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HomeMy WebLinkAboutBuilding Permit # 2/23/2017 ---------- BUILDING PERMITTAORT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION C", Permit No#: 7 Date Received ED Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION -3 Print PROPERTY OWNER Prlt 100 Year Structure yes MAP PARCEL: ZONING DISTRICT:— Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residjontial Non- Residential Li New Building One family Cl clition [I Two or more family E) Industrial A' lterationNo. of units: n Commercial ........... Li Repair, replacement 11 Assessory Bldg 11 Others: El Demolition 1.1 Other g// DESCRIPTI�N 0 WORK TO BE PERFORMED: -JX—f- Identification- Please Type or Print Clearly q OWNER: Name- w Phone: Ly -j- Address:' ' '1 Contractor Name: r, Phone: r Email: j'r\.��JU& - Address. 20 03Y 3�f Supervisor's Construction License: (:)7- —Exp. Date:' Home Improvement License: Exp. Date- ARCHITECT/ENGINEER 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: $ — FEE: $ Check No.: .11;��,, Receipt No.: NOTE: Persons contracting within unregistered contractors do not have access to the guarantyfiend i2l, 3? t ORTH -9 ii own old"osAnd0ver ` '* 0 NoA. LAKE h ♦ er' Mass, COC NtC N$WIC K S U BOARD OF HEALTH Food/Kitchen PEmMIT T %,f LD r Septic System THIS CERTIFIES THAT ............. ,. �..�. .....,.... ,� , .,......... BUILDING INSPECTOR .... ... .... .. . . An 2h, Foundation has permission to erect .......................... buildings on ....,...... v............................. .1 .......... .,.,...... .AlA 1 1 , Rough t0l?e occupied as ......... ....., ................ ....,....,.,...................................,... .......... 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 T ELECTRICAL INSPECTOR LT T Rough Service BUIL,©ING INSPECTOR Final GAS INSPECTOR ecu aucv Permit.Required t® Qccupy Builcliu 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. A rwaral 10 9 05-0405629 RM Emg1ficering r'zI Contractor Registration Jau a ja6 MA Contractor 11091,;trzitlaii No 1 0979 CT Contractor Regbitration No 620120 (,JtII1nll,\l,1 1121121 ENCANEERING' 97CONTRACT F+,"331)`-5112-6345 Page PR W;R"Vid THS CO ORACT IS EUTEllfil)J?jVOLjEjV,,Er .jj HIIjE I I Ls E,:f;'N-URIIX mv ME PESCRIFIED BELOW CMto MER pliONE DAU CL€ENTn WORK oputit I'teven Dickey 1978)08.5-1247 U I 601;2u 1744458 Y 296 2 SERVICE StACt:1 MUM 5741FIJ 37 Waveriq Road 37 Wavo-ley SKIMP CITY.47AVE.7AJI UILUNG cm,rrATFZIp North Andover. MA 01845 North Andover. NIA 01344 i JOB DESCRII-1,140N, [AIR,SFA�IANRii:Prol,idv labor I-IIII(I to seal vrciu 3Nkinst\-sidill. iir 1,.tkage, I lli�.Avork mill lie Iierlilrtued in emmri%%iffl the me of itiveiat it iok and dim-m lo,tssurc Olaf vourlwolt:Itill he tell%%ith I he.11111fill fecal of `:Neflanl"alit ;"T LIMIli"r Material,it-,be jj,:d to s';al N out boale Can ilich, foams and othor productN. Vrim.ir% arv-s fillf 5e�tlijlg jacItideuir lvalia."e it)auk':,bit, SCM01s.Ilituelled gltrave�and other jIjjbk:�I(e(j areas j%Njnjlj)%Vs ijry lot scilwalk. I Tvtlktire 1-1)working hours,A(�tjjsctjotj ill e4k Jiu per nlinklW lcfijl1 k1fair 1511611Tmitill will Mtll�bill 11w oettlal munber(11'Clirl 1.%11(11 IwarameedL 111t;Completion III'tile%veaIlIksI'j)!jjj(Ijj murk,and;]I III)adtli0olud i:i),,t to the holuvowncr,;i Imal 1110%Wr 41001 9jjj&'JIr Ct)I)jjjjj% -contractor it)emUre tile,aktv ofilic indcur air quawy% ,afctl anak sis Ivill IIQ mllducwd 1-the mth Iijill 170.00 AM Sl-iALIN(k llro�jkjt:labor olki tilatcrials(o ilwAl t�-loll VII-N'l RAI ION':I1jt,%,jkjc lalloi and n1mc[ijils 1u c0aust 11"'C'LNjlll kull tllouw"f 11appel%Olt to c0au'l exiNtm, clwfiQ doiltv-; BASI-'.1%lI1'\`f-DOOR:NOVidt!l;d?0(Mk(J materials is illst'I'litu the b3d.