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HomeMy WebLinkAboutBuilding Permit # 10/14/2016 O4 pORT" 9ww-- BUILDING PERMIT �z �Kr1 Ems.. �bnYO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '- " Permit No#: : Date Received 7�4d�ATED�p��cy SgACF1USYa Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 5 Print PROPERTY OWNER L4-v �` Print 100 Year Structure yes no MAP PARCEL- ZONING DISTRICT: Historic District yes 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 Others: ❑ Demolition ❑ Other B Septic ❑Weil f ❑ Floodplain , 1❑Wetlarfds ❑ 1lVatershed D�str�cf 5 ,' r DESCRIPTION OF WORK TO BE PERFORMED: it 5c,4 a� Y rr �' ! 'v1-9 /' $ e-4 !' E Identification- Please Type or Print Clearly OWNER. Name: �v L rf'g r� Phone: ? Address: -57 Contractor Name- Pr-. 4- t f e,V-�L Phone: `l a Email: Address- a'Vl if 7-0 L-1 .A/ Supervisor's Construction License: (06 0 17 `Exp. Date: L12) 119 Home Improvement License: l C��-`7�6 Exp. Date. ARCH ITECTIENGINEER_ 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. Total Project Cost: $ G FEE: $ Check No.- Receipt No.: NOTE: Persons contracti with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑' Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Seger ❑ Tanning(Massage/BodyArt ❑ SwitmningPools ❑ Well ❑ Tobacco Sales ❑ Food Packagiug/Sales ❑ Private(septic tank, etc. ❑ Peunan-ent Dunpster on Sito ❑ THE FOLLOWING SECTIONS FOR'OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on. - Signature COMMENTS HEALTH Reviewed on Si nature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature& ©ate ©rivewa Permi# DPW Town Engineer: Signature: Located 384 fs and Street 1=IRE DEPARTMENT Temp Du.mpsier onsite eyes no. Located d `02.4 Main Street b. Fire Department s�gnaturelda#� , COMMENTS t%®RTH '9 Town of = = : +� 6 ndover No. 4oa-a6iizh IDcoc�„�E h ver, Klass, A°otR?'E D s u BOARD OF HEALTH Food/Kitchen PER T .T D Septic System THIS CERTIFIES THAT .....!q.tj. ....... .................................. BUILDING INSPECTOR has permission to erect.......................... buildings on ........10.0......10154 SAP.....,F�,,,, Foundation Rough to be occupied as WA4W-5^f SA . .1_60 1' ...1A04&% M4W.4............................ 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. LESS' CNS ....... Rough Service ..... .......... ...... Final BUILDING INSP OR 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. 1. Federal IC#0S-0405829 RISE Engine a ring Rt Contractor Registration No 8188 MA Contractor RoolstraUon No 420979 RISE OTContractor Registration No 0211120 GU Shn�{ntnE lioad,Cnntun,11,1UZUZi ENGINEERING' T 339-502-5117 l�.i,\339.502-6345 ® Page '1 t PROGRAM PUS CON Mi CTIS EMEREO MICUMMA WSt EWMEEMMAI1051ECUMERFORWCatKAS - il OESCR10E06ELOW CaamllER �;, - PNlpJE HATE MEMO NJURKOROER 1'attl CraLtey t (617)797-2540 09/20/2016 428781 28604 SEMt 4=MT 91WrJ0 STREET SO Osgood Street 80 Osgood Street e ? 9ERVIOE CITY,STi11E,LP :-;€ el[11HO Citt,smA ,ZIP North Andover,MA 01845 North Andover,MA 01845 Paw_. ,' MICRIPTION €3ARRI12W The]bllovingCOntract is not valid unless aCCOnIpanied fly the illc-Weatherization Barrier Incentive form,signed by your licensed electrician.Work will not proceed will)this{work tnttil we receive it copy of chum lural. SU.UO AIR MiA l,ING:1'rovide labor and materials to seal:upas of your home against wasteful,excess air leakaw. This{vork will be performed in concert with tile use of Special tools and ditlggostic tests to assure that your hon1C will be Icfl with a hrtltlalid level ofair c.,x;hanW and indoor air anality.M aterials to be used to seal your home can include caulks,Ibanis and other products, primary areas for sealing inctude air IeA-agc to attics,basements,attachLd girages anal other unheated areas(%vindows arc Rill�Knerally addressed.) This will require(2) working hours.A reduction in cubic tixt per minute(cfm)orair infiltration will occur,but the actual number of cfm is not Luanlnteed. At I Ilc completion o1-the weatherizat ion work,and at rut additional cost tothe homeowner,it sinal blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety oft lie indoor air quality. .