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HomeMy WebLinkAboutBuilding Permit # 12/6/2016 R Of pORTy '4 BUILDING PERMIT o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �Q-L' Date Received 1 O Date Issued: 1 d �9�SacHvs ��� IMPORTANT Ap licant must complete all Mems on this pa e r✓' �,,' „..^'. F F�- lis-'ti., .; ,� f /'a ;,, fi s ,.✓a Vie.." G" fi / ✓ i / . .-�' ,�k! �';��v,�7 � �� .a �, � �, � ,3a .r^,;t e ✓ E e //� /' �. N C ';: y �, rF r '.,/l ,� M%'C^f'^F9n':.��`{k-5<r�••,4.�, : "�!k' � -' � � /� � �„'a r „� � ✓ k� y �f,..:. u.� '�,.r.. �''��✓n �` �"`� x. �� ���� ° ^`� r "�c �r�' �"s `�r..�s�•�-.,zz'` ��.�r�r�tl i,., .s✓r' -t,..s<`°c �1, ,r r � �r'�'"5Y<r si e -r ra r �cj��-,�^� r.,.; 1�� � ���¢ s✓� �„����� k'v�� ', rr'''w ��kCT�x //! f �,,"✓ " h r.v i �f? ✓�� � �Y�r����F� � �V�� � // � � C f t 1`r Dlstflct r .,ti'� e5,`` `� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )(One family ❑ Addition G Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg E Others: ❑ Demolition EJ Other ` epf E` e r1Flaodplarn p Wetlands F„�,V�/afe���e�t�r�r ` ��”✓ /E5` � l rsh�d �trlcf , ����f I� Wife /r 't�� � � � 1 id �. Identification Please Type or Print Clearly) OWNER: Name: -Ar+kUr 4DUrj<1r`I Phone: Address: 4 �., ?�„I. �. �,,,� °. ,,,� z � �'rr �+ �. �,,,,4,"`:l' � ;�d :�✓ ,,.,'�a �-', 'wc'"��,�ha u��u "'^".fs�,,�C`�� �'�5/. '`" � �' "` Rw°�'.s'�.`fa✓yr�f„ c�' g id r / Cl�������':��l.f�e��r 4��V�G T� � / 5 � �F �, ^JG �f^ lfYa�✓�iy 9J'�✓^ x / � � C,J�� �,,�l.�i - i/;-'' Y,,,r��u✓„',�,''' c. ^',i ::s � tu:,�N.n...,;._W:';✓ �.,,s.�: � ���¢�r �k x:- '. -{" x ^sem �� f �,��ci ARCHITECTIENGINEER 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 Cost: $ S7 A�2/ FEE: $_... 7 Check No.: Receipt No.: 3 i NOTE: Persons contracting with unregistered contractors do not have acres t the uar ty fund rgrture ,f AgenQner SrgrIature of cantracfor �oRT Town of 2Andover . ® 0 No. as _ C% h ver, Mass, / o �oGL^KQ .�. ti ArEv U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT . 0 4 QS ..... . � .I.. VQit� BUILDING INSPECTOR ..,...., .in .1......Is.c..0... ...�....... � .. .Lof Foundation Richas permission to erect .......................... buildings on .. �� Rough to be occupied as .................N.'.�-#..�...-P ...�.. ��.&............................................. 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 C® STRUCTI® A TS Rough Service .............. .. ...... ... .. ............................... Final BUILDING INSPECTOR 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. 12/5,2016 Donaldson,Todd for Durkin.Arthur and Michelle opt 3 jpg(1557x667) ss rea' _ R I z W=30"Avv-IR-ASS EY---SED-�t-S ON T-S AM�VVALL CAE4N-.-- c 'ss , s --ESS M M.D-S ER m - _ `E3.. ;r 5.'S r� ?v=ita .0p,CON-IMMUr i __- -- - ----- - - 3 s --- - - T OA https:/%w ebmail4.networksolutionsemail.coin/appsuitelapi/mail/Donaidson%2C%20Todd%20for%20Durkin%2C%20Arthur%20and%20Michelle%20opt%203 jpg?action=attachment&folder=defaultd%2FINBQX&id=1&a.. 1;1 Donaldson Home Improvement Contract for Services This form satisfies all basic requirements of the state's Home Improvement Contractor IAw(MGL chapter 142A)but does not include standard language to protect homeowners. Seek legal advice if necessary. You may obtain a copy of the Massachusetts Consumer Guide to Home Improvement by calling the Office of Consumer Affairs and Business Regulations Consumer Information hotline at 617-973-8787. i. HOME OWNER INFORMATION CONTRACTOR INFORMATION Arthur DUrkin MA Home MA Unrestricted Improvement Construction License#177721Supervisor CS-105410 r I Scott Circle Expires 1/2812018 Expires 11/30/2017 Donaldson Home Improvement,LLC—Emp#45-3364045 North Andover, MA 01845 525 Woburn Street,Ste2,Tewksbury MA 01876 (978)502-4325 Diane Donaldson,Owner D.Todd Donaldson,General Contractor,Licensee 2. Donaldson Home Improvement, LLC agrees to do the work detailed in attached estimate for the homeowner: Proposed Start Date: wben permits are obtained Date work will be substantially completed: 6-8 weeks Required Permits—The following building permits are required: (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A) 3. Donaldson Home Improvement agrees to perform the work,furnish materials and labor specified above and in the attached documents for the total sum of, $39,221.15 Payment Schedule: (Initiates scheduling,permitting etc.$.t;oo.00 ofthis amount is non-refundab 4. The following material/equipment must be special ordered before the contracted work begins in order to meet the completion schedule.Special payment arrangements if needed noted below: Page 2 of Donaldson Home Improvement Contract for Services CILANGE ORDERS Both parties aclmowledge that unforeseen items may arise during the project that can impact the timeframe and cost of the project. If and when any of these items arise,it is agreed that any items requiring additional work will be addressed in writing with a representative of Donaldson Home Improvement prior to beginning said work. A customer may initiate additional work orders as well,and they will be addressed in a similar fashion. These change orders must be accepted before the work begins, or in some instances before the contracted work continues if said work impacts the completion of the project. 