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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 . .. . .......... 0* A BUILDING PERMIT D 2,," TOWN OF NORTH ANDOVER N FOR PLAN EXAMINATION APPLICATIO P01 Permit No#: Date Received [Date Issued: items on this page ........... ....... ...... U -ON-96", V�, �'N Q LF)g L�r 1 _Y N B--.K 1,SO TYPE OF IMPROVEMENT PROPOSED USE esi ential Non- Residential ew Building V One family Addition 0 Two or more family 0 Industrial [_1 Alteration No. of units: D Commercial- 0 Others- El Repair, replacement 0 Assessory B.Idg El Demolition Other ]D Wbt`16h, w I Fid d-1 , -,Eh. a 'd 8' in amm U VV SqvVei DESCRIPTION OF WORK TO BE PERFORMED' Identification- Please Type or Print Clearly Phone: OWNER: Name: 0,02C)n MCU Address: -Aa u)-(7�t U,D 0 o C_� one, RINI`, zX M_h, r V, Onsbr ff9e ................ _R D91' ARCH ITECT/EN GI NEER ISO Phone- Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SF, Total'Project Cost- $ FEE: Che6k No.- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guarantv fund ------ __ ___4"A�t/Owner nnfiirp Signptgre of contractor F �pRT� own of- ndover 0 No. oh ver, Mass, JA LAKs 'QA cac"Ic Mi WICK` RATED 0`YQ`��(C3 13 BOARD OF HEALTH Food/Kitchen PE I LD Septic System THIS CERTIFIES THAT .... ..... ... t . ......................................... ................... BUILDING INSPECTOR has permission to erect ......................... buildings on .. .��; ,� +,` !!. Foundation ... .• ....1 Rough t0be occupied as ......�. i. .. .. .....�... ....�..................................................... Chimney provided that the person accepting this permit hall 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 MOdHS ELECTRICAL INSPECTOR UNLESS CONSTRUC Rough Service ..... . . ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reriuired to Occupy Building Rou'gh Display in a Conspicuous Place on the Premises - Do Not Remove Final YY No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. RISE E'll"incerin" Federal 10#05-0405629 RI Contractor Registration No 8106 MA Contractor Registration No 120979 RiCT Contractor Registration No 620120 60 REMO,Canton, 1A 02021 ENG11§EREC61- VAX 339-iII12-63.15 CONTRACT Page 2 PROGRAN4 TIPS CON TRACT IS E OINEE DINGANDT1111 CUSIOMER FOR WORKAS DESCRIBED BELOW CUSTOMER PHONE DATE CLIEN I a WORK ORDER Boalih Mid 11/11/20 16 441680 28602 --------------- BOWEN',3THEET HILLING 37REct 112 West Woodbridge Road 42 West Woodbridge Road SLIIVICII CIMSTATE,ZIP 11R.LONG CITY,STATE,ZIP North Andover, MA 018,15 North Andover, MA 0 18,15 JOB DESCRIPTION 1USE Engineering vvill Rliply I'll HI)JAic"ble,eligible incentives in this contract. You vviH Only he billed the Net anlotjfd. Conelilly,11or eli,.tile measures,(,'olumbia Gtc offers'75%,incentive,not to eveed S2,000 per Calendar year,I'll(]BIT inevillive of`1001',)for[lie Air SQ;dinj, .i il nleasurel)ill the litsil S680 and:ill additional$3.10 it'savintp arejuililied 1w the noddoi% For the milol,v and healih ol'yoor lionie's indoor air quality,vw will be Coll d tic I int"it blovvel door dimploilic ol'tilc avilikible ill[ flow In yourhome boill bullae the work is beglin,and alio the weadwrization v%ort,is wilipleiv.We will also Conduct a hill asiessnient ol'the condiliqlitill saf'ety oaf your licaii0g,systefvl and wider hexer. 