(if f1w Nvivilletit door Icadim,ul the- d with H ,id boad ill R-10(IF t!rv:IfCT with the ruitlited Hire raiinp that illei k±llte sections and wmn,;%viiii FIK jljp�,. seafall Federal ID t)05.0405629 RISE Engineeeiitl; Rl Contractor Registration No 8186 NIA Contractor Registration No 120979 CT Conlrl:ctor Rer3istratinn No 620120 RISE GO ShalV411111 Hund.(At 11oll,NIA 1121121 ENGINEERING' CONTRACT 339.;14.2,-51')7 FAX 339-5112-6344 Page x THS CONTRACT 16 ENTERED INTO€3MUEEN RISE tt NIA-1 l ES ENGINFERINO AND THE CWTOMS R FOR WORK AS 0ESCRIBEDf3ELQW C1270VER PTEtl!:L DATE CLIBIA c V€ORK ORDER Steven Dickey (979)695-1247 01f30/2017 444587 28602 SERVICE SfKt:r r BILLING*lAckT 37 Waverley Road 37 Waverley Road SLIMCE MY.STATE,ZIP UILIANG CITY,STATE,ZIP Nortit A4ldover, yJA 01845 North Al](10ver, i111A 01845 JOB DESCRIPTION RISE J:€1'tlinecting Mil apply:111 applicnhle.vfli!ihlc iilufl it ec Gl thk cunlract- You tIitl ouk be hilt;'ShC N'C1 aNti1ll11t C urf'Illk lilr uligihle nlcastiri.s.Columbia Uis o lies 75',',"I ineenlim not to excced`2,1100 per cglendat\ear,and an ince live PI lijim fUi the Air SL'.€li11g nwasoro tip to tate firs :oNfl attif nn alldi131Uial S40 it titlt'n wq arc pislified 111-till'atHii Lot. For thL'SIYICI\'and flCatlii of YULIr hE>p1C,+UkrlUllr 111i'111€ahl%',\5e will hl7 ti01111UCt711!».I hlo%wr€oor di1Nwastic€>l'Il€c ilYailable air Now ill vottr lionit`.both heft rc IN 5511111 is he"Un,alld after the xealliclizatiun 1%of1L is Complete.We%%ill ako Colijil 1 if 44111 fltitit5alEkl'Iq iii the c(lil hustioll-ioru)llI Soul :€nil 1i LUtr lieaivy. I Itis has a value oi'Sk)U anll 11 UI Itp cost to Nou, '. l lic h:nnil wifJ fIt yt i:Ufil1 t1Vthe it sol tl hill contrac(or. I hi,has it valite of S75 and isat no l mei to\'(ell.It i\EliC 4€tiUt lstl[ICF> rc.Ixu€.Ibilih'co close not IIHE>permit IT} c<gwic'tn€ 11 it n11;ni.:ifloii1s iii ifl ,mtpfciiun ll1 this v,ori,. f 0dl;4i1t11T:1l,le 1YCUlIECFi7inliliE iiieim iYe IN S3,13?. :>16i.t11] Total: $755.00 Program Incentive: $690.00 Customer Total: $66.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACC)ROAtlCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'Sixty-Five&001100 Dollars $66.00 UPON t'1A1.€!;FECTION AND APPROVAL BY RISE ENOIYEERING,CU131OVER AGRErFl TO M?,!IT AMCU!IT OUE 1.4 FULL.I!1TERF.ST OF 1"i Vill r_I:i•CHhRGiR}.!O!lTFILY Oe.A`1Y UHpRi €tA1.:11NCE Ar TEU]h BAYS.SL'E REVERSE FOR 1:!PDRTAr1T INFORrdATION ON GVARAr47EE5,RIG)ITS OP RECISION,SCIIEDUEtr1O.A>l0 CO!dTiTACTOR REGISTRATION, AUTHOR SIGNATURi- SE E-.UMtOiwj CUSTO.','.Elt hGCF,PTArtC1t J" f/' // NOTE;THIS CONTRACT MAY Dr,1 fi fflAMN UY US IF HOT t4XrCuftn Vinu€N DA1E OF ACCEPTAUCC ACCEPTACCE OP(.('.JPAGT-THE AM V9 PRICES,SPECiF=-nC!,S AND CO`1171110;-$AB: 30 DAYS. SATISFACTORY TO US AND ARF.HEREBY ACCEPTED,YOU ARE AUT4I0SIZED TO DO THE WORK AS SPECIFIED.PAYMENT\PILL BE r,1ADE At$OUTLINED AfiOVE I RISE 60 Sh�� ut toad, Unit 2 � Canton, MA 020211339-502-6335 awn [Nt.tlN[ERINC " www.d' + f�: raftinn¢a�'i�°ac.aorra OWNER AUTHORIZATION (Owner's Nan-te) owner of the property located at. I (Proper.ty Address) �MJ 4J (Property Address) hereby rautl7 Briar t (' %V '(Subcontractor) _ an authorized subcontractor for MSE Engineering, to act on my behalf to obtain a building permit and to perforrn work on my property. This form is only valid with) a signed contract. Ther(permit will be secured by the insaalatpon contractor, at no additional cost. It is the homeowner's responsibility to close Out this permit by contacting their municipality at the completion of this vroOk. ' o' C3 nor s �+gnature Date ra.2oar> The Commonwealth of Massachusetts Department of Xndustrid Accidents W Q,Bice of Investigations 1 Congress Street,Suite 100 r Boston,MA 02114-2017 www.mass.gov1d& Workers' Compensation Insurance Affidavit: Builders/Contractors/Blectricians/PluL rb rs u� a tion � se n Name (Business/Organization4ndividual): Address: BOX _34W C1 f State/2 111+iI1 �1 Phone . Are You an employer Check the appropriate box: Type of project(required): 1.Ef I atn a employer with_q_ 4• ® 1 am a general contractor and I 6, ®New construction employees (full and/or part-time).' have hired the sub-contractors 7. Remodeling 2.3 I am a sole proprietor or partner- listed on the attached sheet. These sub-contractors have g, ®Demolition ship and have noemployees capacity, employees and have workers' 9. 