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HomeMy WebLinkAboutBuilding Permit #465-2017 - 10 WALKER ROAD 11/2/2016 NORTH EUILDING`OERMIT of tt�o , qti TOWN OF NORTH ANDOVER _ �✓ APPLICATION FOR PLAN EXAMINATION Permit No#: —' a- oa P - Date Received z a.� °RATED "`c5 C '�SSACHUS�� Date Issued: / tAlffoRTANT.-Applicant must complete all items on this age LOCATION ,¢A�f►W YIPh/ C,eW,0 a 12- �✓A'LI�K, i4. A/o fed Print PROPERTY OWNER AT 110&C4A-_0 Print 100 Year Structure yes to MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑AReration No. of units: ❑ Commercial N"kepair, replacement ❑Assessory Bldg R-'Othe s: Rertom?'74�e- ❑ Demolition IoOther rAr pa O Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer ��pp gESCRIPTION OF WORK TO BE PERFORMED: i\�iYt�✓off xt laCc4, Y Poco4lir, ►� !//i! c�.� r 1' dviwoewf hf? k**vel 13P, JAN pM;vc f - !&,Ted I°w � / �N�titiy S� , ►�s�l�-co� _ f.�n2 1�fc✓trv,� + f�fe�-r�.�, Identification- Please Type or Print Clearly OWNER: Name: /f Ai- c042f 4g& Phone. 7�- �2 030 7 Address: Mt,#40o (/1¢tv LkeA_ fZ , 6 /6 O.vee ,9- Contractor Name: )Ayz&- Wout-"CC.& Phone: '7�/- g o .- Email: n d l 0 veil, rye Address: Supervisor's Construction License: CS= Oo 2 f 9 g Exp. Date: 4 1011 Z O/k Home Improvement License: /ZY73/ Exp. Date: d Znl7 ARCHITECT/ENGINEER Phone: r �' Address: e Reg. No. FEE SCHEDULE_BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ? vov ` Total Project Cost: $ Ov FEE: $ 3 6 Check No.: l Receipt No.: 31113 NOTE: Persons contracting wit unregistered c ctors do not have access to the guaranty fund - -.. = �C %40RTy BUILDIN;G*PERMIT 0F�z,Eo ,bgti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ _ y Permit No#: Date Received �RSSgcHus���y Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION _ Pdrit PROPERTY OWNER Print 100 Year Structure yes no MAP . __ _. PARCEL: _._ ___._ ZONINGDISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement D Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic El Well ❑ Floodplain p Wetlands. 0 Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone,- Address: hone:Address: Supervisor's Construction License: _ _ 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.: Receipt No,; NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund Signature of Agent/Owner Signature of contractor', Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TypF-SEWERAGE DISPOSAL i Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ ElPrivate(septic tank, etc. permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 'COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp DumpsterJon site yes _ . no Located at 124 Main Street Fire Department signature/date COMMENTS limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter 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 f ate Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed ed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ 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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location r✓7 /1 A41-._11—QPte/ l C No. 7 Date 1I /�Zfj • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ ' Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee �$ TOTAL $ Check#1 3 1 .1 �L `• j '; J Building Inspector r -1 OORTff '9 ' A 1, 6 ic ve. . O - No. - h ver, Mass 40 Z WJA COC NIC Nl WIC s V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT Awr....C..�►14..s�'R.IQ. ........ BUILDING INSPECTOR ............ ..................................... has permission to erect buildings on /� �.,, Foundation Rough to be occupied as ........1 �. . e ....... .. . ......... .. ...................................... 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 CONS IO Rough Service ....... . . ...... .... Final BUILDING EC OR 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. Q i RIDGE PARTNERS LTD, INC. RIDGE PARTNERS LTD, INC. Estimate General Contractors Date Estimate# 174 Forest Street 08/19/2016 1169 Winchester, MA 01890 (781)721-0670 10/31/2016 ridgepartnersltd@verizon.net http://www.ridgepartnersltd.com Pat Corsaro Meadow View Condominium 12 Walker Road / Unit #10 North Andover, MA 01845 P.Ober Center# Job Location Pat Corsaro 12 Walker Rd./Unit#1=North Andover, MA Service Activity Quantity Rate Amount General • Proposed work to be performed: Meadow View 1 0.00 0.00 Description Condominium, 12 Walker Rd., Unit#10, North Andover, MA 01845 Based on site visit conducted on 08/17/15. We are providing pricing for the replacment of four (4) double-hung windows and shall include the following scope 8 specifications as detailed below. Customer responsible to move any furniture from work area. Discard of all job related debris. Work to be performed during