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HomeMy WebLinkAboutBuilding Permit # 9/19/2016 OO R flay BUILDING PERMIT TOWN OF NORTH ANDOVER a} APPLICATION FOR PLAN EXAMINATION Permit No#- Date Received �S ACHu`3� Date issued ' I PORTANT: Applicant must complete all items on this page LflATICDN 4 Pant PROPERTY OWNER44 r , Print 100 Yebt,struc#bre � yes nc� MAP PARCEL. � ZC7I�J1hJ DISTRICT H�stiric Drstrct yes no' Machine Shap pillage yes no., _ _— ..---------- __-- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family C Addition 0 Two or more family ❑ Industrial f❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: i❑ Demolition ❑ Other E septic D Well 0 Floodplain 0 Wetlands ❑ Watershed Distrjc I❑Water/,SeWer; ES R P N OF WORK TO DE PERFORMED: , cvi/-,a/ems Identification - Tease.Type or Print Clearly OWNER. Name: 1 & -' � Phone: Address:" Contractor Name: 77 � �t m Phone: Email:,- wi;o,, g - Address: PI upeirvisor,s Dc hstructioh License. , �' Map Date: Flarrie lrrapipvement License: Exp Date e ARCHITECT/ENGINEER Phone- civ 'L/C/ .�- Address: ti � �� , . . 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 Cast: $ c ' 5 FEE: $ _ Check No. '56 Receipt No. NOTE: Persons contracting with unregistered contractors (to not have access to the guaranty fond ,signaturehofAgent/Owner � � �� � Signatureofcontractor � Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Pians ❑ TYPE OF SEWERAGE DISPOS Public Sewer Tanning/Massage/Body Art ❑ Swinuning Pools ❑ Well Tobacco Sales ❑ Food.Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dwnpster on,Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF w U FORM LANNING & DEVELOPMENT Reviewed OnSignatureP-N P_ COMMENTS ` p VCONSERVATION Reviewed on I Si nature y COMMENTSJJ o- HEALTH Reviewed on Si nature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: .. _Comments Water & Sewer Connection/sic nature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Durrmpster an s[fe yes na Located at 124 Main Street r Fire Depar#rnent sagnaturelda#e y rr • COMMENTS t4ORTH '9 own of ,� ndover O _ 0 No. CoLAKI h ver, VIass, o,6y � Cac"Ic"a WICM y1. A°RATED S U BOARD OF HEALTH Food/Kitchen PE Septic System Ala; THIS CERTIFIES THAT MIT . . ;....���4. _ ... BUILDING INSPECTOR .�. . ...........:... .4r... ,......nil; Foundation has permission to erect.......................... buildings on .. .. .. ....... \ �/� Rough to be occupied as .. r1.l..,S .....6ft.....Ot� Chimney provided that the person accepting this permit shall in every respect conform to the terms of the a lication Final on file in this office, and to the provisions of the Codes and By-Laws relating t�4� 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 T Rough Ar An ;...Z..... AM Service .. .... ...... ...... Final BUILDING I ECTO 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. -14 CON TE BOCK tvIASONRY RET WALL(TYP., 9 •!9` .` cQ ' SED m •`• ` 9 C CONT cp - n DEC\ r - .' c RIP�RAP LCAT IC' \ 22' A/C UNIT---, \ •'# B-1� if ANDS ULKHEAD FISTING HOUSE - \ r'� t`2'•' 9 %.ri .