�170.UU AIR SFAUNG:Provide labor and tnnterinls to install Q-ion weatherstripping and a doorsweep to(5)dom(s)to restrict air Icako&. $375.00 WALLS:Finnish and install blown ill C1aSS I Cellulose to t I G 17)square feet of shingle and/or clapboard exterior{valls.The bunt of the upper COUTSC ol'YOUr wood siding is cut to drill holes into the wall shcathiug behind.The holes are then plagd and talc wood siding is reinslalleYl t151nSwSt an{1CSS Steel litlish vtail5.Touch-alp paintin2,if ticeded,will be the customer's responsibility. lnvoicingwill occur opus{ completion of Installation.l ionleowner 110.FCCC1vCd a copy of tlic EPA's]Zenovatc Right Laid-Sale information guidc explaining the potential risk of tl1C lead hazard c.I.PD. Iro Isom the Welilllerliallon work Lu be peribnned.Your signature LS your acknnwleda nlcnt of receipt and aLTecment to proceed, $2,991.45 RISC?i'nginecring will apply all applicable,eligible incentives to lois contract. You v ill only be billed the Net amount. Currently,for clipillle measures,Columbia Gals offers 75%incentive,not to crweed S2,000 per calMdar year,told eat inecittive of 100%for the Air Scaling Illl'aL541iCs[lp In the first 5G8t}land nn:lddlllnnal 53tt1 lfsalvink5 are}tlStlfied sly elle audltol, For the sllfCiy and health of your homes indoor air quality,we will be conducting a b1mer door diaynast to of the avalllablc air now In YDUr home both heforc ilia work is bulla,and alter the{weatherl7.at ion work 1s comp]etc.We will also conduct a fall]assessment of the combust ion safety(if your heating system and water heater.This has a value of$90 ane/is at no cost it)Vol], Total allowable {vcathcri2ation incentive is D,I.10. 590.00 i !i I Federal M 0 05.0406620 RISE Engincering RI Contractor RegistraUon No 8186 MA Contractor Roplstration No 120979 RISE CTConiractar Refllstra0on No 626120 GO S€Lntitmt�t Rona,Cnntnn,M��U202T ENGINEER€NG' T' 339-502-5197 F�L4 339-502-6345 Page 2 PROGRAM 7115 MfMCT13 ENTERED IM BERN EEN ME C11G1-ITS ENMICEER111£ANNDTHE CuSTt�MItMaWORK As CU37WWR MIME Mr. C0011: ViOlAMDER Paul Carney (617)797-2540 09/20/2016 428781 28604 CEROCE STREET QILLIHO STREET 80 Osgood Street 80 Osgood Street SRRVICE CM.SMMIZ1P BIWNO CILY,STAle.nP North Andover,MA 01845 North Andover;MA 01845 .1013 DESCRIPTION Total: $3,626.45 Program Incentive: $2,635.00 Customer Total: $999.45 WEAGREE HEREBYTO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUMOF "'Nine Hundred Ninety-One &451900 Dollars $991.45 UP014 FINAL INSP ECAOt7 AND APPROVAL BY RISE BHOINEERINOA CUST04ER AGREES 70 M1TAhWIITDUE IN FULL.INTERESTOF 7 A WALL UE CILAROuED I MITNLY ON AM u?1PAFDQALAIICEArTER3&DAYS.SEEREVERSEFIOEIArORIANVNFOR&ANDNON GUARAMEES.FUG1973 OF RECISION.SCHEDULIWX AND COHMCMR REMMATION. DO NOT SIGN THIS CONTRACTIF THERE A Y ELAN SPAC S _ AURIOrIlIEe SI RlRE• Is ErglneeRinU CUST(NAER C PR}IGE - � NUM71413 CIXNTI,LCTL4YY BE WIniDRAY1N BY U5 IFHOT$XEC0lEO1'l11FiIN tlAIE CF ACCEPUUICE ACCEPTAIICE OF COIMACT•RIE ABOVE PLUCES.SPECIFICAAONS MDCCNDN.ONS ARE 30 SAMFACQAYO. AS SPECT€fO.PAYlcMW&L BE MILE AS ANDARE HEREBY 00LINp UADOME ARE AUniOFiILE01e QOlHE WORK fr, ( - l I'. RISE 60 Shawmut Road, Unit 2 Canton, MA 020211339-502-6336 CID ENGINEERING'" www.RISEengineering.com � 31 1 f r n . OWNER 4 AUTHORIZATION FORM Paul C;rney (Owner's Name) owner of the property located at: 80 Osgood Street, North Andover, MA (property Address) (property Address) hereby authorize / ��P (Subcontractor) an authorized subcontractor for RISC Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This for rriis"oi ly valid Witha signed contract-.- Owner's Signature I Date The Commonwealth of Massachusetts Department O f Industrial Accidents - Office of.Investigations ' I Congress Street,Suite 100 BOs ffin,1VA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plumbers Annkcant Information Please Print Legib Name(Business/Organization/Individual): Address: Akin BOX 956 Alw VBl� NIA t?�8�d citr/Statelzip: Phone#: �? �` G��- S Are you ail employer?Check the appropriate box: Type of project(required): [2. .r� I am a employer with _ 4• ❑ I am a genera[contractor aacl I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction ❑ I am a sole proprietor or partner- listed on the attached sheet. "r. ❑Remodeling ship and have no employees These sub-contractors haveg, ElDemolition working for Erle in any rapacity, employees and have workers' 9. Buildin addition [No workers' comp.insurance comp.insurance.t ❑ g required.] 5. ❑ We are a corporation and its I O.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 plumbing repairs or additions f myself. [No workers'comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that cheeks box 41 must also.911 out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatingsush. tContractors that check this l=ox must attached an additional-sheet shoving the rmle of the sub-contractors e_Rd Uatov:hether or nonhosa entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I nyyt an empl ver that isprouidittg workers'corn kpensadon 1asimancelor any employes. �t loe'is fl epolicy nn� ob sits information, Insurance Company Name. ii�} f`v S fi t�c M N yL y l'oiic,#or ScIF-ins.Lic.# Expiration Date: &/ ?sol;Site Address: �b a C ity,State,'Zip: C �/�►"� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). p Failure to secure coverage as required udder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a u tine up to$1,50().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. Be advised that a copy of this statement may be forwarded to ttte O ce of LnJestigaa-8 of the DIA for insurance coverage verification. do herEoy cern 'under the aias and enaNew o' t;:dury that lite iii orination provided above is true and correct Si nature: Date: 47 L Phone yob_ 7& 36 Of aacial use only. Do not write in this area,to be completed by city or town official City or Town: PermitrLicense# Issuing Authority(circle one): 1. Board of Health 2,Building Department 3, City/Town Clerk 4.Electrical Inspector S.Plumbing.Inspector b. Other Contact Person: Phone#• 611012016 Preview.Certificates of Insurance ® DATE IMMIDDNYYYI Ac"R" CERTIFICATE OF LIABILITY INSURANCE `,,�- 06/1012016 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 pollcy(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 NAME: PHONE FAX Automatic Data Processing Insurance Agency,Inc. AIC.Nn.Ext): A1C.No. 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERISiAFFORDING COVERAGE NAIL N INSURER A: NorGUARD Inswanca Company 31470 INSURED INSURER a: POLAR BEAR INSULATION CO INC INSURERC: PO BOX 856 Andover,MA 0181113 INSURER D t INSURER E INSURERF: 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 70 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. LER TYPE OFINSURANCE €NSD WVO POLICY NUMBER MNVDD1YYYY) ,1MfDO1VYYY) LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS.r.IADE El OCCUR 11REmisEs ma ormrn ca S 1.4EDEXP4Anyourp,—s 5 PERSONAL&ADV INJURY 5 GENL AGGREGATE UP-111JECT APPUES PER: GENERAL ACCREGATE 5 POLICY Pao- -1 ftO LOC PRODUCTS-CChIPPOP AGG S El OTHER- 5 AUTOMOBILE LIABILITY WhIbINIEnbc€EU S. ANY AUTO SOOILY INJURY IPer parsnn} 5 ALL ONNEO F SCHEDULED BODILY INJURY IPer;slden) 