HomeMy WebLinkAboutMiscellaneous - 277 Washington StreetBoard of Appeals: Variance, Peti tion No:_____�Zoning Decision/receipt submitted yes
Planning Board Decision: -----------Comments
Conservation Decision:
I Water& Sewer Conn
OWNER: Name:
Address:c�
Phone:'
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Supervisor's Construction License<sl
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Exp- Date: /7
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H6 e improvement Liqense�
Phone:
ARCH ITECT/ENG1 NEER 69,5---
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Reg. No. 1-)7/eg
PEW -
Address: �-4 � �Q �/ �J ON $125-00 PER S -F -
FEE SCHEDULE: BULDING pERMIT. $12.00 PER $1000-00 OF THE TOTAL ESTIMATED COST BASED
FEE:
Total Project Cost: $
Receipt No.:
Check No.: unregistered contractors do not have access to the guarantyJund'
NOTE: Persons contr N 4q
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Lrw
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for thei� �
Tpjo
Nyees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contra�t 6 re,'
express or implied, oral or written."
An employer is defined as "an individual, partnership, associatio i n. corporation or other legal entity, or' any two or more
of the foregoing engaged in ajoint 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 b6 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-contractoi(s) name(s), address(es) and -phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees -other than the
members or partners, are not required to carry workers' compensation insurance. If anLLCo'rLLP does have
employees, a policy is required. Be advised that this affidavit maybe submitted to the Depailment of Ifidustrial
Accidents fbi� corifinnationof insurance coverage. Also be sure to sign and date the aifidavit. 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 * if you'are r6 to obtain a workers'
or quye
compensatiodpolicy, please call the Department. at the number listed below. Self-in]sur6d 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 now 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
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-AIASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
The Commonwealth o�fMassq chusetts
Department of Industria-lAccidents
I Congress Street, Suite 100
N
Boston, MA 02114-2017
www.mass.gov1dia
Workers' Compensation insurance Affidavit: Buffders/Contractors/Eil�qtriciansiplumbers.
TO BE, F]LED WITH TJJE PERMTTING AUTHORITY.
11AM
a
Name (Btisiness/organizationadividual): �"r A
Address:-') �7
City/State/Zip (7 19
Are you an employer? Che�k &e appiriopriaie box:
Phorte 9:
LF11amaemployerwith - ! employees (full and/or part-time).*
2. r-1 1 am a sole proprietor or partnership and have no employees working for me in
I any capacity. [No woikers' comp. insurance required.]
3. F1 I am a homeowner doing all work myself. [No workers' comp..insurance required.]
4. r] I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5.F1 I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
'fhesb s�b-contractorsfia*e' employees and have workers' co�np. insurance.1
6.gWo are a corporation and its officers have exercised their right of 'exemption per MGL c.
.. . -0
152, § 1(4), and we have no-emplo"yee's. [No workers' comp. insurance required.]
— /eq, -1
.3 7 C..,
Type of project (Tqquired):
7. Wow construction
8. E Remo doling
U Demolition
10 rJ Building addition
11. rJ Elect rical repairs oradditions,
l2.FJ Plumbing repairs or additions
I j. Ro 6 f rep airs
14. FJ Othbr
*Any applicant that checks box 41 Fra . st also fill out the section below showing their workers' compensation policy infbrma�tiom
I Homeownersivho subi@f A�s affidavit indicating they are doing all work and then hire outside contractors must s4bmit a new affidavit indicating such.
tContractors that check this box must -attached an additional sheet showing th� name of the sub -contractors and state whether or not, those entities have
oritractors ave.! th r um
employees. if the sub -c-: employees, ey must provide ei workirs'comp. policy n ber.
lain an employer tfzatispiovidingworkers'compensation insuranceformy em
plbyees.'Below is thepolley andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lio.
Expiration Date:
fob Site Address: City/State/Zip:
Attach a copy of the workers' c6mpe4i�ation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verifiGation.
I do hereby certif fperju ry th at th e information provided above is true an d correct.
y under thepains andpenalties o
0. — - 0+ 1 , ,, Date: 917, 5IL//
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License #
Issuing Authority (circle one): i
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: — Phone#:
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Triple 1-3/4" X 11 -1/4" VERSA -LAM@ 2.6 2800 DF FloorBeamlFBOI
Dry I span No. cantilevers 0/12 slope
February 15, 2017 19:06:36
BC CALCO Design Report
Build 5684 File. Na me: New— . C ol—_ Wellington: Way
Job Name: New Colonial Home Des I cription: DesignsTBOI
Address: Wellington Wa
y Specifier: rloor/Roof Support. Beam
City, State, Zip: North Andover, MA 0 1845
Customer. Designer KK
Com
pany: KDK.Design
Code reports: :ESR -1040 Misc: See Attic Floor Framing
p
BO I z_UO-vu
BI,
Total Horizontal Product L�nllth 12-06-00
Reaction Summary (D6
own /Uplift) lbs
aeaHng Live Dead.. Snow
BO,':3�1/2' 4j812 0 1,407/0
Wind Roof Live
BI, 3-1/2 4181:2 0 .1,407/0.
Live
Load Summary
Dead Snow Wind Roof Live.
Trib.
Tag: Des6ription :Load Type Ref. Start End 100%
1 Aftic Load Unf. Area: (lb/ftA2) L 00-00-00 12-06-00 30
90% 115% .160% 126%
10 ...