� (TYP.) TO ND. =285.69' � I \\ FND DRAIN w 60, 17 5� � �C,� VINYL PICKET S ~yj S y5 $, FENCE , tj - POROUS FND DRAIN PAVEMENT r. _- DRIVEWAY LOT 1 EXlk-TING HOUSE TOP 1=o D. = 8 .14' A-3 -- _- PORCH -_--- B .W. o ------ _ _ / o CONC.BLOCK cV C UNIT t Imo{ J\J PILLAR(TYP.) N AREA OF 25' - -- ! �` �\ Massachusetts Home IMPK OWMent SaM .le COntraet This form satisfies all basic requirements of the states Homo Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Sects legal advice if accessary.Any person planning home improvements should first obtain atopy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a Freo copy by calling the Office of Consumer Affairs and Business Regulation's Consumerldormation Hotline at 617-973-8787 or 1-888-283-3757 or on our wehsite. Co tractorInfor -tion i # , -Homeowner In emotion LJ f f fCJf`�14e rib J�? Name Company Name Street Address(do not use aPost OfficeBox address) �p Contractor/Salesperson/O,vymerName Cityfrown State Zip Code Business Address(must intrude a street address) Daytime Phone EvealingPhone Cityrtrown State Zip Code CY Nd I?7i 0,2 0 72r- 'q r te Mailing Address(It diflc cntfrom above) Business Phone Federal Employer 113 or S.S.Ntmtbe[ }come rmprovemenl C"�dmdorlteg Number FkpExlion date raw r<q�ires lhnt most home Smproreme"[ca"Enclars have .ry�.j p, (% 9 a valid registratimi n"ether /ry d {C7 7V( 1 I � • !�'� The Conti-actor agrees io do the following work for the HOntee{vner: b {T]esc ie in etad the work a onlplstedf specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) i?s l f f e°d 447 'i X17�c�p rl7 #IiAele fjl ' e/Y1e' Pc Ildelt � 541! cde fn? rr�! .sh•n i c�.�- SI�e� u�r✓7p�1 OldI S C z et-e,f fM1197 rdXo70 Required Permits-The following building permits are required Proposed Start and Completion Schedule-Thefollowingschedulewill and will he secured by the contractor es the hnmeovmees agent: be adhered to unless circmnstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of 10'1�/` "�Da�ewhoncontractorwillbegin contracted work. MGL chapter 142A..) �if����'`Fate when contracted vtork will be substantially completed. TOO The, Cl Contract Price and Payment Seliedule ontractor agrees to perform the work,furmish the material and labor specified above for the total sum of; Payments will be made according to the following schedule: $ b�tl upon signing contract(not to exceed 1/3 ofthe total contract pricce.or die cost of special order items,whichever is greater) $ by 1 I or upon completion o€ rel 1 �� /1/101 ®1 $ by / / or upon completion of �uponcanpletionofthecontract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) Th,£ollowingmaterial/equipmentmust hespecial $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(") $ to be paid for NOTU:(y)including all finance charges(")T.awrequires that any depositor down-payment required by the contractor before work begins may not exceed the greater of(a)ane-third ortho total contract price or(b)t11e nolual costofany special equipment or custom made materia] which must he special ordered in advance to meet the completion schedule. ExpresswAk'k'fln -I9 an ex 1'C33`YArI'allty hcingrovtded by the conn•atior? Na Y'CS alt terms of it1 rvarralk must he attached to the conk Act uSubcoutractox's-The contractor agrees to be solely responsible for completion of the work described regardless of tha actions of any third p party/subcontractor utilized by the contractor, q he contractor frutller agrees to be solely responsible for all payments to all subcontractors For materials and labor undertlYis at regiment Contract Acceptance-'Upon signing,this document becomes a binding contract under law. Unless otherwise noted vvithin 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. 