5 AUTOS AUTOS HIREDAUr OS F1 tAUTUD WNED G S AUTOS IPri arxidmll S UMBRELLALUtBOCCUR EACHOCCURRENCE S EXCESS LIAR CLAIMS-€.1ADE AGGREGATE S DED I RETENTIONS S WORKERS COMPENSATION X AND EMPLOVERS'UABILITV STATUTE ER A OFFICER10ABERREXc UDEU? rlvF Y�NIA N POWC772258 01/0112016 01101/2097 E,L.EACTInccloENr S 1,000,000 tMandalary€nNH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 II Va.tla C'ibe—ow 1,000,006 DESCRIPTION OF OPERAYMNS bUaw E.L.OISEASE-POLICY UEIIT 5 DESCRIPTION OF OPERATIONS LOCATIONS!VEHICLES tACORD TOT,Add'Rienal Rama ks Schedule,maybe attached If mora space Is requkrcdl CERTIFICATE BOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WELL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood st.1 suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD https:ifadpia.adp.condiceriefill/ruhlprevieAv/503587/900012975 1!f AC R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMYDD/YYYY) 6/10/2016 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 INSURER(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 endorsements. PRODUCER CONTACT Linda SOg danowicz _NAME: Insuranoe Solutions Corporation PHONE (603)382-4600 111C Nc:(603)382-2034 �g(C,Lo.Exti. 60 Westville RdADDREss:lindab@isc-iusurance.com __ ^ INSURER S AFFORDING COVERAGE NAIL# Plaistow NH 03865 INSURERA:Western World _.._ INSURED W INSURER B Nautilus Insurance Group Polar Bear insulation Company Ino INSURER C: PO Box 958 INSURER D INSURER E: Andover MA 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 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. €NSR TYPE OF INSURANCE A BR POLICY NUMBER MMIDCY EFF MM/DnfyyyY XP LIMITS TR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �I DAMAGE TO RENTED $ 100,000 A CLAIMS-MADE u OCCUR PREM€SES(Eaoccuggnce UPP8274967 3/24/2016 3/24/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,OOO,000 POLICY PRO- LOC PRODUCTS-COMPIOPAGO $ 2.000,000 JECT is OTHER: AUTOMOBILE LIABILITY COMBINED S€NGL£LIMIT - $ Ea accident �... ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIR ED AUTOS AUTOS Per accident). X UMBRELLA LIAO I OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIM&MADE AGGREGATE $ 1,000,000 DED RETENTION AN026407 3/24/2016 3/24/2017 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y ANY PROPRIETORIPARTNERIF.XECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NEI) E.L.DISEASE-F.A EMPLOYE $ W„If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE»POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached it more apace[s requlred) u 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, NIA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/S,TA - ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025r�ntanlE I dT1W _., Office of Consumer Affairs and Business Regulation 10 Farb Plaza - Shite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 1012726 Typo: DBA Expiration: 7/2/2018 TTO 419291 POLAR BEAR INSULOON Co. Vincent LeBlanc P.C . BOX 958 ANDOVER, MA 01810 Update Address and return card.Mark reason for change. sCA 1 C. 2OM-05111 ❑ Address n Renewal ❑ Employment Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individual use only . HOME IMPROVEMENT CONTRACTOR before the expiration date. Iffound return to: Registration: 102726 Type: Office of Consumer Affairs and Business Regulation r, Exiration: 7/2%2018 DBA 101'arltPlaza-suite 5170 p Boston,MA 021.16 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST.15A LAWRENCE,MA 01841 Undersecretary V Piot valid without signature 141 IF Massachusetts -'Department Of s�UWic Safety1 RE sa't Suhdiig Re of afuonss and Standards G:"nµft: ¢a'asa:r¢k'ea Sy>,atart��-ai�ap:-��17�aA;issi:r� cease C►SL-106017 " m PETER A LEBLAN'C 2 EAST PINE S'TREE'T Plaistow NH 03865 G ��asorssssGas'sa c 0412812018 f l