2 RoofLoad Unf.Area (IbffiA�) -06-00 1
L 00 2-06-00: 40,
:10
0700-00
14-00-00
Controls: Summary Value % Allowable Duration: Case,
Location
Pos. Moment 18j038 ft -lbs: 69;3% 100%
06-03-00
End Shear 4,997 lbs' 44.5% 100%
O`ImO2-12:
Total Load Defl. U382 (0.378") 62.8% n/a
06�03-001 p
Live. Load Defl.. U494 (O.�92"). 1 728% rim 2
66-03-00
Max Defl. 1 0,378" 37,8% ... n/a 1
06-03-00
SpOn Depth 12.8 n/a n/a 0
00-00-00
6/6 Allow % Allow
Bearing Supports DIM. (L x W) value: supoort Member :Material
B0. . Post 3-1/2" x 3-1/2" 6,220 lbs: n/a 67.7%
Unspecified
BI Post 3-1/2" x 3-1/2" :6 220 lbs n/a 67.7%
Unspec ified
Cautions
Member is notfully supported at post. BO. A connector is required at this bearing.
p
Member is not fully su pported at: post B 1. A connectoris re uired at this bearing,
q
Notes
Design meets Code minimurn (U240) Total lo aid deflection criteria.
Design meets:Code minimurn (U360) Live load deflection criteria.
Design meeti.arbitrary.(! Maximum total load.deflection. criteria.
Calculations assume member is fully braced.
Design based on Dry Service Condition.
Page 1 of 2:
Oise case
SIP Triple 1-3/4" x 11 -1 /4"
VERSA-LAMO 2.0 2800 DF Floor.13eamIF1301
.Dry I span No
Bt CALCO Design Report
cantilevers 0/1.2 slope February 15, 2017 19:06:36
Build 5684
Job Name: New Colonial Home
File.:Namo: New_CO.L. .._Well ington Wa y
Description: Designs\FB01
Address. Wellington Way
Specifier Ploor/Roof Support Beam
City, State, Zip: North Andover, MA 0 1845
Designer- KK
Customer:
Company: KDK Design
Code reports: ESR -1 040
Misc: See Attic:Floor Framing
Cohnection Dia -gram
Disclosure
b
d
Completeness and accurac yof input must
a
beverified by: anyone who would rely on
0 0
output as:6vidence of suitability for
q
particular application. Output here: based
c
on,building code -accepted desig n
properties:and analysis: methods.
a
Installation of Boise Cascade engineered
woo h
d products must be in accordance wit
current Installation Guide and applicable
buil ding codes. To obtain Installation Guide
a minimum 2" c 6-1/4"
or. ask q uestion.s, please. call.
(800)232-0788 before installation.
b minimum T' d =:24"
e minimum 3"
BC CALCO, BC FRAMERO, AJSTm,
Nailing schedule appliesto both sides of the member.
ALLJOISTO, BC RIM B OARDTm,: BCIO,
BOISE GLULAM-, SIMP LE FRAMING
Member has no side loads.
SYSTEM@, VERSA-LAM@j VERSA -RIM
Connectors are: 16d Sinker Nails
PLUSO, VERSA-RIMO,
VERSA -STRANDS, VERSA-STUDO are
trademarks of Boise Cascade Wood
p
p
Products L.L.C.
Oise Cascade
Double 1-3/4" x 9-1/4" VERSA-LAW2.0 2800 DF Floor B
eamIF1302
BC CALCO Design Report .:Dry I I span I No cantilevers 10/1 .2 slope February 15, 20.17 20;30:36
ild 5684
Bul
File.:Narne: New — Col Wellin9ton—Way.
Joh Name: New Colonial Home Description: Designs\FB02
Address: Wellington Way
Specifier Floor/.Roof Suppprt,Beam
City, State, Zip: North Andover, MA 0 1845 Designer: KK
customer:
Company: KDK Design
Code reports: ESR -1040 Misc: See AtticFl I oor Framing
bo I 0-M-00
BI.
Total Horizontal Product Length 10-00-00
Reaction Summary (Down /Uplift) (lbs)
Bearina Live Dead.. Snow
Wind Roof Live
BO,,3-1/2" 3j850 0 .1,092/0
B 1, 3-1/2 31850/. 0 1,092/0
Live
Load Summary
Dead Snow Wind Roof Live
Trib.
Tan: Description Load Type: Ref. Start End. 100%
90% 115% 160% 125%
1. Aftic.Load. Unf. Area.(Ib/ftA2) L :00-00-00 10-00-00 30
10
07-.00-00
2, Roof Load Lint A rea (lb/fl:A2) L 00-00-00 10-00-00 :40
:10
14 -00-00
Controls Summary Vadue %Allqwable Duration:. Casa
Location.
Pos. Moment.. 1.1,247 ft -lbs, 918% .100% 1
05-00-00
End Shear 3,892 lbs 63.3% 100% 1::
01-00-12
Total Load Defl. U287 (0.399') 83.7%:, n/a .11
05moo-00
Live. Load Defl. U368 (0.31 V),: 97�81/6 n/a 2
65-00-00:
Max Defl. 0,399" 30.9% n/a 1
05-00-00
Span Depth 12.4 n/a n/a .0
00-00-00
% Allow % Allow
Bearina Supports Dith. (L x Value: sup�,Ort Member
Matterial
B0.. Post 3-1/2" x 3-IT2": 4,942 lbs: n/a 63.8%
Unspecified
Bl:- Post 3-1/2' x 3-1/2" 4,942 lbs n/a 53.8%
Unspecified
Notes
Design meets Code minimum (U240) Total load deflection criteria.
Design meets Code minimum (IJ360 Live load deflection criteria
Design meets arbitrary (I.") Maximum total load deflection criteria.
daicu-lations assume member is fully braced.
Design based on Dry Service Condition'.