9 • Don't be pressured into signing the contract.Take tilne to read and fully understand it. Ask questions if soknething is unclear. • Make sure the contractor has a valid home Ira rovement Contractor Re istration. The law requires most home improvement contractors and subcontractors to be registered with the Director oflloine Improvement Contractor Registration, You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Roon15170,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 Form 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 fire contractor inwriting at hislher main Office or branch office by ordinary mail posted,by telegram sent or by dellvery,not later than midnight of the third business day following tho signing of this agreement. See the attached notice of cancellation form for an explanation ofthis right. DO NOT SIGN TMS CONTRACT IF THERE ARE ANY BLANI{SPACESII! Two identical topics ottile Comma t nsust ba completed mid signtd.One copy allould go to the homeowner.The otter copy should bckeptby the can[redor. Homeowner's Signature Cdn1r ca roe's Signature Gl#6 e Date Dali i PARTS LEGEND -1 SKETCH m FEMALE 1 TRCAL INSSTALLERS LAYOUF I ca Lu CHANNEL �ZT TVER ID CUL-ANGLF ICCUTTINGVERIFY ALL FILL MEASUREMENTS BEFORE CUTTING - a:* -0 DBL-CHECKBOM * co A 6< 1 —E THIS JOB HAS NOT BEEN CONFlRWlED. 11-1 A --- PLEASE FAX AN APPROVAL WHEN READY TO ORDER. L to LLJ rn= z 6 3 O >-c R CO z tt -j < 0 Oo =) = < -j C-4 u 3- 5- REI EASE APPROVED BY (586)314-0404 0BUILD 8:SHP IMMMIATS-Y Lo CUSTOMER: US HOME IMPROVEMENT CTI JOB NAME: WASSAF, HADI 3 155/8" WALLS-) 120 I 120 NO TRAPEZOIDAL GLASS U) Al A3 ILL. -j 0 0 LLI 0 in GABLE(s) 0 z < Do Lo Ul ROOF ROOF PITCH PITCH 00 0i OF- W1 w LU" 55 55 36 71 .625 3 111 3 3/16 4 NOT TO SCALE —120" 120" IAPMOEVALUATION REPORT 0118 ICC LEGACY REPORT ESR-1801 2 A r) FLORIDA PRODUCT APPROVAL 5505-RI 40 ICC EVALUATION REPORT ESR-140 FLORIDA PRODUCTAPPROVAL 120.00 FLORIDA PRODUCT APPROVAL 7086-Rl 96.0 FLORIDA PRODUCT APPROVAL 7082-R! A2 FLORIDALPRODUCT APPROVAL 12571 FLORIDARODUCT APPROVAL 3r-l-R2 1SW3295 08/10/16 US—HOME DETAII M BY: MICHAEL RANG ORIDA FLORIDA PRODUCT APPROVAL 9 t/0 C/90 :-A.Lva cK�s Iry y > c m CO w Z 0 m c� M G) m,� : z > ur r�1 > C) C) T `'''si: �r7 rZ 00 � "sa.s. ---I �,a �r O '''": ' m (A Irl C ,,`e. ,, €',' .;a ITJ > C) + ✓ CnGo r .. r m x U) I DEALER:US-HOME 16W3295 PI'§. ( ) TEMO IJI�II C C7Mi, INC. LUAY ESHO, P.E. WASSAF, HADI _ 20400 HALL RD 20400 HALL RD. 64 EMPIRE DR CLIKON TWP, MI 48038 CLINTON(800) 3 MI, 464 3f PFI; NORTH ANDOVER, MA 01845 _ PHONE: 586 PROFESSIONAL 44-s3ONAL ENGINNEER DRAWN BY. MICHAEL RANG ON:013/04/16 SCALL:NONE PAX: (586) 31410404 MA Lfr,. frmddfe W/01,/90 :31V(] -n o" � 'Y' . Vi r _ _ �:o NIL, a 14) � ^I —i —i —i '� �o� A PTI fT1 ITY r�I a d �,��� 0 5 �4 "'(11 u ( MOONtM a5q MOONIM x95 r rn X U) z G) L _ _ — rn m u] 0 r, > m 0 0 Q) z 0 m rI C(7 z> z l :9w Zro C m > 0. 55" WINDO4d S5WINDOW —I-°ri as m C to r W r m I r>�-crym Zw >ZU)> zc rg5p Z> C) C0 Z z r Ci cn >m 0yr DEALER:US—HOME 16W,3295 PH, ( ) TEMO Sw.r'UNROOMS, INC. WAY ESHO, P.E. WASSAF, FIADI 20400 KALI_ RD CLINTON HALL MI, 64 EMPIRE DR CLINTON TWP, MI 4803B PH: (8N ) 3 — 66 �H: (aoO� 344-e�aa NORTH ANDOVER, MA O1845 PHONE, (586) 286---0410 PROFESSIONAL ENGINEER DRAWN BY, MICHAEL RANG ON:O8/04/16 SCALE:NONE . FAX: 586314-0404 MA Lie. freddie �m w r y k r f%v 6 'r �', l iY,i M `.'},�'.*.,y;,'',!.''•' 'Y' +,''Y,. i:t}.`'<`"A,.r,•'i_.if.''it, 7 ''.'lti. ♦,�:a :f�6k: P,. W .':e`i ea• t//�"";�;yrS'* `i 1Y� /may `F�',771 75 •tta: ,f�;R,, ��;,��; ray Sri,,^f• \.\ :}�'a`�,7'3,t,7l.v r�+• '�`r�l• r 'i+� •e••,k (f) 4"jS�'7."�L ri'•ro�e�y ry.7 Y 4.rJ m 'UC7 � 2 S :J;i G7 r)N O iv en _i mcyo to ��m > rn�Mrn mm C7XM0G7 0 DEALER:us—HOME 16W3295 PH. ( ) "fEM(J SUNRO(7fV1S, INC. WAY CSH©, P.C. WA AF, IAC I 20400 HALL RD 20400 HALL RD. 64 EMPIRE OR CLINTON TWP, M6 48038 GLMI, 46 PH:: ((8oo)) 3B44—B3Ss NORTH ANDOVER, MA 01845 PHONE: (586) 286-0410 PROFESSIONAL ENGINEER DRAWN BY:MICHAEL RANG ON:08/04/15 1 SCALE:NONE FAX: (586) 314-0404 1 MA Lio,I Freddie If f'M. C I 4- N (ywna r. qq 0 A t 0 yp,� 7 ✓'..j 1{I --I Y .,u........... ..... WO �W1,32 1) FSI �..