6. WARRANTY Warranty Terms as Follows: Donaldson Home Improvement,LLC agrees to be solely responsible for the completion of the work described regardless of the actions of any third party/subcontractor that is contracted by Donaldson Home Improvement,LLC and utilized in the scope of work of the project. Donaldson Home Improvement,LLC agrees to be solely responsible for payments to all subcontractors for materials and labor under this agreement unless otherwise negotiatedprior to acceptance. (See section 4) Donaldson Home Improvement,LLC offers a One-year Express Warranty of workmanship and installation(all labor)associated with the scope of work and materials described in the project,normal wear and tear excepted. Materials and products utilized in the project are the responsibility of the individual product manufacturer/supplier. (Customer is responsible for retaining and registering all products procured for project) 7. ADDITIONAL CONSIDERATIONS Donaldson Home Improvement, LLC reserves the right to use photographs taken of our projects for use in media, advertising and web use. Donaldson Home Improvement will not use personal information or specific locations to describe the work featured in any of these areas without express written consent of disclosure. S. CONTRACT ACCEPTANCE Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Neither party should sign this document if there are any blank spaces. This contract is to be signed in DUPLICATE. One copy is to go to the customer/homeowner or business owner, the other copy to be on file at Donaldson Horne Improvement,LLC. You may cancel this agreement if it has been signed provided you notify an officer of Donaldson Home Improvement,LLC in writing at his/her main office or by ordinary mail posted,by telegram or personal delivery,not later than midnight of the third business day following the signing of this agreement. Customer/ o ' wner Signature: Date: Donaldson Ho 7Impr Representative: Title: Date: vz)11f1p 1 Scott Circle 11-3-16 Yea 10:40am N.Andover, M.A I of€ CS Beam 4.11.26.1 kmBeannFrgino 4.11.26.1 Materials Datahase 1516 Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: Continuous Standard Load: Moisture:Condition: Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Criteria: 1-1360 live, 1-1240 total 1.000" max. Lt_ Dead Load: ffb PLF Deck Connection: Nailed Member Weight: 15.6 PLF Filename: Beam1 Other Loads Type Trib. Other Dead (Description) Side Begin End Width start End start End Category Additional Uniform(PSF) Top 0' 0.00" 12' 0.00" 16' 0.00" 30 10 Live Additional Uniform(PLF) Top 0` 0.00" 12' 0.00" 0 65 Live Additional Uniform PSF Top 0' 0.00" 12' 0.00" 16' 0.00" 20 10 Live y-, T� - ✓ - .. .. Jay` 12 0 0 12 0 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 a 0.000" Wall SPF Plate(425psi) NIA 3.404" 7595# — 2 12 0.000" Wall SPF Plata(425psi) NIA 3.404" 7595# — Maximum Load Case Reactions Used forapptying point loads(a line leads)to carrying members Live Dead 1 5101# 2494# 2 51019 2494# Design spans 12' 1.750" Product: 2.0 RigidLam LVL 1-314 x 11-71$ 3 ply PASSES DESIGN CHECKS Connect members with 2 rows of 16d common nails at 12,0"cc NOTE:Nails must be applied from both sides Minimum 3.40"bearing required at bearing#1 Minimum 3.40"bearing required at bearing#2 Design assumes continuous lateral bracing along the top chord. Design assumes continuous lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 23061.# 33194.# 69% 6 Total Load D+L Shear 6357.# 120534 52% -0.06 Total Load D+L TL Deflection 0.4179" 0.6073" U348 6' Total Load D+L LL Deflection 0.2807" 0.4049" U519 6' Total Load L Contrd: Positive Moment DOLS: Live=100%a Snw-115% Roof=1250/ Wind=160% Design assumes a repetitive member use increase in bending stress: 4% All pmdact namesom Irademadesol their respective ovmem copydght(C)24)13 by Simpson Stang-Tie Company Inc.ALL RIGHTS RESERVED. "Pss�ng€sdefinad eswhen the member,gaarjors[,beam or girdet st u on This dmvdng meels applicable design cdleda for Loads,Leading Conditions,end Spanslisted on gsis meet The deg nmust ba mvlewedb a uallfied des nor or deg n rofeseional asre itimd fora meal.Thisdeg awsumes vetin3aRatien accardin In lbe manuFacNrers ecificallons The Commonwealth of Massachusetts Departatent of Industrial Accidents W Office of Investigations µ t d I Congress Street, Suite 100 Boston,MA 02114-2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1M0(6VMe,()7�' Address: A f�, City/State/Zip; r S !(0 Phone #: �� d o�" q 5rAT Are you an employer? Check thea ropriate box: Type of project(required): L Are am a employer with 25 4. ❑ I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. M Remodeling ship and have no employees These sub-contractors have g• EDemolition working for me in any.capacity. employees and have workers' [No workers' camp. insurance comp. insurance.x 9 E] Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ PIumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I2.