Page I of 2
I WX10, I Boise Cascade
Double 1-3/4' x 9-1/4" VERSA -LAM@ 2.0 2800 DF FloorBe mIF1302
a
..Dry 1 1 span I No cantilevers 1011.2 slope
BC CALCO Design Report February 15, 20.17 20:30:36
Build 5684
File.;Name; New—Col— __VVellington: Wa
Job Name: New Colonial Home y
DescNption: Designs\171302
Address:, WellingtonWay Specifier: Ploor/Roof Support:Beam
City, State, Zip: North Andover, MA 0 1845
Customer: Designer: KK
Com
Code reports: ESR -1040: pany: KDK Design
Misc: See Attic: Floor Framing
Connection Dlaqram
Disclosure
b d
Completeness and accuracy of input must
a be verified by anyone who would rely on
output as evidence of.suitability for
particular application. Output here based
C onbuilding codeo-accepteddesign
propertiesand analysisTriethods.
Installation of Boise Cascade engi
neered
wood products must be in
accordance with
current installation Guide and applicable
building codes. To obtain Installation Guide
a minimum c =
t
Or ask ques im, please call
b minimum 3" -d = 2411
p (800)232-078.8 before installation.
Member has no side loads.
BCCALCO, BC FRAMER@, AjSTm
Connectors are: 16d Sink' r N
e ails
ALLJOISTO, BC RIM BOARD-, BCIO
BOISE GL ULAMrm, SIMPLE FRAMING
SYSTEMS, VERSA -LAM(&, VERSA -RIM
PLUSO, VERSA-RIMO
VERSA-STRANDO, VERSA-STUDO are
trademarks of Boise Cascade Wood
q
Products L.L.C.
q.
Boise Cas�ade_
Double 1-3/4 x 9.1/4" VERSA -LAM@ 2.0 2800
Floor Beaml!71303
:Dry 1 .1 span No. cantilevers 10/1.2 slope February 15, 2017 23:17:34
BC CALCO Design Report
Build 5684
File.:Narne: New dol
Jo6 Name: New Colonial Home _Wellin gton; Way.
Description: Designs\FB03
Address'. Wellingtob Way
Specifier: Roof Support Beam
City, State, Zip: North Andover, MA 0 1845 Designer- KK
CUstomer:
Com
Code pany: KDK Design
reports: ESR -1040
Misc: See AfticFloor Framing
Total Horizontal Pro duct Length 10-00-00
Reaction summ.a.ry (Dow.n Upllift).(lbs)
Bearing Live bead . :Snow
BO, 3-1/2 11242/0
Wind Roof Live.:
Bi, 3-1/210 .2,400/0
2,400 0 .1,242/0.
Li.ve
Load Summgry
Dead. Snow Wind Roof Live Tribi
Tag Description Load Type A Ref. Start E . nd 100%
I Roof Loa& :Unf Area (IbIft 2) L :00-00-00 10-00-00 40
90 1 % 1115% 1600/6 125%
20
12-00-00:
Controls Summary Value % Ailowalble Duration Case
Location
Pos. Moment 8,289 ftmlbs 69.1 100%
05rOO-OO
End -Shear 2,868 lbs.. 46.6% 100%
61-00-12
Total Load Defl. L/389 (0.2k") 61.7% n/a 1
05-06-00
Live Load Defi. U501 (0.194") 61% n/a 2::
05-00-00
Max Defl. 0.294" 29. 4% n/a .1
05-00-00
Span Depth 12.4 n/9 n/a
00-00-00
% Allow % Allow
Bearina Supports: Dim. (L x W) :,vjlU6 Suvoort Member
Material
BO Post 3-1/2"x 3-1/2" 3,642 lbs. n/a. 39.6%
Unspecified
B1 Post ::3-1&' x 3-1/211.: 3,642 lbs: h/a 39.6%
Unspecified
Notes
Design meets Code minimum (LI240.) Total. load. deflection criteria.
Design meets Code:minimum (U360):Live: load deflection criteria.
Design� meets arbitrary (1 "� Maximum total load deflection criteria.
Calculations a su member is fu c6d.
s me. lly;bra
Design based on Dry Service Condition.
q
Page 1 of 2
Boise Cascade Double 1-3/4" x 9-1/4'.' VERSA -LAM@ 2.0 2800 DF Floor BeamIF1303
BC CALCO Design Repon F ---
:Dry I I span I No cantilevers 0/12 slope February 15, 2017 23:17:34
Build 5684
Job Name: New Colonial Home
File.:Name: New CoL. _Wellington Way
Description: DesignsTB03
Address. Wellington Wa y
Specifier:,: Roof Support Beam
Pity, State, Zip: North Andover, MA 0 1845
Designer KK
Customer:
Code reports: ::ESR -1040
Com pany: KDK Design
Misc: See Attic Floor Framing
Connection Diagram
Disclosure
b
d
Completeness and accuracy of input must
a
re on
output as:evidence of suitability for.:
particul ar. application. Output here. based
c
on.building code-acce te design
�p. d �
propertiesand analysis: methods.
Installation of:Boise Casca cle engineered
wood products must be in accordance with
current Installation Guide and applicable
building codes. To obtain Installation Guide
a minimum = 2" c 5-1/4"
or. Ask questions, please call
b minimum = Tt d =:241f
(000)232-0788 before i nstallation.
Member has no side loads.
BC CALCO, BC FRAMERO, AJSTm
Connectors are: 16d Sinker Nails
q ALUOISTO, BC RIM BOARD-, BC16,
BOISE GLULAM SIM PLE FRAMING
SYSTEMO, VERSA -LAM@ VERSA -RIM
PLUS@, VERSA-RIMID
VERSA-STRANDO, VERSA-STUD9) are
trademarks of Boise Cascade Wood
p ...
Products L.L.C.
p
p
p
w
q
q
BolskCascade.
Triple 1-3/4" X 9-1/4"VERSA-LAMO 2.0 2800 DF FloorBeamlFB04
Ronne!!!= Dry 1:1 span I No cantilevers 10/12 slope February 15, 2017 k57:20
BC CALCO Design Report
Build 5684
File.:Name: New — Col -.Wellington—Way
Jo6 Name: New Colonial Home Description: DesignskFB04
Address.- Wellington Wa
y Specifier: F!
por Suppod.Beam
City, State, Zip: North Andover, MA 0 1845
Designer: KK
Customer:
Company: KDK Design
Code re . ports: ESR -1 040 Mise: See 2nd Floor Framing
Total Horizontal Product Length 13-11-00
Reaction Summary (Down, Uplift) (lbs)
Bearing Live Dead :$now.