�.._ . ._._., ....,__. U HALL C(� 4 C �, ���Il� . X400 h�M�L k�(� �k 38 ct.Vh4 cA4 lw4l W 4R, k1FlE ,G. .. ASSA -, h~ADI 1 1C� a'° l 4 t�M7Psxa4 �e� _ _... a�If f���� � � ��Sit waw, (0a��s s�aa ��56 (` � 1 r��l 4�l NOM1.1 ��GiB&Vm Mt R9 01045 @`,F�C44`wl� (86) a 86 C R( 4 SSIONA Eri�GP4:4 R 4Rr� k �; � ac�I4...t E frpr�, a rsrs� �� ,r ��: ��rt V A" a [ 4C1q-.__. .:� i r �.___._._.�.�.... ...(.��,.._....� � ... � _. .... ___...... _.._....._.__ .__. ......_. . The Commonwealth of'Masygchusetts fJ Department of��adr� t�z�dAcc�dents 1 Coylgre-ss Stpeet,Suite 100 Boston,MA 02114-2017 wwts.mass.gov/dhz ,�. W,a kers'Comp eksationbmu:rance.AfRdavit:Builders/ContractorS/Electxicia7as/pl bees. TO BE FILER MgTH'IE J'ERWTTTNG A.UT'(OMT'S`' A licant�iforznatioxt Please Print Le 'lel Name,(Busi ess/Organization/xndividual): City/State/Zip: yl%a e Phone#: Axeyou an employer?Checktlie alriiropxiafe box: Type of project(.•gquired) 1.1-1'- m aa amployer-Mtlr employees(frill and/or part time). 7. Now cozisfructiozi 2.Q I am a sole proprietor or partnership and have n employees wo'1ft for me in S. ❑Reinodelhig any capacity.[No workers'comp.insurance required.] . ❑Demolitioll 3E]I am a homeownerdoing all Work myself[No workers'comp..imuianea required.]t 10 [�Jtuil(�Jng addition 4.E:]I a3n a homeowner and will be hiring contractors to conduct all work on my property. 'will 11.E Electrical repairs or.additious ensure that all contractors either have workers'compensation.insurance or are sole • j proprietors withno employees. 12 Q Plumbing repairs or additions 5, I am a general oentractor and X havehiredtlte sub-contractors listed anthe attached sheet. 73..Ei ]Roo�i'epairs 'hese snb-rantraltorsl We employees and have workers'corm-1110rance 19.❑�GtlfeT 6. We are a rozporation audits of rershave exerrisedtheir right of exemption perMUL G. J52,§1(4),andw have na..e�nplgyees.[No workersromp,insurance required.] `Azzy applicant that cherlcsbox#I must also X11 out the sectionbelow slacwingtheirworkers'compensation policy information i Homeowners 4vlio sulimitttvs af��idavitindica&gthq are doing all work and then hire outside oorat[artors must sidbmit anev�affidavitindieatin$sucb tContractors that checktb3s box musttEacxed an additional sheet shawing the name of the sub-contractors and state whether ospot those entities Dave '? employees.Icthe sub-caniractars AaYe employees,Miry must provide their workers'comp.policy number. u X asn are eniployer th at is piouicliizgworkers'compensadon Msurancefor my empldyees'Belo)v isthepolley andjob site ^- infonnation. 3' Tnsuxance Company Name: 6 � �? Expiration.Date• � � h/Cl Policy#or Self his.Li �� + Job Site Address: { � city/State/dip: A/1 �Vewl Attach a cagy aiithe o kers' compelisation policy declaration.page(showing the policy number and expiration date). Failure to secure coverage as required under MGI;o. 152, §25A is a criminal violation Punishable by a fine up to$1,500.00 and/or one-year iixipxiso�inent,as well as civil.penalties in.the four of a STOP WORK ORDER and a fine of up to$250.0 0 a day against the violator.A copy of this statement may forwarded toe Qce of Investigations of the DTA far insurance coverageverifoation. do hereby certify under the,pains and pen " s ofperjr�ry that the information provided above is true and correct Si attire: Date: Phone#: ct 4' r[OfficialiveoHly. Do riot•wvrite in this area,to be completed by city or toren official Iown• permit/License# Issuing.A.uthoAty(circle one): ' 1.Board oflfealth 2,BuildingDepartnrent 3.City/Town Clerk 4.Electrical inspector S.lvlumbinglnspeetor S.Other Phone : contact Person: LOS 9/2016 12. 