normal business hours. Exclusions: anything un-forseen, not detailed or unspecified within this proposal Continue to the next page I Paee 2 of 3 Service Activity i Quantity Rate Amount Windows • Vinyl Replacement Windows - (4) total; 1 3,000.00 3,000.00 scope of work includes: materials, labor Et equipment to perform the following: Preliminary Scope of Work: *provide on site field measurements to formulate a window schedule to enable proper placement of window order with manuafacturer, Harvey Building Products; this phase of the job shall also include a deployment to remove at least one (1) window to enable us to access the"actual" rough opening size of the existing window openings. We will then use these measurements so we can place the actual order with the window manufacturer. We will attempt to re-install the existing window back or provide a blank panel to close off the opening until the new window order has been placed, received and ready for installation of new windows. There is typically a 2-3 week lead time from the date of the order with manufacturer in which the new window order will be ready for pickup. Removal Et Installation Scope of Work for replacement of four (4) double-hung windows: *remove Et discard of existing ceramic the on window sills as discussed. *remove four (4) existing double-hung windows, two located in 1 bedroom, one located in 2nd bedroom, one located in 3rd bedroom and discard of these windows. *install window insulation around perimeter of new vinyl replacement windows. *furnish Et install four (4) new fully welded white colored double-hung vinyl replacement windows by "Harvey Building Products" Classic style. To include - double glazed 11/16"thick glass; low-E glass Et Argon gas filled for all window ashes; Energy Star; double locks; sash limit devices / night latches; fiberglass mesh 1/2 screens for each new window. General carpentry allowance which shall include Continue to the next page i i I I ` Page 3 of 3 Service Activity Quantity Rate Amount providing interior window stops as related to this installation. *seal the interior perimeter of new vinyl replacement windows with interior paintable caulking sealant £t the exterior perimeter of new vinyl replacement windows with exterior caulking sealant. *Discard of all job related debris. *Note: includes building permit 8t fee with the North Andover, MA Building Dept. *Note: We will contact the Meadow View Condominium management company, Essex Managment Group prior to starting this job to make sure we follow their required procedures and protocol to perform work on this property. If it is determined that we are required to perform more duties to comply with their procedures beyond just applying and paying for a building permit, any additional costs we incur shall assessed accordingly. Exclusions: anything unforseen; anything not detailed in the scope of work above or on this proposal; any painting. On behalf of Ridge Partners Ltd, Inc., thank you for the opportunity Total $3,000.00 to bid on this project Accepted By Accepted Date j Window Replacement Project Location Pat Corsaro Meadow View Condominum 12 Walker Road Unite#10 North Andover, MA 01845 Subcontractor: Soderquist Construction 83 Midland Street Lowell MA 01851 Attn: Derek Soderquist cp: 978-604-4246 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: �//Iv C4"7'e..t- f'e'c 91, <'- 11 V1 ff dr At (Location of Facility) C� Signature of Permit Applicant Date el,-t, kis '15sac 77/,. � � 4 f-ee- The Commonwealth of Massachusetts Department oflndustrialAeeidents - -- X Congress Street,Suite 100 "-' Boston,MA.02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/FIec,4icians/Plumbers. TO BE MED WITH THE PERNIlTI ING AUTHORR Y. ApiplicantInformation TPllease Print Le •bl Name(Business/Organizatioidudividual): l Q• e/�r 1-7W, .r�`i C . Address: A City/State/Zip: Phone#: Are you an employer?Check the appropriate boa: Type of project(rgquired): i.Q I am a employerwith employees(fall and/or part-time).* 7. Q New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Relnodelirig any capacity.[No workers'comp.insurance required.] 9. El Demolition I I am a homeowner doing all work myself[No workers'comp.Insurance required.]t 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions Z-14 '''etors with no employees. 12.E]Plumbing repairs or additions 5.Lgeneral contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors bade employees and have workers'comp.insurance.: �� 6.❑We are a corporation and its officers have exercised their right ofexemption per MGL c. 14.L ether �����W 152,§1(4),and we have nq employees.