HomeMy WebLinkAboutBuilding Permit #614-13 - Building 27-Apt. 1 Royal Crest Drive 3/21/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: I Date Received
Date Issued f '
IMPORTANT• Applicant must complete all items on this page
LOCATION)
PROPERTY QWNER
Print 100 Year Old -Structure yes.
MAP NG' PARCEL: . ZONING' DISTrRICT: Historic District yes
Machine, Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
El Addition
❑ Two or more family `
❑Industrial
❑ Alteration
No. of units: b
❑Commercial
2 epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic: ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed• District
El Water/Sewer
rnCcrD1DT1nM n;: wnRK TO RE PERFORMED:
C/1,0,0
Please Type or Print Clearly)
OWNER: Name:
Address: l - L
,
CONTRACTOR Name: /L
hone: L �6(K
Address: I(J --(-4-L(11
... f
Supervisor s,Construction License: Ex - G S, Sf1 p• Date:
Home Improvement License fS^ Exp2-9
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: $ ti K0 0 ' "� FEE: $
Check No.: `� ��
Receipt No.: �lf o1 � d
NOTE: Persons contracting with unregistered contractors do not have access to e g ar mry fund
g,nature of Agent/Owner y Signature of contrac
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ mped Plans ❑
19
L
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming 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 - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Towey Engineer: Signature:
Located 384 Os ood Street
FIRE DEPARTMENT -,.Temp Dumpster on site yes no
Located -at -'124 Ma6`4bet
Fire Department signature/date'`
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA -- (For department use
El Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Li Building Permit Application
❑ Workers Comp Affidavit
a Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Li Building Permit Application
Li Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
o Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the app: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Building Permit Revised 2012
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
M ,v www.mass.gov/Zia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
4
v v
Address: ` 1 d' �—/ S
City/State/Zip: U � C ) 3_- hone #:
k an employer? Check the appropriate box:
a employer with !
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
❑ I am a sole proprietor or partner-
listed on the attached sheet. #
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] i
employees. [No workers'
comp, insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. F1 Electrical repairs or additions
11. F1 Plumbing repairs or additions
12. F] Roof repairs
13. ❑ Other
iy applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information.
omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information.
to ?m employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
brmation. 00,
urance Company Name: yt U LM
.icy # or Self -ins. Lid. #: 12- a % 2 Expiration Date: �Z/
Site Address: a9 , 7 V v I'd �City/State/Zip: Q 21 2L
:ach a copy of the workers' comped<ation policy declaration page (showing the policy number and expiration date).
lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
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
ip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
estigations of the DIA for insurance coverage verification.
i hereby certify It
r th pains dpenalties ofperjury that the information provided 72
booe istrto and correct.
nature: Date: /17/3
?fficial ttse only. Do not write in this area, to be completed by city or town official.
�ity or Town:
Permit/License #
ssuing Authority (circle one):
. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
�. Other
Tl_ _ __ - .fl
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
'he Department's address, telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1- 877-MASSAFE
T, ___ 1t /"1n nnn nnnn
i
I
.A,
To: (caul Bruno at B & M Restoration and Contracting
From: MATULA, DAN, Executive Vice President Redevelopment & Construction Services
ORGAN, TONY, Vice President of Construction, Construction Services
STEICH, MATTHEW, Regional Director of Construction, Construction Services
Milinazzo, Dan, Project Manager, Construction Services
Date: March 6, 2013
Re: Executed Contract and Related Matters
Attached is your copy of the executed contract with AIMCO NORTi-I ANDOVER, L.L,C,, an
affiliate of Apartment Investment and Management Company ("Aimco"), for construction services
at Royal Crest Estates (North Andover). We want to take this opportunity to inform you that
Almco Is committed to conducting its business in accordance with applicable laws, rules and
regulations and the highest standards of business ethics. If during the period of your business
relationship with Aimco, you believe the Aimco team members with whom you are dealing are
not living up to these standards, we ask that you report such conduct to one of the following:
• MATULA,DAN, Executive Vice President Redevelopment & Construction Services: (303)-
691.4647
• COHN,LISA, Executive Vice President and General Counsel: (303) 691.4415
• HANSON,MIKE, Vice President — Internal Audit: (303) 691.4376
If you prefer to remain anonymous, you may make a report using Aimco's anonymous and
confidential reporting. system, MySafeWorkplace, which is available 24 hours a day, seven days
a week via the Internet at www.MySafeWorkplace.com or by calling 1-888-481-7123, We
encourage you to use MySafeWorkplace only if you do not feel comfortable reporting issues
directly to an Almco representative.
We would also like to remind you that Aimco has a Code of Business Conduct and Ethics, which
prohibits Aimco employees from accepting meals, entertainment, services or gifts from anyone
who does business with Aimco unless the amount of such Item is less than $25, AIMCO
Construction Services has a $0 policy. This provision Is to specifically include, but Is not limited
to, suppliers or other contracted labor utilized under this project, it Is the responsibility of this
Contractor to advise any subcontracts or suppliers of the AiMCO Code of Business Conduct and
Ethics.
