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HomeMy WebLinkAboutBuilding Permit #1250-2016 - 109 LYMAN ROAD 6/1/2016 BUILDING PERMIT ONo°T bq't'o �E TOWN OF NORTH ANDOVER 3a h.;;:t• 6 APPLICATION FOR PLAN EXAMINATION * ,� Permit No#: {�" ' v�1 Date Received ?,�SSgcHusti��5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION d y (L`-Ic Print- PROPERTY rint_PROPERTY OWNER r _" � (� a-C, V V fid Y Print 100 Year Structure yes no MAP 2 0 PARCEL: a ZONING DISTRICT: Historic District y s no Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑wK eration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑ Other ❑:Seelll - ��- Y � �'Flood I'ai � ®INe �_ `' ❑'_Utrshedtantlstc ❑Wp , fArstnct4 y E Water/Sewer'w DESCRIPTION OF WORK TO BE PERFORMED: , i r s-cal -c L l v CcC i h XM CP C� 1 � Il- Identification- Please Type or Print Clearly 1 OWNER: Name: M%* CkNCA-G� rl ' y Lt'a l� Phone: G LOBS Address: Oq L rvt (U Contractor Name: (,v ►�- oJ fb,,'b` Phone: Email: L;bM Ad d re s s.J P 0 Gox 34-1 viiUh J rltd 0tcl Supervisor's Construction License: o ZSR 7-- Exp. Date: Home Improvement License: ) 3 `� Exp. Date: t(D 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: $ ZSR 0 FEE: $ 3 �-- Check No.: � Receipt No.: 61-4 -L- I. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 4� Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4.. Floor Plan Or Proposed Interior Work 4. Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed 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 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. 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 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 - U FORD PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION__ __.Reviewed on-._. _ _ _ __ _.____ Signature_ _____ I 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 F Water& Sewer ConnectioniSignature& nate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR E Temp'DuKit'ipster on sRe,,.vAes,� -Av". 1 o Located at 124 Main Street• a ' ,of ai4. 51,`c,--'P' y it"! 011 ,!., Y } y f= LY ?: = Eire Department signture/date D. x��.ernttY. +4 �A m §� A4 l+it ''�Aa.�� COMMENTS; °�µ � ,�fyr�� �� l �M {� _�0 Dimension 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 Date Time Contact Name Doc.Building Permit Revised 2014 Location \ � t Pd . 7 No. �G �� '" -0 Date Cl, • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ s Foundation Permit Fee $ Other Permit Fee $ TOTAL $_ Check# I W 0 4 412 Building Inspector r -9111 V NORTFI •q - A- ic . ve- _ No. 9L ./I t _ � Z o h ver, Mass, x,4GOG NIG Nl WICN ��' 5 R�1TEo ►'Pp`',��(5 - U BOARD OF HEALTH Food/Kitchen PERM. IT D Septic System 0 Of 1 BUILDING INSPECTOR THIS CERTIFIES THAT ............................ ..... ............. ....... ..... ....... ... t� ....................... Foundation has permission to erect .......................... buildin son ......��....... ... 11 .. �.............. .. .. ... Rough to be occupied as ..... w.►. !!\.....it.�ai...� �,. ........... Chimney provided that the person accepting this pjrmit sh II in every respect conform to the terms of the application Final on file in this office, and to theprovisionsof the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIQWARTS Rough Service ............40....... ........ .... ......................... 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. Federal ID#06-0405629 1��✓ RISE Engineering RI Contractor Registration No 8186 RMAISE _ Contractor Registration No 120979 `` A division of Thicisch Engineering CT Contractor Registration No 620120 ENGINEERING' 60 Shawmut,Canton,iINIA 02021 CONTRACT 339-502-..i 97 V, 39-5112-6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW rn CUSTOMER 'Q PHONE DATE CUENT 0 WORK ORDER CV Michael Mcveigh C= (978)685-5309 03/14/2016 430585 00002 Lc-i SERVICE STREET Luj I BILLING STREET 109 Lyman Road r= 109 Lyman Road CL_ SERVICE CITY.STATE.ZIP BILLING CITY,STATE.ZIP North Andover,MA 01845 North Andover. MA 01845 OB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas ol'your bonne against wasteful.excess air leakage. '17tis Work will be performed in concert with the use of special tools and diagnostic tests to assure that your(tome will be left with a healthful level of air exchange and indoor air quality.Materials to be Used to seal your home can include caulks.foams and other products. Primary areas for scaling include air leakage to attics..basements,attached garages and other unheated areas(windows are not generally addressed.) 'Ibis will require(8)working hours. A reduction in cubic feet per minute(cfm)ofair infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work.and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will he conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 KNEE WALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(144)square feet of kneewall area. 5504.00 KNEE WALL FLOOR:Provide labor and materials to install an 8"layer of R-28 Class 1 Cellulose added to(180)square feet of open kneewall floor. 5226.80 ATTIC ACCESS:Provide labor and materials to make(3) temporary access to an attic area. The opening will be closed with materials similar to those existing. Finish sanding-and painting is not included. $255.00 VENTILATION:Provide labor and materials to install ventilation chutes in(27)rafter bays to maintain air flow. 554.00 BASEMENT CL•11-ING:Provide labor and materials to install(112)linear feet of R-19 unfaccd fiberglass insulation to the perimeter of the bmennent ceiling at the house sill. $196.00 REMOVAL:Remove(62)square feet of batt style insulation from the basement area. $46.50 REMOVAL: Remove(168)square feet of batt style insulation from the crawfspace area. $126.00 CRAWLSPACE:Provide labor and materials to install (1105)square feet of R-10 rigid lhermax insulation to the crawfspace perimeter wall up to the sill and against the band joist. 5388.50 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible measures.Columbia Gas offers 75%incentive.not to exceed$2.000 per calendar year,and an incentive of 100%for the Air Sealing measures tip to the first$680 and an additional$340 if savings arc justified by the auditor. For the safety and health ol'your honk s indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the weatherization work is coraP letc.We will also conduct a fill assessment of the combustion safety of your heating system and water heater.'this has a value of$90 and is at no cost to vou. Total allowable weatherization incentive is 53.110. 590.00 Federal ID 0 05.0405629 RISE ,- RISE Engineering M Contractor Registration No 8186 _ MA Contractor Registration No 120979 `' A division of Thieisch Engineering CT Contractor Registration No 620120 ENGINEERING- )0 Shawmat,Canton,MA 02021 CONTRACT 339-502-5197 FAX 339-5024)345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT M WORK ORDER Michael McVeigh (978)685-5309 03/14/2016 430585 00002 SERVICE STREET BILLING STREET 109 Lyman Road 109 Lyman Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,M.A 01845 North Andover-MA 01845 JOS DESCRIPTION Total: $2,566.80 Program Incentive: $2,117.61 Customer total: $449.19 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ,*"Four Hundred Forty-Nine&19/100 Dollars $449.19 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE TER 00 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION.SCHEDULING,AND CONTRACTOR REGISTRATION. '% f�l0 NAfi SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 1 t � AUTHORIZED SIGNATURE•RISE EnglneelinB CURT ACCEP ANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT•THE ABOVE PR ES,SPECIFICATIONS AND CONDITIONS ARE , 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE RISE -� �� 60 Shawmut Road,Unit 21 Canton,tillA 020211339-502-6336 ENGINEERING www.RISEengineering.com Ef"cienc cncrgiztd. OWNER AUTHORIZATION FORM Michael McVeigh (Owner's Name) owner of the property located at: 109 Lyman Road, N. Andover, MA (Property Address) (Property 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. d" A Owner's nature 6 Date The Commonwealth ttf tfassachusetts Departnmeni of Industrial Accidents a4 '> Office of Inresligations 1 Congress Street.Suite 100 fit Boston—VIA 02114-2017 www.mas..v.gav/dia NVorkers'Compensation Insurance Affidavit: BuildersfC'ontractors,,'Electricians Plumbers :applicant information + i ('lease Print Legibly, Name it{+ fi f 4n L Address: Oox 311 01Y state 7._ip; u3 _Dlft l'l~+anc y 3S-is. 3 f 3 Are you an emplos°er`!check the appropriate box: type of project±required}, 1.. 1:Irl i a cm(tle?°er 4><ith_S_.....__ h..d i alis,a r kclal c.}l tracts r and 1 # + hair hrrrc�?iii SkiE cclnt,lttilr ! 6. ®��'.0 i�artmirtit?l enmplove s t al and, akar, Crnac=._ , 7 am a,k i.pr prkettir or partrtc r- li,tL i on tl.e anadui l Iieet. ": �Remodeling ship and have no L:nlploycc,, hav,' �DtkTkelrtil+n. work-mg l'or Me m art!(apacktt'. einpk+ co and 3ta1t 1vork. rs' `l, []B uklding aMinOrt �NETt�orke`rti, cornpl. 1111.1lralic corn." IzS.,Friiltt. It).[]ifedtrical repairs Or additions ". � 1t c src a ki.�P}1.3r mr€::t and t.� � p litllit iktt7lCf;lc3 n? ?l t?rl cxtrCs>�Sl l°: .�>rl $s d C�1aFgr s[.�fyll3t$1iing rcpair;.;or tt titf).it '1lk'tic rittf'?o'exec n lion pe <IGL tf tNo a lrkcrs" comp. ' a rU Rcvt f repairs 11�ur3ner r�quir�d.]' t 152 ;1i41,and}+c hacr€H? emplo,�ees, No kvorrkers131)Other comp.in tiiak?cc Iequire3, art,i.anr,t.,h,:rs K,% ! ttv..a,a_ 1P X;tk:-nc;O.nit%ku it ,10z«;;,�a. awt.r �.s•t.ro��r�ar{�,t;tn4 s. -e1NaTIcT.. Ht,tr ci-v--: s:s.jr ;uerrs;:a si..:.vt:<...:.L±;m, t f'.ate xr�t?:l .r r,� �;,:n .: ;.ia5uki cen...a er:mss; I:t•_ n Nu.s-niI-,nj.i_.rn}:s khx'C"wk'i`,'�i Nm-r.0:xo i.#c. r,1< xt kd:.i�.J shty.�h5rAI t:bi:.f 313r,'t I.�: +:�J.t 3...ix.I s xiti 1,14,c t itf-1-cr::li 11'r'N–w iT;.!1T�5 bit*v% t t art€r.i.. .:the�u�c stcr� s ase .�, m:c vrvvi then: Wv-n—x . :a.r;..pir ft+r:r:ck?mr,. I rant an employer that is providing workerscompetnva.an insurunc a jitr try}'entpin}ee� Belau,is the polity and job site information. lrtkir rice:�'t>tii f+�atc �:c:st.:_ �t.A. �t`1St91'�R.c"�tti' t �.r'C n ^_'_.—____.__�__._T.__.� EY�l3rFa[¢lt:l DiEr~: k_�_�.� Job Siie Addr4cs- � L 1 (!` cir ;-state LP:N�,tl n.c4 iJd'+' 01 e L4 Attach a copy of the workers'compensation pstlie declaration page ishoiving the policy number and expiration date?. Viifure w seiare eovtrage as rokluircd Irmi r Section 2.4.:1 o'N,161.c. 15-1`ail{cat w(fie urtpii{Ition of z'rinw,1W Knihwt,os`t2 rine up til Si.-00.00 and:or Pic—year imrtpn%onrremt.ks well as civil penaltics in lite firm 111 a S1 OP E'+`OIRii ORDER and a fine o up to`32`k)_00 I ekly agoinst th-,'vio.laKr, He adl iscd that a copE o .(:his st4tefnenl[Mill Ik:.#forwarded.`d the i 1,71c of investiR'..rr"tnoti``of the DIA for insurance coverage t erl ficalion, I do hereby certify under the pain,(and pen allies of perjury that the ittl`itrmalion provided above is true and correct. Phone 14 Official use anti'. Da not wrilc to dtis area,to be completed he cin,or locant tl(facial. City or Town:_ PermitiLicenss# ksuing Authority(riche onev I.Board of health ?.Building J3epartment z.(.''