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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 tyORTH BUILDING PERMIT oF�T� o TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No# Date Received ArEDee�`(`� �sSRCWt1s�� Date issued: � ��'� ]MPORTANT Applicant must complete all items on this page PROPERTY Ol1IIER � u ON MAP ., ., wPARCELZONING DISTRICT ] �star� xD�stnctk k !e � no ryes no . � Allachrne Shop V�lla`�e ._ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ";�One family El Addition El Two or more family ❑ industrial ❑Alteration No, of units: ❑ Commercial [IRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition -KOther j��i�,� ff Septic ❑11Ve11 = ❑Floadpla�n Wetlands D 1Natersherl Distrtc 2 DESCRIPTION OF WORK TO BE PERFORMED: C l l , Identification- Please Type or Print Clearly OWNER: Name: r Phone: l'1 P �� p1� ` Address: 12 Goritractor Phone Email � r t Address v. e � l p Supervisor's C1 0t10,ri. rcense ` Exp"x Da Hflr`rme ImprovemnteLicense Exp Date .. '. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THF TOTAL ESTIMATED COST BASED ON$125.011 PER S.F. Total Project Cost: $ ���5 C.4 FEE: $ 2-11 Che6k No.: Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access t he uayanty fund .- ature of contractor . rrriatr Grp Sl of A1�entLOwner gi _. mAi RTH q own of n over . �+ No. 12-'4611 h ver, Mass, elrqb C) AKE D -1 �.qs ttATED U BOARD OF HEALTH Food/Kitchen PERMI LD Septic System THIS CERTIFIES THAT ...... .. . . ........ ...... ...... ..�. .....,.,...... .. BUILDING INSPECTOR has permission to erect . Buildings on . Foundation IL I& Rough p .�r. A\!!1►..: ......4C.... .. r...................................................... Chimney y t0 be occupied as ...... Chimne 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T Rough Service ........... .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Re uired to Occupy Buildin Roitgh 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. r From:Kate Bargaesi Fax:(978)662.1975 To:+13395028345 Fax: +13395026345 Page 3 of 4 11116120161:56 PM Fedwral ID•Oa4MM28 RISE Eugmeeria :a Cfa ntrattat rte Wo 1168 : . IAA COPUWW MgfsttaSan Ho 1201974 ass,"', Adivisiaw o!';hlelachEw�lueeTing Cf cwbw�iarRaglltrat""O.�M12f! RISE }4�= .. . 60 Stimmul,Captor,]4A.02021 ENGINf:EMNG CONTRACT 'flags 2 PRQCR" CMA-HES 6WYNEEIpfA7 Atgta fXQ dlaTp OMfRFQH1NDRKM OF�C�IGED WBOW dtET'OYtR - POW DATE CYIJ & Npf1ltORaflf Kale Harpesi (617)877-7312 04!08!2015 429984 Own eDrY M STwlBT .. a uim OTKW 17 Quail Rut Road 17 Quail Run Road sum=CfTY.OTATLzV .MMA"COV.SrAMZEP .. North Andover,MA 01845 North Andover,MA 01845 Jos DESCRE rON $90.00 Total: $4,053.01 Program inicentIve: X3,110.00 o Customer Total: 0 WE A!SkW NE tgW Tq FtJ(1f11&t B�-COYPU INACCORW CE W rM AS�W1:8PECWoAT1 ft FOR TW M OF Nine Hundred Forty-Three S 011100 Dollars $043.01 IIPOM M4P[CTiW1Ai7�APPIIGNALIAfItlll�Npfl1E8111fa.CU6T�pMGNAOwEEATORE/iITAiAWMTWIHNll4.lhlwltlATOi�T%TN416lCXARft�MONIH1.YaMANY lAfAfO. AFT1E111�CAYe.(EER&Y�IIMaIIIMPORTAGITp►OR�FA710lION OUAwANT�B.RiQHT60rN11�57CM34MI�AlRR10.AM{16CtiTwAG'TaRi1Q�0l1TM11aM 00."018101+17!{1SOONMU.