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HomeMy WebLinkAboutBuilding Permit # 4/1/2016 .......... ......... 0 BUILDING PERMIT 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Pernift NO: 2,oy Date Received-__ Date Issued: CHUS MPOAIS 7 t A licant must cam late all items on this a Al /A- LOCATION '7 -S,L�2_ Print PROPERTY OWNER A's -e-d'$4 Print MAP NO: 611_PARCEL:&��A ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Ll One family H Addition U Two or more family Ll Industrial K'Alteration No. of units: Ll Commercial K"Repair, replacement Li Assessory Bldg t_.1 Others: U Demolition 1-1 Other U Septic L-1 Well u Floodplain U Wetlands U Watershed District U Water/Sewer e­cy" Z' 2 2 Identification Please Type or Print Clearly) OWNER: Name: e" S Phone: Lo 7 71 6>e6,3 D Address: ex '2,7 5 eA a,;? t- iv, Ael CONTRACTOR Name: Phone: Ge �Ie'r Address: gyp otli AN 4t, 11-2 cG,­/ Nq 0 ,,'?0 Supervisor's Construction License: Exp. Date: 4)� Home Improvement License: 7 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$7 .50 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S, � cq 0 , (y (') FEE: $ ( Check No.: Q..,`" _Receipt No.: -,- i1i I NOTE: Persons contractrjtg.,Wjfi unregistered contractors do not have access to,, te guarantyft�a� Signature of Agent/Own( .......,signature of contracto, NORTH , irown of Anctover No. law h ver, Mass, �O - LAKE � ' LLJ/7' COC MIC HEWICK A°RAreo ►,��,��(5 S U BOARD OF HEALTH Food/Kitchen E R Septic System THIS CERTIFIES THAT ,,,,,,,,,,,,,,, BUILDING INSPECTOR ............ .. ...... ................ ..... ....... ............................................. 1 has permission to erect .......................... buildings on ... ....... ....................... Foundation to be occupied as14&4j..5...... ® d Chimney Rough p .... ..... ........ ..... .. ..... ....... '..............��...®.. ..... . . +... 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 Rough 'VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES 6 MONTHS ELECTRICAL INSPECTOR UNLESS TIO TARTS Rough 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. Massachusetts Home Improvement of Contract 'flusform satisfies all basic requirements ofthe states Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language toprotect hERECOWRCYS, Seek lept advice ifirecessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Horne Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website, Homeowner Inforniation Contractor Information Name Company Name Street Address(do not rise a Post Office Box raldress) Contractor/Salesperson/Owner Name Cjty/Town State Zip Code B-incas Address(Meet Miclude a street address) 0 k1ly e ,+4 I?A5 10'�,?& 1>2,c,Z,­10- DayfimePhono Evening Flione state 7�p Code 57�79) �7 -,-)/ -,y It 3" 67/ct Mailing Address(It different from above) EuRincmlonc Fed"Employer ID or S.S.Number L - ::. .Alm— I na�az E. W dale taq-1—W—hr-t—h—, "5" The Conti-actor agrees to do the following work for the Homeowner: (Describe in detail die work to completed,specifying the type,brand,and grade of materials to be used,rise additional sheets ifnecessary. c/ 2 Required Permits-Ibe following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's be adh I to nless circumstances beyond the contractor's control arise (Owners who secure their own perinits will e`v e excluded front the Guaranty Fund provisions of cwhen contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work furnish the material and labor specified above for the total sum of _M Payments will be made according to the following schedule: upon signing contract(not to exceed 1/3 ofthe total7 tract price or the cost ofspecial order items,whichever is greater) $_,Z by or upon completion ofAeA -*f,�� e X? $ by _____/-_-_-___!_—or upon completion of $__L?X?0 upon completion ofthe contract. (Law forbids demanding full payment unfit contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted wok begins in order to meet the completion schedule.