❑ Roof repairs insurance required.] f c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box 91 must also fill 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 anew affidavit indicating such. lContractors 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-contractors have employees,they must provide their workers'comp,policy number. I aur an employer that is providing workers'compensation insurance for my eruployees. Below is the policy and job site information. Insurance Company Name: GMRD Policy#or Self-ins. Lic. #: O Expiration Date:3"10"I Job Site Address: 13CO l..0 cV-- City/State/Zip: Iii 0 f-+h ,A fJ0Vt(' (1A 418gj 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 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 the Office of Investigations of the DIA f in ranee coverage verification. I do hereby cer i un the sins and penalties ofperjury that the information provided above is true and correct. Signature: - -- _ - Date: C� Phone 459 � Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 9 6.Other Contact Person: Phone#: I �-� OP ID:JG '4coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDb1YYYY) 12105/2016 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 endorsement(s). PRODUCER CONTACT Todd Donaldson Segrove&Hall Insur.ASSOC.Inc NAME: 305 North Main St. PvcNro,Exti;978-502-7789 FAX No: Andover,MA 01810 E-MAIL AnDREss: Patrick D.Hall PRODUCERTODDD-1 CUSTOMER ID#: INSURER SI AFFORDING COVERAGE NAIC# INSURED Donaldson Home Improvement LLC INSURER A:Commerce Insurance Co. 3.475.4 525 Woburn St Suite 2 Tewksbury,MA 01876 INSURER s: -INSURERC; 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 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. INSRODU BR POLICY£FF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMfDDNYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEIT_ X COMMERCIAL GENERAL LIABILITY PREMISESEa occurrence $ 100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,000 BGPYKG 06125/2016 06/25/2017 PERSONAL&ADV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 BGMMZH 02/1512016 02/1712017 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (PER ACCIDENT) X NON-OWNEDAUTOS Underinsured $ 100130 Uninsured $ 100130 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ HDEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE 0NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRfPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORO 101,Additional Remarks Schedule,it more space 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 ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE ©ATE(M016DmYY) 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 13Y 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. u 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 Ileu of such endorsement(s). )DUCER CONTACTNA Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE PHONEQ.EXI), 877-266-6850 (FAX A/C 585-389-7426 ROCHESTER, NY 14620 EMAIL Certs@paychex.com INSURER(S)AFFORDING COVERAGE MAIC# URED INSURER A: NorGUARD Insurance Company 31470 DONALDSON HOME IMPROVEMENT LLC INSURER B: 525 Woburn Street Suite 2 Tewksbury,MA 01876 INSURER C: INSURER D: INSURER E: INSURER F: IVERAGES 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 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. TYPE OF INSURANCE ASDRUB L DR POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DDNYYY) (MM/DDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS-MAOE�OCCUR ES(Ea occurrence)MED EXP(Any one person) $ PERSONAL&ADV INJURY $ EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Policy 1=1PROJECT=LOC PRODUCTS-COMPlOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNEDSCHEDULED BODILY INJURY AUTOS AUTOS (Per person) $ HIREDAUTOS �AUTOSWNED BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DE❑ RETENTION$ $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS'LIABILITY DOWC700188 03/10/2016 03/10/2017 r ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT $ 100,000A0 OFFICER]MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (f yes,d ory In NH)and Y� N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 Ryes,descdBe under CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Add€tlonal Remarks Schedule,If more space Is required) :RTIFICATE HOLDER CANCELLATION Town Of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 120 Main Street DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY North Andover,MA 01845 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ORD 25(2010/05) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i a 9 i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-405410 Construction Supervisor , T E D T DONALDSON 23 ELLIOT DRIVE LOWELL MA 01852 /Z7, CA— Expiration: Commissioner 11/3012017 JL rJ/rn�rr.�u»ra.�rrnrn�!/r a�'C>�l ruric/r%;e!!s fee of Consumer Affairs&business Regulation ME IMPROVEMENT CONTRACTOR Istration: 177727 Typo: xplration: LLC DONALDSON HOME Ii�IPR UE f��iVt'LLC. TODD DONALDSON 98 BILLERICA AVE,SUITE A- NORTH NORTH BILLERICA,MA 01862 Undersecretary r ersecretary