(P T!f AW ULAWK 8PACE8 LerMTiRiE•@te trp GWR Awee .wgrA!sl���.Ytplrt+oa.uama ..... DAM orACCEFTAWCE ACETA=OFCOWTRACT-THIADM PRM"OPMW"TwM16AWCM=TIMAM .. PA". ANfaMPee�W1E�Dv�t�SrTW"Oa YAe w1 A�Op'411u1l1011QEatO00Tl16WCr111 ^, -:7v% n { Flora:Kate Bargnesi Fax:(978)662.1975 To: +13395026345 Fax: +13385426345 Page 4 or 4 1111612016 1:56 PM G C". n � O N N a oG ro aISE o- %� 60 ShawmUt Road,Unit 2 i Canton,MA 020211339-602-6336 RINEERIN(Y www,RlSEenglneering.com OWNER AUTHORIZATION FORM Kate Baragnesi (Owner's Name) owner of the property located at; 17 Quail Run Road, North Andover, MA (Property Address) (Property Address) ` Merrimack Valley Insulation 23A Sullivan Rd hereby authorize Billerica,MA 01862 (Subcontractor) 3 an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building s permit and to perform work on my property.This form is only valid with a signed contract. 9 awns s Signature l 1 Date The Cotntrrornwealth trf Massachusetts Departtazerrt vfhithtsifialAecHelats � Office of1rzvestigaticrrrs r µ . 600 Washington Sh et Boslorr, MA 02111 f,r ry w w.rraass.go vltlia ot-leers' Cornlpensation Insitrance Affidavit: Boilders/Contractors/Electiriciaos/Plumbers A ) licailit hiformation Please Print Legibly Name (.Business/orgaiiizzition/Individual):_..Merrlltlack Valley Insulation Corp. —��- Address, 23 A Sullivan Rd, Cyity/State///ip: Billerica, MA, 01862_._ ._.....__ Phone #. 978-888-3496 Are you all employer?Check the appropriate box: Type of project(required): 1.R� 1 ani a employer with 18_-- 4. F] I am a general contractor and C employees (full and/or part-tanrc).�° have lured the sub-contractors �' E] New construction 2.El 1 am a sole proprietor or partner_ listed on the attached sheet. 7. Fj Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' coin it7stn'aa�ce,� 9• F] Building addition [T`o workers' comp. insurance p ❑ We are a corporation required.] 5. oration and its 10.F] 1lectrical repairs or additions p 3.0 1 am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI, 12.1_� Roof repairs insurance required.] t c, 152, §1(4), and we have no employees, [No workers' 13.R Other Insulation comp. insurance required.] Any applicant that checks box 111 rratst also fill out the scetion below showing their workers'compensation policy infbrnration- f ntytncawncrs who submit,this affidavit indicatint„they are doing all work and then hire outside,contractors must submit a new affidavit indicating.such. contractors that check this box,must attached are additional shect showing the name of the sub-contractor;and state whether or not those entities have enrployces. If lite subcontractors have employees,they must provide their workers'comp.policy number. I am an employer Haat is providing;workers'connpensation insurance for nny employees. Below is thepolicy and job site in formation. Insurance Company Name: 6Star V3wAAIC American Alternative Insurance i Policy li or Self-ins. Lic./#: V9WG749118 'Expiration Date: 6/18/2017– Job .._..._ Job Site Adclress:__A �l City/State/lip:Aj . 1,0V':I'r.,.1`x! 41& Attach a copy of the workers' coarapensatioaa 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 tine tip to x;1,500.00 tend/or one-year imprisonment, as well as civil penalties in the form of a.S'L'OP WORK ORDER and a tine Of tip to$250.00 a day against the violator. Be advised that a copy of this s�ta�tement may be forwarded to the Office of Investigations of'the DIA for insurance coverage verification. I do hereby certif 7 under the pains and penalties of perjury thtrt the information provided alcove&true turd correct 5igo-t4iturc: �. _ _ .__ _.. ._.._........_.__ ..... .._Date._. .. _..� . __ Phone 1h 8-888-349 Of ficial use only. Do not write in this area,to be completed by city or town?official. City or"Town: ------__Pe.rinit/License# Issuing Authority(circle one): 1. Board of Health 2. Building;Department 3. City/Town Cleric 4. Electrical Inspector 5.Plumbing Inspector Fr. Other Contact Person: Phone#: The Coop-wealth fli I fls!3'-Ic USetLL3 lseparttent Qx indu srrinl Accidents 0Tea 0 1--Yestz� cs 600 Ifo ss- Bos*on;►_ w O�z is rte::"y_T�].�SS._r..lVi triialt`l.. , Co pensatdou surance ff-davit- B0f=vxsl�o :xac o?s� Iec zci slT'l i3abe�s riDlxC iiO?1lufo—a?±o3I.....-PleaseirietLe�bb _Ne ( IisI=L�Swf�rb3T�i U13Rt1vZ�iI�ilk��rTTZSr:� ( ; iJ.i`� �( �!� Lfi SQL�L'S-7ilk L i3 CiL�/Satz- i�_.I ffsrIc . l i 4xe I.ou an empIoyer9. Are you the—homeowner? Check.the approp� ipart-fine. ate r77 der: E _ i i. am an em171Drer with employees(full�tndlo,r part fi n e• i --al-a sate prupelc or a pe�te�sh_p hu';e nD empioyens.fur i s for me i3 !!,'C3r3$Ci . ]. a 11LlufeO�f'37$T CiOIIfcr1l r.'oiti�ivsseji. (S!Q�;Oiti$T5 COsIpE?i52I10�iII5lSSEiICvTCL1t?Ired i T aiLl a generat miWractor•s I have hired- the s-ab-Cain.SCioiS 1isLed oa&e 3ii2Ched SL�eei E ? �^ (These cont acto-Ls.have l."orkers co-ap_tisili.3RCa ws-Lfk il�txe wit Chet 2-way Di Eh@Ir ins.) ! v_ E SFE 3 C6T."f.]GTat'wa a-ad LEn OF"tCe-a hsi=a E:zer cised tboalr r,crtli ai elen iflOn rear IVIC-t. 7�i ! pie hale a.7 L'Lj?I0y eeS_f O ?mSi?�iECE required.) 1 F i a nyUPO icnRtt;atchaei;s cox=(tass_-iso;ffi- :ih83CC;4�beiaros ai.ila�theirti.orizsr'conp.nolir�in arrl,.ion. wq;'"C0V?per_S13lF SI_.b Y it tnh5=afBd.ty t r.dir::f]^±ii:=V arz d r_ 'c:fi ?v: ._�1cc ,iii c�ve.us_wu.a:....s.r_a a'".•s'a:5::�::'.L:.^.�.- ! � :.tLlL!`d�itk�lCtlCn�u�alYCi,_ I Coni&ors lief caeef:this box r usi,t t^.en an ddidocDi-meet shof.in,E!he-a:Yne of t.E 313b-MntrCcti rs e..0 tiicir.o s i cnlF!QeraaQ©tt dolfCy inorii:nlien_ ' i Type rJr uroieC%(re:lUtreQ): disc!:appropriate R : r onstra c-oa 0.3uiaem-O1z�oT+ 0_ Building fz d3flQn emr _Plumb. !21-4-LOG ?3_ 1/ ()theZ- I-tM ail e!!!pf rdr-tf it is nre.idinr:rcr?lCrs'Compensation iizsurancLL for sib%Cmnlapees_Be1w,is thenoiics°slob si.c zr:fo_ Lstl,� �?ce camloftnY dame: '�oHEq,=ox sea=inti-3_.:ic.— at;an I iw: T d fob StGdr ItRC(4 ij ropy fll ilt;islpr's compensationpvlic�(deel.ratior p e (silti;�jnathepoligi number:,ride:-pirat:nli date. 3[�Le���7 SivL CclE(8Ti'y is:eC�':x�CF U Col 52CtioT-t 25_'L Oi NULc-15 —can lea Co Lhe,epOS3i ioFl c (,ifs 1i� gl�aLie?S Oi �utS tli}I'M S-1-m-500.00 3!7'�lb'MileYe^ ?ra TI5Dili 1�R„-'s vial r�5 civil i1Zltr`tis F7%!le form ai STOP ti+t OR.-ORDER a_-tt a ire of up to c25G.00 a tia; the olaiion- Be advised rls�e�cope a�tl s 77teamelit in i'ba onvarded to'Lila alce of Ery."r-esdggafions Df the DI I�.for iosilt''a=-co-Vermp Ver1�IGdttDU. a ti0 LlEiwiJ'r'»vie[ ill-i-t��eC'tie 17-a ?nd u- r7.jilvj�7I aC1lla'?tli?