(**) to be paid for NOTES:(*)Including all finance charges(*-)Low requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)enc-third of the total contract prim cr(b)the actual cost of anyspecial equipment or costom made material which must be special ordered in advance to meet the completion schedule. ------—----- ",x ress Warranty-Is an curress warraull Wag provided by tile contractor? W.D Yes Call terms of it....,mut,must be attached to tire contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontraclor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor RMistration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance document, • Know your rights and responsibilities. Read the Important information on the reverse side of this four,and get a copy of'the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofthe third business day following the signing of this agreement. Seethe attached notice ofcancellation form for an explanation of this right. DO NOT SIGN TMS CONTRACT IF TIFIERE ARE, ANY BLANK SPACESM! Two identical copies dthe carr ]tied and sigred.One copy shoidd go to the honicowner,The ofliff copy should be kip(by We contractor. HcoVeowner's signature --------- Contractor's Signature Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as air alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has ivit7h a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor tile same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,tile contractor may submit the dispute to a private arbitration firin which has been approved by the Secretary of the Executive Office of ConsiallorAff-aiis and Business Regulation and the consumer shall be required to sublin v, rich arbitration as provided„jn 7lassachusetts General Laws,chapter 142A re c Homeowner's Signature Contractor's Signature NOTICE:The signaturetithe parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. Tile homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MOL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike nianner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consurner/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign tile document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems hini/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work- Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at Go online to view the status of a Home Improvement Contractor's Registration: For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 ` Addendum � �������K� ^� 364 Johnson street North Andover -install new 8'vvidoAnderson vinyl sliding patio door leading tndeck -Eliminate windows OOeach side 0fnew slider -Replace back window inaunroornwith Anderson double hung vinyl window -Eliminate front sunroonlwindows and install 2side byside Anderson double hung window units -Replace vinyl siding o0sunnm000 -Patch and sand interior walls esrequired 'KUovn electric as required/install light next tOnew slider aorequired bvcode -Re route and modify baseboard heat toallow for sliding door access -Remove all job related debris .�~. � � [ The Commonwealth of Massachusetts Department ofIndustrialAceldents X Congress Street,Suite 100 Boston,SIA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Ptumbers. TO BE FILED WITS THE PERMITTING AUTHOR11Y. Applicant Information Please Print Let=ibly Narne(Business/Organization/Individual): D g.V a- /'/ (/ G gr,e_ Address: /®V3 City/State/Zip:Pel�i ept, Alg ?o;;:;%, Phone#: 0-.? SO 9 7�,V Are yo n employer?Cheek the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part time)* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 'Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition I❑I am a homeowner doing all workmysclE[Ido workers'cornp.insurance required]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors eitherhaveworkers'compensation insurance or are sole ll.Mlectrieal repairs or additions proprietors with no employees. 12.[Plum ' ahs-©x itions 5. ❑lam a gmoral contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees andhaveworkers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised theirright of exemption perMGl,c. 14.❑ r 152,§1(4),and we have no employees[No workers'comp.insurance required.] i *Any applicant that checks box 01 must also fill out the section below showing the rworkers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and thenhire outside contractors must submit anew affidavit indieatirrg such P $Contractors that checkthis 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,they must provide their workers'comp.policy number. I am an employer that is providing ivorkeW compensation insurance for my employees Below is the policy and job site inforiltation. r Insurance Company Name: q ai,1/11 .L/I 9 Ca � Policy#or Self-ins.Lie.