13 Building addition working for nae trin any capcomp.insurance% (No workers' comp. insurance 5 [3 We are a corporation and its lo.[]Electrical repairs or additions required.] officers have exercised their 11.[3 Plumbing repairs or additions 3. I am a homeowner doing all work n right of exemption per MGL 12.[]Roof repairs myself, bio workers' comp. c. 152, §1(4),and we have no insurance required.] t 13.[3 Other employees. [No workers' comp,insurance re-"'red.] 'Any applicantthat checks 6nx#1 must also drH�tou th a section t giaollrwork and hen hire owing their a outside contzactors must submit a new affldavit indicating such. t Homeowners who submit this affidavit g eY am showin $Cpntractars that check this box must attached an additional shrov de tiaeirtworhe ka s'corx►p e of the gPaii Y number.and state whether ar not those entities have employees. If the sub-contractors have employees,they must p insurance for my employees. Below is the policy and fob site I ane an employer that is providing workers'compensation info"nation. Insurance Company Name: policy#or Self-Ins.Lia. Expiration Date: o 3� 0 Ys- Job Site Address: City/Statelzip: the olio number and expiration date). Attach a copy of the workers' compensation policy declaration page(showing policy Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to te f a sition�T4p f criminal ORDER anclpenalties oa fine fine up to$1,500.00 and/or one year imprisonment, well as civil penalties in the form of u to$250.00 a day against the violator. Be advised that a copy of this statement mabe forwarded to the y Office of p Investigations of the IIIA for insurance coverage verification. I do hereby coni y under the pains and penalties of perf ury that the information provided above is true and correct. Si to e: 7Other only. Do not write in this area,to be completed by city or town official. n: permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. um in Inspector Phone#: rson: Ac R® CERTIFICATE OF LIABILITY( INSURANCE LATE Y, 1o/1812016tsr2a16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTWICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poilcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). TACT Meg Munroe PRODUCER NAME: TAX MARTIN J. CLAYTON INSURANCE AGENCY INC PHONErtt: (413)536-0804 1 tA&Nof: ADDRESS: mmunroe@mjclayton.com 1649 NORTHAMPTON ST.,RTE 5 INSURERS AFFORDING COVERAGE MAIC# HOLYOKE MA 01041 INSURER A: ACADIA INS CO 31325 INSURED INSURER B GAUTHIER INSULATION INC INsuRERc: INSURER D: --- PO BOX 344 INSURER E. IPSWICH MA 01838 1 INSURER F: COVERAGE$ CERTIFICATE NUMBER: 94521 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. LTR ADDL UBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MM/AD/Y M DIYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ A TOR T D CLAIMS-MADEOCCUR PRE hISES aoccurtance $ MED EXP(Any one rson) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PEST LOC PRODUCTS-COMP/OP AGG $ Is OTHER: AUTOMOBILE LIABILITY GEOMaBcIN�051NGLE LIMIT $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ AUTOS AUFOSPROPERTYOAMAGE NON-OWNED Per accident) $ HIRED AUTOS AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LtAB CLAIMS-MADE NIA AGGREGATE $ DED RETE=NTION& $ OT - WORKERS COMPENSATION S ATUTE ERH AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORlPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICERWEMEEREXCLUDED? NIA WA WA MAARP300327 10!30!2016 10/30/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 (Mandatory In NH) If yes,descrllae under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Addlllonal Remarks Schedule,may be attached It more space Is required) Workers'Compensation benefits wilt be paid to Massachusetts employees only.Pursuant to Endorsement WC 24 03 46 i3,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy In farce on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensation/investigations/. 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 THEPOLICY PROVISIONS. 1200 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01&15 Daniel M.Crawley,CPCU,Vice President—Residual Market—WCRIBMA ©1988 2014 ACORI]CORPORATION. All rights reserved ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ACCO CERTIFICATE OF LIABILITY INSURANCE ��T�`�`"� ' 8/12/2016 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 poiicy(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 EC Nancy Usher _ PHONE FAx (4x3}534-7874 Margin Clayton Insurance Agency, Inc. Ext). (413)536-0804 �,No): E-]NAIL 1649 Northampton Street ADDRESS: __ _P. 0. Box 989 _ INSURER[S}AFFORDING COVERAGE NAIC N Holyoke NIA, 01041-0989 INSURERA:Natlonwide MutuaL_-Harleyeville NATIO INSURED INSURQRO Allied World Natl Assurance Co Gauthier Insulation INSURER C: P.O. BOX 344 INSURER D,. INSURER E: r. IPSWICH MA 01938 1 INSURER F: COVERAGES CERTIFICATE.NUMBER:CD1663001850 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. IN7A ADDL SUBR POLICY EFF P0L[CY EXP LlMrrB TYPE OF INSURANCE P LICY NUMONYYt X COMMERCIAL GENERAL LtABILiTY EACH OCCURRENCE $ 1.000,000 oAMACTO RENTED 50 000 A CLAIMS-MADE OCCUR PREMSSE_g_&a ru-M $ _._,' GL43487F 7/612016 7/6/2017 ME_D EXP(Any one parson) $ — 5,000 PERSONAL_&ADV INJURY $ 1,000,000 GERL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000000 X POLICY El ❑ LOC PRODUCTS-COMP/OP AGO $ 2,000,000 JECT OTHER: $ AUTOMOSILE LIABILITY G el 1 GLE I Ea accident) 3; ANY AUTO BODILY INJURY(Per person) $ � AALL UTOSED AUTOSULI 0 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOSPer ECcident) X UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ — 1,000-,Ooo B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 11000,00_A DED RETENTION SBU028251970 10/18/8016 10/18/2017 $ WORKERS COMPENSATION STATUTE ER _ AND EMPLOYERS'LIABILITY — ANYPROPRIETORIPARTNER/EXECUTIVE y( � N!A E.L.EACH ACCIDENT $ mm OFFICERIMEMBER EXCLUDED7 u (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ _ f€yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attsohed It more apace 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 1200 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS, North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©'198&2014 ACORD COAPORATfON. All rights reserved ACORD 25(2014!01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Nlassac Its 02116 Home Improvement ctar Registration Registration: 173410 Type: Individual Expiration: 1011/2018 Trp 299320 KURT GAUTHIER KURT GAUTHIER I 19 COUNTY ROAD IPSWICH, Mei 01938 Update Address and return card.Mark reason for change. (] Address Q Renewal ❑ Employment Lost Card SCA i i5 20M401 c �po �snta9zuearz�d a 'Oaaa� 010m of Consumer,Affairs&Buses Regudatton motion s�alid for individual an only before the HOME IMP ENT CONTRACTOR expiration date. Ufound return tO: i Reg�Hon3490 Type: ice of Consumer Affairs and.Bwiness Regulation 8 Indmduaf iD Pane Pluza Snits 5170 Roston,MA 02116 KURT GAUTHIER ' :- !CURT GAUTMER '�� �v9 r;��hsmm s Cas a4 nsv.�#eaf Frs.tr'tts a4 'a 1� r.:-.z? "s.$bp:e ",;•.i i:' ts;; "`sc'v t:l.t.a,., Cer"!-102362 x "o A P.Q has 3" _ , IP$Wkh MA 4! u � ;E,vsESKsr uaruar osamM7