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HomeMy WebLinkAboutBuilding Permit #741-16 - Stacy Drive 12/18/2015it v 1 `, 11ti poRr L -F- BUILDING PERMIT ,�:�``��`• �Q TOWN OF NORTH ANDOVER (,, APPLICATION FOR PLAN EXAMINATION Permit NO: `t' Date Received Date Issued: �Ss�ctw��� IMPORTANT: Applicant must complete all items on this page LOCA PROPERTY OWNEI MAP NO-.] ! a/ P. V.Anjove,r (g Print ZONIW DISTRICT E/ (Zo tl.r►i�- G� I$� 13, 2v ASSOG Historic District yes Machine Shop Village ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition KTwo or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial JCRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well Floodplain ❑ Wetlands C Watershed District E. Water/Sewer Identification Please Type or Print Clearly) i OWNER: Name: r�'r 01cueCw&ssoGr Phone: -7'7(4-2,8-7,- -52#6s Address: Lane. k6rfh Atk4ioiler. CONTRACTOR Name. iarnond 14jll & 11 1dP-Y-5Phone: - 6 8 Address: qS Supervisor's Construction License: /t 6..mq goq Exp. Date: q I iq 12011,0 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER ri I Q- 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: $ (7 S5. °y FEE: $ 2 - Check Check No.: 2159 A Receipt o.: NOTE: Persons contracting wit registered contractors do not have acce s t a 'uaranty fund Signature of Age O Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL E Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Sianature COMMENTS HEALTH Reviewed on Sianature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments • Ccnservation Decision. Comments 4 e Wafter & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Locaiea ju4 vsgooa Street FIRE DEPARTMENT TerriptDumpsfergnsitey ,es:a 4- ► Locatetljat124[M`a. FireDepartment1signatur"5e/d4te r� 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, rust or service drop requires approval of Electrical Inspector Yes Um 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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/Cross Section/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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 4, Certified Proposed Plot Plan 4. 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 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 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: Building Permit Revised 2014 Location LS -<�4vvl- DO l r No. I I Date 1 Check # 0 1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee �f,.. Other Permit Fee TOTAL � �/_ $�� 1119 - Building Inspector U) 0 Z o Cr S Q �. > ca O 0v m C� U m O CD O (• CD U) O 7 Owj 0 m O N CD CD CD CD U) 0 0 CD 70 B C �Q C r- m 0m Z ;o m o� n cn O Z e� Z - v z: Co n O 70 O D Z 0 S CD O O� CQ O cc X CD 10 0 2. CD .D 3 rr 0 = p w _Mo vii =' -C � � N m 00 0 0 rt Q Cr-) ill 0 _S �� O fA 0) 0. TI Off, S O r-lL Cl) W 5 IOD 0 CD 2 CL O y iC > O O O „O,* to Q O � � n S O CD S CD 'a 'rt �o� O < c0 o=�v' -„ .a Z 0, CD a F C S D (D y n Q. o 0 ` U) . �CD cc, CL i--• Q) 0 CD N rt O 0 rt C it � O �� N `° `D O U) CD 0 0 P DO rt � CD - ii O p) O O 7 CL c O 1 J In In Q7 T a7 T N � T Z7 T (� A T N T 3 o 77UQ rD r�-1• z c fD T m v � z -� �' o .c. 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Ob P Diamond kill Builders, 1,1,C• 98 Portsmouth Avenue, Stratham, NH 03885 (603) 580-5368 1 www.diamondhillbuilders.com Diamond Hill Builders offers complete building and remodeling services including new construction, renovations, home and business improvement needs for individuals and businesses throughout the Seacoast NH area. We are fully insured and offer the highest quality workmanship available. In addition to new home construction and remodeling we specialize in home additions, garages, roofing, decks, windows, doors and siding. All of our work is guaranteed. Date: December 17 2015 Job ID: Great North Property Management: Prescott Village Repairs Customer Name: Great North Property Management c/oPrescott Village Customer Address: Stacey Ln North Andover, Ma • Unit 20,13 Remove and replace the window sash. Prime and paint as needed. • Unit 18 Remove the rotted windows and replace with new Harvey Vinyl Windows. (3 Windows) • Unit 9 Remove the rotted window and replace with new Harvey Vinyl Window unit. (1 Window) Unit 20.13 Window Repairs $ 385.00 Unit 18 Window Replacement $ 2,700.00 