BO, 3-1/2" .2,923 0 1061/0
Wind Roof L ive
8*1 .3-1/2" 2,92.3/0 1,061/0
Live -
Load Summary
Dead. Snow Wind Roof Live Trlb�
Tag Description Load Type Ret. Start End .100%
.90 . %
115% 160% 125%
I 2nd Floor Load� ::Unf. Area (lb/ftA2) L :00-007*00 13-11-00 30
10 1.4-00-00:
Controls Summary Value % Allowable Duratio, Case
rI
Location
Pos. Moment 12,961: ft -lbs 72.1% 100%
06-11-08
[End Shear 3,375 lbs 3&13% 1 d 0 -x.
01-00-12:
Total Load: Defl. U265 (0.61"): 9,07% n/a 1
06-11-08
Live Load Defl.. U361 (0.448'): 99 n/a 2
.8%
06-11-08
Max Defl. 0.61" 6:% n/a 1
06-11-08
Span Depth 17.5 Wei . n/a
-00-00:
% A116W Allow
Boaring:Supports. Dirn.:(L x W) Value Support Member
Material
BO. Post 3-1/2"x 3-1/2" , 3,983 lbs. n/a 43.4%
Unspecified
BI. Post ::3-1/2" x 3-.1/2".: 3,9153 lbs:' h/a 43.4%
Unspecified
Cautions
Member is not fully supported at s. is required at this bearing.
po t BO. A connector
Member is notfully supported at post BI. A connector is required at this bearing.
Notes
Design meets Code minimum (U240) Total load. deflection. criteria.
DO .gn meets Code. minimum (L/360).Live: load deflection criteria.
Design meets arbiteary'(1 Maximum total load deflection c a.
riterip
Calculations assume member it fully: braced..
Design based on Dry Service Condition.
.... ... ...
Page I of 2:
Bolse:Pascade,_
Ttiple 1-3/4
x 9-1/4" VERSA -LAM@ 2.0 2800 DF F1oor:Beam1FB04
Dq
BC CALCO Design Report
1 .1 spa.n No. cantilevers 0/12 slope February 15, 2017 20:57:20
Build 5694
Job Name: New Colonial Home
File:Name: New 0 _�Wellington.Way
Description: DesignsTBN
Addres s:. Wellington Way
City, State, Zip: North Andover, MA 0 1845
Specifier-. P! oor.Support.Beam
Customer:
Designer. KK
Code reports: ::ESR -1040
Com pany; KDK Design
Misc: See 2nd: Floor Framing
Connection Diaqram
........ ..
b d
d
ri
101110closure
a
Completeness and accuracy of input must
be verified byanyone who would rely on
0
0 0
output 9s:evidence of suitability for
c
particular. application. Output here based
onbuilding code-maccepted design
e 0 0 0 0
e 0
ProPerties:and analysis methods.
installation of. Boise Cascade en gineered
wood products must be in accordance with
current installation Guide and applicable
building codes. To obtain Installation Guide
a minimum 2" c 4 -ix,
0 r9sk questions, please call
b minimum 3-0 d 24"
p (000)232-0788 before installation.
e minimum 3"
BC.CALCO, BC FRAMERO, AJS-
0
Nailing schedule appliest both:sides of the member.
ALLJOISTO, BC.RIM BOARDTm, BCI8
Member has. no side loads.
BOISE GLULAM-, SIMP E FRAMING'
L
SYSTEM8:, VERSA-LAMOD VERSA -RIM
Connectors are: 16d Sinker Nails
PLUS@, VERS -RIM@,
A
VERSA-STRAND.O. VERSA -STUDS are
trademarks of Boise Cascade Wood
Products L.L.C.
q
Bol",Ca4a4�_ VERSA -LAM@ 2.0 2800 DF
Quadruple 1-3/4" X 9-1/4
Floor:BeamIF1306
Dry I I span I No cantilevers 10/1.2 slope Febru
BC CALCO Design Report ary 15, 2017 20:.40:09
Build 5684
File Name: New Col we
Job: Name: New Colonial Home llin9ton: Way,
Description: Designs\FB06
Address: Wellington Way
Specifier.. Floor Support Beam
City, State, Zip: North Andover, MA 0 1845
Customer: .... Designer' KK
Com
Code reports: ESR -1040 pany: KDK Design
Misc: See 2nd. Floor Framing
P
BO 16-00-00
BI
Total Horizontal Product Lqngth 16-00-00
Reaction Summary (Down UPlift).(Ibs)
Beairina Uve Dead . Snow
BO, 3-1/2" 11093/0
Wind Roof Live.
BI, 3-1/2" 2,880 0: 1,093/0
Live
Load Summary
Dead Snow Wind Roof Live Trib.
Tau DescrIlption Load Type A Ref. Start End 100%
I :2ndFloor Load: Unt Area (lb/ft 2) L 00-00-00 16-00-00 30
.90%: 115% 160% 125%
10 1.2-00-00
Controls Summary value % Allowable Duration Case
Location
Pos. Moment. 14,995 ft-lFs 62.5%: 100%_
0&00-00
End.Shear 3,445 lbs. 28% 1 000A
01 -00-12:
TotAl Load Defl. L/264 (0.706"). 90.9% n/a
08-00-00
Live Load DO . 4 n/a 2.
U36 (0.512") 98.8%
08-00-00
Max Defl. 0.706" 70.6% n/a
08-00-00.
