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HomeMy WebLinkAboutBuilding Permit # 3/2/2017 4 I R' N BUILDING PERMIT TOWN OF NORTH ,ANDOVERzb a `� r- - APPLICATION FOR PLAN EXAMINATION Permit Ido#: l Daae Received �r� HCHU Date Issued: ' ORTANT:Applicant must complete all items on tbis a e ( OCATI PROPRRTY OWNRR T _. flnv, (off Year Structure YgG Q MAP _ PARCEL _ION! ®]STRICT Hcsortc ®cstr[ct' ye=s no . MacYi .e,Shap lf[llage _yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition ❑Two or more fancily ❑ Industrial ❑Alteration No. of units: ❑ Commercial _ ❑Repair, replacement D Assessory Bldg Others: I1 Demolition ❑ ager �� 11llaters[�etl Q[strcct, D Septic, V11e[] ri l=loo'. an 1�11Vetl N' :. w_ . Water/Se_werr,_m:--- _ - -- _`__ :�.. T:w.. r._�.� _ . .... ---•-- ..._._ ° -. - - - - - - DESCRIPTION OF WORK TO DE PERFORMED: B �cle�ntificatioxt Please Type or Print Clearly OVVNER: Name: ® U 4 Phone: 17-� �� �0�6 Address: � ;wood Ac/C Peter Lebla.nc:. Confir-actcir Name: _ Phane . q wk x r Dae �i 5upervior's Gorisfrucfiion LtceRset } -E I - �D�7�-.G . ..----- Homelmprov�menf ARGHITECT/ENGINEE.R. Phone. Address: Reg. Na FES'SCHEDULE_BULDINO PERMIT:$12.00 PEf2$1000,00 OFTHE TOTAL ESTIMATED COST BASED ON$120',00 PFH S F. [ _Jotal Project Oast: $ ® ® _ Cl o FEE: $ Check No.: Receipt ND„: - NOTE: persons contr aeting with unregistered contractors do not fyve: ccess to the guarantyfund p,% Ty " Town of Andover . ® 0 1 kh ver, Mass, • C4CNfC faE wrcfK 01. V S U BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT .,........ ,..... BUILDING INSPECTOR has permission to erect .. Foundation p ..................,,...... buildings on ....... .. ...... . ... .. ......,.... � Rough to be occupied as ......AA&......S ��.�..�.............. 1.rrlr........�.�..�� .� 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 E I IN 6 MONTHSELECTRICAL INSPECTOR UNLESS T Rough �. Service ........... .... .. .................. Final BUILDING INSPECTOR GAS INSPECTOR CCuRaney Permit Rfluired to 0ecygy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Y1I No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Federal ID fit 05-0406629 °3 RI Contractor Registration No 61f16 r1 " t A Cortlt°°actor Registration talo 126979 vw„ � ivawinan of"t"hhlaah t;lf CtnLnrfrn x CT contractor Registration No 620120 [:PtlC�pNIwIwFIINCi" 139- 1 '„ CONTRACT / aw ouunt, altton,h, ! VAX 339.502-6345 Page "I PROGRAM Tnlss CONTRACT IS ENTERED INTO BETWEEN RISE CIS"IA-111'iS CROINEt'IINIT Alto fill-CUSTOMER FOR WORK AS DESCRIBED SELOW CnslolAr.111 PHONE, DATE CLIENT S WORK ORDER Jealme Dollcrvan (617)240-2086 11/20/2015 405510 0000/1 SERVICE STREET ...._.....,......_._._._._ ......... .__,.,..._,._....__.___...._.._......_._. If11.U@RCI .... ....._,_ ...,.,__......,___ .......,__.,.......__ ,._..._...... __...._..,......., STREET 51 Brigh"vood Avenue 51 Brighttvood Avenue SERVICE CITY,STATE,ZIP EILLINea CITY,STATE,ZIfi North Andover, MA 018115 Noilh Andover, MA 0 1845 JOB DESCRIPTION Af11 SCsAt.iNG:I'rovi1lD labor Baal rnaterfals la) ,it arc,as of"your(tome against wwastellal,excess air leakage. This worts;will be performed in CONCC,11 With the use of sp)MIll look and diagnostic tests to assure that your home will be left with It healthful level of air exchmfi ge nand indoor all-quality.Materials to he used to scaal your holne call include Caulks,lburnts and other pmducis. Primary areas for senlhq,include air leakage to allies,hasenrents,attached garliges and other unhealed areas(windows Ian;not generally addressed.) This will require(S)working hours. A reduction in cubic feet per minae(,cfm)of