnish and Install (4) Voice/data outlets and cabling to common area on wall at column line B-5 15. Furnish and Install (5) dedicated 120 volt ampere circuits. 16. Does Not Include Any Lighting for Studio 1 Painting: 1. Painting of Interior Partitions with 1 coat primer and 1 coats finish of Benjamin Moore Paint. Colors TBA 2. No Painting of the brick is permitted. david c. burton, riba, leed Ira m. baline, aia, leed test r PARKING REQUIREMENTS Miami Fitness & Lifestyle October 26, 2015 Per the Building Code Review on Permit Set dated October 26, 2015: Use = Indoor Place of Amusement or Assembly Occupancy Load = Business (100 Gross) = 8 Recreation Room (50 Gross) = 40 Total = 48 BUILDING CODE REVIEW APPLICABLE CODES 1. BUILDING MASS. STATE BULDING CODE 8TH EDITION 2. MECHANICAL MASS. STATE MECHANICAL CODE 3. PLUMBING MASS. STATE FUEL GAS AND PLUMBING CODE 4, ELECTRICAL MASS. STATE ELECTRICAL CODE 5. ENERGY MASS. STATE BULDING CODE, ARTICLE 13 (780 CMR) 6. FRE SAFETY MASS. STATE FIRE PREVENTION REGULATIONS, 527 CMR 21 7.ACCESS,.1TY MASS, STATE ARCHITECTURAL ACCESS REGULA11ONS, CMR 521 8. ELEVATOR MASS. STATE BUILDING CODE, ARTICLE 30 (780 CMR) DESCRIPTION CODE REF. PROPOSED GENERAL Use N. Andover Zahn Bylaw g hdoor Place of Amusement or Assembly Indoor Place of Amusement orAsserrialy ConsttructionType Table 601 III or IV same Height and Area Table 503 Tenant Area 2,730 SF OCCUPANCY LOAD Busiless Table 1004.1.7 100 Gross (730/100) 8 Recreation Room Table 1004.1.2 50 Gross (2000150) 40 TOTAL 48 Per the Zoning Bylaw of North Andover Amended May 20, 2014 Section 8.1 Off Street Parking and Loading: Public Assembly = .25 space per person based on the design capacity of the facility (.25x48) Total Parking Required= 12 spaces Total Parking Available on Site = 240 spaces ii 11%Feccentloh' literfa7nment,,. Public Assembly • 0.25 per person in permitted capacity Museum 1.5 per 1,000 annual visitors Library 4,5 per ksf GFA Religious Centers • 0.6 per seat Cinemas 0.5 per seat: Op to 5 screens: 0.33 per seat: 5 to 10 screens: 0.3 per seat 0.33 Theaters (live perfonnaiice) 0.4 per seat Arenas and Stadiums 0.33 per seat Golf Course or Country Club 50 per nine (holes); plus the patting requirements for food or beverage uses desetibed above Health Clubs and Recreational Facilities 2 per player or 1 per 3 persons permitted capacity www.db2arch.com 660 Main Street, let Floor, Woburn, MA 01801 'IA , o E i- ... 0 ... 7 1 1 ci m F K ff ..i1M1Y1 01,191t1,41114N1WM,1 1 d'11)111'11'11'll'ill1111111111;111111111111111111111 rE —I Xi 00 z 713 ti as Is IN m r m T x IDm 00 z;B w 11 a ardrozardr 4 Ar, 1744- y 7,0" aaj r r r :111 ,1',,tall,illIaIa3aTan30111.111aaa3131111110Ill.VIV,y11 Li 3,aa..raaaaaraaaaaaaa,o3333,33.n.aaaao, a 4111111193313111,33111331Pa, •tl.(111.,.....411111011111111111111111111111I1111111.1.1.1.1.110.0111..1:11.1.1.1.1.1.110..r ea 110 0 0 0 0 0 0 0 d I I 0 I d 0 I -n 0 n— z 0 co 0-1 JJ 1E1C ZO 4,2 .1 4 d r z Z iro 70) 0 ao IRE Z oo � N --1fn = C -I Zo vz 0 m m INViN david c, burton, riba, leed ira m, baHne, aia, eed 2/ 111111. tr PARKING REQUIREMENTS Miami Fitness & Lifestyle 111111 October 26, 2015 Per the Building Code Review on Permit Set dated October 26, 2015: Use = Indoor Place of Amusement or Assembly Occupancy Load = Business (100 Gross) = 8 Recreation Room (50 Gross) = 40 Total = 48 BUILDING CODE REVIEW APPL1CAPJ F CODES 1. BUILDING MASS STATE BUILDING CODE 8TH EDITION 2. MECHANICAL MASS STATE MECHANICAL CODE 3. PLUMBING MASS. STATE FUEL GAS AND PLUMBING CODE 4 ELECTRICAL MASS. STATE ELECTRICAL CODE 5. ENERGY MASS STATE