Span Depth 20.2 n/a n/a 0,
0
d -00-00
% A116W .%Allow
Bearinqsuolports Dlrn.:(L x W) Value Support Member
Material
BO Post 3-11/2"x.3-1/2fl 3 973 lbs n/a 43.2%
Unspecified
BI Post :3-1/2" x 3-1/2", 3,973 lbs: n/a 43.2%
Unspecified
Cautions
Member is not fully supported at post BO. A connector is:required at this bearing.
Memberis notfully supported at post B I. A connector is required a t
t his bean
Notes
Design m.eets.Code minimum (U240) Total load. deflection criteria.
Design meets Code.:minimum (L/360) Live1oad deflection cri ericl.
Design meets arbitrary (I") Maximum total load deflection criteria.
Calculations atsume member it fully�braced.
Design based on Dry: Service Condition.
Fastener Manufacturer-.8impson Stro.ng7rw, in C..
:'age I of 2
I vxw I Boise Cascade,
Quadruple 1-3/4" X 9-114
VERSA I -LAM@ 2 0 2800 DF Floor BeamIF1306
lower_—_ Dq 11 span No cantilevers
BC CALCO Design Report
0/1.2 slope :Fe bruary 15, 2017 20:40:09
Build 5684
J6 Name: New Colonial Home
File.:Name: New Col Wellington:Wa
Description*: Desi_gnMFB0_6 Y
Address* Wellington Wa y
City, State, Zip: North Andover, MA 0 1845
Specifier Floor Support Beam
Customer:
Code reports: ESR -1046
Designer KK
Company: KDK Design
Mise: See 2nd. Floor Framing.
Connection Diewram
Disclosure
b
d
Completeness and accuracy of input must
be verified by: anyone who would rely on
output as evidence of,suitability for
particular. application. Output here. based
onbuilding code-�accepted design
properties. and. analysis. methods.
installation of Boise Cascade engineered
wood products must be in accordance with
current Installation Guide and applicable
building codes. To obtain Installation Guide
a minimum 1-1/2"c 6-1/4"
or ask questions, please call
b minimum 6" d =:24"
(800)232-0788 before installa ion.
t
e minimum
BC CALCO, BC FRAMER@, AJS-,
Beams Tinches wide wil'l:be assumed to be eith er top4oaded only, or
ALLJOISTO, BC RIM.B.OARD-,. BCI8,
equally loaded from BOISE GLULAM-, SIMPLE FRAMING
each side.
SYSTEM8, VERSA -LAM@, VERSA -RIM
Install Screws with screw heads in the loaded ply.
PLUSCID, VERSA-RIM8,
Member.has no side loads
VERSA -STRANDS, VERSA -ST Do are
U
Connectors are: SOW22634
trademarks of Boise Cascade wood
Products L.L.C.
Solep Cascade
Triple 1-3/411 x 11 1/4" V81RSA-LAMOZO 2800 DF FloorBeamIF1309
Dry 11 span I No. cantilevers 10/12 slope
February 15, 2017
BC CALCO Design Report 21:14:05
build 5684
File.:Name: New Coi
Job Name: N _�Wellihgton—Way..
.ew Colonial Home D
e escription: Designs\FB09
Address. Wellington Way
Specifier. Floor Support Beam
City, State, Zip: North Andover, MA 0 1845
Designer' KK
Customer:
Com KDK Design
Code reports: ESR -1040 pany:
�:Misc: See I st Floor Framing
I I T
P
BO 14-00-00
BI
Total Honiz.ontal Product Length 14-00-00
Reaction Summary (Down I Uplift) (Ibs)
Bearim Live D ad Snomi.
BO, 3-1/2" ..3-920/0. 1086/0
Wind Roof Live.:
B1,3-1/2" 3,920/0
Live,
Load Summary
Dead Snow Wind Trib;
Roof Live
Tag Description Load TOe Ref. Start End 16011/0
.906/6 115% 160% 125%
1 AstFloorL.oad: :Unf Area,(IbIft A 2) L 00-00�00 14-00-00 40
10 14-00-00
Controls Summary Value .% Allowable Duration Case
Location
Pos. Moment 16,393 ft4bs 63% 100%
WmOO-00
End.Shear 4,127 lbs: 315.8% 1.6 0 O�o
di -02-12:
Total Load Defl. W74 (OAM") 64.1% — n/a
07-06-00
Live Load Defl. U478 (034"). 75.3% n/a 2�
07-00-00
M a*x Defl. 0.43 4" 43.4% n/a
07-00-00
Span t Depth —114.4 rila n/a 0.
06-00-00:
% Allow % Allow
Bearing: Supports. Dim.41- x W) Value Support Member
Material
BO: Post 3-1/2")c 3-1/2 5;006 lbs.. n/a . 54.5%
Unspecified
BI Post ::Iwl/2" x 3-nll/2" 5,006 lbs: h/a 54.5%
Unspecified
Cautions
Member is not fully supported at s
po t BO. A connector is:required at this bearing.
MemberAs not fully supported at post: BI. A connector is required at this bearing.
Notes
Resign meets.Code Minimum (U240) Total load. deflection criteria.
DO .gn meets Code. minimum (U360).Live: load deflection crit ena.
Design meets arbitrary (111) Maximum total load deflection criteria
Calculations assume member is fully:braced.
Design based on Dry: Service Condition.
)age I of 2:
Boise Cascade, Tri.ple 1-3/4" x 11-1/4,
VERSA-LAM8 2.0 2800 DF Floor B amWB09
e
Dry I I span I No cantilevers 0/12 slope February 15, 2017 21114:05
BG CALCO Design Reporl:
Build 5684
m
Jo6 Na e: New Colonial Home
File.:Narne: New Col Wellington: Way
Description: DesignsABO-9
Address: Wellington Way
City, State, Zip: North Andover, MA 01845
Specifier Floor Support Beam
Customer:
Designer: KK
Company: KDK Design
Code reports: ESR -1040
Misc: See 1 st Floor Framing
Connedion Diawam
Disclosure
b
Completeness and accuracy of input must
a
be
kverified by anyone who Would rely on
1 0 0
-vid
outPutas:e ence of suitability for.
c
particular. application:.Output here. based
onbuilding code-maccepted design
properties. and.
0
analysis. methods.
e 0 0.
installation of:Boise Cascade engineered
wool products must be in accordan ce with
current Installation Guide and a pplicable
building codes. To obtain installation Guide
a.minimum 2" c
or ask questions, please call
b minimum 3" d 24#1
(800)232-078.8.before installation.
e minimum 3"
BC CALCO, BC FRAMERID, AJS'rm
Nailing schedule applies to both,sider, of the member.
ALUOIST(M, BC RIM BOARDTIA,: BUD,
BOISE GLULAM-, SIMPLE FRAMING
Member has no side loads.
SYSTEMO, VERSA-LAm(g) VERSA -RIM
Connectors are: 16d Sinker Nails
PLUSO, VERSA -RIMS,
VERSA-STRANDO, V ERSA-STUDOare
trademarks of Boise Cascade Wood
p
Products U.C.
B Ise Casca
0 x
Triple 1-3/4 -1/4 VERSA LAW 2.0 2800 DF Floor
BeamlFB10
Dry 4 spans No cantilevers 0/12 slope Febru
ary 15, 2017 2114:57
BC CALCO Design Report
Build 5684
File. Narne: New Col
Job Name: New"Oolonial Home — Wellington—Way
Description: Designs\FB10
Address: Wellington Way Specifier-. Floor Support Beam
City, State, Zip: North Andover,
MA01845 Designer KK
Customer: : -
Company: KDK Desi
ign
Code reports: ESR -1040
Misc: See I st Floor Framing,
0640-00 06-00-06
80 131
06 -OD -00
0749-00
A,
B3
B4
Total. of Horizontal Design Spans
25-09-00,
Reaction Summary (Down I Uplift) (Ibsy.
Bearing,: Live
BO
bead Snow
Wind Roof I Live
3,754/483
1,01010:
BI 1:0,4734 0
3,02010
B2. :,9,665 0:
2,192/0
83:. 12,139/0
3,569 t 0
B4 41609.1301
.1,355/0
Load Summary
Live
Dead Snow Wind Roof Live
Trib.
Tag Description Load Type::
1 1 st Floor Load Urif Are (IblftA
a 2)
Ref. Start En& 1000/0
L :00-00-00 25-09-00 40
90% 1156/6 160% 1:25%
10
2 2nd Floor load Unf. Area (lb/ff�)
L 00-60-00 25-a_oo
Ab
14-00-00
3 Attic Floor Load. UnfArea (lb/ftA2)
.20
L 00-00-00 2&;09-00
30
10
14-00-06
14-0000
Controls Summary Value
:
%Allowable: Duration,
Case
Location
Pos. Moment : 9,967 ft -lbs
55.4% 100%
3
22-05-11
Neg. Moment. -11,.110 ft -lbs
61.8% 100%
.6
1&00-00
End.Shear 4,498 lbs:.
481% 1001/o
3:.
18-11-00:
Cont. S
,hear 6,855 lbs
74.3% 100%
6
18-11-00
Total Load Defl. U669 (0.139"
35.9% n/a
3
22-01-03
Live Load Defi. U999gliv.)
h/a n1a.
9
22-01-03
Total Neg. beh U999 (4-039")
hlg n/a
15-05-07
Ma D :
x efl. 0, 1
1.3.9% n/a
3
22-61-0
SPan Depth 16 A
n/a n/a
0�
00 -00-00
Notos
Entered/Displayed Horizontal.Span Length(s) Clear Span 1/2 min. end. bearing:+ .
1/2 intermediate bearing
Design meets.:Code minimum (U240) Total' load defiection criteri
Design meets:Code.mihimum (U360) Live load deflection criteria.
Design meets arbitrary (V) Maximum total load deflection criteria.
Minimum bearing.length for BO:is 1-1174:
Minimum: bearing length for BI is 3-7/16".
Minimum. bearing length for B2 is 3'
Minimum bearing length for B3:jS 4".
Minimum bearing: length for B4. is
Calculations assume member isfullyb c
ra ed.
Design based on Dry Service Condition
Dage lof2.
qolse Cascad
I . . 'VERSA
Triple 1-3/4" x 9-1/4
-LAM@ 2.0 2800 DF Floor BeamIFBI 0
E=c=== Dry 14 spans I No cantilevers 0/12 slope February 15, 2017 21�:14:57
BC CALCO Design Report
Build 5684
Job Name: :New Colonial Home
File. Name: New Col .:Wellington: Wa Y.
Description: Designs\FBIO
Addre s*s:. Wellington Way
Pity, State, Zip: North Andover, MA 0 1845
Specifier: A oor Support Beam
Customer
Designer KK
Company: KDK Design
Code re ports: �:ESR-11040.:
Misc: See Ist Floor . Frami ng
Connection Diageam
Disclosure
b
d
Completeness and accuracy of input ust
m
a I
I
beverified by anyone who would rely on
0 0..
0 0
output as: evidence of.suitability for
c
... particular application..Output here based
onbuilding code -accepted design
pjroperties�and analysis
e 0 0, 0
rn ethods.
Installation of:Boise Cascade engineered
wood products must be in accordance with
current Installa tion Guide and applicable
building codes. To obtain Installation Guide
a.minimurn 2" c 4-1/4"
or ask questions please call:
(000)232-0788 before installation.
b rhinimurn 3" d 24"
e minirhu.m 3"
BC CALCO, BC FRAM ERO, AjS-
Nailing schedule appliesto both sides of the member.:
ALUOISTS, BC RIM.B.OARD-, BC16,
BOISE GLULAM-, SIMPLE FRAMING
Member has. no side. loads.
