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HomeMy WebLinkAboutBuilding Permit # 9/7/2016 IAORTy BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION x M1: Permit No#: -' Date Received �Sspcwus�s Date Issued: XM ORTANT: Applicant must complete all items on this page LOCATION 1O'A SVI C 1J05�4 P c'od S Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial LAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other {: r 7r:fM' F.� e Ic��� INeU °max ��.�-� � '❑ Ffood lain a,� DESCRIPTION OF WORK TO BE PERFORMED: M , u 1.o-.." i CL ' � Identification- Please Type or Print Clearly OWNER: Name.. Ptsv-\& rA Phone: u34 9 Address: 1" ,iW <rwoocl Oy-ig t N - A-r\cLW-C f- n 14 61 el"t S- Contractor Name:� �cw4+\+tr Phone: G(-te 3S'k�o • TA Email: phi ro1�Lr�- �n Qt Ww� Address,JPb6zK 3A H 1p,\w k Lkx n i l 36 Supervisor's Construction License: ���- Z Exp. Date: '��� Home Improvement License: 3 -Q Exp. Date: 4 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED CAST BASED ON$125.00 PER S.F. Total Project Cost: $ 3 ZO°i -`t D FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund txORTt-t Town ofndover :. _ : � 6 O 0 No. 1 O LAKE h ver, Mass,jukj*o 7 ,g- COCHtC NZwKK ��' Are o U BOAR©OF HEALTH Food/Kitchen PERR T T LD Septic System THIS CERTIFIES THAT ............ .. .,. ..... .. ...�.�........... .... . ... ....... BUILDING INSPECTOR .... .... . .... D49 Foundation has permission to erect ..................... .... buildin son .��.�., ,f�'!� �R .,.... ` /� � � Rough to be occupied as Am.................... .... ... �! .. 4.:. . . . .......L�... . .... .. Chimney Y provided that the person accepting this rmit shatl in every res ct conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By Laws relati q o th inspection,Alteration and Construction of Buildings in the Town of North Andover. � � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TIO Rough Service Z.... 4LD === . ... Final BPEC R GAS INSPECTOR Occupancy Permit Required t® 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. Pie Comirtnrrwetiltlr r>/':1'1rrt.�rtc:lru.,Etts Departmetit of IndustrialArcidems :._ 'a,'y Office i)J Irtresttgatioits WA F 1 Congress Street,Suite 100 Bacton,;'t`i.A 02114.21117 `.,:��� �'`� ltr►l'a+�.trttrs.r.gi)l�ltliit NN'Orker,,' Compensation Insurance affidavit: 13uilcitrs�Contracturs,I:Icett iciansiP[utnl�er Applicant Information Please Print Le gihly Nam I FAL tFSC rt�t�fYir;rlxarr'trfr i��iiu�Il: ( j h �I 1�4)�(h.,�l�✓1��L�� _� _ � ��_ ._� Nllot�c Are 4-oat ilta tslaaploy�r" Check the gip__-lr�rer�ria�te_ .� _._ ._._. .�.�........._.,�,�.�.�.,� _ _ �:y.... ix: Type of project lreguirccli: . [ I a , i��ener:ai wflu icto and 1 t- 3 ani . cn7)1ItY�cr cath (i, [] \cu i:or,,, r:iction clllplo%cc•s(Cuil zindor p.ar1-tatttei.�" hse�c hired fire lith idrlt act[>ti � 11"Inioll111: at=tched Meet. Rcrt,rrdcling ® i asn a sole(�rnpractcYr cx p.trttrcr- � ,,hip and have no c mpio ees ltc•�r sulk-cisl�lt:ittiYt w hu1'i; f a. ® �7llttu�l;tpiltt rill' Ori :lrlN'i:'.ilrtcit�. e1T:pl{.?1'le5 sFtd have S5'i)rXw'1`5 %'orlon Ior . i ). � i3t iltiin ailciitac�n t:iYrn�1 rti+11r;3P"1L�. i [No«f>ri;cr•;- citrnp. in>urarlew i WC k4r .S COfj[}ratl[rit 1rTll ]E tiY_® t.ICCifiCdf it-pFsffS 01"add rccilaircal.