Loading...
HomeMy WebLinkAboutBuilding Permit # 2/24/2017 BUILDING PERMIT ,�- TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION • ,,� �- oma,,�a =.�wKK Permit No#- x A Date Received �rysa��T p FPR mot CHUS Date Issue LV PORTANT:Applicant must complete all items on this page I°� ff � ._ _tc - _ r - _ - Pnnf - - PROPI-RTY ®WNER - Pnn# f X70 Year Sf ucfirere Yes rio i11fAP _ PARGEL w ZONfNG DISTRICT: H�s�fiar�tc`®�stnc� yes no IVlachtr�e.Si�op V�flage, Yes nc� TYKE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: [I Commercial ❑ Repair, replacement n Assessory Bldg ,Others: ❑Demolition ❑ Others ` " `µ- `' V11aershecl [ stric .. CJ 5eptie ❑ V1lell _ Flio`elpfain D 11Vetfands ,• - DESCRIPTION OF WORK TO DE PERFORMED: 7-J "C Zdentifica#.i.on- Please Type or Print Clearly- OVIINER: Name. a: Ifo r Phone: 5 X50 Address: Peter Leblanc7m- ARCHITECTIENGINEER 3`11' 0 ;' w x at6 r�cticiri LtceFse ? X, =LiceA RCHITECTIENGINEEIR Phone: Address: Reg, leo. FEE SCHEDULE:BULDING PE WIT.$-12F00 PER 1D40.QQ OTH�TOTRL ESTIIl�lA7ED CC7SI BASED ON$125.00 PER SA _, �fal Projeo-� Cost: $ � V. d FEE: ®-vv Check No.: ? Receipt No,- 5. �NOTE- Persons covet acting with, unregistered contractars do not ha e_ essjo the guaranfyfund .............................. ....... ........................ .......... ........... .......... .T t4ORT11 A?Vw -r®w o fAr% lidu v er ® h Ver, Mass, 2qe 2A11 '9' coc C^AL..: 0 ATE g) U BOARD OF HEALTH Food/Kitchen PER Septic System P Ce BUILDING INSPECTOR THIS CERTIFIES THAT ... ... .. ...... ............ . ............... T� — ............... ..... ... ...­­...... has permission to erect .......................... buildings on .....1. .....L.4....... ...led. ............. Foundation % Rough to be occupied as .....Al, r sea) 16 visul"Whools6". • %J �.�'�°��,�,,.. Chimney "Itt'a"ll in every respect co provided that the person accepting this per orm 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 CONSTPION Rough Service .....411 ......P. Final BUILDING IN ECT GAS INSPECTOR Occupancy Permit REquired to Occupy Bu 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. .......... Federal ID#05.0405529 RISE Engineering RI Contractor Registration No 0100 /. MA Contractor Registration No 120970 CT Contractor Registration No RISE60 Shawmut Road,Canton,MA ENGINEERING' CONTRACT 339-502-6335 FAX 33'0-502-6345 ...... .. Page 1 PROGRAM THIS CONTRACT IS CMERED INTO BETWEEN RISE j ('M A-HES ENGINEERING AND ME CUSTOMER FOR WORK AS OCSCIUSEO BELOW CUSTOMER ._. -..... . -- "a 1 PHONE DAY CLIENT# WORKOROER Craig Dccosta :k (508)450-5133 02/02/2017 439570 350014 SERVICE STREET ..... .. .... BILLING STREET I I little:Road I I Little Road SERVICE CITY"STATE,ZIP WILLING CITY,STATE,ZIP North Andover,MA 01845 ";a North Andover, MA 018'5 JOB DESCRIPTION AIR SLAKING:Provide labor and nnrtcrials to scaal areas of your home against wasteful,excess air leakage. This work will be performed 55115.00 in colicert avith the use of special tools and diagnostic tests to assure that your honic will be left with to heahhful level of air excluuage and indoor air quality,materials to be used to seal your home can include caulks,tbams and Diller products. Primary areas for scaling include air leakage td attics,basements,intached garages and other unheated areas(windows are not generally addressed.,) This will acquire(7)avcrrkfrrg houna.A reduction in Cubic feet per minute(efnr)of air infiltration will occur,but the actual number of efin is not guaranteed. At the completion of the weatlnctizalion work,and;it no addilion l cost to the homeowner,it final blower door and/an Combustion safety analysis will be conducted by the Sill)-Cont melor to ensure the safety of the indoor air quality. AIR SFAHNQ Provide labor and materials to insudl Q-horn weatherstripping and a do orsweep to(2)doors)to restrict air leakage. $160.00 DAMMING:Provide labor and naaterials to install a 12"layer of I'(-38 unftced fiberglass bans to(28)square feel for damming purposes. S57A0 A"1"1'11 FLAT:Provide labor and materials to install an 8"layer of it,•28 Dass I Cell lose added tai(610)squllre tact of open,,attic space.. 