11lis hils;E Value ors9l)link]is Ill no Cost to you. Tolal allowattle Wcadlerizalion hivenlive is S3,1 111, The 11COnit will bewculed by the insulation contractor,nt ill)additional CI)SI,It is the holueowner's responsibility to clow Out illii permit by Contacting lbeir municiratio ynt the colliplelion oftlik vNoth. Total: $1,668.75 Program Incentive: $1,454.06 Customer Total: $114.69 %VLAGREE HERCUYTO FURNISH SERVICES-COMPLETE ill ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THESUM OF '**One HUndred Fourteen&69/100 Dollars $114.69 INBr ECTurrl ANrt APr=raOVAI.DY rasa.aNOINEErnNc.pusTOv,aea apmtEa TO Turnor nrnOunT Doe IN FULL.urTEnrzsr IIrP I n WILL.nE CIrnR<IED LIONTIu.v pN nNY Nnra PAR) ARCP APIF"30 DAY3-see ReVERS"FOR I"PORTANI INFORMATION Oil GUARANTEES,RIGHTS OF RECISIOD,MIEDULIE40,ADD COMnAc1OH BeGISIRATIOm AUTtr IZED SIONA IT V,ME NOM TIIM CO)ITRAC I MAY tic vilroDRAVOI BY US IF EMT EXECUTED,Voonivj DAIEOFACC(PTANCE ............— ACCEPTAW&OF COMITACT•TIIE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAY3, a A713FAC TORY to 113 ANO ARE RERMY ACCEPTED,YOU ARE AUTHORIZED 7000 THE WORK RISE60 Shawirnut Road, Unit2 1 Canton,MA 020211339-602-6336 ENGINEERING" www.RISEenglnearing.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: Vj mvjd6r(d (Property Address) (Property Address) J Merrimack Valley insulation 23A Sullivan Rd hereby authorize (Subcontractor an authorized subcontractor for RISE Engineering, to act on my behalf in;a b u i I d!n, permit and to perform work on my property.This form is only valid with 0.signed contraft whe s Signature Date ,Lzi DepnIon eat of in.[��i?5 �5 ^ATLomtzs -Cc of Tip eX=+satbans ddi VVOrkees C©=1Iens'-t 'dohs ranee fffda-3I- B ject rC-iFSSjTlumberS �s FJIiCkTtoi?k71r0 'Ti y -p! -,P �i e. ;div r ' r `J iT2( IiS?v'S�?Q3 .rs:nwi_OL�?; Lts-C-1-aa O Ler_ y 471 h.a '14-111,Ful r LIST i Ail;yull 81t eumployexe- �re E 1. am au v=;plDyEirwimij _cgplee.JR a_:Akrpari me. i E 1 a Sate pro}"1.emcGtar 7 r'. partuters'alp&ha is ao et"R.�CJtO�um woNg r on b:L a11v C3IJae"LT- r � 2_ psi?a Fl�r-1eQilZcrCe07i1gsibx':'orli ia`Gt ('io tOitk C4 c��ctl0e`!ur51��_rfLwfCud -TQ E '{ - aril c general CJr{t,-ac,0. t have[ETrwe-- -:rG S"u_i-LOFL"C' CT.Oi'S�t3ie:.i QIL i�?3LiuC37.SQ 5��= E T!hese cou!raCMOs S have1;'3r ke r.-i4mp^kaSa7,-aaLa a-a r iT z-r c h e(i 2 CDpy-D'heIr Ire ) E v 740 axe=cq=OOZ•K_Ca awd Ry OALK- xa'hirve X21 Ci'a2u. 2TT'r< �Di exam'^RL per YIC-L r rt j?S i i W,C ii2 LtiYC=s7 et�ti0r� 4r5.I 0 r.or c v.+;rt1p.za3S{?r?s10e32c�Lsrt�E�-� 1 _l. i i Q n'2��,71iC1[Il'iii�:ti crmc i e:aKt. l iM SfB�i�[e3C^-eI�S'a GL"10:r 37a1F[GT int=iY M1"M&am" q i'el aL:7sP3m _ U_�se w._it—..=0 any ,zir�gZ—ra L. Caai c;or�1:E cued:his too;r=.usr t:�ci a s sd�i iasna i ee�snnr i; _ r on=Q< eai:7persa�ion uaric�irr o=ss:;�iiea_ Type 0'pro ect(requiredi- Cimclt apprDpI"�.4ifl= ; �7- 3 tL ?? 7-ftdin sz `GT3 faD. i A-_Plb„i= RzOtT� �- T tt[r?tt empiin�errr;pis n�erFatar.rGt?