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HomeMy WebLinkAboutBuilding Permit #571 - Exception 4/7/2008 NORTH BUILDING PERMIT 0 -fuz° 06�tio TOWN OF NORTH ANDOVER �� °�`'- °� APPLICATION FOR PLAN EXAMINATION ° Permit N0: Date Received ` "`"" d-K SSAC64►15� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 450 Winthrop :;kv enu-e Print PROPERTY OWNER Socony Mobil Oil Print MAP NO: 026 PARCEL: 210 ZONING DISTRICT: B3 District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commerci epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Pai4uilding fascia with Mobil blue (2/3) on white background (1/3) . Paint storefront grey. Existing white canopy to receive 2D blue (2/3) non-illuminated fascia. Modifications to existing tank top and piping system. Identification - Please Type or Print Clearly) a OWNER: Name: Socony Mobil oil c/o Ayoub Engineering, Inc. Phone: 401/728-5533 Address: 414 Benefit Street, Pawtucket, RI 02861 CONTRACTOR Name:__A/?// L4���` Phone: 7/ '. b �If u i , I Address: ���� --.. �T ���� MA Supervisor's Construction License: Exp. Date Home Improvement License: Exp. Date: Alan J. Micale, P.E. ARCHITECT/ENGINEER Ayoub Engineering, Inc Phone: 401/728-5533 Address: 414 Benefit Street, Pawtucket, RI 02861 Reg. No. 40143 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: T 0, 000 'FEE: $ Check No.:� Receipt Nose NOTE: Persons contracting with unregis r d contractors do not have access to the guaranty fund ignature ofAgent/Owne Signature of contractor Ayoub Engineering, Inc. nt for ExxonMobil Corporation. Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools STobacco Sales Food Packaging/Sales ED(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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED ,HEALTH COMMENTS L ti Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Maim Street Fire Department signatureldate COMMENTS Dimension Number of Stories: 1 Total square feet of floor area, based on Exterior dimensions. 2,590 s,f, Total land area, sq. ft.: 26,136 s.f. 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) i ❑ Notified for pickup - Date ....................... ............-._.........--..................................._................................_..._............................------.............................-----........._.__......_.......................---...---.....................---..............................---._......................_....._.....................................-...... Doc.Building Permit Revised 2007 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ 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 Per;nit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract or Mass .check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location,-- No. ocation,No. Date r MORT1y TOWN OF NORTH ANDOVER F A 41 a 4 i Certificate of Occupancy $ ^e �ss,KMust<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #! 2" 2 1 051 Building Inspector 1 AYOUB ENGINEERING , INC . ENGINEERING AND ARCHITECTURAL CONSULTANTS EMAIL: info Qayoubengineering.com CORPORATE OFFICE: NEW HAMPSHIRE OFFICE: 414 BENEFIT STREET 254-B NO. BROADWAY,STE. 206B PAWTUCKET, RHODE ISLAND 02861 SALEM,NEW HAMPSHIRE 03079 401-728-5533/FAX 401-724-1110 603-894-4828/FAX 603-894-4827 February 28, 2008 Hand Delivered Mr. Gerald Brown Town of North Andover Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: ExxonMobil North Andover, MA 350 Winthrop Avenue AEI Project No. 3462.107 Dear Mr Brown, ExxonMobil is proposing minor modifications to theei-.:existing store at the subject location: The following information is submitted for permit approval. The scope of the work proposed is as follows: 1. Paint the existing building fascia with Mobil 'blue band (two-thirds) and white background(one-third). 