BUILDING CODE, ARTICLE 13 (780 CMR) 6 FIRE SAFETY MASS. STATE FIRE PREVENTION REGULATIONS, 527 CMR 21 7. ACCESSBLITY MASS STATE ARCHITECTURAL ACCESS REGULATIONS, CMR 521 8. ELEVATOR MASS STATE BUILDING CODE, ARTICLE 30 (780 CMR) DESCRIPTION CODE REF. PROPOSED GENERAL Use N. Andover Zoning Bylaw Indoor Place of Amusement or Assembly Indoor Place of Amusement or Assembly Construction Type Table 601 III or 6/ SPILi Height and Area Table 503 Tenant Area 2,730 SF OCCUPANCY LOAD Business Table 1064.1.2 100 Gross (730/100) 8 Recreation Room Table 1004.1.2 50 Gross (2000/5D) 40 TOTAL 40 'VP' i ,1,91PM ttotp77MVPIWPWAT9W),,,,, , r),PMV.M,'T,,,,,,'M ' Per the Zoning Bylaw of North Andover Amended May 20, 2014 Section 8.1 Off Street Parking and Loading: Public Assembly = .25 space per person based on the design capacity of the facility (.25x48) Total Parking Required= 12 spaces Total Parking Available on Site = 240 spaces ri ,yoyi e x, --veiscwit /, ittttttol PublicAseint,1y 0.25 per person' capacity Museum 1.5 per 1,000 annual visitors Library 4.5 per ksf GFA RelCenters0.6 per seat Cinemas Single -Screen: 0.5 per seal: Up to 5 screens: 0.33 per seat: 5 to 10 screens: 0.3 per seat Theaters (live performance) 0.4 per seat Arenas and Stadiums 0.33 per seat Golf Course or Comity Club 50 per nine (holes): plus the 'talking requirements for food or beverage uses described above Health Clubs and Recreational Facilities 2 per player or 1 per 3 pe sons peunined capacity www.db2arch.com 660 Main Street, 1*` Floor, Woburn, MA 01801 da\Ad c.. burtpa, fiba, ieed ira n hhv io, aia, PARKING REQUIREMENTS Miami Fitness & Lifestyle October 23, 2015 Per the Building Code Review on Permit Set dated October 13, 2015: Use Group = A-3 Occupancy Load = Business (100 Gross) = 8 Exercise Room (50 Gross) = 40 Total = 48 BUILDING CODE REVIEW APPLICABLE CODES I. BUILDING MASS. STATE BUILDING CODE 8TH EDITION 2. MECHANICAL MASS. STATE MECHANICAL CODE 3. PLUMBING MASS. STATE FUEL GAS AND PLUMBING CODE 4. ELECTRICAL MASS. STATE ELECTRICAL CODE 5. ENERGY MASS. STATE BUILDING CODE, ARTICLE 13 (780 CMR) 6. FIRE SAFETY MASS. STATE FIRE PREVENTION REGULATIONS, 527 CMR 21 7. ACCESSIBILITY MASS. STATE ARCHITECTURAL ACCESS REGULATIONS, CMR 521 8. ELEVATOR MASS. STATE BUILDING CODE. ARTICLE 30 1780 CMR) DESCRIPTION CODE REF. PROPOSED GENERAL Use Group Section 304 A-3 A-3 Construction Type Table 601 III or IV same Height and Area Table 0 Tenant Area 2,7 0 SF OCCUPANCY LOAD Business Table 1004.1.2 100 Gross (730/100 Exercise Room Table 1004.1.2 50 Gross (2000/50) 40 TOTAL 43 Per the Zoning Bylaw of North Andover Amended May 20 2014 Section 8.1 Off Street Parking and Loading: Health clubs and Recreational Facilities -7 1 space per 3 persons based on the design capacity of the facility (48 person/3 space) Total Parking Required= 16 spaces Total Parking Available on Site = 240 spaces Cullural/RecreationaliEntertainnietit Pithlw _ po,r poi ,on pkliouro.lcolwity .Nilhoun I 5 roi Irmo normal I 5 Tot \ ( o p<1 'ilientos 5 pel I 0.33 pei 510 III ,elo:11, 11.3 pei I IR:mei,' bye 1),:i LIII'Z111,1 S1"1111111• pc`l ,.eat 50 IIILI. iIi' hr. palla1./.2 ("muse 1 rrnti CluIr re' phyei 01 I pei pct,ou, peim II6)1111 I IiiIr nil Rocivdi 6)11,11 Laillitio, (',11,11Y www,dbaarch.con) vvohurn, (THol through facility) Fast Food Fast Food (with -drive through facility) r;& I mror 1 6 b 91w 15.0 per ksf GFA 12.0 per ksf GFA Data Processing/Telemarketing/Operations Medical Offices (multi -tenant) Clinic (medical offices with outpatient treatment: no overnight stays) Veterinary Establishment, Kennel