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HomeMy WebLinkAboutBuilding Permit # 1/24/2017 BUILDING PERMIT4,, 16 10 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 2o PermDate Received C�>it No#: Date issued:----t2 41 IMPORTANT: ust coniplete aff items on this page /�/, r/����//�%l�����/� �� 1, , / MEN N" "Ov, MA ,rr �i�`� _ st TYPE OF IMPROVEMENT PROPOSED USE --—---------- Res,, tial —---------------- Non- Residential F1 Nevv Building One family 11 Addi ion F Two or more family Ll Industrial Li A ration No. of units: Ll Commercial ial epair, replacement 0 Assessory Bldg 0 Others: 11 Demolition 11 Other 1;—;N SCRIPTION OF W TO BE PER ED. Iden " ation- Ple("eType or Print Clearly OWNER: Name. 1 Phone: Address: g // /ii �,xq-t A,�g"//V$',//",%/"/�,, R-1 /rog�ll ,,f 110 ARCH ITECT/ENGINEER-- Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.-$12-00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125,00 PER S.F. Total Project Cost: $ i6bo- � FEE: $ 11;2z> "—.- Check No.: A)1 172 Receipt No.: 73 1-4 L,,"7 NOTE: Perso, s contracihTg with unregistered contractors do not have access t the guarantyfund e contra nature of Act nt/Owner -,_�gna ure, of contra tApRTy q Town of2 _ �* 6Andover O �. No. * *� o h ver, Ma ANo� - mom S` U BOARD OF HEALTH Food/Kitchen PIEK I- T LD Septic System THIS CERTIFIES THAT (A e 9 BUILDING INSPECTOR Foundation has permission#o erect .............. buildings on ........ ......R-11 �.., ...............,.,.................. .� ..... Rough to be occupied as .....,... �i ..... V*q � ................................................ 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 CONSTRUq4lON STAR Rough .�. Service .... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Re re to Occupy Buildink Rough Display in a Conspicuous Place on��YYthe Premises — Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector, Burner Street No. Smoke Det. Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost & I 4) 10,000.00 M $ $ 120.00 Plumbing Fee $ 15.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 15.00 Total fees collected $ 250.00 4 Millpond 733-2017 on 1/24/17 Kitchen Remodel s r- ` ) KTM Properties,LL(" 25 Spaulding Rd Suite 17-2 F'renlont, NH 03044 Phone: (603) 895-0400 A Service Provider for lax; (603) 253-2600 Company Represc�►tative: Customer Infin Mark Minasalli .Iob It:N/A (87433495 Passariello Paul) (603)234-9320 3487 - Passariello, Paul Mat'knl(a,)kttrlproperties.cofll 4 NI 'lillpond, tub Number: NIA (87433495 Passariello Patti) North Andover, MA, 01845 (617) 549-7734-mobile (978) 738-0986 PIE ESTIMATE,12/12/21 revised DCSCI'E1lt.it)fl .� PIE ESTIMATE 12/12/21 revised total: $0.00 CABIN1.,r INSTALL Description Permits Permits Tall Cabinets Install Wall Cabinets tl u. Base Cabinets Install Base Cabinets IAlall113ase1�illcrs Install wall/base fillers Ktxll�s/1't.tlls Ktli:>bs/Pulls Installation CM SCRIM, MOLDING AssenlblylModilicatioil Assc:m111ylMoclilicttt.io►1 K install oFloase harts Woe kick Install toe kicks at base cabinet Shims Install Shines as needed lolc and pcElnitrations Make penetrations as needed R `I OP DOES NOTINCLUDE COUNTI R TOP INSTALLATION CC)[JN`I`I CARDBOARD DISPOSAL, PRICING IN THIS CATE'RGORYDOE'S NOT INCLUDE.CARD130A1ZD DISPOSAL_,. C-;[j1,.,T )MCR IS R} SPONSII LI". KTM C:AN PROVIDF,, IT FOR ADDI`1"IONAL, FEL?S C`C)IZ13E:[.,S (SUPPORTS) Install ea►'bels to support catul[e►•(ops of decorative I3atll vanities Install bath vanities 2 baths CAM NET INSTALL total: ` 2,565.00 h,LEX-1121CAL, Description Receptacle/switch rep lacc:file fit Replace existing tipgtade to GFCI (installer provides) TAMPL;R PROOF DisliNvasher Wife dishwasher with existing power present add cord and box