�ilio iilt"GTlAii4Tl,."]E�:=I�C�t ahoYDe lS ls'!!e�I}a:.OriZCF. eLe- Of"LriaE use- C,iv_ Do not in tLis area_to bW c©m-ple;ed by-,i%or tOw_i C'( dMd- {17� n L- = J 1 i '...it? 01 3Tl�TI". E�vj'�t�l_d T 1. Board ofFlealth '- BuRdina Dept- 3�rC:Lq 11_n_ Gteek 4Eicctd ala �011«Ct 81a01i_ LgirinL, Non. E f' AC y� T DATE(MWDDNYYY) C R" CERTIFICATE OF LIABILITY INSURANCE 11/07/2016 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), AUTHOR12ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 CONTACT Carolyn A Coughlin ON Charles J Coughlin insurance N Et FAX 14 DinleyStreet Ea (978)957-3588 we Ne: P.Q.Bax 10 Aw VSs: carolyn@coughlinins.com Dracut,MA 01826 �_..,....,------INSURERS)AFFORDING COVERAGE _.....__.....................-----_-.-- MAIC# _ _ INSURERA: Northland Insurance Company 24015 INSURED Merrimack Valleylnsulation Corporation Joseph A.Ryan,Jr. INSURER B; Safety Standard 39454 23A Sullivan Road INSURERC: Torus SpecialtylnsuranceCompany A0159 N. Billerica,MA 01862 INSURER b INSURER E: EIIE� INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS S 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 ADDLSUBR pDL;CYNUMBER POLICY EFF POLIO EXP LIM6rS LTR A COMMERCIAL GENERAL LIABILITY W8274182 01/21/2016 01121/2017 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE M OCCUR PREMISES Ea i -xcEurrence 5 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ABV INJURY $ 1,000,000 GENLAGGREGATE LIMITAPPOESPER GENERAL AGGREGATE S 2,000,000 J POLICY JEa LOC PRODUCTS-CO/PlOPAGG S 2,000,000 OTHER S B AUTOMOBILE LIABILITY 6205006 1112512015 11/25/2016 COM131WD SINGLE LIMIT 5 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED / SCHEDULED AUTOS ONLY V AUTOS BODILY INJURY(Per accident) $ HIRED IWNAWNED PROPERLY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident { S UMBRELLALIAB OCCUR 875931_161ALI 01/2112016 01/2112017 EACH OCCURRENCE S 1,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE S 1,000,000 DED i 1 RETENTION S 0 S WORKERS COMPENSATION AND EMPLOYERS'I.WBILrrY YIN STATUTE EER r ANYPROPRIETORIPARTNERoEXECUTIVE ❑ NTA E.L.EACHACCIDENT S OFFICERAdEMBER EXCLUDED? --- (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE S It yes,describe under DESCRIPTION OF OPERATIONS belmv E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS f LOCATIONS l VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached if more space is required) Insulation Installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover,Massachusetts 120 Main Street North Andover,MA 01845 AUTHORRED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD f1 ti�a �i p 1I A n I� p�?p [�g� �a MERRVAL-03 WEJE CERT ICA Il E OF l�ilABllt ITY �k1�1e�7�1if ANNE oA'relinlr�aormY) 6113/2016 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 RECPRI=SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(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 CONTACT NAME: --— Automatic Data Processing_ Insurance Agency,Inc PHONE -- AX Air Na Ext: AIG.Na 1 ADP Boulevard E4!IAIL Roseland,NJ OT066 ADDRESS: INSURER{S)AFFORUING GOVERAGE _ NAIC R INstIftERn:5Star V3 AAIC American{Alternative Insurari. INSURED Merrimack Valley Insulation Corp INSURERS: 23a Sullivan Rd INSURERC: North Billerica, MA 01862 INSURER D: __----____ . _ ._ _.