SYSTEMV, VEkSA-LAMO VERSA -RIM
Connectors are: 16d Sinker Nails
PLUS@, VERSA-RIMO,
VERS -STRANDS
A VERSA-STUDO are
trademarks of Boise. Cascade Wood
Products L.L.C.
Bois# cascadg.
Triple: 1-314" x 0-1/4"VERSAml-Aft 2.6
2800 DF Floor BeamIF1312
BC .. CALCO Design Report Dry I I span I No cantilevers 0/12 slope February 15, 20.17 20:31:42 1
build 5684
File.:Name:. New-tol-
Job: Name: New Colonial Home -Wellington: Way
Description: DesignsXF13112
Address:, Wellington Way
Specifier:, Floor Support.Be
am
City, State, Zip: North Andover, MAO 1845 Designer KK
Customer:
Compan KDK Design
Code rep orts: ESR -1040
Misc: See Attic Floor Framing
BO 13-11-00
BI
Total Horizontal Product Length 13-11 -00
Reaction Summary (Down Uplift) (.Ibs)
Bearim Live Dead Snow.
130, 3-1/2!' 2,923 / 0 1061/0
Wind Roof Live.
81, 3-1/2" 2,923/0 1061/0
Live
Load Summary
Dead. Snow Wind Roof Live Trib.
Tag Description Load Tym Ref.. Start E . nd
1 : Attic Floor Load Unt Area (lb/ftA 2) L 00-00-00 13-11-00 30
909/0 1 . 15% 160% 25%
10 1400-00
Controls Summary Value % Allowable Duration Case
Location
Pos. Moment. 12,961: ftmlbs 72.1 % 100%
06�1 1-08
End Shear 3,375 lbs:. 36.6% 100%
: 61-00-12:
Total Load Defl. of
U265 (0.61 Y' 90.7% n/a
06-11-08,
Live Load, Defl.. L/361 (0.448 99.8% n/a 2
06-11-08
Max Defl. 0.61" 61%.. h/a..
06-11-08
Span Depth 1.7.5 n1a n/a o.
do -00-00:
% Allow Allow
Bearinqsupoorts Dirn.11- x VA Value Support Member Material
BO Post 3-1/2" x 3-1/2" 3,983 lbs. n/a. 43.4%
—Unspecifled
BI Post ::3-1/2" x 3-1/2" 3,98.3 lbs: n/a 43.4%
Uhspecifled
Cautions
Member is not fully supported at post 130. A connector is. required at this bearing.:
Memberls notfully supported at Post: B 1. A connector is required at this bearing.
Notes
Design meets. Code minimum (U240) Total load, deflection. criteria.
De
.sign meets Code:minimum (L/360) Live:load deflection criteria.
Designneets arbitrary (1") Maximum total. load deflection criteria.
Calcul aklons assume member is fully: braced.
Design based on Dry Service Condition.
Page 1 of 2:
ABN Bois
00 Csvkpade� Triple: 1-3/4" x 9-1/4".
VERSA -LAM@ 2.0 2800 DF FloorBeamlFBI!
mm� .Dry I I span No cantilevers 0/12 slope
BC CALCO Design keport February 15, 2017 20:31:42
Build 5684
Job Name: New Colonial Home
m
File.:Na e: New Col
D _Wellingtop_Way
escription: Designs\FB12
Address. Wellington Wa y
City, State, Zip: North Andover, MA 0 1845
Specifier: Floor Supp ft Beam
0
Customer:
Designer: KK
Code reports: E5R-1 040
Company: KDK Design
Misc: See Attic:Floor Framing
Connection Diaoram
b
—all
Disclosure .
Completeness a nd a ccuracy of input must
a
0 T
be verified by anyone who would rely on
output as�evidence of suitability for
c
.... particular. application.Output here based
onbuilding code-waccepted design
properties:and analysis m ethods.
e 0 0.
Installation of.Boise Cascade engi neered
wood products must be in accordan ce with
current Installation Guide and applicable
building codes. To obtain Installation Guide
a minimum 2" c =4711/4"
or. ask questions, please call:
b minimum 3." d ='24"
(800)232-0788 before installation.
e minimurn 3"
BC CALCO, BC F RAMERS, AJS
Nailing schedule appliesto bothsides of the member.:
ALUOISTO, BC RIM BOARD-, bba
Member has no side loads.
BOISE GLULAM-, SIMPLEFRAMING
SYSTEM@, VERSA -LAM@ VERSA -RIM
Connectors are: 16d Sinker Nails
PLUS@, VERSA -RIM@
VERSA -STRAND@ VE RSA-STUDO are
trademarks of Boise Cascade Wood
Products U.C..:
AIN
Bolqe CoiWadje; Triple 1-3/4" x 9-1/4" VERSA. -LAM@ 2.0 2800 DF
FloorBeamIF1315
:Dry 11 span No cantilevers 10/12 slope
BC CALCO Design Report February 15, 2017 19:09:18
build 5684
Job� Name: New Colonial Home File.:Name: New�Cqj -.Wellington—Way
e Description: Designs\FB15
Address:. Wellington Way
Specifier... Roof Support Beam
City, State, Zip: North Andover, MA 0 1845
Designer: KK
Customer:
Company: KDK Design
Code reports: ESR -1040
Misc: See Attic Floor Framing
BO 12 -00-00
Total I'lorizont.11 Product Lqngth U-00-00
Reaction Summary (Down Uplift).(Jbs)
Bearingi ive
BO, 3-1/2" Ll . . - Dead :Snow.
3,360/0. 915/0
Wind Roof Live:
BI, 3-1/2" 3,360 0 9161b
Load Summary Li.ve
Dead, Snow Wind Roof Live Trib.