{�r5'r�maesssaea insur..nc^_��r�v emato�e�.Bcir�is tae aoG�=zC ia5 siva Sr:�v_ tExpira-Eim. Date: Policy 0 or swoon-WO OSI site_} �,s^rlress: ut{CIt{i CCGZ"Qii?D::iYC"$COE3RBF3Su�OR IIO'�]CI'F�eCt::F"7UII 17^ca�S�IBTrE13iitC617C'+'sciliFii32C��£s{iZ;'jlti'!iQTL 1tAr_e. r-.i3tiv 5 ctom.a c,-1 a .2'�;A F}y.t!f�i C.15 !aad to the tm0zz:a E j,�tnln _ i r •3^ L�'vrs:�c.: ��c �Lrl�Br 5 Ci'I-O_ - � _ r g{:1Ays of a too Up tC2 S-1,509.00-nand 0r 0_te v'8��*060am-m-q asm!!aS 6-Al-BiTe1°iit�S I Im mum Di L F {:YQ�i-L�OMDE�i e.i{Ct uice;'it"up iC 25ftM day a�ei15t tb"-8ialalion- ��dvis4C`Ti-at .C'�p C?i C13iS €e,fbrvA;aTdiad o the OUf E'-ECO-.0 UYeS"LTgai6US Of thaD A'oi'I75illaace-ccir mow- Lifi .iD"on. 3o i2L'rMi7`Cmc t �F:-i-i�lti ct �n RS?i?G q�.:`;2ji3�jFpz6a;�y-Lizai-th l i,65wmatloil L'i7".=[�eCi BEO:'�15 SiZlw�P,. C4?-2Ct. ZDY.— ,•� - � Date- Man-- Ji C)j iilG i ;r- 1 _.`.e �{ i�-� �� tG be campl�ei=Jz'city Oi to--v- OfRc !_ ! tL-i i-.S� �._..t_ G�T.E)�-.zee Tt,�i-:a=.:� _ unk 1 il� G?'=vGicflet _ �^ E _ BIT.tiQin Je„� _ +,-., ssi7k vm-t'~-Q& =�LiBCi:i N?�V. i�l[ksdlb i1:�zS B_ tithe.__..� i t. OW of rim ih = _ — 1 C-�RrrmetperaQm CpTirlia "^ The C'otrmtonwealth a "Massachttsetts Departtraew gfIn(lustrialAccar/ews w # Office gj'hivL'St1;titZflDtS y 600 Washir°rgtota Street � ° Boston, MA 02`.X11 ivwyv.ratass.gov/tlict Workers' Compensation Insurance Affidavit: Builders/Cooat:]ractors/Flcctricia>ns/Plumbers A licant hifo r enation Please Pruitt Legibly Name (8usataess/Ort<trii7.atioti/Individual): Nl.errlmack Valley Insulation Corp. Address: 23 A Sullivan Rd. C ity/Stat:t°fCip:_..Billerrca,.MA 01.862. _....__. Motto 9: 978-888-3495 Are you an employer? Check the appropriate box: Type of project(required): 1.® 1 ain a employer with 18 4. F] I am a general contractor and I employees (full and/orIaat�t-tante;)." have hired the sutra-contractors 6. El New construction 2.❑ 1 am a sole proprietor or partner_ listed on the attached sheet, 7. [j Remodeling ship and have no employees These sutra-contractors have g, ❑ Demolition working for the in any capacity. employees and have workers' 9. 0 13aaild'uag addition. [No workers' Comp. Insurance comp insurance:. 5. We are a corporation and its 1011 Electrical repairs or additions required.] ❑ p 3.0 1 am a homeowner doing all work officers have exercised their I I.[] Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 1.2.❑ Roof repairs insurance requirecl.l i' c. 1.52, §1(4), and we have no employees. [No workers' t3.91 Other Insulation comp. insurance required.] ' 1ny applicant that checks box##l Inuit also fill oast the section below showing their workers'compensation policy information. tdoaateowaaers who submit this affidavit indicating they are doing all work and then'hire outside cnntrautoas mast submit a new affidavit,hidictating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractor;:have employees,they must provide their workers'comp.policy number. h aria art employer-that isrrrovitting ivorl(ers'cornpensatiort irtsurance fear rrty employees. ,Below is the policy and.job site infor"union. Insurance Company Name: 5Star V3 AAIC American Alternative Insurance Policy 4 or Self-ins.Lic.#:w V9WC74911$ Expiration Date: 6/18/2017 Job Site Address: ..W�°;�� �h )C)ucc�`����..�t�t' ��t�.