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HomeMy WebLinkAboutBuilding Permit #778-2016 - 10 OLYMPIC LANE 1/4/2016 �1 TOWN OF NORTH ANDOVER NOR7N APPLICATION FOR PLAN EXAMINATION ?°b•,�".;e "o°� i Permit NO: 1 Date Received ,SSICHUSE� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION O, p V Pri t PROPERTY OWNER 3:C%4 L:Ok— CAU+( ++ mm Print MAP NO.: 1� PARCELO ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resi 'al Non-Residential New Building One family Addition Two or.more family Industrial -alteration No. of units: Repair,replacement Assessory Bldg Commercial Demolition Moving relocation Other Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED M(*-S t S wll L: Q�( S 0.�► '. (�(owl(Y�i�•�l', C-�L�J( �1�.� ►Y� d� Nei C.� V Identification Please Type or Print Clearly) OWNER: Name: �,LC�11 t_A C'�Or C�.7 Phone: I V 3 Address: k0 0k V 1(` L, CONTRACTOR Name: �J1 'LPhone:Q 3J� 3y e 3 Address: P(U QC,),\ 3 y�-1 C�Jw 1 lv� rl 0101315 Supervisor's Construction License: 1 D �Z- Exp. Date: Home Improvement License: 3 1 Exp. Date: t 1 r, ARCHITECT/ENGINEER Name: Phone: 1 Address: Reg. No. FEE SCHEDULE:BULDIN PERMIT:$12 00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ r �q x12.00=FEE:$' r Check No.: L � Receipt No.: Page I of 4 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes J Planning Board Decision: Comments L ' I Conservation Decision: Comments i Water& Sewer Connection/Signature& Date Driveway Permit k f DPW Town Engineer: Signature: Located 384 Osgood Street FIyREDEPAR�TtMEIVTbTe p 4 p ..x, , �x� ,, , , , mph umpster on site_{,yes�, }� s .s,attt no ___ . , i�L•'ocated,�at�12�4�MainFSt�eet� �" �� „ `�`��.`�' �,;,-�* �; '�r�#�;`"Ftg;��`�� c�-.��r+ �;�•, .��" c - { I �f'ar'�.�""^-�Y..r..s..-d .� Yi-r ' ..tr.t r-i-,:' t � al+�z= � T�ria*si ,� '� r+ .t r *♦ s R � ?. n f n. FiretDeppartmentdsignature/darter r x ,,�t _ , a ., �' � S:) �S�',4 wf r 3., r Z a*�{ },Y a } 1'1 �,��. '.'4!{"i♦X'4'% *«`i7 i-�'r'i.�f tfY' `.r+T 'S`,:.. « �_.�fi ��'ry .� �,�,,(y'..^Ir1 .. .� .��-f p. �Lr �. �t 3`. ♦ .7 �,.ex r.'y#t'Y•CT ♦ T< t •: `� ' x �a t COMIV—C7VT S .f♦ 1 x. .Ir.i f •y,x r t 't '1°f� 'J l r i I Dimension 1 b f Number of Stories: Total square feet of floor area, based on Exterior dimensions. J Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 ' I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits � Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses � Copy of Contract Floor Plan Or Proposed ed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks k Building Permit Application �6 Certified Surveyed Plot Plan Workers Comp Affidavit � Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. Thea applicant must then et this recorded a PP g t the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location � ` 7 . NJ-� ��� Date . - TOWN OF NORTH ANDOVER LEI)1 �` . Certificate of Occupancy $ lab Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#G�-29-� r, r r + 0 Building Inspector OORTH Town of EAndover I\x No. _ _ C, q,2b h ver, Mass1%j Coc"Ic"a WICK 4 'x,95°RArED f' - U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ............�54%1.'CA......(9V......... ............................... BUILDING INSPECTOR Foundation has permission to erect .......................... build'ngs on .. ... aR!!�. ..l. ��• . � �� � � Rough to be occupied as .. .. Q!. .. . ........... ..1`!. ... ......�... l�... .i........... ....... Chimney provided that the person acceptingthis f rmit shall in eve respect conform to the terms ole app lication � p Fina 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 CONSTRUCTION STAR Rough Service t ....................t.............. 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. FadaratlDe RIU E13ginewleg W camraawee8oawD IAA 4tontramsrit�tsestloalb AM bb lehob>ztrgloeMag arc-- asbmn=t ` CONTRACT Ln OGRAM > CM -HZS ltmsiwl3otbet cv (617)792-0376 OL2 MIS 414480 00002 10 Olympic Lege Q 10 Olympic Lane North Andover,MA 01845 f f-__' ::. �""' Notch Andow,MA 01845 JOB DESCRIPTION ' AIRSEALDKkAovidefaboraodamonhktoad wassarywhesoap6stwaddidemairtmlmge.ubvarkwmbe pafbmmdIn,msoatwitbtheuseertpodalmotsanddE attcteststo9mtyaw too wMbetdtwhbabmMdWWMof dresodm ad hdoorawgwft.blatarfala m be mad mad your boas can ew2s.timm and othw pteda ' ftsary areasfbrseaftfachaleair Imbptoattics. anw*Adge ng l andaftaftudaraaa(whdowsarcrApsemBy addressed.)This w7il reqube(0)aalmag home.A mduniae is suras fen per tairasm(cftn)orafr h ftzdoo wiu oeaaG bat fhc ectual j aamberercGu istrotg,rmmseed Mlles amopladasortbewmathobadat work,mtdat nea MWasml cestm tboMmoovraw,a fhmi Mowerdoormdkroma uom oft maty*wgl be comk mad by me aab.=otracmr m comm 1ha ur*afdo indowafr oWhy. if680.00 AM BLUM ADDER:(4)wort hoar:. $340.00 DAMdIAMProvidelobmaudm=WsmimWialrfayxofttMw hadf -Sh beltsm(g6)aquaefmtoard > $176,30 ATncFLAT.be"hdwandttmmietsmfmlalleotrIayaefR-nCIm1Cellukaeaddedm(119 sgmmfeatafopenattic Waaa.KEEP B>aMW FLWR I $1,64.26 KHMAUS:Pmwi a maraad mel do m won r FSK fitt w settti-rigid fibagJms board h Astim m(225)square tbetor Imeewali ams. $987.30 ATTIC ACC=Provide labwwdzasW ars m WWH(i)easily moved,i cover fwtbe attic nes ens stria The saver his itde�al vue -stripping m reeler au fmlmga. $200.110 ATMACCESS:ProvideldwodtrmlerialsmWW oetlasbedsafftoftdoewithrdgid7lamamebomdaadudfbadoors adye wtw weethamip�g m restrict afr icakew $73.91 VENTILATK)K hovida Mwead mamah m msmtl vela doom to(42)rafter bays m emint6 ah ftow. $$4A0 KASEMOIT DOOR Pi. Idward m fawdeted a back aftbe basesreeat dow m dos but>jw d wide r rigid bond drat mens rhe actions R-316.SA and 316A regnirem orbnitdiog code.goal all o%es and sown whh FSK tepe. $72.22 RISE Ettgh cftg wM apply all apptWdft eligibb ioostltvm m tttb carman You wen only be bimed the Not sasoum.Cmrmdy, fa d ft mesntaes,Colombia Gm affas 75%Weatim sot to emceed$2.000 peresfasdar year,and as faesxitive of lOWA fbr ase AirSmihfgmmrma ap to the fist$660 and as addidard$340 ifsaviop am jna4fied by the aadimr. Fartb =fta>dhcutboryow',radsfndowdrgmft.wewalbc==bodegabteamdowdiegtasdcofdoavafhdaedrfiewin your hese bm6 berme the wart is hegsas,god Awftwestlabadonvisk fs ecut0ate We wiu also cendran a rim ane set of i r iedatal ro a RISE Engineering m Contractor ReglstrBtton No MA Contractor R000811ott No A dWWn ofTblds h Eoglocu ttg CrContraoOor Re On No EDSbawaaat uDtt tX Cwto`,NA 0=1 CONTRACT 339 34 FAX 339-SM-&W Fuge 2 PROGRAM TMCOf1R=mEN-MIN,D ,ME CMA-HES meg TRaeaSTIOMFORWOMM Jessica Gorbet (617)792-0376 0828!2015 414480 00002 10 Olympic Lane 10 Olympic lane North Andover,MA 01945 North Andover,MA 01845 JOB DESCRIPTION Uro con*usdon safety of your heating eystam and water heatcr.This has a value of$90 and is at no cox to you.Total allowable weathe ization itu=dve is$3.110. 590.00 Total: $4,145.19 Program Incentive: $3,110.00 Customer Total: $1,035.19 vm Am=mim rTo FuRNw SES-CONPLBra an AtCOnDAUMwr R AWM SPECw=TKwi;.FOR TME SM OF "'One Thousand Thirty-Five S 191100 Dollars $1,035.19 WON FBNLOIJMONARD APPROVAL BY RISE ENMEBUIO.WSTOMAORUSTO RBUTAteUM DWQI FUU-UR 1 MOF ISTALLSEC11AROF0 UOUna.Y ON OWN UWAIOBAtANOEAPM300AV&SEE REYElIBEFOR DIPORrARrDffpRWT10N ON GUARAMMMWOMBOFREtlipKGMWULUMANDCOMRA=REOtaiMML Do NOT SIGN TMS CONTRACTIF THM ARE ANY BLANK SPACES Signature- uSOn Gwtwl Wm 70.2016) Email: jusdn.gorbet@phoo.com NOTPITWS oelnRAeT wr BEwti1W W11NN9YIW W NOT exEGu11IDYMWN ACCE" t8 OF e07trRAer-TW: EC61<ATpNSA1IDCONGMMS i 30 OAI& ABSATaiFACTONYPA aUSMWALRS0SUADE 1A9O0UTLOR®.YAOaUOA(E@AUiROAQPD TOOO1NEWORN OWNER AUTHORIZATION FORM Liz {Owner's Mame owner of the property located at 10 01 xw s L 1✓ ' (Property Address) /L40� (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perfarm work on my property. ,:, G,t6er C)vuner's Signature Date [E0IV F. SEP 1 2015 The Commonwealth ealth o "Ma zerhtasetts Department of Ind striat Accidents Oflire of Investigalio as 1 Congress Street,Stole 100 > o0on,MA 02114-2017 wwwinassgorldia Worker 'Com enation Insurance Affidavit;Builders!ContractorstElectriciattsfplumbers ApWicant information Please Print Uzihty Name(Business' ui ttion!trsd v d l): 1A Address: 60 Q OX 3`4 _,.__... �. �e. �....... . ...._ .......�,. cit f tate'li a I P one Arc you an etnpl ; Check the appropriate box: Type of project f required) , arra a general d i contractor an 1.� 1 cern a employer with�_ � 1 fr. New ctatt;+tructicars cr cloy+ (full and/or part-time).* have hired the s ontraetors 2.Q 1 area a scale propriclor or partner- listed on the attached sheet 7. Retax cliarg, ship and have no nplo)ves The slr � -con Vit etars have S. Demolition wo*ing for me in any capacity. employ cs and have workers' 9 Building addition [No workm,c:omp.insurance ccarnta_insurance.- n grtir .] 5. [] e area corporation and its 10. lectrical repairs or additions 3. 1 arra a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions ",If, [No workers'comp. richt of exemption per.MGL 12.