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HomeMy WebLinkAboutBuilding Permit # 9/26/2016 BUILDING PERMIT s10RTy TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION " o� 1, Date Received Permit No#: �sSacHUS�� Date Issued:s IMPORTANT: Applicant must complete all items on 1khis page LOCATION �� ��°i- To b, Print PROPERTY OWNER 3"0 5C PV4 a�! 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 ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg A Others: ❑ Demolition ❑ Other )1\5i 7-/'0 0 ❑�Sepfitc� �Well �, Q Flaodplatrl �WetlarJds � D Wafiershed D�sfir[ct .� u^r DESCRIPTION OF WORK TO BE PERFORMED: v� ,� rt�c s�r4 a®b 7-0 ,gyp y y ri'>l a7lo� Identification- Please Type or Print Clearly OWNER: Name- '57p S,- av i m ii Phone: q.>F. - 3 It/ Address: .1 YS c'� r L to ok Peter Leblanc P® I�ISLII�►Tl®N Contractor Name: AL Phone: Email: Address: 78- - 16-58 Supervisor's Construction License: /t�o '> Exp. Date:. Home Improvement License: it l 7 L Exp. Date: Z a- ARCHITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. i Total Project Cost: $ b®- 013 FEE: $ Check No.: l Receipt No.: ' 1 NOTE: Persons contractin with unregistered contractors do not have access to the guaranty fund t10 T H �Q own of 6ndover 0 No. y � y ID �^K. h ver, Mass, ,p cOc./�C HE we[x �'�• �.g A S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ��?..S._61 Qdz'ov!!�................. BUILDING INSPECTOR has permission to erect .... buildings on �+18,�....,C# % % Foundation ...................... .... . ...... ... ......... .. womw Rough occupied as to be occu p .. ... . w�iru.���� ...��+r�i�r.��� 4...... .��l�ws.0 Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR . UNLESS CONT S Rough Service 510N ........ Final BIJILDING1. IP�E6i&W- 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. i 3 a USE e� 10 C"Rtnscbr tilgiatreCan No ING A division of Iblelsth ligtneerioetACatt6goEpr Roototrmtao rte 1[4979 g RISE Company Addrem City,MA 00000 °'` CONTRACT 401.123-1�4 1rA8A01.123.1234 Page 1 PROGRAMCM8>'4 �e t �tags aeteer FMWO KA9 atarnea'te � Pltda! DACE uauexrar wor4uca:»en Joseph Quinn j rev 004=6 4363M01AQ2 ftER a weer T rn taerara eunasr 1 B9 Uar�eton Rnxd ' qj 189 Cstieton Rand �M. aanrvtca etrr.euA�ar �, •���� � oduroaryaet7km+ North Andover,MA 0184§- North Andover,MA 01845- r� ,ri SOB DESCREMON fll;AI.TH 8t SAEErY Weathasizraaid vhsrlc eanuot Fumed until meds mical wmtaatiOa that will provide(i)cfln(cubic feet per minute)of coutiinursrsalr flawhas bm installed in yourhame.BLOWER DOOR-3363 @.So PA. CUSrORWR NE=T0 DWALL A RATH VENT FAN DESIGNED POR OONriNUOM RUN AT 60 CFX THISCAN HE ONA TIMER.SWITCH TOCYME 23 MM PER,Hl3UR THAN CAN AIRSBAAL TO 2370® ' CFMISO.ONE RXH FAAN[SAA PANISONIC SELECT.LOOK AT Ep1.Op a $0.00 HAZARD AARRI6R we have identified that there era retxsaed lights Present in your home.unless the moon ed I10t3 aril owtiw as 1C-rated(inadatiaa OmMot Riled)vre will create a 3"cksranoc space around the fin=by ung fabw&n bbmket uasdat�c ss a dtatmb*madCisl,ao htmkion will be Instathd across the top end closed cavities v&kh contain recessed lights wM not to fnsidate& $000 HEALTH dt SAFErY:Wwtlteriaetion wodc cannot proceed wttiil the spilhVefeambustion Sm is fixed $0.00 H AL?H 'Y:weathairntIon vmrk cannot Procced until the�t drftaissue isfoted $0.00 g AIRSEALING:Provide labor�d oaate>lals to seal Mot your home against wunstefuf,excess air Thh wnrk w016a ' Perfomted in concert with the uscaf special tools and ftMostio tests to an that your home wM be left wish a healthlftal levd of air cxch=p sad indoor esr gialfty.Materiels to be used to seat your home tan include cauilp,foamy and other pmdx ts. Primety areas for sealnog iaueiutdo aslr ieaka8e to attics,basemeuntan,attached fiW and other umheatedartas(ti*A%s ase not genuxaliy add[ sod.}This w0I tagtdne(9)working houm A teuktatian fn 0Xw fee!Pear mfntde(eft)of air infiltration w0)oocw;but the actual number ofcfm IsnotWrantcftl At the POMPUtlOn of the w93111OW len vrork,and st no additlond wa to the homeownu,a f d Now door andibr u>omlratraA safety analysis vAll be couducted by the mb•eontrncsor to ea4uc the safety of the Indoor air quality. 5765.00 DAMIvBl&Provide tabor sadma aWS to instal!a jr layer of R-38 unt'xacd Sag=tatu to(231)sgtmto fees for damming PmPo= E473.SS ATTIC HAT:Provide 4abor and mauls to festal!a 7"huger of li 23 Cim 1 Cdhdose added to(1152)sgtwe feet of open attic R• 51,497.60 ATTIC AOCM Provido labor end materials to finsvtate the baric of(1)attic hatch vntb 2"r4dThe max board WedherA4 the perimeter. S60-00 ATTICA1 Prov&feiabornudmaidiatstolnstsil(1)emlymoved,cswtatinsower for the attic acoesyfolulutgstsir Asmall flat surface of Plywoodwiili be uxeated around the opo insvifhtn the atlfa This will allowtho covets integral w Wher gftingto restrict air Wwo 5237.65 0 u I I � r�1 Or • Fadafe11DD03Q4Qsa38 RW Bering W Coaft*r Roglabatlon No OW RISEAdivision ofThieluh 1%gineering oatma�o�Raptetmaon tCompany Address.City,NA 000W3 CONTRACT 4a1-123.1234 FAx401-11'3-1734 Page 3 PROGRAM CMAC wsam aK8 CL23" rreartramett Joseph Qubm MWS-31 06114016 436308 00002 BMW ausst Malo two 189 Cmletnst 12Ded 189 Carleton Road amtvxa�arsreaw.aa eatttsa asranta,t� Nortlh Andover,MA 01845. North Andover,MA 01945- JOB DFSC JMON VENTW-1013 Provide labor end matuials to instep(3)8'diameter reef vast(a)to itcasese vcntOetiou in etifc axes The vent can be sappHod in(circle rotor)Usk brown,gay or MM fkadL s2s6.SO VENTR.ATION:Providelaborgad mataWstoinstall(1)f WWodexlseasthosetoexstinghrt6room6m(s) 550.0D VENTH ATION.Provide labor and materials to iesstatl ventuatfon chairs in(9p)tmft r bays to metsss d air flows $198.00 COMMON WA1.0 Provide tabor and materials to install 2'F51C teadsem&rigid 6bp8Eaa board iasdstlon to(68)sgssata feet of common wall area. $238.40 INCENTIVE R1SEEagmemingvr7lepAlyallappldce5tgelig�Ci ,tath oontsaee, Vbuvr81o*beWWlhc ctamount. Gmrmtly.far dl tem Cofuahbla Oen offesa an baagt Wwf 7PA not to meed S2.00D per calendar year,and an&gWive of 100%for the Afr Sting mcasurs W to tho first 36g0 and an of iona15340 ifs ata jn;ti8od 6y the auditor FOR A C.IIvIIT®TIME:Colombia Ossvv8l silo offer an addillw a1 S100 hucathve towards titevntharization work outlined is this P reposaL Tb's V=W Amer boenthve is awifable to homcovmets vdto have hod their Colambta fins home esmw waft before 31,2D16. AsWiedproposdfor Mienneedstobesrbm8tedbyMost 8.2016andvwrtcmustbecomptetedby9eptem6 30,7016, For the safety and hwltb of your bomds indoor air quality.we v+t0 be condactiag a Mower door dia"io of the avai[atle adr now Yaw home t otb bdbm ft wrk is began,and after the%osibcdt awn woslt is oomplety.We Witt also ooadnct a fill assnament of the combustion saf2ty of yntr hestiag system and wrier hcster.Tbbh ua value of S90 and Is at no cast to you, 3 be maxEoruRu allowable incentive for all mcawc;!wbAbhg air soft&b 53 210 590.00 y n Fodud is 0 054406= RISE Engineering ir1ACot►tr Riga eo 0 188 _ AdlAsloaorlittisehEhgioeeNog RISECompany Address,City,HA 00000ENGiCONTRACT 401-tMI234 PAX401-!?3.1734 C 0 Page 3 PROGRAM CMA KM vas °cus> =AD aamapA pow OW cam MtM WAR JosophCiumtt {978J5.3111 004/2016 436348 OOOQ2 d saw=a +r euta�sar 189 C uicton!toad 169 OuWon Road 1 North Andover,MA 01845- North Andover,MA 01845- JOB DESCPJMON Total: $3,886.30 Program Incentive: $$858.00 C d merTolal: $1,011.30 rxearr�Ym s�usc�•teatate:alenatteewml asaessaecaa Faseh[sates o� "Vne Thousand Eleven&301100 Dollars $1,011.30 uPowwNs �PPreavu.arnma asr�r�raanaima�wv_staP�rm�.,aseR�aeneior�Yogrirr wrvAsa m�va.csaimrasra��°�a aa.p�noaP amoo�aetas�ian6umn n OTSIGNIHISCOHMMIFTWMAW KSP f Ausaww►kwa. eat mt�eoRwwrnnearsrrerres� �aami aPxstePoucca 30 a��°°vyyeia �010°iwaco��n0° +e�oc OAY& AAOl�PA17FJIrlgal.8H�i0@AaOfJ00®Aiafa i "u RISE 60 Shawmut Road, Unit 21 Canton, MA 020211339-502-633677 ENGINEERING' www.RISEengineering.com OWNER AUTHORIZATION �:.. m> Joseph Guinn (Owner's Name) owner of the property located at: 189 Carleton Lane (Property Address) North Andover, MA 41845 (Property Address) hereby authorize O -ccsv�, (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. 