#: 1 f k S 16-7 Expiration Date: Job Site Address: �% asp-> 51--/V/+,7 6(,�, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required underMOL 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 WORD ORDER and a fine of up to$250.00 a j day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi y under the pains and enaldes of perjuty that the information provided above is trist. e and correct te Si nature• /`'�' Date: ! / / c2-0 Phone#: 3' 7 � Official use only. Do not ivrite in this area,to be completed by city or town offlelal City or Town: PermitlLicense# 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#: ® insurance Solutions Corporation - Page 1 of 2 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE3�18�2016 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 THEBRED OLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED, the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subJect to the terms and conditions of the pollcy, certaln pollclas may require an endorsement. A statement on this certlflcate does not confer rights to the certlflcate holder In lieu of such endorsement(s). Kathleen Miller, C25R, CPIW PRODUCER NAME: PAX PHON6 (603)382-4600 AIC NO;(609)982-2094 Insurance Solutions Corporation AIC Ne Ext 60 Westville Rd A�DREea,MAILkmiller@isc-insurance.com IN@URER @ AFFORDING COVERAGE NAIC Plaistow NH 03865 INSURER A Merchants 23329 INGURED INSURER B: David M Degagne INSURER C! 1049b Mammoth Road INBURGRD; INSURER E: Pelham NH 03076-2193 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1631826091 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDOIYYYY 1,000,000 X COMMERCIAL GBNERAL LIABILITY EACH OCCURRENCAGE 10 REN I E $ ]{ CLAIMS•MADE ❑X OCCUR PREM18E3 Ea occurrence g 500,000 BOPY.087863 11/4/2016 11/4/2016 MEDEXP(Anyonepemon) $ 15,000 PERSONAL&ADV INJURY $ Included GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,Q00 PRODUCTS-COMPlOP AGG $ X POLICY E-1 SOT 0 LOC Progeny damage-sin0le Ilml[ $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY BODILY INJURY(Per pemon) $ ANY AUTO BODILY INJURY(Per aoddent) $ AUTOSS AUTOSULED NON-OWNED PerracGdenDAMAGE g HIREDAUTOS H AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCE68 LIAB CLAIMS-MADE AGGREGATE $ $ DED RETENTION WORKERS COMPENSATION TA UTE AND EMPLOYERS'LIABILITY Y/N *OSE BELOW E.L.EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE -1 N/A -EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE (Mandatory In NH) If yea,de3cnbe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Rwarke 3ehedule,maybe etteehetl If Mora apace le requlrotl) *The insured has purchased Workers' Compensation coverage through the MA Worker's Compensation Assigned Risk Pool. We have requested the servicing carrier issue a CPrtiaQate of Insurance on your behalf. Agents are not permitted to issue Certificates of Insurance for Workers' Compensation coverage on policies issued through the MA Worker's Compensation Assigned Risk Pool CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY Of THIS ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn; Building Inspector 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Keith Maglia/KRM <- ®1968-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ® ' LIABILITYCATE INSURANCE DATE(MM/D 031181201=6 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 CONTACT NAME: INSURANCE SOLUTIONS CORP. PHONE Fax A/C No Ext): (A"' A/C No): 60 Westville Road EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURERA: AmGUARD Insurance Company 2390 INSURED INSURER B: DAVID M DEGAGNE INSURERC: 1049B MAMMOTH ROAD INSURERD: INSURER E: PELHAM NH 03076 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $ CLAIMS-MADE 1-1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 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 LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N R2WC658267 11/4/2015 11/4/2016 TORY LIMITS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100f000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The workers compensation policy does not provide coverage for David M Degagne CERTIFICATE HOLDER CANCELLATION Town Of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover, MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD dIxe je�a�U/G�ca�aclrra�C�a 0,1FIce of aConsumer Affaie s. Business ibegutation mE W10ROVEIVIEN�CONTRACTOR F TYtra: �gistrati�ra: ,;7866 d�z,s!ration:;::5/2$% 016:, lnc,ividuPi•. I�P,VIb tiEGAGNE '.; DAVID DtOAGNE 4049 MAMWA0TH RD 1 N1T B PELf1/�M,NKP376 VndersecranTy License or regisfeition:Yaird fo t dividul use only before the expiratiaplAate. fffound r.Oiurn to: ,®ffwe.o ons� Cto r.Aff is rid I$usiness Regulation _ , X10 Paik Plaza'-Suite 517If Boston,IO�IA�t#2 . "x y y•.. ,� ... _j.""��``���-�' �'����{+F��iFr ' • a f Not v#!#. ith6 sigma_ e r Massachusetts Department of Public Safety Yy 5� Board of Building Regulations and Standards License: CS-075353 F Construction Supervisor DAVID M DEGAGNE� "<< 5, 10498 MAMMOTH RU = PELHAM NH 03076 CA_ Expiration: Commissioner 08/23/2017,