[3 Roof repairs insurance required]t C.152,§1 l4$.and we have no employees,('co workers' 13'[3 Other a ortap..ins°tsaance required.] Any 4pplirant that ctxsl*ststra 41-,rust also fill aaat dtr stcrinut below sl iiag tear vs xrs aortspcnsmtion policy infmnation. t Hp-nteoxa"�rnest who:tt fmit this:aft'&*it indicating they are doing all%cork and thin#airs otasicfc Ctantrac MP Mao submit anew a#'idsaxit indicating sea h. ;Conntractats that check this box rrust attac°hal 2M aetstitinautl ab a t susrt the name o he sub- ont;acta m and state ute t zr m not:thrive:cntitics hsvic crttlsloya. t:°'thc suh-c�+atractcc�l;ax�estspla ,s,€:trees mit lnn+.nrrct�L?setT xia�;"s:va� Iicgr;tsme. I racer an emplatyr that is providing ovorken'camper anion insurance r urf€mployem Below is thepoficy andjob site information. lnsurance t~ompany Sante:— -- FolicyExpiration Date:A-0 +Q ] _.— loh Site Address: t -Mjw L City state'zip\3 ,(A h LUW CX' .n�o Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requited undAcr Section 25A of MGL c. 152 can lead to the imposition ofcriminai penalties of a fine up to$l.5W.00 and/or one-year irnprasoTanciu,as wctl as€ivil pco alties in the fom of a STOP WOR.ORDER and a fine of up to$250,Ott a day a aing the violator, Be:advi;sod that a tory i4this statement maybe forwarded to,the Officc of Investigations of the DIA fear insurance coverage verification. rr I do hereby cetWfy under the painsand Penalties of'per,jury that di r information Provided alcove is true and correct. aittrr: €Iat€° official use on& Do no wrim in this area,to be completed by r ty or town official. City or Town; PermitTl kcense Issuing Authority(cirde one); 1.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector s.Plumbing Inspector 6.Other Contact Person' Phone�: DATE(MMIDDNYYY) A�V CERTIFICATE OF LIABILITY INSURANCEF 7/7/2015 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(ies)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 Nancy Usher NAME: y Martin J Clayton Insurance Agency, Inc. _PHONN Ext): (413)536-0804 A NJ_(a13)s3a-7874 1649 Northampton Street A E-MADRIESS: _ P. O. BOX 989 INSURER(S)AFFORDING COVERAGE _ _ NAIC#__ Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURERB:Allied WO_r_l_d__N_atl Assurance CO Gauthier Insulation INSURERC: 44 ESSEX ROAD INSURER D: INSURER E: IPSWICH MA 01938 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 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. IiJTYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DCY EFF MO SR LICDY EXP LTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE �OCCUR PREMISES_Ea occurrence) $ 50,000 X GL43487F 7/6/2015 7/6/2016 MED EXP(Any_one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO-JECT 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ FALL OWNED SCHEDULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE AUTOS AUTOS $ HIRED AUTOSAUTOS (Per accident)_____ I L $ x UMBRELLA LIAR OCCUR ;E.L. H OCCURRENCE $ 1,000,000 B C EXCESS LIAB CLAIMS-MADE REGATE $ 1,00_0 000 DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE OR ANY PROPRIETOR/PARTNER/EXECUTIVE EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MPIMML-d with pdfFactory trial version www.pdffactory.com A4t0RECERTIFICATE OF LIABILITY INSURANCE 9tESt2415 THIS CERTIFICATE 1S ISSUED AS A NATTER OF INFOPMATIONa EEN$tw'f AND CONCEro r KC# ccti3,570"ME