9w'ner s Signature Date I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite IOD ' Boston,K4 0211420.17 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print Ile 'bi Name(Business/Organization/Individual): PO BOX 958 Address: ANDOVER,AAA 0161 City/State/Zig: _ _ Phone : Are you an employer?Check`the appropriate box: pe of prof ect(required)� 1.t® I am a employer with 4. [� T am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 5. ❑New construction 2.❑ I am a sole proprietor ar partner- listed on the attached sheet. i ` ;. ❑Remodeling ship and have no employees These sue-contractors have � $, �Demolition working forme in any capacity. employees and have workers' [No workers' comp.insurance comp, insurance.( 9. [�Building addition required.] 5. [ etre are a corporation and its 10.El Electrical repairs or»dditions 3.❑ I am a homeowner doing all wont officers have exercised their 11.E]Plumbing repair'--or additions m self. o workers' com right of exemption per MGL y p 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box R 1 must also Rt]out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this hox mast attached an addi!ionall sheet sheaving the narne of the sub-cont!actars acid state:;hethe:or nct.those entities have empioyees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I nm an etnplryer that isproiddhtg iporPe:s'compensation insurance for my employees. Bela::is the policy and fob site, information. /� Insurance Company Name: in o �-Cr V h k �n rtr r U ,�ef ✓1_s' 3 Policy#or Sclf-ins.Lic.#: ?p V)C ;> Expiration Date: 1> job SitcAddress: �' <'A�l,�r -f-0 1,1 City1u« '��at:,/l�Jip. Anda✓�+� s tt2ch a copy of the workers' compensation policy declaration page(showing the policy number and expirat an date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a l=ine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WOFK ORDER and a fine of up to$250.00 a day against the violater. Be advised that a copy of this statern€nt may be forwarded to ttta Ot ice of Investigations of the DIA for insurance coverage verification, do hereby cert( •undef the sins and enaltie:o' erju that the information providers above is true and correct. Si nature: Date: 2 /G Phone#: q 7& 36 Jf tcial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# t Issuing Authority(circle one): a 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b. Other Contact Person: Phone#: p1 i 611012016 Preview:Certificates of Insurance DATE(M"oJYYYY) ,4�oieo CERTIFICATE OF LIABILITY INSURANCEF. 06!10!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 THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING tNSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(les)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). PRODUCERA NAME' Automatic Data Processing Insurance Agency,Inc. PHONE AlC.Nn.Ext): INC.Net. 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER{S)AFFORDING COVERAGE NA1C M INSURED A: N-GUARD Immmp a company 31470 INSURED INSURERB: POLAR BEAR INSULATION CO INC INSURERC: PO BOX 958 3 Andover,MA 01810 INSURER D INSURER E 1 IHSURER F: COVERAGES CERTIFICATE NUMBER: 503587 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 HE 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. POLICY EXP INSR LTR TYPE OF INSURANCE INSO YYVO POLICY NUMBER MMIODIYYYYI WDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCUR?ENCE S SG'E"TO'rtIET X CLAI}.ISf,IAOE ❑OCCUR I+r1Ef.