[No workers'comp.insurance required.] C��KCt.Mttif r:. *.Any applicant that checks Box#1 must also fill out the section below showing their workers'compensation policy information. t homeowners who submit Ons affidavit indicating they are doing all work and then bire outside contractors must submit a new affidavit indicating such. tContractors,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-corilrad&s Crave employaes,Tey mist provide their workers'comp.policy number. X ain an employer drat is providing workers'compensation insurance for my employees.'..below is thepoUcy and job site information. Insurance Company Name: Ate— �/u G a�`✓'�/a0`✓�C.Q We of-1 h Policy#or Self-ins,Lie.M 6 4 A&f ff ` V Y IV/1-7-/41 Expiration Date: 6��d Y /-2-0/ 7 T Job Site Address:, 'I?- k//YL Le^-/K O/ O City/State/Zip: P. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify under tike pains and penalties of perjury that the information provided above is true and correct Signature- Date: 10 Phone#• 77*1 7 2 0 6 7 Official use only. Do not write in this area,to be completed by city or town officiaX 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 Persons: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires 4 employers to provide;workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract f hire, express or implied,oral or written." An eiMloyer is defined as"an individual,partnersbip,association,corporation or other legal entity,ox any two or more of the foregoing engaged in a joint enferprise,and including the legal representatives of a deceased employer,or the receiver or trustde of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill-out-the workers'compensation affidavit completely,by checking fihe'boxes that apply to your situation and,if necessary,supply sub=contractoi(s)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited.Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents£ox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if yoiu'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter-their self-insurance license number on the appropriate.line.. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you.to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peumit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. I The Department's address,telephone and fax number: The Commonwealth of ssachusetts Department of IndusAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-AIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia ® DATE(MWDD/YYYY) AC40R O CERTIFICATE OF LIABILITY INSURANCE 5/19/2016 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(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 Ellen DiNicola NAME: John A Pierce Insurance AgencyPHCNNo (781)729-8770 AX No:(781)729-0053 934 Main St. ADORES edinicola@johnpierceinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Winchester MA 01890-1994 INSURERAAtain Specialty Insurance Co INSURED INSURER B.SafetyIndemnity 33618 Ridge Partners Limited Inc INSURERCAce American Insurance Company 174 Forest St INSURER D: INSURER E: Winchester MA 01890 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1 6140117 3 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MWDD/YYYY MWDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE To D A CLAIMS-MADE a OCCUR PREMISES Ea occu encs $ 100,000 CIP269759 10/23/2015 10/23/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY❑JEPRCT O ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY ==)SINGLE LIMIT S 1,000,000 Ea a B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED Ix SCHEDULED 6229085 6/12/2015 6/12/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUTOS Per accident PIP-Basic $ 8,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION R I PER OTH- ANDEMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N❑ N I A C (Mandatory In NH) 6S620B-4494P13-7-16 1/4/2016 1/4/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover, Town of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. Bldg 20, Suite 2035 North Andover, NA 01845 AUTHORIZED REPRESENTATIVE Kevin Pierce/ED ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS02519014nn i i i r ���(' f('(/!U/tnittl('It���(�r'/(((.!J(I('�ltJ(✓�! Office of Consumer Affairs&Business Regulation License or registration valid for individul use only �1 SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �. egistration: 124731 Type: ! Office of Consumer Affairs and Business Regulation `' f�7Expiration: 8/14/2017 Individual I 10,Park Plaza-Suite.5170 -f sT Boston,MA 02116 1 Dana P.Marrocco Dana Marrocco �II 174 Forest Street Winchester,MA 01890 Undersecretary Not valid without signature s Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-002199 Construction Supervisor DANA P MARROCCO 174 FOREST ST WINCHESTER MA 01890 r-I"M CA— Expiration: Commissioner 061OU2018