air inlillrNlioR will occur,hill lite sfctual ml11nl)Cr or Crm is not guaraotced. At the completion ofllrc wealherization work,and at no addttomll cost to lite holncoNviler,a 1111111 blower door and/or combustion safely analysis will be conducted by the sift)-Contractor to ensure Ile°safely of"tie indoor air quakily. $6110.01) y, ( ) �� A"C"fIC,,,t 1..A"I":provide Iabnr atrrd malcriais to itmslall'MI Bal Lr rtf R•512 C'las.a 1 C'Ltulosc atldCd to 61'2 square fCel ofOpel m ttlliu space. Sl,p)15.21) A"I"HC,ACCESS:Provide labor and materials to insulate lite track ol`(1)attic hatch with 2"rigid"I'ltermax board.�Wcatherstrip)life perimeter. $60.00 V1sNl)l A'1"OP7 f'rowiele itubor orad materials tv iRslalll(t)irPsadmtcd axhmtrsl hose Tvptdr rcr<af ofourttecf tlrfppatr vont to n.xhrfust cxisllRg �� " bulhroolu Hants). 118./5 71171071CMI"provi ialabor and Ruaterituls to instal vcatiltttieon clatrtcs,irT(1#t)rafter hayc to maintain air flow. $156.00 I3AS1,CvptaJ'p"( l:;,IL,INCi 1'ra>vidc ka1)or and materials to ilasitdl(10,#)linear petit of"fit-1)untituca�l fiber la�sw insulation to the perimeter ofttc bascolcr)t ceifing at the house,sill. $182.00 OVI MANC;:Provide labor and materials to install(160)square fuel of 3.5"R-13 kraft faced fiberglass phis l"rigid polyisocyanu ate board insulniiorm to arr exterior ovetrmnging Itcaof. All scams will be scaled, $526.40 lt1Sl�:l ngfrrcerfng will apply fall applicable,eligible itrc ntives to lit is Contract. You will only be billed lite Net amount. Currently,torr cligible rncat.snus,C ohofnbia Otis a)ifirs 15591"incentive,not to exceed$2,000 per calendar year„and tin incentive of 100194"for the Air Sealing mcaesures atm to file first$680 mad tar additional$:310 if"savings are justf Pied fly the auditor. For rte sati ty and lfcalth ol'your homes indoor air quality,we will be conducting a blower door diagnostic of the available air plow fru your home boat before tine work is begun,and alter tete weatheriratiort work is complete.We will also conduct a full assessment orthe caornbustnn Safety of your Incating,System and water hentcr.'I"hfs has 11 value of.SOI)and is at mo cost to you, Total allowable weallrcrizlrtion incentive is$3,110. Federal irk#05^0406629 ISE Engineering `� �' ; RI Contractor Registration Pier 6106 SNA Contractor Registration No 120979 RISE A division Nf't'hicIsch Engineering CT Contractor RSgistraflon No 620120 ENGINEERING' Fro Shapmmil,Carlton,NIA 02021 A 339-502-5197 FAX 339-602-6345 Page 2 1'ROORANI TRIGS CONTRACTIS ENTERED ROD BETWEEN RISE CMA-11ES ENGINECRINO AND THE CUST00KER FOR WORK AS DESCRIDED BELOW CUSTOMER PHONE DATE CL.IENTA WORK ORDER ,eantTC 1:)I,mlovan (617)24()-2086 11/20/2015 405510 00004 SERVICE STR x UNN.LINGd STREET 51 Brightt oud Avenue 51 1;right vood Avenue SERVICE MY,STATE,ZIP 01110M CITY,STATE:,GNP Orth Andover, MA 01545 North AtTdover,MA 01845 JOB DESCRIPTION Total: $2,8139.35 Program Incentive: $2,3513.76 Customer'rote1: $529.59 WE AGREE HERT °TY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE NTH ABOVE SPECIFICATIONS,FOR THE SUCH OF k"F'I a Hundred Twenty-Nine&69/'11D11Dollars $629.59 UPC N HI Rc6�:`USPrC`HON AND APPROVAL RY RISE ENGINEERING,CU+S'I'41Pu E'll AGREES TO N�NOVOt AMOUNT DUE IN FULL.INTEREST OF 1%WILL RF CHARGED tldPCJ HHLY ON ANY uNPAID ALA CE AFTER 0 DAYS,SEE REVEMSE FOR � 'COT@ RECAST RATION _ _ H TNN"CT&CTAN'Y TNRN'C,N1CkuC,A'T'a00d CTN Oglda.(i/OMITEES Itk{aHTS Or RELISICTN SCkIFoONYt.C1.E0 AaAdCA COSCYYkAC CTO NOTSIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUT'H' TG O S v1P8nx RCr.w RISC EalgygTSdsaFYGrYgJ C.U3T Tk AC'CEP I' C qti NOT EXECON10 WITHIN DAT"E OP ACCEP..,.,._�..._ NOTE:YNINS COPpxNa�AC'T MAY BE YdIT'Nit7RAYWN BY ta'�S la" � xAPVCE ,.,.,.._.....,. _.