Unit 9 Window Replacement $ 900.00 Total $ 3,985.00 Comments: Please note that this price is based on the work requested. Please note that any hidden damages are subject to a change order. Please note that this price includes materials, labor and dumpster. Initial--------- WARRANTY CONTRACTOR WARRANTS that all materials, facilities, workmanship, and equipment will be free of defects, and of specified quality, and will function properly for a period of 1 year(s), from the date first written above. Contractor will assign and deliver to owner all guarantees, warranties, and operating instructions of any Subcontractors, Manufacturers, or Suppliers that are applicable to any portions of the work. Within ten (10) days of first knowledge of any defect, or failure to function properly, Contractor is to be notified, in writing, of same by owner or his/her agents. Contractor shall be given first opportunity to promptly repair, replace and/or correct any item found to be defective, or that fails to function properly, at no cost to owner, within, a reasonable period of time. This Warranty does not apply to any construction work that has been subject to accident, misuse and abuse, nor to any construction work that has been modified, altered, defaced and/or had repairs made or attempted by others. Under no circumstances shall Contractor be liable, by virtue of this Warranty or otherwise, for damage to any person or property whatsoever, or for any special, indirect, secondary or consequential damages, of any nature, arising out of the use or inability to use because of the construction defect. THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED. We thank you for choosing us for your new project. We hope that we have been Knowledgeable and helpful to your design and pricing process. We look forward to doing business with you... If you should have any questions please contact Chris at 603-235-9526 Diamond Hill Builders, LLC www.diamondhilibuilders.com Diamond Hill Builders, LLC Prescott Village Initial--------- 2 LINE # DESCRIPTION_ QT'S UNIT PRICE E'X'i hiNuLv 10000-1 Welded Vinyl RW 2 -Lite, Unit Size 62.5 x 47, RO 63 x 47.5 1 Full Screen, Fiberglass Mesh, Screen Shipping Separate = No W' dow Label = Harve Double Locks Sash Limit Devices = None Pin A11;-1— Exterior Sash = No Overall Glass Thickness =11/16", Double Glazed, Low E, Argon Filled, Custom Annealed IG = No, IG MFG = HY Unit 1: U -Factor = 0.3, SHGC = 0.3, VT = 0.55, NFRC CPD Number = HII M 47 00003 00001, Custom / Call Size Option = Custom Size, New Construction, Reverse Sash Pattern = No Unit 1 Left Glass, 1 Right Glass: NFRC CPD Number = HII M 47 00003 4.� 00001 Base Color = Almond Energy Star Overall Rough Opening Width = 63, Overall Rough Opening Height = 47.5 Integral L Fin Adaptor, Receiver Pocket 6 9/I6", Primed, 4 Side Factory Applied Room Location: None Assigned LINE # DESCRIPTION QTX . UNIT PRICE EXTENDED 11000-1 Welded Vinyl RW 2 -Lite, Unit Size 62.5 x 54.5, RO 63 x 55 Full Screen, Fiberglass Mesh, Screen Shipping Separate = No Window Label = Harvey, Double Locks, Sash Limit Devices = None, Pin Exterior Sash = No Overall Glass Thickness =11/16", Double Glazed, Low E, Argon Filled, Custom Annealed IG = No, IG MFG = HY Unit 1: U -Factor = 0.3, SHGC = 0.3, VT = 0.55, NFRC CPD Number = HII M 47 00003 00001, Custom / Call Size Option = Custom Size, New Construction, Reverse Sash Pattern =No Unit 1 Left Glass, 1 Right Glass: NFRC CPD Number = HII M 47 00003 00001 Base Color = Almond Energy Star Overall Rough Opening Width = 63, Overall Rough Opening Height = 55 Integral L Fin Adaptor, Receiver Pocket 6 9/16", Primed, 4 Side Factory Applied Room Location: None Assigned 6i 5 "CS•Ei Last Update: 10/201201 12:38 PM. Page 1 Of 3 Pdnted:10/20/201 12:39 PM 5 5 LINE # JftbUxlr l lute V A X 12000-1 Vinyl Casement, Unit Size 27.75 x 65.5, RO 28.25 x 66 1 Fiberglass Mesh, Screen Shipping Separate = No Window Label = Harvey, Sash Limit Devices = None, Standard Overall Glass Thickness =11/16", Double Glazed, Low E, Argon Filled, I DSB, Custom Annealed IG = No, IG MFG = HY Unit 1: U -Factor = 0.3, SHGC = 0.27, VT = 0.47, NFRC CPD Number = HII M 38 00925 00001, Custom / Call Size Option = Custom Size, New Construction, Hinge Right I Unit 1 Glass: NFRC CPD Number = HII