� # 3. i am a hmn'o',ancr doing, iii%Toth o2(li�:r• i9t4`i' V ftlScd til'±t' ; I. i'!13¢llbim, repairs or adLit[1011 h rlg ,,cY c�cmi 11cs s ,et NIGL ti n�ycill [\o a"iYri:�rs comp, !io1}t to(3.til insurance required.] + 1. l�',_ It€1,mid u; 11,11C 1110 >~IrEIniT;'ccti. [!o wc7rier ctrnlp. irts�rrtnie .�eiiuise�i-� %n% -ipph ar..t as hcc;..c hr,3--1 niu+1 3!,-;f-Il out Phi* .iia'_ t l,,,• rf����r>S•:n� ;,i'^�>>,uh;r.3:rt i.5 s1?ial:�Si; ::d.[,s i«I?IPS'•:' i.;t,€ ail t,:-,,:s..a...:r i �t?I13,s.i<<r':ntra_tnr;ntiri;4 u;h!->>F.;rr..�:�l:i�la.i.rn�ra:lt r ti:at',t. t t.,ta�ors 111.11 e!Yrcb. L,_i at S.YY; ;7 lht� _ th:: a.il� ,t::i,E,t'.c t .•II:1��s i:'lh.i>r.1L-ir,tliAi; .:t:r,c�•3 r.�ee,, `vC� nY�-�its[;«�i:etizS �Si^F'n�S, �t':f.t' 1 1i�;;t',uiri'[7ti� I Urtr un emlih)'re'r that is providing workers'ewnpeination insnrcance for nr}•ernplo ee... Below is the polict'andjob site information. 111,ur,1lrcc C•otttp my Nan t.Ct 4 1 w I'«lr .v . cEr elfwiras, [:iL. + i x pirarwn Dw : t -3 ltd 1:ril)Site Address� �4'L S�tfwpc Ck Or# if— t.--:it��'�tatcLif`'.����nNw VIC : iach a copy of the workers'compensation policy declaration paoc(shins in) the poliesr number and expiration date?. 1 viluTr ':is"'ecal-e iovemi:,c a"; I-Q(j11l1'C'd UTICIk r 4ci:tlirn 25A<Yi'MGL c. I�_'t':aii Icad t0 tilt H11110,011011 ctf it'imill�,I hctlalrlt� 0 tit lineup tit i,3Cft1Ot�andsur otTe-v��ar at a,risiYra1sCn€, ;as zt°rll as citil l�cn ita' iit titi firm o a y'f OP WORK ORDS rail a litre. iJf S3iT to J(1_00,r d:f3'a,,;Iiilsl file t'wl.itor. Be ad%ked til.il .f copy [S['1111si slatEnictil Il x� be 16rwm- d to the Office of lane ti_arii�rts of tlw DIA 16r in,;iminc ci,•:crs,Wrc ',cri!]i:atlon. I do hereby c'e^rtij•l'tundra the pains•and penalties of pq-jury that the information provia'cii above is true acrd correct. 'i"naturc_ i� -' �- 1)<3tr: tk y(I' C)ffrcial use curls•. Do not write in this area,to be c-ompleteif by Citi,or town official- ( its"or Town: _ Permit",t-ice Ilse � .. _ _... ......... ----------.—_... I�,tiuing authority Icircle one): I.t{oard of Health 2,Building Divpartment 3,('it}`t l'oscn(Merl; a.Electrical Inspector 5.Plumbing Impvctor 6.Other _... i..'onlact Person: --------- Pltarne Jt; F u d ui ra II D 0 05-0-105629 1"Allyine rillo r3l Contractor Regi5trition No 3136 MAContractor Registration No 120979 A dilisioll of lilickch Colllpall% Addri-s" 'Hy.MA 1104"Ill Jm^a 0 E M 01,111 EEP I I'll G 4111-12.3-123-1 FAX-1111-123-1234 Pago, V IMOR A%I IA13 C CN TRACT t 5 E UrE rl C 0 71110 0 r,IN!:E N R 15 E ri c?I=r.R I t I r,,rZ D I,J'-,'C t Jl;=,1:ll F C,'t W C F I K A S 5SCSVL'D E38LO'd c u 5 a PHCnE OA, CUEUT" viclIK cncmn SMOSh ASIM111 07'2)'2016 -137336 GOW3 'UR91CF. 37REET BILUNG"I-11SET 10.1 Shenvood Drive 10-1 Shcnvood Drk c :]Envlcr-. North Andovcr.NIA 011,'P; North Alldo%i;r,:\ik ONNw J"C)B DESCRIPTION' [)I IA SiEl 0"'!F-I ro ilk ysal 6w ill I,calcmix x:.lr -1%ts' as f hisu%ti ion Contact Rgvdi vv%+ffl cic,lic a 3, clearmcc, around the fir%ttle k uiininsulation as'i klammimu material,mi in.,uhatioll .