5835.70 VENTILATION:Provide labor and inatexiais to install(i)insulated exhaust hose in existing bathroom r'an(s). $50.00 COMMON WALLS:Provide Tabor and materials to install blown in Glass I Cellulose u)(80)square feet of"4"common weal]through an 5148.00 interior surface drill and plug method. Plugs will lac spickled and jell in a relatively smoolli Condition.finish sanding and touch-tap priminWpainling will be the customer's responsibility.Iionicowrrer has received a Copy ofthe EVA's Renovate Right lead-Safe intilnnation guide explaining the potential risk Of the lead himard exposure from the weathcrizarlion work to be perlbrined.Your signature is your acknowedgernem ofreceipl and agreement to proceed. S"l'AIRIWLL t.;Provide labor ami materials ata install Class I Cellulose insulation to the sheetrock or plaster ceiling and/or walls afar $175.00 stairwell which are Common to treated space,through it surface drill and ping method. 1"Ire holes are plugged with styrlfioaun phlgs,and spickled to a rough finish. Any sanding and painting required are the customer's responsibility. I Iorneowner has received it Copy of the EPA's Renovate Right Lead-Salle information guide explaining the potential risk of floc lead hazard exposine fi-om the weatherimliou Work to be performed.Your signature is your acknowedgement of rcecipt and agreement to proceed. BASI;r".1"'(PN'T C'lat.NG:Provide labor and materials to install(89)linear feet of R-19 unf"aaced hiberglass insulation to the perimeter of S155.75 the basement ceiling at the house sill. GARAGE C'EILIN(h Provide labor and materials ua install 10"R-35 densely packed Class I Cellulose insulation to 162 square feet of S335.34 garage ceiling located below a heated floor area,by drilling holes in the ceiling from below. Holes drilled will be plugged. Plage will be speckled and lefl in a relatively smooth condition.fnnish sanding and touch-up hrrirraitrty'patinting will be the clistollm's responsibifity. I i 1 Fodoral ID#05.0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 t luE CT Contractor Registration No RISE60 Shawinat Road,(:Dnton,NIA F,NGInbFERINU CONTRACT C 339-502-6335 FAX 339-502•6345 Page 2 I'Ii(7GRAM TIUS CONTRACT 1$ENTERED INTO BETWEEN RISE (,AA-11ES EfJGINEERP40AND THE CUSTOMER Fort WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT WORK ORDER Craig Decosta (508)450-5133 02102/2017 139570 35001 SERVICE STRECT OILLING STREET I I Little Road 1 I Little ltoa(I SERVICE CITY,STATE,XIP BILLING CITY,STATE.,ZIP North Andover, NIA 01845 North ATtdover, NIA 01845 JOB DESCRIPTION IMF Engineering will apply all applicahlc,cliuible incentives to this contract. yott will only be billed the Net amount. Currently,for 590.00, eligible measures,Columbia Crag offers 75%incentive„not t0 exceed 52,000 per calendar year,and an incentive of 100'/4 for the Air Seahltg rrrcaellres t1t'P to tine tlrst Sfi81J anti atr ad{titit'nuil 5340 if sitvings aro Iustiticd by the urrJlhor. Vor tine sat'ety and health of your home's indoor air-quality,we will he Conducting it blower door diagnostic or'the available an flow in your lame both before the work is begun,and ufler the weatheriz ttion work Is cotnplete.We will also conduct a hill asseSsInent of the Combustion safety of your heating system and water heater.This hits