1 Page Form, GC, Lump Sum, Contract, 2 -Jan -12
GENERAL CONSTRUCTION SERVICES ONE-PAGE CONTRACT
Contract Number 15519 - 47.2094 - CP - 00003
Contractor:
B & M Restorailon and Contractin
Property:
Royal Crest Estates North Andover
Address:
107 Orleans Street
East Boston, MA 02128
Location:
50 Royal Crest Drive
North Andover, MA 01845
Re resentat(ve:
Paul Bruno
I Issuing Office:
AIMCO Regional Office
Telephone:
617 561-9998
1 Address:
Two Greenwood Square 3331 Street Road
Bensalem, PA 19020
Facsimile:
Email: )bruno a bandmrestoration,com
Contract Sum:
$4,840.00
1 Contract T s:
Lump Sum
This General Construction Services One Page Contract ("Contract') is
effective as of 3/5/13, by and between "CONTRACTOR" (as identified above)
and AIMCO NORTH ANDOVER, L,L.C., ("OWNER'S for construction and
services to be performed and/or material to be supplied for the property
known as Royal Crest Estates (North Andover) (the "Property). In
consideration of the acceptance of CONTRACTOR's bid and/or proposal for
furnishing supplies, goods and/or services to the Property, CONTRACTOR
agrees to perform the following services and/or supply the following materials
(the "Worle):
CONTRACTOR acknowledges that the Work shall be for the benefit of both
OWNER as well as the beneficial owner of the Property. The Work shall be
performed In accordance with the following dates (the "Construction
Schedule):
Date of Commencement: 03/20/2013
Date of Final Completion: 04!0,12013
This Contract does not establish an exclusive right to furnish supplies, goods
and/or services to the Property and OWNER reserves the right to terminate
this Contract at any time without cause.
Ali services, materials and employees used by CONTRACTOR shall comply
with all applicable federal, state and local laws and regulations, including, by
way of Illustration and not limitation, the Americans with Disabilities Act
("Laws'.
To the fullest extent permitted by law, CONTRACTOR shall Indemnity,
protect, defend and hold OWNER, the beneficial owner of the Property,
their affiliates, parent and subsidiary entities, Including, without
limitation, Apartment Investment and Management Company (AIMCO),
and any of AIMCO's subsidiaries and affiliates that may directly or
Indirectly own or manage the property at or for which CONTRACTOR
performs any Work, and their respective partners, managers, members,
employees, officers, directors, trustees, shareholders, counsel,
representatives, agents, successors and assigns (the "Indemnified
Parties") free and harmless from any and all liabilities, claims, demands,
actions, costs (Including reasonable attorneys' fees), suits or matters
arising from or related to (1) Injuries to persons or damage to property
(excluding the Work), (II) any alleged violation of any Laws and (111) a
notice or claim of Ilan. CONTRACTOR's obligations under this Contract,
Including Its Indemnity obligations, shall not be limited by a limitation
on the amount or type of damages payable by or for CONTRACTOR
under worker's or workman's compensation acts.
CONTRACTOR waives and releases all claims for or right to any
consequential, incidental, exemplary, punitive or special damages.
CONTRACTOR shall not bring claims or lawsuits against any principals,
employees, agents, officers, directors, stockholders, partners or affiliates of
OWNER, the beneficial owner of the Property, AIMCO, AIMCO Properties,
L.P., or AIMCO-GP, Inc. CONTRACTOR further agrees that the sole and
exclusive remedy of CONTRACTOR for payment and/or performance of this
Contract shall be against the assets of OWNER. „
OWNER: O NO h�,A ��lireseL4OWNER
CONTRACTOR shall purchase and maintain, at its sole expense, commercial
general liability insurance with limits of no less than $500,000. The liability
Insurance shall cover all labor, materials, or services furnished hereunder and
shall Include a contractual liability endorsement. CONTRACTOR shall furnish
OWNER with a certificate of Insurance, naming the Indemnified Parties as
additional Insureds. CONTRACTOR shall also purchase and maintain
workers compensation insurance as required by Laws and shall furnish
OWNER with evidence of such Insurance.
Nothing contained herein shall create any third party beneficiary rights In any
person not a signatory to this Contract except OWNER will be third party
beneficiaries of CONTRACTOR's agreements with all of Its subcontractors
and CONTRACTOR shall include or cause to be Included similar provisions in
each of the aforementioned agreements naming OWNER as third party
beneficiaries, The undersigned shall be solely responsible for the
employment, control and conduct of Its employees and nothing set forth
herein shall have the effect of creating an employer•empioyee relationship
between OWNER and any of CONTRACTOR's employees.
All trade discounts, rebates and refunds and all returns from sates of surplus
materials and equipment shall belong to and accrue for the benefit of
OWNER.