%Ill i.:Instalictl zlcrtls 111c top and cavilici Widl eollu"ll li�_,Ilts%%ift not I-c:in.mikild %l R Provide klIX)r and materials toreal n-cas oryour home at!.wlst w'Ist'J"O. ;1ir ic,tkarc. 'I his w,lk s01 K- p";orincJ ill wn';erl %%ilh the ti".orsilcall tat tutt8 d6gfw„l W ic,tS to a.,WN lhhA gvnar f)onle%%111 K�L:Ct a ll,%Ilrhfni Ica of c,I, oir exchmv.tc mid imhlor air qmllitY Matcrinis I'l K:tried to seal roar lionle cml incluk,caulks,Ioallls and either jlroklticts. I'limar" aras I'Or,_lhllu illclu&or lkakaae to alt Ics.I a!l.�jcjjcd and oilier unhcalQd area. k are 11,4 3ddlV';SCkL) "dais will require t 12 1 hows.A ledij--tion in cubo feel per minwe i din)ol';m in011ratilm %%fll occur,hill fliv actt,;il ntanth�r 111'.Em is not etraaauatecd At the complo io,ii ot'tfic vuathcrizat ion w,rl_:llld at no adkfil wllA cost to tile ht,rlcwmcr,a CmA Nov.�el,",or amt'or comt,oq ion safety allak:;is t%ill I,c colldlr.tcd fl., the to cibllc the ,;lfctv i'l,the indoor Etir qirJ1ll-, 1'020,00 I)AMNAING!Provide latw and materials to install a 12,laycf of R-3�,wil'aced kiws it- 5i l,sillurc fcct 12,r&1111111ing ~x112.75 A'i Tl C FLAT�11 r,7v ide lziK,r and j nta ci­6 I s t i t insiAl 1 7" hy cr a t'R-2 5('Ix,; I Cvilulo.,k:ac!,!cd I.;2 0 e 1'ccG of oll eal;attic space()VI-T %I AS IT I)RI:AD W l(lM A N I)(W FAT I,(X)%1, 7.`,3:1 ll_%7 I 1 '771,"t,tda_hF.,r sand_wtl ci i.l k t 17:! 7,:c_d lila rn_ti5 fil,_r'JAsa I,)LI rd haled lit,n I r I aptie(cet l' k ncowffl area 6clASI F R 131):10)O%1 ()SI"T ATT I(.'AUA 11 rt t%,idu,):tlx)r rand n ri i criak lei iosnil I f I t casts) moved,iwilki I ill!!co ver A Ir f Ile al:I is nccsw to Will!.,m�l ir A irral I 0:11'W'I'dCe klt*l)k'M OJ N01!"I'CrC.UCI!;JrOlMd lilt:111)Clllnt;withiat the ThiS'M 11 the lnccilrsll t%vjOl restrict air lcakw'Q, AT H C'A(ATSS I I racy lalNir anti mal ct ink I"maL v 12) I cl n jvrjr1 tc ase tet Ul At t ic;Irva, I he opcil ill g,%,,i I I lx;clo.•cd%,�it it mulawls mmiLtr to iliosc Vnwll saildill'u,and pamla l!.k not S 170,1 ill VEN FILAJ I(),N:Provide lalor and materials w,illmall 121 insillalvd eximnit Purse mth roof molmicd Hipper vellf it,exhou'l nJ,tin,_,htdlloom I'lintsi VI-XI V ILA R'I( 11rovide lal,or x1d 111:11crnik vclmlauiotn chute,in 03, ratter s it,maimam:air dow FCdoral 10 t,'05-0405629 RISE Elighlecring R1 Contractor Registration 110 8186 ,",V,Conlractor Regintratioui No dilisiol,"I"Illiviscil Colllljlltj} Allllre,%,('it% NIA(101)(11) -101-123-1-134 FAX 461-123-123-1 1CUNITRACT Page 2 IIRo (;RAM Nivit: DAIZ CUENT, WORK o1olift Sure d)Asharti S 1-03-18 OT22i2010 -137336 SERVICE.S"REET BILP90 10.1 Shemood Drip 104 Mlemood Dliv'- 5111IVICC CITY.rl,1111E,ZIP S,WW Cire.stim,ZIP Nonk Andover,MA MS-ti ""mill Amlover,MA 0111-15 VFNHI A'1102�:. 2)-l" N ;W,rcclalwuh;oluMMUll mAttt vent"to ;tllic meas.spvotl% colol,\1111u o% DR( O'l i.I I a,jJ* MN11 I' WAIA S Lilvi and iwacri:ik to in,uill FSK. 1'.ncd iu d llher!.Alsw h):11-d inml4lt joll to 1.1111'quare Ivv[of c0liluloll Wall area I PI',F! ll.,:rIlccrm!1.%111;1.1111% r01 I,Iit,,tl,lc lve�i to I hl+corltrt!,n Ifoll%,Ak onli.,hlfIcA fliv""o 11mot:111 - I-uIrclit iy,I'Or dwil,lo mc.lsurc,:, 61ullha "tlCr, ln incent i%ool not tox C, Qed w2.w 1�I Ilcr cAcIldAl %ex :wd 211 iuc auitie of 1011"",for the Air weabllL llmouc.s tip to tile fifA `�6,0 acid ao additional S�1-10 it' are ju;1 Ificd by the amfilor. H IR A U SII 1110 :,EM1.1, Co�lumi,la Qt, .0- otfe; .an ld,hl iollai:I N incew I%c i he v,orl:out hw,I Ili Oil, prddlydwwltL Hli,specca'kMMIcr 1%c da lN tai homcm%ll,:I"Min Ila%c il'o'l iheir �,olullhia home g., A."Jit lvt*or 4:)u;,y 3 1,20 1!, A kVocd propostd Cor%,oxhexlzall forl nccd;to!%:suhml Ick! 'w'd mq k lial't I%,cwlipictc]hN 30.2016 h,t the s,!1,er% arld hclhh of'.our !H" %%v 1,,:colljinn a Idldda. r E!Io,»r -t the avalLIWe sir I k,%%an our honle M It 1%� !,Oro the w,rL 1., ind I h': i"'ItiorI%wr% i"compl,:tc %Vc%%W al, a CIIII the al"cjv oI'vots llclums% xul hcutcc. Fill;has a%alue of'S'4n and i>;it no cok to%ou I lie lntl\ilmt,o :IllowaHc incentive Air all iocluhiw air oalilw.is"3.-'111 I lie Iletilm -mll -o aurc4E 11" 01c 12-1UW11 :OrWlr.wt,�r.r.t no![!jl000.A %"I It l,the 114�1110� t"cloe.ollf 0�a7, ajmmqmll % ztt the "I'Oil, 4")o IRVi FGdwal ID N'05-0406629 RISE RI Contractor Registration NO 3186 MAContractor Registration No 120979 A dhisioll or,110VI.Sch Vil".i live Hllt,' R I ENGINEFRING' 1111-123-1234 FAX 41111-123-123.1 NN TR A C T Page 3 PRO (;RAM 1143 CCii-MACT 13 EIM-RE0 VIT)BEWA`�EPI tU3E L. UMIl E'EMINCIANO'34E CV37W,'4R FC1 W4VU As CV37J.T.J? PFIC@tE D".M CUENTU %YCRK C111-1 Suresh Ashara 078)6SO-03,48 07212016 437336 SERVICr 311HET MIA.ING s rIZET 104 Shertwod Wvc 1O-t Sherv,,00d Dri%e _11P U�LLJNGI CITY.ST11_1=_1 ZIP Norffi Aiidoer,MA 015,45 North Andover.MA 0118,41 Total: $3,209.90 Program Incentive: $2,784.93 Customer Total: $424,38 WEAGREF HEREBYTO FURNISH SEWACES.CMITLETEIN ACCORDANCEWITH ABOVE CPECfP=1,T10N&FOR THE SUM OF *"Four Hundred PivenLy-Four 9.98/100 Dollars $4124.98 7JRCUTX,1=1170UE PIFULL.IN—_RESrWVt7DLLSE CHARG_'*0P.rMiLYC,11 ANY UNPAID UALANCII-A-IN-If')DAY s.3 E a FIEVEA 5 t FOR lWCn-M IMIF vYA41�_Zrlllcl-1 DO NOT c r N nJIS COt,ITRACT IF TiIERE ARE MY QUM SPXES ­10 AUTHORI 'D WIAWRE.RWIE ,Jrlorl ROM: AC 30SA*DSI*ACInRY US APIDAng f15REDY ACCEPT=D.YOU AREAVIMPiZED70130 THE WOU, DAY3. ASSPECInED,PAYrSnTVIILLTOSt-t,*,�DE�AUCU.UtiCOA53VJE RISE 60 Shawmut Road, Unit 21 Canton,MA 02021E 339-502-6335 ENGINEERING" www.RISEengineering.com AUTHORIZATIONOWNER I, b 1'2 V-c'-' (Owner's Name) owner of the property located at: (Property Address) 11 (Property Address) hereby authorize /r\► C t y �,� G "10►'1 y v-- (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. 61" 0er's Signature Date .AC"RE7 CERTIFICATE OF LIABILITY INSURANCE DATE{MMlDD1YYYY} 1 08/12/2015 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(los)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 endorsements. PRODUCER .NAME:. Kaitlyn Da Sh W_. FAX MARTIN J. CLAYTON INSURANCE AGENCY INC PHa"E •, : (413)536-0604 E-MAIL kda sh meta tan,cam 1649 NORTHAMPTON ST„RTE 5 INSURUR{SI AFFORDINGCOVERAGE NAIC t1 _ HOLYOKE MA 01041 INSURER A: ACADIA INS CO 31325 —. ___,-_----_--._---_---.. ----..__ ._.__._ _ _ _ INSURED INSURER e: GAUTHIER INSULATION INC INSURERc._YA,____.-- —,- —__-__- IN$URER a PO BOX 344 INSURER V IPSWICH MA 01938 INsuftERF COVERAGES CERTIFICATE NUMBER: 76793 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 #R �3 5 3TR'lW�� -- 1 POLICY EFF POLICY E%P LTR T { { POLICY NUMBER DD V LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE• S t I ? Ash A-G11T6R1~ B $ CLAIMS-MADE Ir�OCCUR I I PREM SE Ei a MEA EXP( -one person $ NIA PERSONAL&AOV INJURY S G[N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY D JEC ❑LOC 'PRODUCTS•COMPIOP AGG S OTHER: �. AUTOMOBILE LIABILITY M WEDS I T $ �Ea g�adept ANY AUTO BODILY INJURY{Per parson) $ ALL OWNED SCHEOULED e0D#LY INJURY(Per arcidenl) S AUTOS AUTOS NIA i NON-OWNED I PRl1PER DAMAGE HIRED AUTOS AUTOS I E)MaR LI ALEA8 OCUR I EACCHOCCURRENCE S _�._. EXCESS AS CLAIMS-MADE N/A AGGREGATE: DED RETENTIONS t pp S WORKERS COMPENSATION _ STATI�TE — ERH AND EMPLOYERS'LIABILITY ANYPROPREETORIPARTNER7£XECUTIVE YIN E.L,EACH ACCIDENT $ 5300,000 A 017RCE"IEMSEREXCLUC N1A NIA NIA MAARP300327 10130/20151 10/3012015 (Mandatory in NH) E L DISEASE.EA EwMPLOYEE $ 500,000 li es,descnba under i-- -------- a lies OF OPERATIONS elow E L.DISEASE-POLICY LIMIT S 500.000 NIA i DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more spate Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees In states other than Massachusetts If the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status at this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensationrnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION HATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1200 Osgood Street AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel N1.CrOw 11y,CPCU,Vice President-Residual Market-WCRIBMA ©19$8.2014 ACORD CORPORATION, All rights reserved. ACORD 26(2014181) The ACORD name and logo are registered marks of ACORD '/Xe g Office of Consumer Affairs and Business Re,ulation . -» 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 101112016 Trt# 257812 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 IPSWICH, MA 01938 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card OfFce of Consumer;lffairs d Rosiness Rc,:ulation License or registration valid for individul use only ROME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 173410 Type: office of Consumer Affairs and Business Regulation Expiration: 1011!2016 Individual 1€1 Park Plaza-Suite 5170 Boston,INIA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD ure IPSWICH,MA 01938 Undersecretan of valid w" out signat Board Ot a ur�d of PLJ4�4jc Satoty ing Rcquiaj.ons-, Ind S tanaarcj��, License, CSSL-102562 KURT R GA EITIf P-0,ROX 344 IPS-kh MA 019JR �r ase Mwov