2. Paint existing storefront grey. 3. Existing white canopy to receive 9 2D blue nor -Aluminated fascia(two- thirds' 4. Reface existing high-ris: "Mobil" ID SISM faint sign poles and frames white. No change proposed in sign square f-)otage. 5. Reface existing "Mobil Mart" sign and relocate slightly to the left on the same building face. '-No change proposed in si�,n square footage. 6. Reface the "Pegasus"wall sign. No change proposed in sign square footage. ti REGISTERED: MASSACHUSETTS RHODE ISLAND CONNECTICUT NEW HAMPSHIRE NEW YORK MAINE VERMONT FLORIDA NEW JERSEY MARYLAND PENNSYLVANIA WWW.AYOUBENGINEER]NG.COM w 7. Reface "Mobil" and price signs on freestanding ID sign; paint sign poles and frames white. The price portion of the ID sign will change from a three-product sign to a four-product sign. The square footage of the sign will remain the same. 8. Remove existing island spreader bars. 9. Modify the existing tank top and piping system. All the proposed improvements are per the attached plans. We appreciate your assistance in reviewing the attached plans. If you have any questions, lease do n q ,p of hesitate to call. Very truly yours, �y Alan J. Micale, P.E. Vice President Attachments: 2 sets of building plans 1 Application for Building Permit 4 Application for Sign Permit ExxonMobil Authorization Letter Cc: Lt. Andrew Melnikas, Fire Prevention Officer w/plans i Exxonmobis Fueis Marketing company 3225 Gallows Road Fairfax,Virginia 22037 EV, oil Fuels Marketing August 7, 2006 To Whom It.May Concern: ExxonMobii Corporation ("ExxonMobil") does hereby authorize Ayoub Engineering, Inc. of 409 Benefit Street Pawtucket Rhode Island 02869 to apply for and represent ExxonMobil in filing of any applications for required permits and/or approvals for the construction, operation and maintenance of convenience store/self serve gas stations. This authorization also includes, but it is not limited to, appearing before any governmental agency at general meetings or public hearings addressing such construction/improvement of ExxonMobil retail facilities. Very truly yours, ExxonMobil Corporation By. David O'Toole O'Toole Construction Project Coordinator C I SafeWasteTM Aboveground Used Oil Storage Systems from Containment Solutions Page 1 of 1 CONTAINMENT SOLUTIONS 5150 Jefferson Chemical Road•Conroe,Texas 77301-6834 Phone(800)537-4730•Fax:(936)756-7766•Website:www.containmentsolutions.com SafeWaste'M Aboveground Storager Systems A versatile double containment storage system for storing used oil safely, indoors and out. SafeWasteTm Storage Systems feature a UL-listed storage tank and diaphragm suction pump. Included are features like automatic overflow protection and an audible overspill prevention alarm. SafeWaste Storage Systems are designed to be fully operational with minimal installation cost. Benefits: • Superior environmental protection • Engineered to meet national and local codes • Eliminates underground liability • Tamper-proof self-containment • Versatile applications/indoor/outdoor • Movable by forklift Standard Features: • UL-listed aboveground flammable liquid primary storage tank • UL-listed air operated suction pump • Environmental security enclosure cabinet • 110%secondary containment • Automatic overflow protection • Audible overspill alarm • Liquid level indicator • 100%observable primary and secondary tanks • Corrosion resistant coatings on primary and secondary tanks • Optional collection caddy A complete selection of Containment Solutions storage systems are available nationwide. Our experienced sales staff is ready to assist you in selecting the tank best suited to fit your needs, or to custom design a complete system for you. Copyright©1999 Containment Solutions,Inc. http://www.contaimnentsolutions.com/products/safewaste/safewaste—P.html 