41 7817498822 JOHN J. LAMB INS PAGE 01/01 orn[ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDINYYYY) ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDE=R- IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed, If SUBROGATION IS VIIAIVED,subject to the forme and conditions of the policy,certain policies may require an endorsomsnt. A statement on this certificate does qot Confer rights to the Certificate holder in lieu ofsuch endorsements). PRODUCER NAME: Uohn J. Lamb 1ne ran ae Agency PHONEFAX 781 789-6950 N (7Q3) 749-OB22 24 North Street E,"uL Hingham, MA 020.43 ADDRESS: k.aran @ '1ambinsuranoe.0031 INSURE 3 AFFoRD)NG COVERAGE NAIL# ........ .-..-...--•-•-•------...........-......----------^--..- -..........,.».».,.»_....»...».....-....._.- INSURERA:Sftfaty Ins 1NWROP 1NsURPAo;f`auazd Ins- Bureaus _ John H Carroll INSURER C dba US Home Tmprovemiantr INSURER D: 27 Hamilton Rd INSUR> s: Peabody, MA 01960 II+SuReR P; COVERAGE$ - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS i3 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFLOW HAVF,BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THI= POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHE=R DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDI I) BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ton LTR TYPE OF INSURANCE N POUCYNUMBER MM10[}!YYM (MMIOD/YYYY1 LINTS A GENERALUABILITY RMAb005758 6/20/16 6/20/17 FAC14000URRENCE $ Q 0 000 X COMMEROKOEMPALOABILITY R M E ?EA00c ry $ 100,000 cLAIMS.MADE Eloccup M D W Am or*Dena, $ 1() 400 PERSONAL&ADVINIURY $--110-0-0-1 000 GENERAL AGGREGATE S 1 000,000 (3IwN'LAGORi GATE LIMITAPPL.IESPER -PRODUCTS-COMP19PAGG & 1,000,000 POLICY PRO• LOC 8 AI.ITOMODLE LIABRITY COMBINED S)NG LiMrr faaoaiderd $ ANY AUTO BOD[LY INJURY(Por pQr5an) 8 ALLOWIED SCHEDULED SOMLY INJURY(PRr wridont) $ AUTOS AUTOS NOWOWNED I PROPS E $ HiREDAUT03 AUTOS ParnDcidla ffi UMBRELLA UABOCCUR EACFtOCGURRENCE $ F,XCESSLIAB CLAIMS-DIADS AGC7K(3A7E- DED RETENTION$ $ $ IAORKERSCOMPENSAMON i R2.WC647329 10/7/x5 XO/7/16 NIGSTpTU- OTW- AND EMPLOYERS'I,IA9tLITY ANY PROPRIEMRIPARTNER1EXECUTHE Yl I E.L.EACH ACCIDENT $ -100,000 OFFIC>RIM NIBEREXCLLIDED7 N/A M iandOwy hi NH) E.L.DISEASE-EA EMPLOYE 100,000 ify�s,dastribeundar DESCRIPTION OF OPERATIONS below I G1.01ME-POLICY LIMrr 8 500,000 M$CRIPTIONOFOPP-RATIONS1LOCATIONS/VEMCLES (Attach ACORD901,AddtionalRcrrrrsfsSehadulQ,ifrnorespoa istegEired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE 0ZSCRI13FD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE; DEUVERI:D IN Town o-f North Andover ACCORDANCE WITH THE POLICY PROVISIONS, Building Depar'tmen't 1600 Osgood Street AUTHORRED RE"WSFNTA'nVE Bldg 20-:Ste, 2035 North Jeanne R McPhail @ 1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax; (978) 6889542 E-Mail; Massachusetts Department of Public S1afet' ` Board of Building Rego€lations and Standards License. CS-106653 Construction Supervisor 3 JOHN H CARROLL 27 HAMILTON ROAD PEABODY MA 01960 CA- 1� C, mfssioner Expiration: . 05/06/2018 Office of Consumer Affairs&Busifiess Regulation — 1 "HOME IMPROVEMENT CONTRACTOR �a Registration 130768 Type: Expiration 44812416 BSA U.S- HOME IMPROYEMEIVr 1 JOHN CARROLL 27 HAMILTON RD. _ }^ 4 PEABODY,MA 01860 Undersecretary