CONTRACTOR is prohibited from providing gifts or other things worth more
than $25 to OWNER or any of Its employees. CONTRACTOR's violation of
this precept shall constitute grounds for immediate termination,
CONTRACTOR's obligation to properly and timely perform and complete the
Work shall be absolute. CONTRACTOR shall carry on the Work during all
disputes or disagreements with OWNER.
Conflict of Interest: Although CONTRACTOR and Its contractors,
subcontractors, consultants and vendors may employ relatives of employees
of the OWNER, Its affiliates, parent and subsidiary entities, Including, without
limitation, AIMCO and any of AIMCO's subsidiaries and affiliates that may
directly or Indirectly own or manage the property at or for which
CONTRACTOR performs any WORK (the "AIMCO Employees'),
CONTRACTOR shall immediately so Inform OWNER as soon as known, or
discovered, OWNER reserves the right to require that CONTRACTOR and/or
its contractors, subcontractors, consultants, and any vendors to modify work
assignments of the AIMCO Employes's relative where a conflict of Interest, or
the appearance thereof, is deemed by OWNER to exist. CONTRACTOR shall
Include this provision in any of Its subcontracts and material agreements,
CONTRACTOR acknowledges, understands and agrees that OWNER may
execute this Contract by an authorized representative. Notwithstanding
anything contained herein to the contrary, such authorized representative
and/or Its affiliates shall not Incur any liability, or other obligation, under this
Agreement to CONTRACTOR, for any reason, including, but not limited to, for
any payments that may be due CONTRACTOR hereunder.
This Contract entered Into as of the day and year first written above,
CONTRACTOR:B
5lgnatum.- //I., l! Signature: Y
Print Name: Matt Stelch ej It Slf 3 Print Name: Paul Bruno
Print Title: Regional Director of Construction Print Title: Principle
1 Page Form, GC, Lump Sum, Contract, 2•Jan-12
AcoRcf CERTIFICATE OF LIABILITY INSURANCE
`•-�
DA 74/2013
3/1
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
Burgin, Platner, Hurley Insurance Agency, LLC
14 Franklin St.
Quincy MA 02169
CONTCTE. Jean Sullivan, CIC, AIS
PHONE (617) 472-3000 FAx o (617)472-7248
E -MAI jas@bphins.com
INSURER(S) AFFORDING COVERAGE NAIC 0
INSURERA:Hanover Insurance Company 2292
INSURED
B & M Restoration & Contracting, Inc.
107 Orleans Street
East Boston MA 02128
!NSURr:RB:Safety Indemnity Insurance CO 33618
INSURERCAcadia Insurance Company
INSURER D:
INSURER E:
INSURER F:
CUVERAGES CERTIFICATE NUMRFR,2013-1412ertUmbUndate RFt,AQIAN NI IIURPR•
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.
ILSR
TYPE OF INSURANCE
ADDL
SUER
OL CY BER
POLICY EFF
OLIC EXP
MfYYYYl
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
'Y
N
ZHNS997647
ILdditional Insured
Primary by Written
Contract
/17/2013
3/17/2014
EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTEff—
PREMISES ° occurrence) $ �i 100, 000
MED EXP (Any oneperson) $ 5,000
PERSONAL &ADV INJURY $ 2,000,000
GENERAL AGGREGATE $ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO LOC
PRODUCTS - COM P/OPAGG $ 4,000,000
$
B
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNEDX SCHEDULED
AUTOS AUTOS
X HIREDAUTOS X NNUO,rN-OWNEDWaiver
AOS
Y
Y
6208157C
dditional Insured
per Written Contract
of Subrogation
1/6/2012
11/6/2019
G 11000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE$
-(Per acdclent)
PIP -Basic $ 81000
A
X
UMBRELLA LIAS
EXCESS LIAB
X
IOCCUR
CLAIMS -MADE
Y
NN905512100
ollow Form
/17/2013
3/17/2014
EACH OCCURRENCE $ 5,000,000
AGGREGATE $ 5,000,000
DED I X I RETENTIONS
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYDRYLIMITSFR
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
Ifyyes, describe under
DESCRIPTION OF OPERATIONS below
N f A
N
C-20-20-003740-00
6/10/2012
6/10/2013
SVvC STATU- OT -
E.L. EACH ACCIDENT $ 1 000 000
E.L. DISEASE - EA EMPLOYE $ 1 '000,000
E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Project: Royal Crest Estates(North Andover) Contract# 15519 -422094 -CP -00003; AIMCO North Andover LLC is
additional insured
Aimco North Andover LLC
50 Royal Crest Drive
North Andover, MA 01845
H%,UnU AD tLu-lu/ub)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
..► aoc.
Besse, CIC CISR CPI
U 1988-2010 ACORD CORPORATION. All rights reserved.
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Location<:92
No. & / I/ I ) -? Date - I <
Check # S-�-1 �
26218
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $ TE --
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector