HomeMy WebLinkAboutBuilding Permit # 11/2/2016 00RTFJ
BUILDING PERMIT
TOWN OF NORTH ,ANDOVER � : �
APPLICATION FOR PLAN EXAMINATION
Permit Na#: .' Date Received
Date Issued:AJ
l+✓ PORTAN T Applicant must complete all items on this page
aY
J'"AL,
LOCATION% i B i
PC1Rt
PROPEITY;OWNhR%;
/' }�r1C�t i/ '/ Year StfllfxtkA6e // o ��i 1130
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f1llAf� P,Ar CEL., ;� Z"ONING DISTRICT __' Nistonc Districtrtrr
,Mach irl�„�hpp�,/Allage' yep foci
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
D New Building D One family
D Addition D Two or more family D Industrial
D Alteration No. of units: D Commercial
❑ Repair, replacement _ . ElAssessory Bldg Cl Others:
D DemolitionROther a e lost
D Septic Cl Well _ EJ Floodplain 11 Wetlands Cl Watershed District
D Wad r/Sever -
OINK TO BE PERF®F�IVIEL7:
d C,rAlo
®ESCRIPTON OF
` -
Identification- Please Type or Print Clearly �
OWNER: Name: t Phone: °
Address:
Peter Leblanc
Contractor'NarTie o Phone.-
Email. '
Address-`
9 5-OW-763
Supervisor's'Canstcucti,on License: I exp; I7at�: T
Homo,Improvement License:- ,Exp. ”Date:
ARCHITECT/ENG[NEER Phone:
Address: -_ 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: $ � FEE:
Check No.: .� -.._ Receipt No.:
1101'0: lersons contracting with unregistered conte-actors do not have access to the�t�cercar2ty�uncl
Signature of Agent/Owner Signature of contractor
x.10RT#hj '4
own of 2 � _ 1� b ndover
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No. _
mp h ver, Mass, I$ %
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[p[MI[Kl WI[R y
�lq °00ATEU I&,��(5
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT ........Pt44Ir CAR NC BUILDING INSPECTOR
,�iAr� a l......01i0 Foundation
has permission to erect ...................... ... buildings on ,...,� ....... .��.� � r
^� • ug
to be occupied as .......>�.... ....... .e a�..
. .... ... ..... ....... �........�..4� .r
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mnh e
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 CONSTRU/. .4.
TA TS Rough
Service
....... ... ........ ..........BW .D NG.INSPECTOR. Final
GAS INSPECTOR
Occupancy Permit Required to OccupjE 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.
"A'..............
Federal to 0 05-0405629
RISE Engineering RI Contractor Registration No 406
MA Contractor Registration No 120979
CT Contractor Registration NO
RISE (pit sbawroul Road,Canton,NIA
ENGINEERING" (401)784-3700 FAX(401)784-37111 CONTRACT
PROURAM Pago I I
rant CONTRACT as CUTFAVO Mute 811 TMCM Mr.
CINIA-11ES OWPOEMNO ANO Tilt COMM POR WORK AS
DESCRUMEDUELOW
01810MER, MONE DATE CUEnY WORK 01111M
Jot Cinscrulli (978)989-3424 10/07/2016 401,123 35004
SCAML STRUT DRAING 37REET
10 Pine Ridge Road 10 Pine Ridge Road
SERMF CIMSTATE,23P MUDIG CITY,STAICZW
North Andover,MA 01845 North Andover.MA 01345
JOB DESCRIPTION
Alit SFALINQ provide Ialwr and materials to seal areas of your home against wastefill,ex"ms air leakage, 'fbis'work will be
pe r Ranted in concert with the use orspeciai toas mut diagnostic tests to mistire that your home wilt be lell with a health fill level or
air exchange and indc*r an-quality,Malcrivils it)he used to seal Your horta:can include caulks,f4ams and other producis. Primary
arom A)r scaling include air leakagl:to antics,bascrowits,attached ganiges and other indicated arcg(windows are not gancially
addressed) This%Vill requirc(1O)working hours.A reduction in cubic reel per minute(erne)of air infiltration will occur,bill the,
actual nurnher of crit'l is not guaranteed.
At the completion ol'tbe%wathcriziaiort work,and at#to additional cost to ific fillincowner,a final Mower door and/or combustion
srutty analysis will be conducted by tile sub-tontractor to ensure the si4ety of the indoor air quality,
'�fi5ff TNT
AIR SUALING:provide labor and materials to install 0-Ion weatherstripping and a doorswep to(3)doot(s)it)rearict air leakage.
5225.00
DAMMING:Provide labor and materials to install a 12"layer ofR-38 unfaced fibcrgkvs,;baus to(133)square feet for damming
purrx*Ls.
S272.65
A TIC FLAT:Providc labor and materials to instill a 9'laycr of'R-33 Class I Cclhdw,�cadded to(1176)square f±ct of'open attic
"puce
$1,681.69
`VE TIL M10M provide labor avid materials as install(2)insulated exhaust hose with,nx)f mountcd flapper vent to exhaust
existing bathroom I'mas).
$237.50
VEN't II.A'l ION:provide labor and matcriak to niqtall ventilation chutes in(95)rafter bays to maintainair flow.
S190,00
GARAGECUILING:Provide labor and niatcrials to install 10"IW5 densely packed Class I cellulose insulation to 506 square fixt
oft'arage ceiling;located below it heated floor area,by drilling holes its the ceflinge flora,below. Holes drilled will be pftigee& I'lugs.
%Vill liv spaeWd and felt in u relatively'anotull coutfitiom Finish sanding and touch-up will he the Customer%
fcsporlsibihly.
$1,047,42
TE
E'
0(""( 1 ,3 2016
...................
Padaral ID 4 0"405629
RISE Enginivering RI Contract'DrRoy botrallOn NO 8106
MA contractor Registration No 120979
RISE60 sliam Inut Road. anton—NIA CT Contractor R"Istrottlon No
ENGINEERING' CONTRACT
(401)784-37,(1() PAX(401)78-4-37141
Page 2
PROGRAM Voila C0,4111ACTIS CNIERCO MO DETWE"WE
LITOLOSCERM3 AND THE CUSTOMER FDA WOMAS
MA-llFS DEficuluourAfM
CUSTOMER DATE cur'NI a Wonis OMW11
Joe cinsertili (978)989-3424 10107/2016 401423 35004
*ERVtCC STREET IVWNG STREET
10 Pine Ridge Road 10 Pine Ridge Road
SEAMCE,CI`rY.5TAT6,ZiV OaMa CITE$rATF,ZIP
North Andover.MA 01845 North Andover,MA 011515
JOB DESCRIPTION
RISC'.lingincering will ripply all applieRI)Ic,efigible incentives W this epnerel, Yon will only be billed the Net anuount, CurrClItlY.
for eligible loc-,tsures.Colutilbia Gas oMrs 75114 incentive,'lot 14)execEd.S.),ola),per calendar year,and ail incentive Of 100%fbr
the Air Sealing niezisures Lip it)lite first$680 and an adifinonal$3,40 if savilirr;DI'viu5tifiled by the auditor,
For Ila:%.ttrciy and ticafth Of your horre's indoor air(tuality,we will be Conducting a blower door diagnimic orthe available air flow
III lour honsic JTUIIJ 17cf(WIC jbc w0tk is begun,and after flIc wcathcrization work is cOmpletc.We will also condnet a fall asscs'51"e'll
of the cornbustion safety of Nour healing system and mater healcuThIS IMS a v"lilc OfS90 and iq tit lit)Cost to you, 'I'mal
incentivc LS S3.1 10,
9)(1.00
o
J J
rotal: $4,594.26
Program Incentive. $3,110.00
Customer Total: $1,484.25
wt AGREE REREBY To rURNISH SERVICES-COMPL.ETEltJACCORDANCE W$TIIA130VESPECIU'iCA'fIONS.rOR'IIIESUMOF
"**One Thousand Four Hundred Eiglity-Four&251100 Dollars $1,484.26
UPIONntiALI�46PLCFIOfJA)IDAPP�WOVAL.UYttICE19<)mNfl.rRibiti,CUSTO,VERAORCAC TO RLAI11AMOU"t DUE W FULL.MIERCSTOF t%"�tt,LI&01AACCOMONIPLY MANY
�1 MftAClOAmGts-ntA*nwi.
WMAiD UALANCE AFTER 31J DAY4,441"-ftEVEIMI,Fort IMP010ARI PUFORMAM04 B3 GUARANIEtsItuants OF REUIM(m.SCMEmuno,Moo CU
00 NOT�SIN THIS CONTRACT IF T14ERE ARE ANY 0L AN K SPACES
hi N r SNA
A9TROI4;rK'O SIGNATURE-ME r,1WMft(L-J CU9TodAr'.E
y lopfjotEt T"Ll cou ritACT PAY RE 1W1 WHORAWN BY US IF sior rxccatea rmitao OMEOFACCEPTANCE
M'MoPtAUCE OF M4TRACT.114a A001ill,PAIM,OVEGIMA71OKS AND CONDITIONS ARE
SATISFACTORY TO US ANDAIT9 REAVOY ACCEPTED,YOU ARE AUIHORQ9D TODD IRP WORK
AY31 AUTSPECIFIrD.PAYMI!NIMLLOPMADEASQUILINCOAtRoVil
RI S E 60 Shawmut Road, Unit 2 1 Canton, MA 020211339-502-6335
ENGINEE R- ING' www.RISEengineering.com
OWNER AUTHORIZATIx ON FORM
r v I
(6ner s Name)
owner of the property located at:
3 rt
(Prop rt I Addre's
Cp-r;'per ty Addres
6
hereby authorize
(Subcontractor)
an authorized subcontractorfor RISE Engineering, to act onmy behalf to obtain a building
permit and to Perform work on my property. This form is only valid with a signed contract.