__. .._.... City/State/7,ila:i_A._f1rDdQvt°.r Mf�..U1� tS Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration elate). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of to fine'up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$250.00 a day against Mae violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of'the DIA for insurance coverage verification, X tlo her-eby certify under the pains and penalties cif perjury Haat the hifarrnativn print"fled above is true and correef. Phone v�.: 8-888-349 _. Q,ficial use only. Ila nett write in this aretr, to be cotnpleted by city or to;vn official City orTown: _ _Perinit/License# Issuing;Authority(circle orae): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Ct. Other Contact Person: Phone#: ACS CERTIFICATE OF LIABILITY INSURANCE DATE( 11/0 2016 16-� 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 Charles J Coughlin Insurance PHONE Fax 14 DinleyStreet a. (978)957-3588 Arc No: P.O.Box 10 Ea nasss: caroiyn@coughlinins.com Dracut,MA 01826 _ IN5URERLSLEFORDINGCOVERAGE _ NAICIf IN_SURERA: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURER B: Safety Standard 39454 23A Sullivan Road INSURERC: Torus Specialty insurance Company A0159 N. Billerica,MA01862 _..... ._ _ ....___. INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 NTH 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 INSD WBR POLICYNUMBER P DY EFF IP pYEXP UMRS LTR A COMMERCFAL GENERAL LIABILITY WS274182 01/21/2016 01/21/2017 EACH OCCURRENCE _ b 1,000,000 DAMAGE NEED CLAIMS•MADE �OCCUR PREM SESJEa accurtence S 100,000 MED EXP(Any one person) 5 5,000 PERSONALaADVIN.ruRY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 J PRO- [:1 LOG PRODUCTS-CCMPIOPAGG $ 2,000,000 POLICY 0 JECT OTHER $ B AUTOMOBILE LIABILITY 6205006 11125/2015 11125!2016 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY{Per person) $ 3 OWNED / SCHEDULED BODILY]MUM(Per accident) S AUTOS ONLY V AUTOS HIRED / NON-OWNED PRCFERTY DAMAGE S AUrOS ONLY V AUTOS ONLY Per accident C UMBRELLALIABoccuR 875931_161ALI 0112112016 01/21/2017 EACHOCCURRENCE s 1,000,000 EXCESS LIAB WCLAIMS-MADE AGGREGATE S 1,000,000 DED I I RETENTION $0 b WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY YIN STATVM ER ANY PROPRIETORIPARTNEREXECUTNE ❑ NIA E.L.EACH ACCIDENT s OFFIC-ERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descrtW under DESCRIPTION OF OPERATIONS beiow E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS rLOCATIONS IVEHICLES(ACORD 101,Addirtional Remarks Schedule.maybe attached ff more space Is requIrad) Insulation Installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBE©POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VNLL BE DELIVERED IN Town of North Andmer,Massachusetts ACCORDANCE VVITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ...w•wwwr,y @ 1988-2015 ACORD CORPORATION. At rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I t MERRVAL-03 WEJE CERTRL ATE OF LIARUTY WSURANCEUY) ATE(tt?XD1)YYY 6/13/2096 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 poiicy(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). PCONTACT RODUCER Automatic Data Processing insurance Agency,Inc PHONE 1 ADP Boulevard Arc o >xt EfiAA1L Roseland,NJ 07066 ADDRESS: INSURER{S)AFFORDING COVERAGE NAIC V 1NSURERA:5Star V3 AAIC American Alternative insuran' INSURED Merrimack Valley Insulation Corp _LNSURER113: 23a Sullivan Rd INSURERC: - -------_-�- North Billerica,MA 61862 INSURER 0.