3/21/2008 Mar 13 08 02:02p JSP Land Development 413-564-M5 p.5 The Commonweahh ofMassachusetts Department of Industrial Accidents V 00 r Office of Investigations 600 Washington Street U P cc 0-o-j-0 L,-,Vv.e2 4 z Boston,MA 02111 - www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electriciana/Plumbers Applicant Information Please Print Legibly 'Tame(Business/Organization/Individual): Address: r City/State/Zip: - Phone #: All Are you an employer?Check the aPP appropriate nate box: �� 1.0 I am a employer with. /y 4- ❑ I am a general contractor and I Type of Project(required): employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' 8' Demolition [No workers'comp.insurance comp.insurance.$ 9• ❑ Building addition required.] 5. ❑ We are a corporation and its 10-❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 2-E] Roof repairs employees. [No workers' 13-❑ Other comp. insurance required.] "Any applicant that checks box#I must also 611 o t Lit the section below showing their workers'compensation policy information. Homeowticts who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check ibis box must attached an additional sheet showing the name of the sub-connamrs and state whether or not those employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, entities have I am an employer that is providing workers'compensation ursurance for my employees. Below is thepolicy and job site information. Insurance Company Name: ��• �, �� Policy#or Self-ins.Lic.#;_��„ Expiration Date: i Job Site Address: _/ City/State/Zip: 01 r Attach a copy of the workers'compensation Policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. .do hereby certyy under t shins and malt' of perjury that the information provided above is true and torted Signature: Date; 3 i Phone#: t [[6Oclt cial use only. Do not write in this area,to be completed by city or town offaciaL or Town: Permit/License# ng Authority(circle one): ard of Health 2. Building Department 3.Cityfrown Clerk 4. Electrical Inspector S.Plumbing:]1nspec]tor Iter act Person• Phone#• Mar 13 08 02:02p JSP Land Development 413-564-0405 p.6 Fax: Mar 13 2008 11.09an P003/005 AC[fRDCERTIFICATE OF LIABILITY INSURANCE PRO�R aDrr Two CERTIFICATE ISSUED A6 TTENfOR11U1TI >!oley Iaelvraaae aaroup ONLY AND CONFERS A MAR OF I.37=200r ON S NO RIGHTS UPON THE CERTIFICATE 37 83m Street HOWE7t. THIS CERTIFICATE DOES NOT ApIENp, �T�p OR THE COVERAGE AFFORDED B TME POLICIES BELOW, Peet Springfield MA O1Q69 INBURW INSURERS AFFORDINp COYER110E NAW 0 J. 8. 1pwJluliB Ladd Dev+el•oDment Inc., DBA: JSP I uRm&Teeehnolo Ialeururau Lwll 2 Notre Deuce street Slaetuelace Co. • l+suREA c: eetEioldXh 01065-1125 uRa INSURER E: TtiE POLICIES OF INSURANCE uSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEligD INDICATED.NO RFAUIREBUENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MITI1 RESPECT 16WHICH THIS CEATIFlCATE N1AY BE 186UED OR NIAY PE G PERTAIN. THE INSURANCE AFFORDED By THE POLICIES UE8CRIBED HEREIN to SUBJECT TO ALL TME YEWS EXCLUSIONS ANO CONDMo% OF SUCH POLICIES. INSR ADO LM mm WIDE OFIN911"W E POLICYBUMER aA EFfE011VE POU 11EJ0�8ATgN .LIABILITY DA MN/OOIYY � A CRAUMCIAL RENERAL LIA61t ITV EMN newrw. 3mcf, f 1,0001000 DRAEMA6-E-D RENTED 100.000 A CLMM6LV40E 1K000UR C8iI109tti68 1/15/9008 1/15/a009 $ s S,DOD s 1,000 000 Mg GENL AGGREGATE LWIITAFPLIEB peR 2,000,0641 * .0L1Cr PLM ! 2.000.000 AUTDMOBILE w81uTT ANVAUTO COMBINED SINGLE LWT A :EaaCdaMl) ! 500,000 ALLOUMEDAUTOe BAe10016A 1/15/2008 1/15/9DD9 X SCMEMMAL40B BODILY INJURY R WIRED AUTOB (Pow Ween: i x NONOYNIEDAUTOti BOOILYIN1uaY cPo..p,la,,,o a PROPERTY DAMAGE a IPar WANN OARAOEI/ OW" ANY AMID SOON - A C i WNERT.MMI C i AUTO ONLr. E710EM MMPEllA LPAB UTY AOG c OCCUR []CLAIMS MADE S a,000.Doo MON T 2.009.0aa A DEDUCTIDLE CD6106398 1/15/2008 •1/15/2009 a �XlFrOVDX 0,01110 = H EMPLOrEAB T710MAN0 O ANY PROPRETORIPARTNERIEXECUTNE E L 500.o00 WKERA IMILA EXCLUND7 t Ac (DENT f� 1/38/2006 1/15/9009 iid"itowow B.EAEMPLOc 500,OOD ROM an oTIIeR - L -2635 500 000 DOMIPTX)A•OF OPERATIONL%GrATIDNSNERICLUMXCUACN9 ADDIq W ENDpRaEyEIyTfBPECU►L pRDPIBi0N8 Bite 'Addreave Kobita. 3B0 WLathrop Ave, north MNdowr, CERTIfJFATE HOL DER CANCELLATION TOMB SHOULD ANY OF TM ABOVE DEBGRIBED POLICIEO BE CANCOLLED BEPDRE TME 120 eQe Worth nsLdower E=PIRAMN DATE TNMIEDF, T"'B fiaNG INIUPM VALL ENDEAVOR TO MAL 01s 13BtrCrieet -0 DAYS WRITTt1t1 NOTICE TC TMe Ca"RCATE MOWER NAMED 10 THE LEFT.BUT N. 2lNdo�v�es, >ISA RaLURE VO DO BD WALL IMPOSE NO OBLIGATION OR LIAIXLnV OF ANY XWO OpON TIIE M18URE 179AOENTSORREPREaENlATIVr�. AUTHDRRED"Mim INTMIVE EIXisu POiey. CIC, bXA acoRc za�aoouoa� ,•""°"' •. .- OACORD CORPORATION IWC I Mar 24 08 02:52p JSP Land Development 413-564-0405 p.2 i r i or Budding Regulatio s and Standards onstt m*Jon Supervisor License License: CS 78874 Fxpiration: 3/612010 Tr# 18732 Resixiction: 00 JEFFREY S PECHULIS 181 NOTRE DAME ST �`- WESTFtELD,MA 01085 CoraWssioner I Page No.1 of 1 Pages AYOUB ENGINEERING, INC. 414 Benefit Street Pawtucket, Rhode.Island 02861 LETTER O F (401) 728-5533 T RA N S M I TTA L Fax(401) 724-1110 JOB NUMBER: 3462.107 DATE: 4/1/08 TO: ATTENTION: Mr. Gerald Brown RE: North Andover, MA Town of North Andover 350 Winthrop Avenune Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 WE ARE SENDING YOU M Attached ❑Under separate cover via the following items. ❑ Copy of letter ❑Prints M Plans ❑ Specifications ❑Other: COPIES DATE NUMBER DESCRIPTION 1 CONTAINMENT SOLUTIONS STORAGE SYSTEM SPECIFICATIONS 1 FEE FOR BUILDING PERMIT AND FOUR (4) SIGN PERMITS 1 JSP CONTRACTOR INFORMATION - IMAGE 1 LAMOUNTAIN CONTRACTOR INFORMATION -TANK TOP UPGRADE THESE ARE TRANSMITTED as checked below: ❑For approval M As requested ❑Approved as submitted ❑Resubmit ❑ Return M For your use ❑For review and comment ❑ Approved as noted ❑ Submit ❑ Other ❑FOR BIDS DUE/DATE: ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS: If you need anything further,please do not hesitate to call. i i COPY TO: SIGNED— If IGNE If enclosures are not as noted,please notify us at once. Alan J.Micale,P.E.,Vice President 03/26/2006 15:27 FAX 002/002 .4t.\ The Commonwealth of Massachusetts V U cc u ( ` Department of Industrial Accidents t Dice of Invesdgations 600 Washington Street U Boston,MA 02111 r www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers APPlicant InformationPlease Pr'nt a fbl Name(Business/Organization/individual): k.�o 1�,"^ G *�►,.may Address: TC& �kt1� City/State/Zip:_�X or'rr, U 1%'140 Phone#:_ Are u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4- ❑ 1 am a general contractor and 1 employees(full and/or part-time).* have hind the sub-contractors 6. ❑New construction 2. 1 am a sole proprietor or pamper- listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its l0.❑Electrical repairs or additions required.) officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. (No workers' comp. c. 152,§1(4),and we have no 12.1[:]l Roof repairs insunmcc required.)t employees.(No workers' 13, Other�j comp.insurance required.) •Any applicant diet checks box#I must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they arc doing alt work and then hire outside contractors must submit a new affidavit indicating such. tContractors thatcheck this box must attached an additional sheet showing Ole ntrme of the sub-contractors and their workers'comp.policy information. ,ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name.— Policy dor Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: ��Jn "-,k Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the fort.of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebyrli n Crrtli'or tns an penalises of perjury Ilial the Information providedhh above is true and correct. ate: 7 Z(o Phone : - Ofeial use only. Do not write la this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Hoard of Health 2, Building Department 3.Cityll'own Clerk 4.(Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone N: 03/19/2008 15:01 FAX 0 002/003 03/19/200B 14:58 5689875517 OXFORD INSURANCE PAGE 02/82 CO .a CERTIFICATE OF LIABILITY INSURANCE 03/18/Z008 PRODIXERORD hone: NC SAGE Fm: WAY.OM TKIg CERTIFICATZ N ISSUED AS A MATTER OF INFORMATION OXFORD INSURANCE AGENCY INC p 0 ONLY AND CONFERS NO RI0HT8 UPON THE CERTIPICA?e OXFOORDRD MMA MOLDER, TNIA CERYTPICATE DORI NOT AMEND, tiMND OR A 016W ALM TH!COVEPAGE AFF02DCO BY 11H.1 0 CIE$ BELOW INSURERS AFFORDING COVERAGE NAIC d INSURED INSURER A: Hudlon insumnce Cpm LAMQUINTAIN BROTHI M INC, INSURER e: Commence I nsurence Co. 37 FEDERAL HILI,ROAD „ OXFORD,MA 91940 INSURER 0: Mud ao_n Ineurano�Company _ ~..... INSURCR 0: COmnwco 81 Indudm Inlursnce C0. INSURER E: COVBRA6FrS THE POLICIES E TERm co l) 00.OW NAVE BEEN ISS�50 TO THE 1N UREO WACO ABOVE FOR HQ POLICY PERIOD INDICATED, N eTANDiNG ANY RlQU�R6AIENT,TERM OR CONDITION OF AMY CONTRACT OR OT1460 DOCVMF,Nt WITH RESPECT TO WNIt;H TN N MAY PERTAIN, ?HE INSVRANCE AFFOAOpG SY THE POLICIES DESGRI9E0 HEREW ($ VVSACT TO ALLT}15 T ICH IS CER Inc ANDMCON85 IO BED SUCH POLICIl1, AGGREGATE LIMITS SHQWN MAY HAVE BECK REDUCED er PAID CLANKS Lm TYPE OP IN9U11AN06 POLIOY 1 MMA Pumv TE ILA= po11CY lJIPNUTpN LIMITS FECT0002os 11/01ror 11ro1/QA ACHoe FE a z.QOD,Qov X COMMERCIAL GENERA,LIABILITY P X IMS CLAMADE LAI OCCUR MSD.AE�C Ql Il s 601000 end p.r.oq •S" 000 A X ACu IMGIUDED %PERSONAL A ADV INJURY a 2,000,000 X MAA rADDITIONAL NVS GENERAL AQOREOATE" e 3,000,000 GEW AOGR6MTE LIWTAPPLIEB PGR: pR0• roL+or Loc PRODUCT8�cOwmp,40 s 3,000 000 �c AUTORME LIAMLtrY XT"2711/OtfDf 11101/Orlt X ANY AUTO COMBINED SMOLE Lwrr (E.�oa10M1I 9 11000,000 ALL OWN80 Avros eODgr(WURY X 3CNCDULEDAVTOS IPerpenan) s 0 X MIRED AUTOS X NON•OVINED AVrpB �CRY X VCM END INcLumD ., — PROPERTY DAMAGE i GARAGE uAesLrn v« ANY AUTO -FAtgWV.T ! OTHER THAN –6A 9 AUTO OmLr, AGG 3 e OM 111/UMBRIOAA LIMILrT'r pg�000 11/01/07 11/01/08 EAON OCCURRENCE s_ 21000,000 X OCCUR r CLAIMS MADE ApOREGAT! S C 2,000.000 DE000TIBLE 8 _ RETENnoN s S W01m Rs WMPENSATMN AND WC5314976 09/30/07 rrc a Tu EMPLOVERb W91Lm 09/30108 X TolrrvM o7►or D AlIrP6pPPIGTOR(►A� EL EAcHACCIDEGT s 1,000,000 o�Rlrerwll eravo� Iryr`�M�M4wdw E.IDINW9-EAEMPl0Y6B s 7,000000 vKvu Pna"Im helm c.L.D16FASE-PoLIcrLIMIT s 1,000,000 OTHER;POLLUTION LIABILITY P CY pe6700DZgg 11/01f0y 71/01/08 A $2,000,000 per gwwmnce S3.000.000 AggregaN DESCRIPTION CF OPERATIONSkOCATIONSIVIiMICLEAOdEXGLU31ON9 ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Fxxc M abll,350 Wlnthmp Ave.,N60 Andover,MA CIERTIFICATE Nd-L-0- R NCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DM80101Iew Poucea lE CANCELLIM BerORET116 1600 098000 STREET EXPwATIQN DATE THEREOF THE I2S UNA INBVRER WILL ENOSAVOR TO MAIL 3e DAVE NORTH ANDOVER,MA 01815 0 0WRITTEN$HALL RJPOBe NO OD TO THE IFICAT9 14OLDER NAMED TO ?MEiGAT10N 01111 AeILRY F ANY kwo vP�oN BHS[-INAILURE SURBk, ITS AGENTS OR R04MENrATNn. AUTHOR EPJ1086NfAT1VE L �� Att�ntlon: /wee' ' , ' ACOIRA 25(2001106) JoSo h E.Ahastaal Certificated 41520 0 ACORD CORPORATION 1580 03/19/2008 15:01 FAX IA003/003 �omavroonei �aaaka • Board of Building Rcgulagon and Standards 11 COnstruetlon Supervisor Ucense i U4 : CS 65103 B id81t9::_ 11984 ' 09 TON 2379 PETER D LAMOLI� 37 FERERAL HILL RL1�' • - -� , OXFORD,MA 01540 Commissioner a9aaat1 slgs Jo pogaoJ asnsa s1 apoO 8111p11no 0�91S'sposag319ssUN ani 3o uola!pa 7paaana a ssassod os awed samog f.UUIBd Z t-91 1100 danassw-V 1 a3eds pasol3w 13 0801E-00 I