M 38 00925 00001 j Base Color = Almond f Energy Star Overall Rough Opening Width = 28.25, Overall Rough Opening Height = 66 Integral L Fin Adaptor, Receiver Pocket 6 9/16", Primed, 4 Side Factory Applied Room Location: None Assigned LINE # DESCRIPTION QTY UNIT PRICE EXTENDED 13000-1 Vinyl Casement, Unit Size 68.75 x 44.25, RO 69.25 x 44.75 1 Fiberglass Mesh, Screen Shipping Separate = No Window Label = Harvey, Sash Limit Devices = None, Standard Overall Glass Thickness =11/16", Double Glazed, Low E, Argon Filled, ( , Custom Annealed IG = No, IG MFG = HY Unit 1: U -Factor = 03, SHGC = 0.27, VT = 0.48, NFRC CPD Number = k HII M 38 00925 00003, Custom / Call Size Option = Custom Size, New %/ `j Construction, Hinge Left, Venting Pattern Configuration = LR ! Unit l Glass, 2 Glass: NFRC CPD Number = HII M 38 00925 00003.+3,,; K,; -- Unit 2: U -Factor = 03, SHGC = 0.27, VT = 0.48, NFRC CPD Number = F `�z , HII M 38 00925 00003, Custom / Call Size Option= Custom Size, New Construction, Hinge Right, Venting Pattern Configuration = LR Base Color = Almond Energy Star Vertical Common Frame 0" thick, 44.25" length Overall Rough Opening Width = 69.25, Overall Rough Opening Height = 44.75 Integral L Fin Adaptor, Receiver Pocket 6 9/16", Primed, 4 Side Factory Applied Room Location: None Assigned Last Update: 10/20/201 12:38 PM Page 2 Of 3 Printed: 10120/201 12:39 PM 5 5 Workers, Compensation Insurance Affidavit: Sunders/Contractors/ii igetricians/Plumbers. TO BE PILED WITH TEE PERMITTING AUTHORITY. A licantIin£ormation Please Print Le 'bl Name (Business/Organization/Individual): aI b �r�Fs u Q• Address:— City/State/Zip: The Commonwealth of massmchusetts Type of project ()required): Department o f'IndustrialAceldents — I Congress Street, Suite 100 - ' Boston, MA 02114-2017 , ;�`.. 'M•��� www.mass.gov/dia Workers, Compensation Insurance Affidavit: Sunders/Contractors/ii igetricians/Plumbers. TO BE PILED WITH TEE PERMITTING AUTHORITY. A licantIin£ormation Please Print Le 'bl Name (Business/Organization/Individual): aI b �r�Fs u Q• Address:— City/State/Zip: kA.ny applicant that checks box 41 must also fill 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. tContracfors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees,1ey must provide their workers' comp. policy number. .I am an employer drat is pidvid6ig workers' compensation insurance for my employees ' Below is the policy and job site information. Insurance Company Name: Cro.� `InsuxC� ����I 0. Policy # ox Self ins, Lic. #: Expiration Date: �JJ� lob Site Address: City/State/Zip: ' UAV A Attach, a copy of the workers' camapeVatio- policy eclaration page (showing the policy number and expiration d te). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fim 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. fdoherebycertifyunderfliepai andpenaltiesofperjary iiatthe'iform�ctionprovi/dedabo� ist �artcl^correct. Date: S Of 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person.: Phone A reyou an employer? deck -the appropriate box: Type of project ()required): mployees (full and/or part-time,).'-' 1.d I am a employer with4P11 7. [.I New construction e proprietorip and have no employees working for mein. 2.[]Iamasol p p 8. 0Remodeling any capacity. [No workers' comp. insurance required.] g, ❑ Demolition 3.Q 1 am a homeowner doing all work myself [No workers' comp. insurance required.] t ] 0 ❑ $.uilr�ing addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will have workers' compensation insurance or are sole 11. Electrical repairs or additions ❑ ensure that all contractors either - - - — -- . plUmbirlg-repatts.Or.addlilo115 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors Bade employees and have workers' comp. insurance.: 13. r -j Roof repairs I4. 01OthBr WJ u 6. Q We are a corporation and its offigers have exercised their right of exemption per MGL G. insurance 152, § 1(4), and we have nq.employees. [No workers' comp. required.] kA.ny applicant that checks box 41 must also fill 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. tContracfors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees,1ey must provide their workers' comp. policy number. .I am an employer drat is pidvid6ig workers' compensation insurance for my employees ' Below is the policy and job site information. Insurance Company Name: Cro.