with oudette Microwave -New Circuit Run a new Circuit fora dedicated microwave hoot! (installer provides Components) Arch fault Breakers Supply and install arch Paull breakers as required by code IIectficttl Pef•nlil Supply electrlettl permitand inspections I.XIS'I'INCi otftlette if there are exislillg ot►tletS where new cabiltets arc} aiElg to cover� c will cut it into the cabinets and leave the outlet of,place a blank plate over it inside the cabinet, lZemoval of the outlet will be additional east, NL ) UPGRADE T]IAT ARE NOT ON IHFCCDI UPGRADES IADDIlIONAIlASKS ARL1L ? ) CZ ? [:,STIMA'ITADDN IONAI.FEES FOR•I"iixtsPI CiFic WORK WILL BF, IN ADDITION '1'O THIS ES"TIMATE- ELECTRICAL tett 52075.IItI PLUMBING L)e.scriptiot� Connect to underniouht.Cttt3nect to under motint or integral howl sink w/ faucet, disposal SIZES: vvhhln Por existing location. (Installer provides braided supply lines, shot off valves, piping and traps as heeded) CutlCap Cott & Cap plumbing for new cabinet installation Dishwasher Plumb in dishwasher next to sink MAN AN full permit; rough & Bial inspcetions- includes permit cost PLUMBING total: $2,012.00 Total for all sections: $6,952.00 Tom l:[VZTSii�ii The ahave, sigmMire does not conlink either party to the,side oflhc above listed items 0A%Vifthis contract states Preliminary 1511 trate as one of file first lines.'I lle signature above represollis a Full understanding of um Iwke anti scope of labor for the('i(Iegories listed only, Pt'iCes:Ire snlnfem to cluirige hosed on the filial (teljq laymd of tile kitchen and unftlivseell conditions. WeCANNOT shirt the work at your lot) until tile necessary permits have been proCumd and a signed"Owl M 1S.Y'lL l SM'[" is on HE. Please contact us should you ne'e'd a STY of this. luvollfDERS:this inslaflation quote is based on normal working ]lotus 7a n4prn,unless other arrangcmcnls have been made pa iot with K'EM, Plumbing& Flectrical work is based on 2 trips-one rough and one finish; finish will occur atter countertops. Code or local mspccmr requirements not ntcritioned in this estinnnte will bean additional east,(_'abincts must he delivered in kitchen area or adjacent space on saiue level,which must have heat. I f cabinets haveto be.moved by K`I'N,I,additional fees will be charged. Countertop templates require you to be rtnsite, no exceptions! I t you plan to s('.cllre yotir own trades(plumber,elmirician,etc)for your protect,and I;'t'M's halal i 1welion is held up because of their inspections,then you will be regi and to sign a punchlisl tion wavier at tare end of your job signifying K'I'M is complete expect Ibr the final building sign off, is Hy sy"ing tills vnitract,the above prices,spccllications and conditions are satisfitC oro and am hereby accepted. You are authori7.Cd to do the work as spec.Aul. 10tyrtneint will be male as outlined above. Any alterations or deviation from above specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimate. Ail agreements contingent on the delays heyond our control. Again if it is NO'J'mentioned above all(] In writing ill tIlb,Contract hien it is NOT i part of,or included crrnEsitt. Customer tniiials Ilcrc�: _, ___. . C'tlantfe (3rcicrs l f there are change orders required on your job,there'N'll,l.be time delays, Sm time delay depends on the sire ol'the change order, l'lrasc consult ether your project Coordinator or Mc aEike Rtr an estimated time(lchly on your specific pr(>ject. 13y initialing here,),t)t)accept that the change orders will result in lime delays on ynttr project. Custonler Initials Ilere: Company Authorized Signature Date Customer Signature Date CuStOnlel-SigMature Date This estimate was last edited by Mack Minasalli ((603) 234-9320, Markm(cr?ktmpcol)cr(ies,cotii) on December 21, 2016. The estimate may be withdrawn if not accepted within days. i i i I r i Legend 1 UF3(181/8) ,.. -. ,...._...,. (UF3(18 118)) 2� UFG / t (UFG) 3. BWBTI5 (BWBT15) k 4 SB30 BUTT I W331 P '�. X 24 BU .:. �� ___-".'- 1 - 30 BUTT) ,r,,.. . ..., ...-n 4B fir`,-. ..._,_.__._.... (M315 1 _ DF'�BUTT) G. UF (181/8) 3{if} /Oj .., (UF3(181/8)) 1: SSS36L WO (BSS36L WD) 8. UF3 p j 1 (UF3) s1: Bu5t' ro Bss36R WD (BSS36R WD) 11: UF3 (UF3) 12: W1830L (W 114301.) ' - 13: W3330 BUTT (W3330 BUTT) 14: ,... ,. W3012 BU fl' (W3012 BuT) K23- ... 160, PDT75OSSrSS 3 2 { 1a., WW123 16WER243OR d" (WER2430R) rJL r 17 UF3 10 B33HUFT (B33 BUTT) 10: UF3 1, (UF3) 20: UF3 ., n (UF3) 1 21: VSB4234H 23 (VSB4234w) 24 22: UF3 (UF3) 23: VSB243411 BUTT (VSB2434H BUTT) 24: VD82134H (VDB2134H) ...- .. ....... ... P I I I i ��® a DATE(MWDDIYYYY) CERTIFICATE OF �.� ILIT`� INSURANCE 02/2412016 THIS CERTIFICATESUED 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(3), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 15 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). j CONTACT PRODUCER NAME: MARSH USA,INC. PHONE FAX AIC No: TWOALLIANCECENTER 1AIC,No Ext. I 3560 LENOX ROAD,SUITE 2400 ADDRESS: ATLANTA,GA 3026NAICn I INSURER 9 AFFORDING COVERAGE 100492-Home 0-G A W-#6-t 7 INSURER A:Steadlas€Imurance Company 26387 INSURED Zurich American Insurance Co 16535 INSURER THE HOME DEPOT,INC. e: 23841 HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins CD 2455 PACES FERRY ROAD,NW INSURER D:Iillnois Neli0nal Insurance Company 23617 BUILDING G20 ATLAOTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL00374i3i0-a8 REVISION NUMBER:a THIS 15 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 VVITH RESPECT TO WHICH TH€S 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 MAY4HAVE BEEN REDUCED BY PAID CLAIMS. TLTR TYPE OF INSUADDL SUBR POLICY EFF POLICY F.XP LIMITS RANCE POLICY NUMBER MMIDDIYYYY MMODIYYYY A X CioMK�ERCIAL GENERAL LIABILITY GL048877i4-08 0310112016 03101/2017 EACH OGGURRENOE 5 9,000,000 DA'AIC TO RENTED 1,000,000 CLAIMS-IMADE El OCCUR PREMISES Ea occurrence S LIMITS OF POLICY XS MEO EXP(Arty one person) g EXCLUDED OF SIR:Saul PER OCC PERSONAL&ADV WJURY S 9,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 9,000,000 PRO- ❑LOG PRODUCTS-COMPlOPAGG S POLICY❑ 9,0aa,aDD x JECT S OTHER: i B AU101,00BILE LIABILITY BAP 293886313 03!0112018 03101/2017 Ea aHc deptSINGLE LIMIT 1 Oa04UU tl X ANY AUTO SOMLY INJURY(Per person) 5 ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(PEs accident) 5 AUTOS AUTpS pROPERTYpAMAGI- NON-OWNED 5 HIRED AUTCS AUTOS - er accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LEAS CLAIMS-h1A0E AGGREGATE S 5 DED RETENTIONS C WORKERS COMPENSATION INC015519215{AOS} 0310112016 03f0#12017 X STATUTE ERER C AND EMPLOYERS'LIABILITr YIN WC0355#9217 AK,KY,tJH,NJ,V 03101!2016 03101!2017 1,ODD,400 ANY PROPRIETOWPARTNERIEXECUTIVE n N!A ( E.L.EACH ACCIDENT S D OFFIGERIMEMBER EXCLUDED? WC015519216(FL} 03!0112016 0370112017 E.L.DISEASE-EA EMPLOYE 5 1,DaD,0a0 (Mandatory In NH) It yes,describe undar Contnued on Additional Page E.L.CASEASE-POLICY LIMIT 5 1,000,000 r777 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Add€llonal Remarks Schedule,may be attached If more space is required] CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE %0DOSGOODST. THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee I Q 1988-2014 ACORD CORPORATION. All Tights reserved. ACORD 25 (2014101} The ACORD[Tame and logo are registered marks of ACORD �,Velllth of The COMMO Depurt,'"Ml of officc of investigQlians I Congress Suite.1 00 SO'- -4-2017 Boston, �14 02.11 WWw.1naYs.uovldia to rs[Eleetricians[V lumbers Insura_aee,A,ffidaYit: Builders/Coatrac Workers' Compenjatlon �prjnt�Lvgib�lv licantInifir"MatJ011,11 ,ssjor;anizationfl idi am Addres3� N f 5 -Phone 9: City/Stat�-/Zip: Type of project(required); y,,Ian employer" Check the ropr ate box: Ara4. p5 1 5. M N construction am a pneral contractor and I 1.Ej I 33n a employer with ha re hjvA the sub-contractors 7. [2'R' emodeLinCg, employees{full.and/or part-time),* listed on the attached sheet D I am a sole proprietor or partner- These sub-contractors have Demolition ship and have 110 employees employees and have wo&er3' 9, Building addition ,orlon; for me in any capacity. romp. 10❑Electrical repairs Or additions DTO W0.6-e-Ts, comp, haslrmce We are a corporation and its required-] officers have exercised their 11.0 Plumbing repairs or additions er doing all w0rl{ right of exomptioU per IVIGL 12.0 R0, T 3,FI I am I h0TneQ'vru c. 1-52, 91(4),and we have no 13. Other .L-io workers, COMP. x0a- izsizaace required_] t employees, DI 0 worlc-213' corop, in3uyance;rrquired-I eLT Workers,compellsatioll Policy iI)fQEMRLion, at the,__c�on,�ejo%�ho ng affidavit indicaLing 3uch- _r"Ist]ISO fill o 3, doin,all VvOr'k a -hat�beckS b(yk 41 and thea hire 0,1mide cory=tm must subalit a n OA,17 applj,-anz L jC3613g"= t those�,Iltities have ittis ifficixiit indicating of-hr er�who-,ubm ,sub-contractors and�tat�whrthrr or no t 14om own an additional 3be.-t showing the 13ame policy aumbu. must attached is box lcoarmclors that chodr th cy mast provide their workers'coma. actors hav-,zraployt�ss,th employees. Below is the pylic} andjob site employees. If the sub-cDntr cefor my toyer t1tat is providing workers'comPallsafi"insurance an employer infonnation. Name' insurance ComPaILY Expiration Data: Policy 9 or Self-ins.Lie, 9: City/State)Z Job Site Address.*q-wdp (showino the policy numberexpiration date). 101, 1)01 PC sation policy declaration page Attach a copy of the workers' cow 25A of MOL 0, 152 can rad to the hriposidon of orhminal penalties of a Failure to scour;,-coverage as r, er Section quired and MI penalties in the form of a STOP WORK ORDER and a frie ff ae,up to$1,500,00 arid/or ane-year jMpri301ullellt, as Well 23 c this statement may be forwarded to the Office Of of up to X250.00 a day against the violatoT. Be advised that a copof y Investigations of the DU for inSIgzmce coverage verifIcatitIn provided above its true and correct of perjury th at(it e informatio n de lepains and penalties I do hereby c nde'I Date: Si Offielal use only. Do not write in this area, to be completed by city or town official Permit/Licenseg City or Tawe: issuing Authority(circle one)'. 1.Hoard of Health 'I,Buildiuc.,Department 3. GtYffown Clerk 4.Electrical inspector 5,Plumbing WPM" 6.other Phone k-.__ Coutact Person; DATE(MMlDD+YYYY) A R CERTIFICATE OF LIABILITY INSURANCE HE a2r,srzals AND THIS CERTIFICATE IS ISSUE£? AS A MATTER OF INFOAMEND, EXTEND CONFERS NO ALTER RIGHTS UPON T COVERAGE AFFORDEDCERTIFICATE THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT HOLDER. A CONTPJ�,C T BETWEEN THE ISSUING INSUP.�R(S►, AUTHORIZED OUG REPRESENTATIVE OR PRGDUCER,AND THE CERTIFICATE l€tifPORTANT: if the cert-s€icate holder is an ADDp{cOeNA aINS INSURED, an endorsement. A statement on thii9s)must be ando.Sad. s certificate Ad es not yconfer Drights tto subject the terms and conditions of the policy,certain p Y certificate holder in lieu of such endorsement(s). coNTACT NAME: 'I FAY PRODUCER PHDNE AEC NO: MARSH USA,INC TWO ALLIANCEANCE CENTER E-MAIDRESS: L 35601 ENOK ROAD,SUITE 2400 ADMAIC p,TLAh!TA,GA 30326 WSURER 5 AFFOROING COVERAGE "0387 INsuRER A:Steadfast Insurance Company 2-HameD OAVti'`-16-17 �1"0535 10049 INSURE" B:Zulich American Insurance Co INSURED23841 THD.AT-HOME SERVICES.INC. INSURER C.Nel7 Hampshire Ins Co DBA THE HOME DEPOT AT-HOME SERVICES 23817 2690 CUMBERLAND PARKINAY,SUITE 300 INSURER n:Illinois National Insurance Company ATLANTA,GA 30339 ENSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-14 REVISION NUMBER.9 THIS IS TO CEIRULIUY I!F 7HSTANDING�NYIREC REQUIREMENT. TER OR CONDITION OF ANY CONTRACCE LISTED Ei LOW HAVE BEEI� UED TOR OTHER DOCUMENT WITHE tNS TH RESPECT PO VJHICHT!Op INDICATED. NOTWITHSTANDINGBY THE CERTIFICATE MAY BE ISSUED OR MAY PQL�ClIES.LIMITS SHOWN MAY AFFORDED $�EN REDUCED BY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY EFF POLICY EXP LIMITS ADDL SUBR€ POLICY NUMBER MMIDDrrvvY c;1MfDDA�nI ` 9.000,000 !NSR TYPE OF INSURANCE IVSD WVD E f S LTR. IGL04287714-06 03!0112016 103101,2017 EACH occuRRENGE A X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED 5 1,0017,000 I pREMI5E5 rEa ocou encs EXCLUDED OLP.Ih.1S-MA.DE OCCUR LIMITS OF POLICY KS V.ED Exp(Any one person) 5 ''.. 9,000,000 OF SR:VM PER OCC I ` PERSONAL&ADV INJURY 5 9,000.000 GENERALAGGREGATE 5 GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS-CGMPfOP AGG 5 9,000,D00 I�, m.- i k PRO- rvLiG(i�, )ECT 07HER: 031 -12010 Iu3101i20t7 1 CEaaBE dent SINGLELn lr ; 1,000,000 ©AP 29„8363-13 3 AUTOiJOBiLc LIABILITY I BODILY INJURY{Per person} K ;,,141'AUTO j BODILY INJURY(Per BCment)I S ALL CWN'cD SCHEDULED SEL;iNSUREJ At11'J PHY DiviG 1 ,I PRDpERT'(DAMAGE I ALTOS AUTOS {Per accident) y i NON-0`P1!`EWD �I HkREO AUAUTOS I II i l I EACH OCCURRENCE 5 UMBRELLA LIAR OCCUR !1 AGGREGATE S EXCESS LIAR I CLAIMS-MADE S PER 0TH- DED RETENTION s NC015519215(AOS) 0310112010 0310112017 X sTAr 17E FR C f WORKERS COMPENSATION 5 0310112016 0310112017 1'000'000 AND EMPLOYERS'LIABILITY Y f N WC015519217(AK,KY.NH,NJ,!T� E.L-EACH ACCIDENT 5 C ANY PROPRIETORIPARTNERIEXEGUTIVE 03101J2017 1,D00,000 OFFICER+MEMBER EXCLUDED? � N!A WC015519216(FL) 03I0112Q1"v E.L.DISEASE-EA EMPLOYE 5 1,000,000 000 000 D (Mandatory in NH) E.L.DISEASE-POLICY LINIEr I S ,desc G DES ba under N OF OPERATIONS below E;OnilnUed On Additional Page DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD tai,Additional Remarks SGhedu(e,maybe attached if more space is required) EVIDENCE OF INSUF2ANCE CANCELLATION CERTIFICATE HOLDER FPACES ERVICES.INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CSADEPOT AT-HOME SERVICE" THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RY ROAD 339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjes ©1888-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD C/-L )I4' Q?11 �L' C YICCC!'GCC S — _ Office of Consumer Affairs and Business Regulation - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmprovemen.t-,Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 813(2018 THD AT HOME SERVICES, INC. '1 RICHARD FALLONE 2455 PACES FERRY ROAD, HSC G = ' ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address iJ Renewal 1 Employment Lost Card ,CAI {s 20NI-65"I —=' face of Consumer Affairs&Business Regulation License or registration valid for individual use only rJ before the expiration date. If found return to: t TOME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Business Regulation Registratiofs 126893 Type; 10 Park Plaza-Suite 5170 J Expir �ian g�31 � Supplement Card Boston,MA 03116 THD AT HOME SERVECES INC THE HOME DEPOT AT kiOME S7.RVICES RICHARD FALLONE. 2455 PACES FERRY ROAD;HSC efidh t si afore AT'VANTX GA 30339 Undersecretary r: p Massachusetts -Department of Public Safety Board of Building Regulations and Standards Canitruation Supervisor License: C5-071077 CHARLES J hIIN � 25 Spaulding Rd Sfe t s Fremont NH 03044 ` 1 Julsq t Expiration Commissioner 07/25/2017 ir