Ther Permit will be secured by the insulation contractor, at no pari
itio 'sresponsibility to close out this Permit by contactin�l their municity at the completion of this work.
Sigf1atW'0)-
..............
-X3
J
6,2016
The Commonwealth of Massachusetts
Department oflndustrial.Accideiats
- Office oflnvestigations
- -1 Congress street,Suite 100
BOston,111A 02114-2017
www.mass gov/dla
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Avolicant Information Please Print Le 'biv
Name(Business/Organization/Individual):
Address: PO Box 958
AILIVEt� A fli®1il
Citi/State/lila: Phone
Are you ai employer?Check the appropriate'-ox: W
4. ❑ I am a general contractor and I Type of project(required;:
I.t� I am a employer with_�
employees(full and/or part-time),* have fired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. i. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp. insurance:t 9. ❑ Building addition
required.] 5. ❑ VVe are a corporation and its 10-0 Electrical repairs or additions
1 3.❑ i am a homeowner doing all work officers have exercised their l Plumbing
myself. [No workers' comp_ right of exemption per MGL l.❑ oofr repair or additions
insurance required.]t C. 152 12.❑ Roof repairs
§1[4},and we have no
employees.[No workers' I3.❑Other
comp.insurance required.] J. I
,Any applicant that chocks box ml must also Ili out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indica.ingsuch.
lCentrectors that check this box must a4ta6ed an additional sheet sh_wing the panic of the,ub-contvactars snt1 s:ate.rhethc:or no;thosa entities have
empioyces. f the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an emptZyer that isproviding workers co.7&vensatis►a insurancefor my 2-=sployees. Below is tl epolley andjr)hsite
information,
Insurance Company Name: J d L Y 7 U K i e yt,t�4
Policy#or Sclt ins.Lic.#: pt,d C .2�2, Expiration Date: PO I>
Job Site Address: � � C;t /Stat;,/Zip:_A, 11A)i�ulf
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the.forma of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to tine O.�ce of
Investigations of the DIA for insurance coverage veriEcation.
do her Eby cerci Wider the pains and enaltia:of erju tlrat rile in orination provided above is true and correct.
Si naiare.
Phone#: q>Y L/0- 7 G �6
['0Jfjfi*c1a1 use only. Do not write in this area,to be completed by city or town offrciaL
City or Town: P'ermitCLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b. Other
Contact Person: Phone#:
a�R�0 CERTIFICATE OF LIABILITY INSURANCE DA7E(MM/DDIYYYY)
x/10/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the pollcy(iss) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAMe CT Linda Bogdanowicz
Insurance Solutions Corporation PHONE (603)382-4600 Not (603)3822034
50 Westville Rd E-MA1L lindab@iso-insurance.com
ADDRESS:,l i _,.
_ INSURER($)AFFORDING COVERAGE NAIC(k
Plaistow NH 03865 INSURER A Western World _
INSURED -.- INSURER B Nautilus Insurance Group _
Polar Bear insulation Company Inc INSURER C:
PO Box 458 INSURER D:
INSURER E:
Andover MA 01810 INSURER F:
COVERAGES CERTIFICATE NUMBER:CI.1632326134 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.
TN RF— TYPE OF INSURANCE ADDL SUER PgLICY EFF POLICY EXP LIMITS
LT POLICY NUM13PS YYY MM/DD/YYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
ACLAIMSMADE OCCUR DAMAGE TO RENTED 100,000
PREMISES Ea occurrence) $
NPP9274967 3/24/2016 3/24/2017 MED EXP(Anyone person) $ 5,000
-PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY PE 0. ❑LOC PRODUCTS-COMPIOP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTYP � dtDAMAGE $
HIRED AUTOS AUTOS -.-W------.-.