� `InsuxC� ����I 0. Policy # ox Self ins, Lic. #: Expiration Date: �JJ� lob Site Address: City/State/Zip: ' UAV A Attach, a copy of the workers' camapeVatio- policy eclaration page (showing the policy number and expiration d te). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fim 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. fdoherebycertifyunderfliepai andpenaltiesofperjary iiatthe'iform�ctionprovi/dedabo� ist �artcl^correct. Date: S Of 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person.: Phone 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 Bite, express or implied, oral or written." An employes' 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 Ell -out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -'contractors) name(s), address(es) and -phone number(s) along with their certificate(s) of ---�nsux-ante: Limited�iabiliity-Companies-(LL��or Y;imite�Lrab7iliiyflrartnerships (LLP�ith no emp ogees o er ante - 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 fox 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, mot the Department of Industrial Accidents. Should you have any questions regarding the law ox if you'are required to obtain a workers' compensation policy, please call the Department• at the number listed below. Self iir'sured companies should'enter•their ' self insurance license number on the appropriate line. - City or Towns 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 "fob 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 fature permits or licenses. Anew 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. ## 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax ## 617-727-7749 Revised 02-23-15 www.mass.gov/dia ACOR I@ C40 CERTIFICATE OF LIABILITY INSURANCE I DATE (MWODNYYY) 1 9/21/2015 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONNTACT Jessica Hildreth, ACSRE CROSS INSURANCE - LACONIA PHONE . (603) 524-2425 Nu: (603)524-3666 155 Court Street E-MAIL hildreth@crossa en com ADDRESS: 7 g � INSURERS AFFORDING COVERAGE MAIC 0 INSURERAFrankenmuth Mutual 13986 Laconia NH 03246 INSURED INSURER B :Continental Indemnity I Company INSURERC: DIAMOND HILL BUILDERS LLC INSURER D: 98 PORTSMOUTH AVE E INSURER E: INSURER F: I STRATHAM NH 03885-2415 COVERAGES CERTIFICATE NUMBER-CL1592150689 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 TYPE OF INSURANCE A S R POLICY NUMBER MOWDDY EFF POLI EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR DAM TO RENTED 300,000 PREMIS SES Ea occurrence) $ MED EXP (Any one person) S 5,000 BOP6165548 9/19/2015 9/19/2016 PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I JECT [X] LOC PRODUCTS - COMPIOP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY EOMBBIINdED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNEDX SCHEDULED AUTOS AUTOS BA 6165548 9/19/2015 9/19/2016 BODILY INJURY (Per accident) S X HIRED AUTOS X NON -OWNED AUTOS(per. PROPERTY. DAMAGE S Per accident Uninsured Motorist $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ BOP6165548 9/19/2015 9/19/2016 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? �y (Mandatory in NH) N I A 46-843442-01-05 9/19/2015 9/19/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT S 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 A EMPLOYMENT PRACTICES LIAB BOR6165548 9/19/2015 9/19/2016 EACHCLAIM $100,000 RETENTION: $5,000 AGGREGATE $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Christopher Howlett is excluded from Workers Compensation coverage. i Where required by written contract, Great North Property Management, its officers, directors, and employees are listed as additional insured for ongoing operations with respect to liability arising out of work performed by or on behalf of Diamond Hill Builders LLC. )766-6295 Great North Property Management 3 Holland Way, Suite 201 Exeter, NH 03833 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 J Hildreth, ACSR/JH5 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgmann �( Massachusetts - Department of Public Safety �J Board of Building Regulations and Standards Construction Supervisor .� License: CS -059504 PAUL RABENIUS= '•; 134 MILL RD S% N HAMPTON NH 03U2 '%�... �'• " "'' Expiration Commissioner 09/19/2016