it value of S90 and is al no Cost t0 you. Total;II10w,'Ible weather'iztuion incentive is 53,110, `total: $2,602.19 Program Incentive: $2,031.64 Customer"total: $570.55 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE BUM OF 'Five Hundred Seventy& 551100 Dollars $570.55 UPON FINAL INSPECTION AND APPROVAL BY RISC ENOWCERING.CUSTOMER AGRECS TO REMIT AMOUNT OUC IN FULL.INTEREST OF Pio WILL BE CHARGED MONT RLY ON ANY UNPAID BALANCE AFTER AS DAYS.SEE REVERSE FOR IMPORTANT fNFORMATION ON GUARANTEES.RIGHTS OF RECtStON,SCHEDULING.AND CONTRACTOR REGISTRATION. -SIGNED by Nathan WeissE-SIGNED by Craig Deco t AUTHORIZED SIGNATURE.RISE Enitineatina ...... CUSTOMER ACCEPTANCE Februar 02, 201 NOTE'.THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE .,........,._ ," ..,_. .„ ,..,.....___........ ACCEPTANCE OF CONTRACT FHE ABOVE PRICES,SPECIFICATIONS AND CONDRIOIJS ARE SATISFACTORY To US AND AfiE HERr:flY ACCI:PTCD.YOU ARE AIPTHORIZCO Fb Dtl THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OtPTLINED ABOVE ;f A° 60 Shawmut Load, Unit 2( Canton, ISA 02021 339-502-6335 R I S E ENGINEERING www.RISEeiigineering.com OWNER AUTHORIZATION Craig Decosta I, (Owner's Name) owner of the property located at: Litltle Road (Property Address) North Andover, MA 01845 (Pronorty Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. E-SI(GED by Graig Deco to Owner's Signature February bate The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600 Washington Street Boston,AM 02111 sv►vw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/1;lectricians/Plumbers Applicant Information 1Ti N Please Print Legibly Name (Business/Organization/Individual): PO BOX 958 ANDOVER,MA 01810 Address: City/State/Zip: Phone CT 6- 5/,?f- Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with_(�7 4• ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp, insurance.1 required.] 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 110 Other comp.insurance required.] *Any applicant that checks box 41 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 a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: z> S1 A td. a)n iv f A ?0 t Policy#or Self-ins.Lic.#: Paw, P"( 0 (p Expiration Date: d t + ad 4? ,lob Site Address: l he City/State/Zip: 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 for insurance coverage verification. I do Hereby certify under the pamandpenalties ofperjury that the information provided above is trite and correct Signature: Date: i / 23112 Phone#: Official use only. Do not write in Ibis area, to be completed by city or toturt official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 113/2017 Insurance Services CERTIFICATE OF LIABILITY INSURANCE DATEYYYi Qi 103=17 TH15 CERTIFICATE lS ISSUED A8 A MATTlwR 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 NAME: Automatic Data Processing Insurance Agency,Inc. NCNtio.EXI: Arc,No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAIC It INSURERA: NorGUARD Insurance company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURERC: PO BOX 958 Andover,MAGI 810 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 598370 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. AVULLTR POLICY EFF PULIUY PAP INSR TYPE Of INSURANCE INSD MND KI POLICY NUMBER MMIDD1YYYY MIDDIYYYY LIMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ CLAIMS-MADE �OCCUR PREMISES(Ea occunenw) S HED EXP(Any one arson) 5 PERSONAL&ADV INJURY 5 GEHL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 POLICY❑PRO-JECT F—]LOC PRODUCTS-COMP;OP AGG S OTHER. $ AUTOMOBILE LIABILITY (Ea mcidentl S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Poe=Idem) S AUTOS AUTOS NON-OWNED PROPERFYVARAGEg HIRED AUTOS AUTOS (Pex accident S UMBRELLALIAa OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S .ED RETENTIONS 5 WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOPWARTNEFUEXECUTIVE YIN E.L.EACH ACCIDENT S 1,000,000 A OFFICERAiEMBEREXCLUDED? Y❑NIA N POWC840361 01/01/2017 01/0112018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE, $ 1,000,000 If yCs,descdbo under OESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 1a1,Additional Remarks Schedule,may be attached if Moro spare is required) Contractor License:CSL 106017 HIC 102726 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main st North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved, ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD https:lladpia.adp.comlISExtertial/appiiiidex.htnn?clientid=2037315&teques(From=ntnitlhome 111 ��®0 DATE(MMIDDJYYYY) CERTIFICATE OF LIABILITY INSURANCE F6/30/2016 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. It 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 endorsemen s. PRODUCER CAMNeACT Linda BOgdanowicz insurance Solutions Corporation PHONE (603)382-4600 No.(603)382-2034 60 Westville Rd E-MAIL ADDRESS:liadab@isc-insurance.cnm INSURERS AFFORDING COVERAGE NAIC 0 Plaistow NH 03865 MSURCRA HOS6ern World INSURED tNSURER B-Nautilus Insurance Group Polar Bear Insulation Company Inc INSUAERC. PO Sox 958 INSURER D; INSURER E Andover MA 01810 1 INSURER F, COVERAGES CERTIFICATE NUMBER-CLI632326134 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, INSR TYPE OF INSURANCE ADA SUER POLICY NUMBER MPOM/LICYDDI EFF POLICY YXYP L7 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE F OCCUR PFIIAMISES 100 000 P E ISIS Ea occ rrence $ + NPP8274967 3/24/2016 3/24/2017 MEO EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 K POLICY PET LOC PRODUCTS-COMPIOPAGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea axWmnt ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(For accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS eraccfdent S )[ UMBRELLA LIA9 OCCUR EACH OCCURRENCE S 1 000 000 $ EXCESS LIAR CLAIM&MADE AGGREGATE $ 1,000,000 DEO I RETENTIONS AN026107 3/24/2016 3/24/2017 S WORKERS COMPENSATION PER OTN- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOY $ If yes,describe under DESCRIPTION OF OPERATIONS tlefow I EL_DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHIGLES(ACORD 101,Addltlonal Remarks Schedule,may 6e attached It more apace Is required) CERTIFICATE=HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRItS90 POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Sire 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, HA 01845 AUTHORIZED REPAESFNTATIVE Keith Maglia/SSA --T e01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered rnarks of ACORD IN S025 r�a�ent3 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration ReWstration: 102726 Type: DI3A Expiration: 71212018 Tor 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX 95$ ANDOVER, MA 01$10 Update Address and return card.Mork reason for change SCA 1 0 20M-001 [�Address []Renewal [] Employment ❑ Lost Card f,� r�fc�rr+nrvcnirrr+rrrll�of�'f�rrt;ar�rrtcffS ornee or consumer Affairs&Buibess Wg Iaiion License or registration valid for individual use only to HOME IMPROVEMENT CONTRACTOR before the expiration nate. If found return to: Registration. 10272& Type: Office of Consumer Affairs and Susmess Regnlnlzon ` Expiration. 7/212018 DBA 10 Park Plaza-Suite 5170 5-f A Boston,MA 023.16 POLAR BEAR INSLlLATON CO. Vincent LeBlanc 5180.CANAL ST.:5A LAWRENCE,MA 01841 {indersecreE rrs Not valid without signature iitaSSaO'nL;S±'i5 -'.1.+37=•; r!C- C 3E 0vi 0'=ii.liiCif,ICl R,E.'gU aw01a --.Ind 5ndElydS CSSLA06017 PETER A LEBLANC 2 EASTTc'M STREET Plaistow NH 03865 Cr";s8P.Un 04128120/8