or Pet Shop or Similar Establishments Bank Branch with Drive-in Funeral or Undertaking Establishment Other Business or Office Uses Not Otherwise Listed Above 6.0 per ksf GFA 4.5 per ksf GFA 5.5per ksf GFA 0.3 per ksf GFA 5.5 per ksf GFA 0.05 per ksf GFA 3.0 per ksf GFA IA R&D establishment, manufacturing, industrial services, or extractive industry 0.8 per ksf GFA Industrial 2.0 per ksf GFA Manufacturing/Light Industrial (Single -Use) 1.5 per ksf GFA Industrial Park (Multi -tenant or.mix of service, warehouse) 2.0 per ksf GFA Warehouse 0.7 per ksf GFA Storage 0.25 per ksf GFA Other Industrial and Transportation Uses Not Otherwise Listed As determined by the Planning Board, but not less than 0.25 per ksf GFA R iip oum a 1 Elementary, and Secondary Schools 0.35 per student; plus 1 per 2 employees College University Determined by parking study specific to subject institution l V alb iYt Pt4�'�11% 'r�y� I II FI ( m ura ea aF ° ex ,w, o �wam�.,u�mu u�w,H mimmo Kivu w�drovuaoPM�irc rn�w.�nu nu���un.(. Public Assembly 0.25 per person in permitted capacity Museum 1.5 per 1,000 annual visitors Library 4.5 per ksf GFA Religious Centers 0.6 per seat Cinemas Single -Screen: 0.5 per seat; Up to 5 screens: 0.33 per seat; 5 to 10 screens: 0.3 per seat Theaters (live performance) 0.4 per seat Arenas and Stadiums 0.33 per seat Golf Course or Country Club 50 per nine (holes); plus the parking requirements for food or beverage uses described above Health Clubs and Recreational Facilities 2 per player or 1 per 3 persons permitted capacity 88 Town; House Two Family Dwelling Veterinary Hospital &.Kennel xxr.,.eT,..,,..;.,., 2 Recreation Area Research & Development Facilities Retail Establishment Retail Plaza Rooming House Taxis De of Public Garages & Accessory Buildings - Public Service Corporation Public Sanitary Disposal Site Public Storage of Equipment Printing & Reproduction Private School for Profit Professional Offices* Public Building or Use Nursing & Convalescent $omes* One -Family Dwelling Personal Services Places of Worship Multi -Family Dwellings & Apts. Municipal RecreationArea New Car Sales* Non -Profit School Lumber, Fuel Storage or Contractor's Yard Manufacturing* Medical Center* Motel or Hotel Golf Course - GuestHouse Incubator or Business Park Independent Elderly Housing Indoor Place of Amusement or Assembly Indoor Ice SkatingFacili Commuter Rail System. Congregate Housing Continuing Care Retirement Center Day Care Center Eating 8c Drinking Establishment Funeral Parlor Bus Garage Business & Other Offices Car Wash Agriculturalilse* Art'Gallery Auto Service. Star/ tion* Auto&'Vehicle Repai.Body Shop Permitted se yzzz ?:zbz e,zKz .ez.K yzKK SP SP SE. 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Y Y N-, N Y* N SP N YNN Industrial n l2 13 IS e,zzzzzz'-< ZzZZZb'‹b.KZzzZbKKbzKK zzZZZKK zKzzZzzzzKzK'<zzKzzzzzzzz-<zzzz KKzZZZbKKbKK.K ZKbzzKKZZ44KKKZK zzbzzKKKzb4zKzKKK KKKzzzzzzz.<4 { KKKZzKzzzK.-‹°f! zzzKz*<zzzKK 2.1 pi ff U/if(noG� The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114 2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERM En NG AUTHORITY. Applicant Information Name (Business/Organi7ation/Individual): 040'• - • i-®.n4-r Please Print Legibly (-0awpe,d id1L• Address: 0 r Az City/State/Zip:0, lOokJovt•cr /IAA)OIV4s Phone #: hcC 6 C s L 6 Are you an employer? Check the appropriate box: 1.0 I ama employer with employees (full and/or part time).* 2. n I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.n I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.n 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 Proprietors with no employees. 