{!SES IFa occu S N LIED EXP(Any onn parson) S V PERSONAL&ADV INJURY 5 GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGAIE S POLICY❑JECT 0 LOC PRODUCTS-COMR01'AGO S '� OTHER: S AUTOMOBILE LIABILITYfEi.xcidenll 5 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDUIED BODILY INJURY(Prt accideN) $ AUIOS AUTOS 3 NON-OWNED 5 HIREDAUres AUTOS !Per aendcnl] S UMBRELLAUABOCCUR EACHOCCURRENCE S Excess UAB CLAIMS-MADF AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION X I STATUTE ER AND EMPLOYERS`LIABILITY A orrICERVEM6EREXCLVMD?LcurivE Y�NIA N POWC77MB 01/01/2016 0110112017 E.L.EAcsJAcuaENT 5 1,000,000 (Mandalory in NH) E.L.DISEASE-CA EMPLOYE 1 S 1,000,000 Il yrs,descdhu un E.L.DISEASE-i'OUCY ULIIT 5 1.000,000 DESCRIPTION OF OPERATIONS bd— DESCRIPTION OF OPERATIONS I LOCATIONS]VEHICLES IACORD 10L Addalon.9 Rem&ka Sebedula,may be attached It morespaco Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS, 1600 Osgood St.I suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 4. AQ 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD https:ifadpia.adp,cornlicericf/l/tun/preview/5035871900012975 ill AC a CERTIFICATE OF LIABILITY INSURANCE 7610/2016 (MMJDD/YYYY) a 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 a 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 polloy(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 a. PRODUCER CONTACT Linda Bogdanowic7. Insurance Solutions Corporation =% (603)382-4600 FAX No); 60 Westville Rd E-MAIL lindab@isc-insurance.aom �� A ooaess: INSURERS AFFORDING COVERAGE MAIC# Plaistow NB 03865 INSURER A:Western World INSURED INSURER B-RautilUB Insurance Group Polar Bear Insulation Company Inc INSURERC: � Po Box 958 INSURER 0; INSURER E: Andover MAS 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632326134 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 1NITH 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 POLICY NUMBER MM/DO/YYY MM/DD/YYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1� CLAIMS-MAGE � PREMISES OCCUR DAMAGES(Ea acaurreRENTED nce _ � $ 100,000 _ NPP8274967 3/24/2016 3/24/20.17 MED EXP(Any one person) $ 5,040 PERSONAL YAOVINJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY M JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accldenE -- ANY —ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS MIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE_ .W_ � __ $ 11000,000 DEA I I RETENTION AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'L€ABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/FXECUTIVE E.L.EACH ACC3DENT $ OFFICERIMEMSER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Magl.ia/SJA �' _: J ���C- — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgnien l t C oV Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA Expiration: 7/2/2018 Tr# 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX, 958 ANDOVER, MA 01810 Update!Address and return card.Mark reason for change. SGA 1 ca 20M-osetl F] Address [-] Renewal (] Employment Lost Card - r"`:A�r Yaur»rr+�rracrrr�/�cr t"'flirtrrrc/rr%rcf/.t Office of Consumer Affairs Bc Busi ess Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration da#e. If found return to: Registration: 102726 Type: Office of Consumer Affairs and Business Regulation 4a Expiration: 7/2/2018 DBA 10 Park Plaza-Suite 5170 Tyn Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST,#5A LAWRENCE,MA 01841 Undersecretary WCNeotvalid withon#signature I Massachusetts -'Department of PubbG r Safety/ Board of d3uk ding Reagulatoons and Standards 6'"aauatr aa�8aanta fsupervisor'�pkMaaki _f&����su�se: CfiSL-106017 a . ��' f PETER A LEBLANC 2 EAST PINE STREET Plaistow NH 03865 k"°xp nrat'ion ;csaatatr,saQawmwa 04/28/2018 m