CE1#k3,'#CRTE ktCFttIER.TF1IS 3 cmwicATE DOES 4 W F"a"dRMfk7C'1 LY Ok,'£vkT:VW AMfN0,.WFNE>OR ATTER THE COVIEXAGe RDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE 00.5,WT CO T€ ITr A CONTRACT BETWEEN THE ISSVING I RMS),AEiT-MIZEts REPREMNTATIVE€R PRODUCER,AhM THE CERTIFICATE MOLOE:R, I;;PGRTMM If Ow 7;7five*Fa;#cler ex an AI3I7 IO"L INSURED, e pokyt ars)must Ge esdamesl.tf SJ ON IS WAIVED,Wb)ed-0 the tems'"CCO&UMS of the policy,cea wI,p04cftF,:may*eqv" A state"**on sins cee ese do" OMFLr fk*S tD the e dw,cate h€ad4r in heat Of: 2+ arsCr t 5 Clsyto n Martin J Ings Agency Inc Now: 8crtcl�y Asp i�d Risk SerAces 1 i+1c11lrnglitsn St P!3 Box no en $ ;£ a8$ -«r�. tBbb 215- 236 14MA 01041 rt ss- i�a��y ry sag sicK�aSt ��>sz'uwGccas�ti x : wsay�alx i0. 3 t Gauthfar Insuisdon Inc nar, PO Box 3" Ipewbctt,MA 0106 n�cz r €I CERTWY ThAT TH!MZC- OF MSI,EMCE USTEE 8.2 OW ,AVE 6r #ESUMTCTHE ; OF THE POUCY 3 IJ .•A€E3$_K74ds1 ASTAhati'C.ANY REDviREMW.TERM £:MID B i I or ANY CONTRACTOR OTHER DOCJ ENT WITH RESPECT TO Ya'®ffi H TP+Z CERT4FIe~ATE MAY SE IESSIED ORWAY PEATAW.IME44SURANCE AFFORDED BY THE MMMESOESCRIGEDHEREA IS SUBJECT TO AL ThE TE4 OM, E;SdC:..U%K)(-M AkV CCki4tM"OFSUCH PFJ &- S.LIMT&SHOMMAY HAVEKEN 2IlEDUcMSY PAS T4 -(.Mx_OMAAWA +'U1.3 K4.dk♦"v:9, sFWih.D„i'YY*^,as ,h�tAI RtaAL GEMEPR2. 3�5t Ad'�„awge: kpawAe5-tkaE 's�27C:e3A 4:Efl¢XP t4^ar+a*•r vaw,Yw? S A bk1Rl .Rd4' � ,a�aiA.Rt,b CT titY0lKt7tl4E I31�2'rf'... moi.. E#far3>iwKP •�` jt*AMV%4AAlaS 0- �AA:f ad�T'� 9tSCAI'.'49/i;��b5'SRAf ewsaA's � �_ . �..Ait"'L9a `eeY iaRIWCT!4 ;c e E" FL`u+ A,Ux`•k&e£aA' s R Lj dam'niY"-*-A s ' AAM !'1x :L33'�teu!"8 a C"Iw%cx49tA C] OR-O.""MiFi ?aEB 24 .R+-Tup;S°s Wear: €3 DMASF-poucv't*xr 1r 9 R'.. -1L 'b'."...SE'S02:.K� �:*.'�,,. °w-:_ �eaY �K?R,�',+.aY a3sce ig exr.{u?a•�?_. CERTIFICATE CANCUUMOR OESC p `eanisult Tw-EXPWT d ZA7E'How-of.NOMEWILL SEMICs Rn iv contractor$vcs ACCOMVM%"TNE 0 Y PROMs, 50 Wsshidsoop Str4rot w M Westborough,MA 01581 �ignatwe: ACDRD 25(20101€15BRAC 1135 i Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor .Registration Registration: 173410 Type: Individual Expiration: 10/112016 Tr# 257812 � KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 ......... .... ... . . _ ._...... IPSWICH, MA 131938 ... ........ ........_............................. ._....................__....... ....._. ......... . _... . Update Address and return card.Mark reason for change. p 7 SC:A1 0 'LOM-ilxii Address Renewal Em to anent { ost ar , _'Of£ee of ConsuwrrAftim&Rusintss Regulation License or registration valid for individul use only Z , OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 173410 Type: Office of Consumer Affairs and Business Regulation 1 ' xpiratiot►: 911(112©16 individual IO Park Plaza-Suite 5174 .p Boston,MA 02116 KURT GAUTHIER " KURT GAUTHIER 44 ESSEX RD ... IPSWICH,MA 01938r _...._._�_._..., Undersecretary `ot vali4wi nt signature I I 1�asamchus�ts �L7e J ett o f pUbl,c SaWy BOArd of 8uffoingftns and Standards #`.:ra�z�[z asp term a��t rozx>r�* zt�§tit' License,CUL-i""2 rkh MA O1'Mal A quo* r