5. [] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6. n We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (recjuired): 7. ❑ New construction 8. emodelirig 9. ❑ Demolition 10 [] Building addition 11. [] Electrical repairs or additions 12. n Plumbing repairs or additions 13. Roof repairs 14. f-1 Other *Any applicant that checks box#1 must also fil1 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 pot those entities have . employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: T rc'uieltrs ®w c e- C-a w e. Policy # or Self -ins. Lie. #: (n H J b - -t i5CO I2L1 ` _ 4 y Expiration Date: / 1 \ I 16 Job Site Address: ' . OZ S -- -' -. n S"� r'�'4 City/State/Zip: IIJ•tAAAsfrcrj M4 l O 1 %'4 C 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 WORK 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. I do hereby certif under th pain and penalties ofperjury that the information provided above is true and correct. Signature: -; Date: /42/2 V "Le3 ( S Phone #:f G ` Z `' 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 #: ACCAREP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/26/2015 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(les) 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 Mathias Insurance Agency, Inc 200 Sutton Street, Suite 160 North Andover, MA 01845 CONTACT NAME PHONE (NC. No, ExIL, 978-688-5531 E-MAIL ADDRESS: FA X INSURER(S) AFFORDING COVERAGE INSURER A :Navigators Specialty Inaurance Co NAIC INSURED Charles Construction Company, Inc. PO Box 847 North Andover, MA 01845 COVERAGES CERTIFICATE NUMBER: INSURER B Safety Insurance Co INSURER c Fist Mercury Insurance Co INSURER D Travelers Insurance Company INSURER E INSURER F — 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 Sf ?OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - NSR LTR - TYPE OF INSURANCE ADDL Han $UBR wv0 - - - POLICY NUMBER POLICY EFF MM/DD/YYYY) POLIOP (MWDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000 000 CLAIMS -MADE rillOCCURPREMISES (Eat o urrence) $ MED EXP (Any one person) $ A I 1 G11 3 } a 2 Ifa 05j1fi/1,5 05/16/16 PERSONAL & ADY INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ - X JECT LOC POLICY C--1 PRO- r�� PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY Y INi LnsINGl.b LIMIT (Ea accident) $ 1,000,000 — ANY AUTO —' 62 1 3 52 06/06/15 06/06/16 BODILY INJURY (Per person) $ 13 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident "WOPER1Y'DAAiA $ X HIRED AUTOS X NON -OWNED AUTOS ! _Peraccidern $ 1,000,000 $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE 05/16/15 AGGREGATE $ 5,000,000 DED RETENTIONS NJEX000004370 .02 05/16/16 ;$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I PER LSTATUTE OTH- ER D ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N NIA E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) 61-BUB- 9800M24-7-15 06/11/15 06/1.1/16 E.L. DISEASE - EA EMPLOYE-S 1, 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ 1 , 00 0 , 00 0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requ red) CERTIFICATE HOLDER Town of North Andover Building Department 1600 Osgood Street Bldg,'20, Suite 2035 North Andover, MA 01845 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHO' 'ED =.t .,'ES• TATIVE ©1988-20 4 ACORD CORPORATION. All rights reserved. ACORD25 (2014/01) The ACORD name and logo are req'•:'fred .rks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-005712 Construction Supervisor STEVEN C MATSES 202 SUTTON ST NORTH ANDOVER MA ..AA Commissioner Expiration: 10/23/2017