Tag Description Load TvDe Ref. S-
1 Roof load ::Unf. Area A 100%
(lb/ft 2) L 00-00 00. 12-00-00
.90% 115% 1.60% 126%
40
Controls Summary Value % Allowable Duration Case
Location
P6s. Moment. 11,864: ft4bs 66%: 100% A
06�00-00
�nd.Shear 3,516 lbs, 38A % 0%
61-00-12
Total Load Defl. U337 (0.411 71.2% n/a
06-00-00
Live Load Defl. U429 (0.3231) 83.9% :.n/a 2
06- 0-00
0
Max Defi� 0.411 41.1% n1a 1
1 06-00-00:
Span Depth 15, n/a 0.
0_00_00:
Bearing: % Allow Allow
Supports: Dim.K x Win Value Support Member Material
BO Post 3-1/2".x 3-1/2" 4,275 lbs. n/a: 46.5%
Unspecified
BI Post :3-4/2" x 3-1/2": 4,275 lbs:: h/a 465%
U nspecified
Cautions
Member is not fully supported at post.1BO. A connector ismquired at this bearing..
Member: is not fully supported at post. B 1. A connector is required at this bearing.
Notes
Design meetsCode minimum (U240) Total load. —defiedon.criteria.
Design meets Code:minimum (IJ366).Liv& load de ectio
fi n criteria.
Design meets arbitrary (1') Maximum total load d6flection criteria.
Calculations assume merriber it fully braced.
Design based on Dry Service Condition.
)age I of 2:
Triple I -3/4" X 9-1/4"VERSA-LAW
2.0 2800 DF Floor BeamIF1315
Dry I span No. cantilevers 0/1.2 slope February 15, 2017 19:09:18
BG CALCO
Design Report
Build 5684
.,File:Name:. New—CoL. ...Wellington_W . ay
Jo6 Name: New Colonial Home
Description: DesignsTB15
Address: Wellington Way
Specifier: Roof Support Beam
Pity, State, Zip: North Andover, MA 0 1845
Designer KK
Customer.
Com pany: KDK Design
Code reports: ESR -1040
Misc: See AtticFloor Framing
Conne�tion Diagram
Disclosure
b
d
Completeness and accuracy of input must
a
beverified byanyone who would rely on
V
0 0
output gs:evidenoe of.suftability for
particular application..Output here based
c
on building coole-maccepted, design
properties and a nalysisrnethods.
a
0 0 0
installation of Boise Cascade engineered
'Must
wood products be in accordance with
current Installation Guide andipplicable
building codes. To obtain Installation Guide
a minimum =7' c = 4-1/4"
or ask questions please call:
(800)232-0788,before installation.
b minimum — 3" d = 24"
e minimum 3"
BCCALCS, BC FRAMERS, AJSTm,
Nailing schedule appliesto both:sides of the member...
ALLJOISTS, BQ RIM BOARD-, BCIO,
BOISE GLULAM-, SIMPLE FRAMING
Member has. no side loads.
SYSTEMS, VERSA -LAM@ VERSA -RIM
Connectors are.: 16d Sinker Nails
PLUS@, VERSA -RIM@
VERSA-STRANDO, VERSA-STUDO are
trademarks of Boise Cascade Wood
Products L.L.C.
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSFA-102931
Construction Supervisor 1 & 2
Family
ROBERTA MESSI"
277 WASHINGTON STa
8'34
GROVELAND MA Oilz,�4�
Expiration:
Commissioner 08/31/2018
4C��, Off
ice of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTOR Type:
F
gistration: f648.29
-1 Private Corporatiol:
xpiration:
INC.
P ENT:--COMPA-
MESSINA DEVELO M .
ROBERT MESSINA
277 WASHINGTON ST
GROVELAND, MA 01834 Undersecretary
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MESSI-3
OP ID: RC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMLIDDNYM
F 03/2812017
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 have ADDITIONAL INSURED provisions or 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 978-686-2266
Foster Sullivan Insurance
163 Main St.
CONTACT Kelly Pappas, JD, CPCU, AIC
NAME:
PHONE 978-686-2266 FAX -686-6410
(AJC, No, Ext): I (AIC. No): 978
North Andover, MA 01845
Foster Sullivan Insurance LLC
--
E- A kpappas@Fos—t-e-r-s—uWivangroup.com
A DO RLE S 6:
0811412016
08114/2017
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: ATAIN SPECIALTY INS COMPANY 17159
MED EXP (Any one person) $ 10,000
INSURED Messina Development Company, I
277 Washington St
Groveland, MA 01834
INSURERB:ZURICH INSURANCE COMPANY 16535
INSURERC:
DUCTS - COMP/OP AGG $ 2,000,000
$
INSURER D:
INSURER E:
INSURER F:
rnVFRAr.F-R CFRTIFICATE 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSD
UBR
WV13
POLICY NUMBER
POLICY EFF
IMMfDDIYYYY)
POMIUDCD=
IM
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
CIP269351
0811412016
08114/2017
EACH OCCURRENCE $ 1,000,000
PAEMMIGSEESTO(ERENTED 100,000
occurrence) $
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY 0 jpp& LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
DUCTS - COMP/OP AGG $ 2,000,000
$
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
IR
H N �D
AUTWS ONLY AUROM
1
COMBINED SINGLE LIMIT
(Ea ilWde!]b $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
ER IDAMAGE
P P '�� )
(Rora d $
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
4
DED I I RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS* LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE r--1
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
It jes describe under
D SdRIPTION OF OPERATIONS below
NIA
I
PER OTH-
STATUTE ER
E.L- EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
B
Builders Risk
ER09251382
05/27/2016
05127/2017
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
rFRTIFIrATF 14OLnFR CANCELLATION
ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED IN
Town of North Andover
ACCORDANCE WITH THE POLICY PROVISIONS.
Town Hall
AUTHORIZED REPRESENTATIVE
120 Main Street
North Andover, MA 01845
ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD