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HomeMy WebLinkAboutBuilding Permit #030-14 - Exception 7/9/2013'a. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � Permit NO: �® tI Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page ; s -- - - -- L®GATiI ST' } j IPRFOPERI}Y�OWNERtzSTf-y2, N4 C\ O r a 1QOYeald�St c rOture� r no * a t Y MAPNO 'L PARCEL; `�' ZONING DIST==RIOT, �Histonc�Dyistn t e& no" - _ `_ _: _ �M neShopVillage 10 yes rio ache r j TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial o F,�epair, replacement ❑Assessory Bldg ❑ Others: emolition ❑ Other -7- P E ❑ISepticz +Welli r `' dor 1aint: ®Wetlantls, �D WatershetlDiStrct - - 111,Vater/Sewers DESCRIP ON OF WQR TO BE PERFORMED: -5 ILu te 1 51.1\4 w. Identification Please Type or Print Clearly) OWNER: Name: S7-e-v-p— F?Ai C1O(,'4 Phone: S 7 JP3 t1 170?- Address: r- 81) C F,NTRACT®R Name.: �'c_v� --�1�.4� , c�c�S �ln _ P:h"one,. 7 _13 kn1J0-7. � � ' Address r F 0.. _ 2 H Y`_. z a - — u 77 Su ervlsor'sCon tructon�License Home Improavemed Lic-ens�e _ 3 r Exp#T Gate -:- ARCHITECT/ENGINEER Phone: Address: Reg. No. r FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ / Check No.: Receipt No.: �� NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ e TYPE OF.SEWERAGE.DISP.OSAL •. Public Sewer ❑ Tanning/Massage/BodyArt E]. . Swimming Pools , ❑:, + well ❑ Tobacco Sales ❑ Food Packaging/Sales . ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on ` /( ---S Signature COMMENTS I 1 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance Petition No: Zoning De ' g cision/receipt submitted yes 1 Planning Board Decision: Comments Conservation Decision: Comments I Water & Sewed' Connection/Signature& Date Driveway Permit DPW Toivo Engineer: Signature: Located 384 Osgood Street FIREDtPARTfII.ENT '- Temp Dumpster on site yes no �- Located at 124 Mair"Street Fire ®eparimer fisignatik61date`. ! COMMENTS I 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 ® Notified for pickup - Date E Doc.Building Permit Revised 2010 Building Department The fol .3wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofiriig, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit L3 Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o 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) La Building Permit Application o Certified Proposed Plot Plan o 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) o Copy of Contract ❑ 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 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 apn.,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must by submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location 4Fr V No. Date i I • - TOWN OF NORTH ANDOVER • • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 3 u Building Inspector i Town'of North Andover NORTH 0 �,T%.e° 16 Building Department 11. �s � 1600 Osgood Street o ' ��j•; `� North Andover MA 01845 r Tel: 978-688-9545 Fax: 978-688-9542 yy •.s h LAKI O� CCKKIC(WICK y1. DEMOLITION OF BUILDING AFFIDAVIT �s,9s Rare° - SACH115 DATE OWNER'S NAME &ADDRESS 5f --� { LOCATION OF PROPERTY TO DEMOLISH DESCRIPTION. Si `�`��� D �'l-�" "PI' CONTRACTOR'S NAME &ADDRESS S `c� N�w�UL ��'�-R-w� •�J R �y�.., y�S i i.� :,,,' �U 2� �'w4. 0 l 9 �� / DEPARTMENT SIGN-OFFS DEPT. OF PUBLIC WORKS -'WATER: SEWER: DEPT OF CONSERVATIO S " HEALTH D PT: Septi V,leif J �� 5b � HISTORIC COMMISSION GAS J ELECTRIC �0 3 /L( `/TELEPHONE \/CABLE Ad I4 /TAXES POLICE i 6r d fwal r )EIRE IVA- EXTERMINATOR Aa ^� DUMPSTER—ON/OFF STREET ►� 1a DIG SAFE NUMBER Zfs 1_� 2."3(� 70 O DATE REC'D BLDG. INSPECTOR i it a , NORTH Town of tAndover No. t T _ T " • h , ver, Mass, C( '3 o COC NIC HE W IC. A°RA TE D J1k'r S S U BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System THIS CERTIFIES THAT .. r1. 1 0 ........, BUILDING INSPECTOR . Foundation has permission to erect ................... buildings on �l�....J '. !!�•e~•....0+W... Rough . ................................................. Chimney to be occupied as ............ .. ...... .. .......... ... .... ... . ........ v 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT RTSRough Service .......... .............................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE f i twassachusetts -Department of public Safety �! Board of Building Regulations and Standards Glnlruction Super%kor License_ CS-010578 ` ,k-.1 :"N STEPHEN P F[XNCIOSA F. 8 NEWELL FARM DR Ya W NEWBUIF Y MA 01985 P Expiration Commissioner 12/18/2013 Infinity Abatement Services, Inc. 91 Farnham st. Lawrence, MA.01843 Project: Realty LLC 858 Johnson St. North Andover.01845 This proposal is submitted in accordance with your invitation to provide a quotation for asbestos abatement and decontamination services. The undersigned, having become familiar with the scope of work, agree to finish all material and equipment to complete, in a competent and workmanlike manner the contracted work. All work will be done in strict accordance with EPA, OSHA, state and local Regulations to your complete and acceptance for work covering the following scope. Scope Of Work 1- MA DEP permit and additional permits as required. 2- 10 Day waiting period (per state regulation) 3- Full Containment ( preparation and isolation of work area , decontamination chamber ) 4- Installation of engineering controls and decontamination system. 5- Asbestos abatement of various materials. 6- Decontamination of all surfaces. 7-Encapsulation of all surfaces with lock down encapsulation 8- Disposal of all debris. i Special Conditions Owner will provide the following: 1- Supply all electrical and water requirements. 2- Relocate all movable items not contaminated from work area. Infinity Abatement Services, Inc. Will provide the following: 1- Make all necessary notifications to all local, state and federal regulations. 2- Do all work during a mutually agreed upon schedule to least disrupt day activities. Close- Out Documentation Upon completion of the work specified, documentation for the complete project will be submitted to the owner. This documentation includes Manifest, completion Certificate and final air test clearance Results. (if required) - Project Costs : Total cost to perform the scope of work is as specified: Vat" n Ot1�r�vim�4n�� • From: infinityabatement service iniinityabsaef'ra;r'It `�hOtrru iI-�;:��r11 Subject: (No Subject) Date: July 2,2013 6:16 PM 'To: sfranciosa@aol.com Hi, This is the permit and proposal Please let me know when you get it. Thanks Alicia Germosen Commonwealth of Massachusetts i 10018©554 Asbestos Notification Form ANF-001r Important: �ecaLN _- umb Important: When filling out A. Asbestos Abatement Description forms on the computer,use 1. a.Is this facility fee exempt-city.town,district:municipal housing authority,owner-occupied only the tab key residence of four units or less?15./?]Yes -_i No to move your ! cursor-do not b.Provide blanket decal number if applicable: '-- - _ use the return Blanket Decal Number key 2. Facility Location: RESIDENTIAL 858 JOHNSON ST Y - ... .. ,.._ .. ..-..................._.., ..... _ -. a,Name of Fac ttty, „ ,n., _ b.Street Address !NORTH ANDOVER MA 09845 _..:r Cr City/Town d.State a Zip Code f,Telephone Number INSTRUCTIONS 3. Worksite Location: ;OUTSIDE 1.All sections of this form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e Room completed in order to comply with 4. Is the facility occupied? '✓;;(Yes 4'- No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: of Occupational INFINITY ABATEMENT SERVICES INC 91 FARNUM ST Safety(DOS) a,Name b Address notification . requirements of 453LAWRENCE 101843 19782087256 t _ CMR 6 12 a Ci !Town d,Zt Code e.Telephone Number AC000733 f g.Contract Type: ✓;!Written {verbal �MAURICIO FERREIRA PRESIDENT _. .... li Factl i.Contact Persons Title 6 zMAURICIO FERREIRA ,AS001078 _ ___.-__M..... _ ;a.Name of On SRe SupervSorlForeman b.Supervisor/Foreman DOS Cer ifrcatton Number WORT'HEAST ENVIROMENTAL LABS +AA000153 7D_­_,­____ _ _ .. ... _ a.Name Prect tdor)rtor b Project Monitor DOS Certification Number IN/A g a Name o"Asbestos Analytical Lab_ b Asbesios Analvtical,Leb....S Certtticatlon tJumber 07%17/2013 _ 107/17/2013 i0 i a Project Start Dat®(mm/dd+yryyl.-._......... ._--._ 61d Date(mmlddlyyyy) ... _ 0 1:30-3:30P !WEDNESDAY hours Sat-Sun. o 10. a.What type of project is this? ®- u 1 ucsn rvuuuc i nal wvauv,i Repair Other,please specify: b Describe 11- a.Check abatement procedures: k-1 Glove bag '-7 Encapsulation Enclosure Disposal only ,Lj. Cleanup r Other,specify: _ Full containment b.Describe _- - --- ------ — Q 12. Is the job being conducted: ir. Indoors? if Outdoors? , ® anf001ap.doc•10/02 Asbestos Notification Form•Page 1 of 3 Commonwealth of Massachusetts __._._.® ;100180554 Asbestos Notification Form ANF-001 Decai"um ` A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed;enclosed,or 1p 1400 a oaf pipes or duds(linear f)., 5 Tofaf ofhei suaces lsquaref) _._ j c Boiler,breaching,duct,tankd.Insulating cement - - snrface coatings L+n_ff:._._ S4,n..,_...:.._.. Lin ft Sq ft e.Corrugated or layered paper I _ ... f.TroweUSprayer coatings ._ pipe insulation Lm ft. Sq ft Lm R' Sq ft i S a fireproofing i h.Transite board,Wali board g pray-on P n9 l n.ft Sq.tt Lin ft Sq ft c 1400 i Cloths,woven fabrics Un ff, S ! Other,pleases pe i Lin R 3q i 4 k.Thermal,solidISADING core pipe i._....__. 1. ,�_......._,.._...___--_ _......_._.,. ..._. i insulation !in'ttµ ' Sq.R. I Specify 14. Describe the decontamination system(s)to be used: THREE CHAMBERS RECON AND SHOWER 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 614(2)(g): wET REMOVAL DOUBLE SIX MIL POLY 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: a. me of C3�P bffcai __.___ b Yale. .. c Date(mmlddryyyy)of Authorization d DEP Waiver ,e,Name of t50S Offictiei _......_ g.Date(mmiddlyyyy)of Authorization h DOS Waiver N ° 17. Do prevailing wage rates as per M,G.L.c. 149,§26,27 or 27A—F apply to this project?` Yes ✓j No ° B. f=acility Description N .... .._..__-._._ _....__. ............ ............... ..._..-.._ _-.......... .. ;RESIDENTIAL =rte 0 1. Current or prior use of taGltty: 2. Is the facility owner-occupied residential with 4 units or less? ✓ Yes No _ 'REALTY LLC { =858 JOHNSON ST 3 a Fac+i ty Owner Name b Address o c CitylTovm 01845 _ 1r9783._6 17078NORTH ANDOVER Nu er(area code andetension fdZi Code e Tetephonem ..- u q _ e a Name of Facility Owner s On Si a Manager b On-Site Manage Address .. _ Z __...; f Q o City[T mown d.Zip Code a Telephone Number{area code and extension) anf001ap doc•10/02 Asbestos Notihcation Form•P e 2 of 3 Commonwealth of Massachusetts ;100180554 Decal Number F ®rm ANF-001 Asbestos Notification at 6Q n B. Facility Description (cont.) _ 8 NEWELL FARM DR STEVE FRANCIOSA b i a Name of General Contractor WEST NEyVBURY,MA. Y! °01985 _._ _ d Zip Code e Tel Number(area code and extenswn) c Cityf7own ,w .._... . ._.._ - _ g Policy Number Number Of floors h Exp Date f+n��IYYYY i.Contractor s Worker's Comp Insurer 6. What is the size of this facility? a:Square Feet ti. C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary). FARNHAM ST _. ,INFINITY ABATEMENT SERVICES,INC b,-Address a,,Nameof„Transporter,,, Note.Transfer 978 994.8734 -....,. ;01843-,_...... . (___?_._.,_._. ._.__ ._...., ...... ...._.. Stations must LAWRENCE,MA. --- e.Telephone Number ._____.. ..._.. d.Zip Code comply with the c.Cityrrown Solid Waste -..._.- Division 2. Transporter of asbestos-containing waste material from removes/temporary site to final disposal site. Regulations 310 56 PYLES CMR 19,000 ;SERVICES TRANSPORT GROUP,INC LF b Address_ - Nameof transporter„-_ .. - , ___ ... 877 999-9659 NEW CASTLE,DE w ... 19720 Telephone Number ----__ c.CttVliown.._.. . . r._...M 3 I _ a.Refuse Transfer Station and owner - r-_ -- d Zip Code a Telephone Number c C TTown 4. MIPIERVA ENTERPRISES INC b Fina)Disposal Site-Location Owner s Name a.Final Disposat sde WAYNESBURG X9000 MINERVAROAD - d CtyfTown - c Final Disposal Stte ACdLem_ _- )446 343588 ; 866 OH e . . Zi Code ephone Numb er e.State ro c a D. Certification =N ---"" The undersigned hereby states,under the MAURIClQ FEREiRA _ b Autnor¢ed Signature �° Penalties of perjury,that he/she has read the .. ... Commonwealth of Massachusetts regulations PRESIDENT for the Removal.Containment or a Position,Tite d pate(mmJddlYYVv) Encapsulation of Asbestos.453 CMR 6.00 and ig78)994-8734 No�ef r 314 CMR 7.15,and that the information e~Tel...... _Number,_ f R_epr_esenUnq._ contained in this notification is true and correct g1 FARNHAM$T. =----�—'a to the best of hislher knowledge and belief. -- �:,Addres .._ LAWRENCE,MA.01843 _.. .i h CR rrovm _.. ._. 1.Zip Code Y Q Asbestos Notification Form•Page 3 of 3 0 anf001 ap doc•10/02 858 north andover.docx 17.6 KB I I i CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 14✓1 0512212013 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 CONTACT La Cowan Cowan Insurance Agency,Inc. HONE 9T8 372.1451 FAx 978 521.4669 359 Main Street E-MAIL . larry@cowaninsurance.com Haverhill MA 01830 INSURERS AFFORDING COVERAGE NAIC a 1N URER A, Endurance Insurance Com an INSURED INSURER B: Franciosa Construction Inc. INSURER C 9 Newell Farm Drive INSURER D: West Newbury MA 01985 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. (NSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY $100,000 CLAIMS-MADEFX OCCUR TBA 0512212013 0512012014 MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LtM(r APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 POLICY PRO- X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ r—IDED I I RETE TI N $ WORKERS COMPENSATIONOTH- AND EMPLOYERS'LIABILITY Y/N WC STATU-1'T ANY PROPRIETOR/PARTNER/EXECUTIVED E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Ifes,describe under D S RIP I OF OPERATIONS below E.L.DISEASE-POLICY LIMIT f$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Residential general contractor. CERTIFICATE HOLDER CANCELLATION City of Gloucester SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 22 Poplar Street Gloucester,MA 01930 AUTHORIZED REPRESENTATIVE Fax:(978)282-3036 ©1988.2010 ACORD CORPORATION. All rights reserved ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD .AcoRV CERTIFICATE OF LIABILITY INSURANCE DATE (MM)O YYYY) `� 06/07/2013 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). CONTACT PRODUCER NAME: _ NORTH ANDOVER SNSURANCE AGENCY INC. PHONE FAX Ektl: 1979) 696-2266 FAX AGENCY, I fyG Not:1978) 686-6410_ M.J. FOSTER INSURANCE SERVICES ADDRFSs: llariviere@nafins.com PRODUCER 163 MAIN STREET CUSTOMER In BILL HALL INC NORTH ANDOVER MA 01845-2508 IN_SURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A :HANOVER INSURANCE CO. '131534 BILL HALL, INC. INSURER 8 4 VIVIANA STREET INSURER C INSURER D INSURER E METHUEN MA 01844- 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. ILTR I TYPE OF INSURANCE I INSR i WVD L POLICY NUMBER IMNINDNYYY)F t MIDIDM(YY)� 1 LIMITS A GENERAL LIABILITY IniBN9162587 06/11/2012 A6/11/2013 EACH OCCURRENCE is 1,000,000 I 06/11/2013 b6/11/2014 { AMA E I X !COMMERCIAL GENERAL LIABILITY I i aBN9162587 PREMISES Ea occurrence $ 100,000 CtA10A"PIDE n OCCUR i iy t / / / / ';"Tm EXP(kq one PP-%M) l PERSONAL&ADV INJURY 1$ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ( I / / I / / !PRODUCTS-COMP/OP AGG 1$ 2,000,000 I POLICY F—PRO- JECT RO —�LOC -- i A I AUTOMOBILE LIABILITY AM8306899 06/11/2012 b6/11/2013 COMBINED SINGLE LIMIT $ 1,000,000(Ea �+tM1 ANYAUTO ! I8306899 06/11/2013 06/11/2014 i BODILY INJURY(Per person) ALL OWNED AUTOS I$ �; BODILY INJURY(Per accident)1$ - I SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED (Per accident) r i X I NON-OVVNED AUTOS / I I I g Is I A iX UMBRELLA uaBX�OCCUR { �1019175864 06/11/2012 06/11/2013 EACH OCCURRENCE $ 2,000,000 EXCESS LAB i UNN9175864 06/11/2013 06/11/2014 ! ! 1 CLAIMS-MADE AGGREGATE $ 2,000,000 1 ! I I DEDUCTIBLE i / 1 I / / i I$ _ F RETENTION $ i IWORKERS COMPENSATION i W HN8326066 06/11/2012 06/11/2013 i WC STATU- j ,0TH-1 A AND EMPLOYERS' LIABILITY i i I I !_—LLOR LIMN' ER ANY PROPRfETORPARTNEREX£CUTNE YIN) WnM326066 ,06/11/2013 06/11/2014 E.L.EACHACCIOEN7 S 500,000 OFFICERIMEMBER EXCLUDED? :NIA I I Q I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,$ 1500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 I 4 l i i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER 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. FRANCIOSA CONSTRUCTION INC 8 NEWELL FARM DRIVE AUTHORIZED REPRESENTATIVE WEST NEWBURY MA 01985- 4 ACORD 25(2009!09) 01988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD I NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: $_ �'p RwSo � � is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) ^ Signature of Permit Applicant Date rQe e,,t; hi, % ►5Sae 7, c� � 4 (-,ee-