- I ____.______._ ._ -.--- --•---___ . _ _. INSURER F: COVERAGES - COVERAGES CERTIFICATE NumaER: REVISION NUMBER: i THIS 15 TO CER'"FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN ISSUED TO THE INSURED FIRMED ABOVE FOR THE POLICY PEM)OD INDICATED- 1MOTWITHSTANDING 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. ItN7R I TYP1 OF INSURANCE InsSri two i POLICY NUMBER -� tl A1dDlYWI°mo wrr u LIMITS GENERAL LIABILITY I EACH OCCURRENCE j s DAMA(it;IUKLNI 1 COPAMERMLGENERALLIASiLrfY El4_ 15ES.[Ea accunenceZ_ts I CLARAS44ADE OCCUP 1 MED EXP(Any u_naceruvn)--s5 ----------- - --- L PE.RSONAI_&AOV INJURY p 5 ` I GENERAL A_G_GR£GATE� 5 I i I GEITLAGGREGATEUNIT APPLIES PER! i PRODUCTS-COIAPIOPAGG S j -------._— — �--- — f POLICY i PRC- F-1 LOC I S > EJECT + AUTOP,IOBILELIABILITY I i 1 COA181NEDSINGLEL1h1IT - Ea accident 5 AIdYAUTO BODILYINJURY{Perpersan} S I hLLOWNEO SCHEDULED s j B0131LYENJURY(Peracddenl) S i AUTOS AUTOS j NOi'q-OWNED PROPERTCDWAGE IS HtREU AUTOS AUTOS P..racelders i - -- U€ABRELLA LIAR OCCUR EACH OCCURRENCE 5 — EXCESS UAB CLAIMS�iADE AGGREGATE � S — #3ED P.EiI=NirONS ---�--_._.-----_ 5 — WORKERS COMPENSATION X +ORYUn n_ ER• AND EPAPLOYERS'LIABILITY A FAIYPROPRIETORIPARTNERIEX£Cl� YIN V9WC749113 611812018 61/812017 E.L.EACH ACCiDEUF — 5 — — ,o00,U00 OPFICERI RARER EXCLUDED? N f A — — — — S{@AdnddLaryinNH) E-L.DIS EASE-EA EMPLOYE 5 1,000,000 IP YYes,descObe.undar ❑ESCRIP110NOFOPERAEONSWe& E.L.DISEASE-POLICY Uf&' 5 1,000,t}n0 t S I DESCRIPTION OF OPERATIONS ILOCATIONS IVEHSCLES (AMachACORD 101,AddiUanalRemar3rsSclteduleifmorespace Istequired) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.SEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN Town of North Andouer,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andoder,MA 01845 THDRIZED REPRESENTATIVE I ©1988.2010 ACORD CORPORA►ION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1 " 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvemenf'!Contractor Registration Type: Corporation Registration: 180506 Merrimack Valley Insulation Corp" .. Expiration: 11/28/2018 23 A Sullivan Rd Billerica, MA 01862 Update Address and return card. Mark reason for change. SCA t 0 20M-05/11 M Address 11.Employment D-1-nit rardl �''%�r^��ro>irrrrcrreecee^rr�/�c��"°!/Lrr,l�rrr°�orlrrlf°s Office of Consumer Affairs&Business Regulation %_J�,;/, HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only i Type: Corporation before the expiration date. If found return to: " 9 Office of Consumer Affairs and Business Regulation 86clistryllon Expiration 10 Park Plaza-Suite 5170 1t10506 11/28/2018 Boston,MA 02116 Merrimack Valley Insulation Carp Joseph Ryan 23 A Sullivan Rd �' - - - Billerica,MA 01862 Undersecretary Not v lfi ithout Signature I ��aassachusatt 'Cohn�i Lament sof Public S�fcIt° Board of Suild;ng cqu" ,cr'5 and S ^'ard f v irxa"+C iFta.¢➢ir:, .ai�.i k.,nxi` ;a ;ocnse: CS-075541 '11'err° 200 King bail Dr.-'Apti"201 Lynnfield MA. 01940 _. c'rr rraa:;.s icacscr 02/04/2017