$
X UMBRELLA L1ASOCCUR EACH OCCURRENCE $ 1,000,000
B EXCESS LIAR _ CLAI"MADE AGGREGATE $ 1,000,000
DED RETENTION AN026107 3/24/2016 3/24/2017 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYER$'LIABILITY YIN STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICERJMEMBEREXCLUDED? N/A
(Mandatory In NFA E.L.DISEASE-EA EMPLOYE $ �
It yes,describe under
DESCRIPTION OF OPERATIONS bebw E,L,DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace to 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 Maglia/SJ'A `: —
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS02500140ii
6!1012016 Preview:Certificates of Insurance
r T GATE(MNIDDNYYY)
,4coRc�® CERTIFICATE OF LIABILITY INSURANCE
�,✓ 0611012016
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 policles may require an endorsement.A statement on this certificate does not confer rights to the
Certificate holder in Ileu of such endorsement(s).
PRODUCER CONTACT
NAME:
PHONE
Automatic Data Processing Insurance Agency,Inc. Alc.No.E■f: AIG.No
I Adp Boulevard AODHESS:
Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAICN
INSURER A: H-GUARD Insurance Company 31470
INSURED
INSURER B:
POLAR BEAR INSULATION CO INC INSURER C:
PO BOX 958
Andover,MA 01810 INSURER 0
INSURER E:
INSURER P:
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 BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE])HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS,
LTR TYPE OP INSURANCE INSo wVD POLICYNUMBER MW'DDNYYY MMfDIVYYYV LIMITS
COMMERCIAL GENERAL UABILITY EACH OCCURRENCE 5
GIAifJS-f.TAOE ElOCCUR 1'REf.IISES[Ea occwmnce 5
MEO EXP(Any Ono pets—c S
PERSONAL&ADV INJURY 5
GENL AGGREGATE(Ft.II1 APPLIES PER- GENURALAGGREGATE 5
PCLiCYPRO-JL CT LOC PRODUCTS-CCF.IPPOP AGG $
OTHER; $
AUTOMOBILE LIABILITY FUll5
(Ea ceOOM,
ANY AUTO BODILY INJURY(Per pe,son) S
ALL O'PFNEO SCHEDULED BODILY INJURY 1Pes,cdderd) 5
AUTOS AUTOS
HIRED AUTOS t`'Or"WNLO U S
AUTOS IPu accidmll
g
UMBRELLA LIAR OCCUR FACIA OCCURRENCE S
EXCESS UAB CLAIMS-MADE AGGREGATE 5
DED RETENTIONS 5
WORKERS COMPENSATION XE FI
ANUEMPLOVERS'LIABILITY STATUTE ER
Y!N
A ANY HTCPRIETMPARTNEFLEXECUTIVE F.L.EACH ACCIDENT S 1,])00,0])0
OFNGERAIEMSER EXCLUDED? �Nla N POWC772258 01110112016 01!0112017
(Mandaknry In NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000
if yes,dcscnbe md,r
OESCRIPTION OF OPERATIONS bda.v E.L.DISEASE-POLICY LIMIT 5 1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS]VEHICLES(ACORD fel,AddiTlonal Remarks Schedule,may he attached If mwo spam is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL $6 DELIVERED IN
Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS,
1600 Osgood St.1 suite 2035
North Andover,MA 01 B45 AUTHORIZED REPRESENTATIVE
AO 19BB•2014 ACORD CORPORATION.All rights roserved.
ACORD 25(2014)01) Thu ACORD name and logo are registered marks of ACORD
https:lladpia.adp.comliecrtcffS/run/previe%v/5035871900012975 1I1
2 -�
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite .5170
Boston, Massachusetts 02 116
Dome Improvement Contractor Registration
Registration: 102726
Type: DBA
Expiration: 702018 Tr# 419291
POLAR BEAR INSULATION Co.
Vincent LeBlanc
P.O. BOX 958
ANDOVER, MA 01810 —
Update address and return card.Mark reason for change.
sent 0 2DM-05111 Address Renewal n Employment F1 ]Lost Card
office of Consumer Affairs&Business Regulation License or registration valid for individual use only
m HOME IMPROVEMENT CONTRACTOR before the expiration date. If'found return to:
Registration: 102726 Type: Office of Consumer Axffnirs and Dosiness Regulation
Expiration: 7/212018 DBA 10 Park Plaza-Suite 5170
Boston,MA 021.16
POLAR BEAR INSULATION CO.
Vincent LeBlanc
51 S0.CANAL ST.95A
LAWRENCE,MA 01841 Undersecretary Not valid without signature
1 Massachusetts -'Department of Pubw is Safety
Board or Building RegWations and Standards
��aual[�l6[4K.k3at&R�'.��i,"ia,`r�ttioab"'�69t!w:IdAi�ro'
e arose: CSSLA00017
y.
PETER;A LEBLANC
2 EAST PINE STREET
Plaistow NIS[ 03865
— 1
t Epi ration
"Onllmssaoner 04/28/2018
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