__... ..... ._.._...._.._..... ._..................... _......,. .. _....., ACCEPTANCE OF CONTRAC'T-IN IE ABOVE PRICER,SPECIFICATIONS AND CONOHIONS ARE 30a'YAYS, SATISFACTORYTOUSAtWDANTEIiFrtERYACCEPx'E'D.YOUAREAIJYHOI'U,L,EOTODOTHEIVORNC AS SPECIP'llel>,PAYMtNT 4411.1-TTIi ILADE AS OtJ'TUt,4ED AROVE OWNER AUTHORIZATION Jeaiine Donovan (Owner's Narne) owner of the property located at 51.. Bri.ghtwood Ave, North Axidover, Mtn 01 845 (Property Address) 51 Bright:vrood Ave, North Andover, MA 01845 (Properly,address) hereby authorize.- C, ��W���m _���V C to, i� (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform worm on my property. Owner's i .., r w..,,,... .......... , a„ Date I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly INSULATIONPOLAR BEAR Name(Business/Organization/Individual): PO BOX 958 ANDOVER,MA 01$10 Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with (�7 4• ❑ I am a general contractor and I 6 F1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have $• ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp, insurance. requited.] S. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. (No workers' comp. right of exemption per MGL 12,❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 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. 3Contractors 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 ain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: V til :M v r° 6-0 MP� t Policy#or Self-ins.Lic.#:_?}WO P0 t*p C Expiration Date: 4Y r k,,; .2a►�' Job Site Address: hf,51ALIAod L City/State/Zip:-f 11 Qd'�✓r 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 underenaldes ofperjury that the hiformation provided above is true and correct. the Dins andp Signature: Date: Phone#: q?5--- `f off" P63 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): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACR®� CERTIFICATE LIABILITY INSURANCE DATE(MNUDD/YYYY} s/zo�zal6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO HIG14TS 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 poiioy(iea)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 LNOAMNTACT Linda Hogdanooricz Insurance Solutions Corporation PHONE (603)382-4600 FAQ Na.(603)382..2034 60 Westville Rd -MAIL 1indab@isc--insurance.corn ADDRess: INSURERS AFFORDING COVERAGE NAIC# Plaistow H'8 03865 INSURER A Hestern World INSURED INSURER B Nautilus Insurance Chou Polar Sear Insulation Company Ino INSURERC: PO Box 958 INSURER D: INSURER E Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632326134 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 13E 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. ILSR ADD 5 POLICY EFF POLICY EXP LIMITS 7YPf:6p INSURANCE POLICY NUMBER i M M1M Y MMA)DNYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 10OCCUR DAMAGETORENTEO 100 000 PREMISES Ea as Ir n. S , "PP8274967 3/28/2016 3/24/2017 MEDeKP(A"Y0Ae rson) S 5,000 PERSONAL&ADV INJURY 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 S POLICY❑SECT LOG PRODUCTS-COMPlOPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NUTOS ON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS WaraccldenE S g UMBRELLA LIA0 OCCUR EACH OCCURRENCE S 1 000 000 B EXCESS LIAB i CLAIMS-MADE AGGREGATE S 11000,000 DED I I RETENTIONS IAN026107 3/2412D16 3/24/2017 $ WORKERS COMPENSATION PEA RT, ETH AND EMPLOYERS'LIABILITY ANY PROPRIETOMPARTNEWEXECUTIVE YEN E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-E4 EMPLOYE $ It yes.describe under