__._ _ --•--�—... _____ INSURER E: - I INSURERF; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE SNSUREU NAMED ABOVE FOR THE.POLICY PER101) INDICATED. NOTWITHSTANDING ANY RECIUIREnIENT_TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W 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_ __.��__. ADDLSSUBR EFF 7 AOLICYI%P �IL7R I TYPEorINSURANCE INs�-.- RI7�uVD -_-v--POLICY NUMBER t 67prVIID1YYYY ! 616UDDI' Y LEM17175 I GENERAL LIABILITY I EACH OCCURRENCE j S I COtAMERCDILGENERALLIABILfly I PRE67ESESjEaoccusTencL _v_y - ;CLAIMS-MADE OCCURi M[OEXP(Any_one person) is - --------.-_. - -- } I PERSONAL S ACV INJURY =S ` LT—I _-- -- -- G_ENERAL.S_G_GREG_ATE a -- GEN1AGGREGATEUMITAPPLIES PER: ! i PRODU07S-COIAPICPAGG S 1 I ------ - —_ --- i POLICY r FIFO 1 11�I lCC 5 AUTUi:10BILE LIABILITYaccidaAt COSIBINE051NGLE UTAIT • Ea S l ANY AUTO i 6G01LY INJURY(Per person) �S - - - ALL OWNED SCHEDULED [ I BODILY INJURY{Per accideat) S AUTOS AUTOS I I PROPERTY DAMAGE 5 HtRec)AUTOS AUTOS 1 i (PeraccidAnS] Ulm R&LLA t1A6 OCCUR EACH OCCURRENCE 5 __ EXCESS LIAS CLAIMS I AGGREGATE 5 ` OED 1 RETENIiONS I -.�V-------- S ---- WORKERSCOhsPENSATIONWGSTATU- DTH. AND E.9PLOVERS UADIUTY TORY LIhSRS ER A IANY PROPMETORIPARTNERIEXECUTME Y� V9WC749448 fi!1$I2D98 612812417 E.L EACH ACUDEtV S �vV 'x,000,000 OFFfCERlIlEtlHEREXCLUDEO? NIA �'—� --- i (MandatnrytaNH) Y EL.USEASE-EAErAP€AYE S 1,()()()0130 If es,describe under - O 5GRfPiIONOFOPERATiOPIShPEO'ir Ill - E.L.D)SEASE-POLICY Urtfr' S i � I DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 1471,Additional Remarks Schedule,itmore space is required) f CERTIFICATE HOLDER CANGELIATIORI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO.BEFORE THE EXPIRAMON DATE THEREOF, NOTICE WILL BE DELTVEREO IN ACCORDANCE WITH THE POLICY PROWSIONS. Town of Norlh Andowr,M assachuselts 12{)M Bin Sire@t THORIZED REPRESENTATIVE North Andow,MA 01845 I O1988-2010 ACORD CORPORATION. Ail rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD cxry \ V5 K 1/j�w ck 1/j VJ& a 't 0// (,- Office Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Type: Corporation Registration: 180506 Merrimack Valley Insulation Cori?:; Expiration: 11/23/2018 23 A Sullivan Rd Billerica, MA 01862 t Update Address and return card. Mark reason for change, SCA 1 Co 20M-05111 D_Adrirms 1110strarri .ti ("�%✓re^��>cerirrrrrurru�rr�/�r��/;,rrs„5rre�rr.Frr/✓.7 +a Office of Consumer Affairs&Business Regulation i n1r � HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only 1 Type: corporation before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration Expiration 180506 11/23/2018 10 Park Plaza Suite 5170 Boston,MA 42116 Merrimack Valley Insulation Corp Joseph Ryan 2.3 A Sullivan RdC -°- Billerica,MA 01862 Undersecretary Not v id Ithout signature ff6assrachus � - DcPzlrtnlant Of P0i3t¢c,�fk'a1F ScarcJ of Suildir•;r Rc9u"^ i:r. E'z 1 'ur cansc: cS-0755411"r0K j JOSE,PH A R'YArV " [ 280 King Rail Dr..ApE 20l _ I fynnf'ield MA 019140 pp �„ �„o5,nv,w r��•� �t:4 5�. .,�.,i�34:ik110�'CY rosr4z'r't¢^;, 4on�^r 02/04/2017 i I f