DESCRIPTION OF OPERATIONS heSow E,L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additlanal R4marks Schedule,maybe attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIC15S BE CANCELLED BEFORE 'own Of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, ,Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01645 AUTHORI'XEA REPRESENTATIVE Keith Maglia/SJA ©1988-2014 ACORD CORPORATION. All rights reservers. I ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I I INS02519014ot1 3 3 I 1/3/2017 Insurance Services ACCPR" CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDDIYYYY) 0110312017 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 UORTACT NAME: PHONE FAX Automatic Data Processing Insurance Agency,Inc. Arc.No.EXI: Arc,No): 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAIC p INSURER A: NorGUARO Insurance Company 31470 INSURED INSURER B: '.. POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 Andover,MA 01810 INSURER D. INSURER E: INSURPR 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. P-VULLTR INSR TYPE OF INSURANCE IN5D wVD POLICY NUMBER MWDDmYY MJDOIYWY POLICY EFF LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE F-1 OCCUR PREMISES Ea occuirenca S MED EXP(Anyone person) 5 PERSONAL&ADV INJURY S GEM-AGGREGATE LIMIT APPUES PER; GENERAL AGGREGATE S POLICY ❑JECT PRO- F]LOC PRODUCTS•COMPiOR AGG 's S OTHER: COMBINED bINU1FMrF-- AUTOMOBILE LIABILITY (Ea accidenll S ANYAUTO BODILY INJURY(Per person) S ALL ONINED SCHEDULED BODILY INJURY(Per m6denll S AUTOS AUTOS NON-OWNEO {Per PROPER'ni IANIAGL S HIRED AUTOS AUTOS - 5 UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMShcADE AGGREGATE $ DEO I I RETENTIONS S WORKERS COMPENSATION 2U STATUTE_ I 1 ER _ AND EMPLOYERS'LIABILiTY _ ANY PROPRIFTORPARTNEREXECUTIVE YIN E.L.EACH ACCIDENT S 1,000,000 A OFFICERIMY❑EMBEREXCLUDED? NIA N POWC840361 01/0112017 011011201a 1,000,000 {Mandatory In NH) E.L.OISFASE-EA EMPLOYEE 5 4 yes,describa under1,000,000 DESCRIPTION OF OPERATIONStldat: E.L.UISEA5E-POUCYLIMIT 5 DESCRIPTION OF OPERATIONS 7 LOCATIONS I VEHICLES(ACORD 101,Additional Romoks Schedule,may be attachad if more spars Is squired) Contractor License:CSL 108017 HIC 102726 u V CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main at North Andover,MA 01845 AUTHORIZED REPRESENTATIVE AO 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and lags are registered marks of ACORD https:lladpia.adp.conVISExternal/app/index.html?clieiitid=2037315&regktestFrom=mn#/home 111 10 . Office of Consumer Affairs and Business Relation wu j.. 10 Park Plaza- Suite 5170 Boston, Massachusetts 0'2I16 .Home improvement Contractor Re n=ation Registration_ 102726 Type: DBA Expiration_ 71212018 T* 419291 POLAR BEAR INSULATION GO, Vincent LeBlanc P.O. SOX 958 ANDOVER, IIIA 01810 Update Address and return card Mark raunn for ebange, 5CA t ti 20FsS-06l4t Address []Renewd ❑ Employment o Lost cord Jar�rr:��E1ur�»rrru/lf a�G%�f�rcrrfrfir�so�ls Mee or Consumer aids�c Susmess.Rpguloflon License d)3'rt glstrr:tiob valid forindividual mse only HOME IMPROVEME T CONTRACTOR be�iorethe expiration date. If found return to: q � Office of Consumer ifairs a:d $nsinesca a on�t 2 G ExptraUon: 71212018 DBA 10 ParkPl=a-Suite 5170 Boston,MA.OZ1.16 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO_CANAL ST_95A LAWRENCE,MA 01841 Undersecretary V rj;tz_alid without signature 1 ii � '?: '� •mac C-�:^ . :?' . .. ;"�`'f S4� ! ic; a^G, i3 .:� ;iF? .. � .i:;' •�c! L�, . S;r ;Oz'ci Z):'::C'_mLiSelg Regu..i-.—Woos c:71!:ltt'i€L=:?Ls5 Ce 8 106017 t. - PETER A LERLANC ,= 2 ii.ST PIS STREET Plaistow NH 03865 u ' 0 s !I 3'