.ityn'ou n Clerk 4.Electrical lttc*ctor S.Plumbing inspector K.Either t'untdCt I'erstxu: Phklne :. ACOORO CERTIFICATE OF LIABILITY INSURANCE F DA7 7/201(MWDDN"s 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 Martin J Clayton Insurance Agency, Inc. PHONE (413)536-0804 FAX No:(413)534-7874 A1C No EX C 1649 Northampton Street EMAIL ADDRESS: P. 0. BOX 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harle sville NATIO INSURED INSURER B:Allied World Natl Assurance Co Gauthier Insulation INSURERC: 44 ESSEX ROAD INSURERD: INSURER E: IPSWICH MA 01938 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR DAMAGE ( RENTED 50,000 PREMISES Ea occurrence $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D JET r LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED ident SINGLE LIMIT $ Ea acc ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 HDED RETENTION BE020792125-194985 10/18/2014 10/18/2015 g WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/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(2014101) The ACORD name and logo are registered marks of ACORD Mrrdrdftad with pdfFactory trial version www.pdffactory.com '---04N AC_OR& CERTIFICATE OF LIABILITY INSURANCE -" t �.,.► 911W015 w ThiS CERTIFICATE IS ISSUED AS A HATTER OF INT-O MATIO-1 ONLY ANO CONFERS ND RIG.T'S U?Ctia ziE^�RStFFGAi€HO-."F_THIS CERTIFICATE DOES NOT AHIRMATi IE+Y OR NEGATIVELY AMEND, 3CTEND OR ALTER TRE COwlERraGE AFPGRAFD 13Y'Tt4L POLICIES BELOW.TM15 CERTIFICATE OP INSURANCE DGS KOT CONSTI UTE A CGNTRACt B€TWEEN T:iE 1SSIA145 INS FR€R(S).AUT4.DRIZED REPRESENTATIVE OR PRODUCER,ANO THE CERI iFICF.Tf NQLDER. IMPORTANT:If the tertifieate holder is an ADOi3TGNAL fN-SUnED,the 001etY(ws)must be erw ursed If SUBROGATION'15 WAPd=D,Wb).-a to th? tents and cc-4—tions of the policy,certz,n pokles rrrr req j re an erdvrserrent.A staterrervt cn this ceftzrkate doer rv..confer rig Ar to the xstfacam holler pn Iwu of sum endrkse-*nt(s), Clayton Martin J Ens Agency Inc 5ertley Assigned Risk Services 1644 Northampton St PO Box 989 c tom: (80f}}934 3588 A G.wwoi c866}2tS 811€ Holyoke MA 01044 tis Ppf erSrrayrzsli tAss 3332 Gauthier tnsutation Inc PO Box 344 tis raEar=. IpsVA0%MA 03938 r=rxERa COVERAGES CERTIFICATE NUMBER-- REVISION'NUMBER; 7tiim IS TO CERTFY T14AT Thr POLIC€E5 OF t4SUP.ANCE!S i ED SELmv rtALE EE,aq ISSUED TO TLE 1I$UREp%M,!ED ABOVE FOP,THE FVLICY PERIOD Y4emr--Sc-Noni vmMS'rR'+iDIt1G wy piout,'G'Et+1T.TERM OR C:O!IDITI(Xs Or 1.4`Y iWCT OR OTitER D€3Cjw..EtiY WITH RESPE:.`T TO VMCFt TtALS eErgTPrSGAT E MAY BE iSSU CA MAY fR"AS<-TTt2 I2254RJf fE ASC wDEE1 t3Y Td!E PQLICAES IDESG3t1EEQ 1EREiA!15 1,U9 IECY TO ALL T 4E TES?f tS EXCI-L&O S AND CONOITw014S CLF SLrCPi MOCTES-LUTS SOJO N MAY HAVE SEEN REDUCED 'GAIN ajiMs- _ ::V TYPE 0-SC&AMr..E vt�t rar rey.Ic'e�r�rt :+.iuyo .x*u�+t=wL eau`s _ G .L waAnnm - i ! :.ee�OtCw.^Fkerfi£ S i c�yERGL�L OEn£RA`LSA6i.-Y - �t�'xr7!$6: t "4J GL+a0.Ai1•:A7F. �7Z't}k �, :� -C:=Y(hY.cti�.w:Yf7 rE Kw—NA.,b 43V 9i S c,E,i?xxe kWe-E 5 C*N-t tirCJtif7A'L Lexx:.SA�E9Es'xs; »GJ,X:"3-rl">1-Arm, Rxrcv ', r lit tQu 5 Ea acv, LIA prLy.Y Po.titi"Y iFw�spw'a�• 4CGN.Y RA'JKY tow a.^Ors_-4. AY wwtr:.wando _ : m ILj IVAoWALAE" LJ D=aw - i,..3 £AC,-C1CZL a'•WX S I � FR�f45 test G.AtaS+'+9E i6.::reff„w�. t SSS ` t ,.wr'K--s S AND EY}Vt4yC S d..HMI.RY t; 1F zO,Y tx.=s .�'�ER AtiY * cr{s rrrrr n� tasC 2i7I 1CI.r stt:Lit�a _Icrt..*CCOLN' S x �Ic€ a€xa wkA 1RAAFHtC+1327 c . �� q t PA-4bryx =I:IV ACT_.EAEWACr`sr r res.arsar" oEKRPI ,.-OFOfftATOIC'non ¢ It D(SFASE-Nkkytir S rk`L3 - tkdxcwftrYY E446-+:Pat+ h,s 4A t�iiPei?S1PeaS: E GERTIFICAT'E HUL—DERK CANCELLATION - Sh0V,LG kW CIF IE Ab0, 0ESC F S t D PO`_I ZZE=8=GANCeLLL 8UV—,C: -- Ckeresult TNF E WRATsDrt.TATE')*RF_OF.^tt r_E 4bE C vE d'EFa e4 Contractor Svcs ACCORZANCE tvtWT? MassachusettsµDeDertrrMcnt of public Safety Board of Building Regulations and Standards f"rift\t!4ciiO4% rriso�r:ti/r c'iiltti - - ILicentre:CSSL-902202 P.O.%x 344 Ip wk-h MA 019,� w f ✓�,�,.,,�r 1 dt iii t+� Expiration Co"tavl tner 25/2097 H.. f . o 23 _- Office of Consumer Affairs and Business Regulation 10 Park.Plaza - Suite 5170 Boston, Massachusetts 02116 Home .Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10/1/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER �.._.._.._ P.O. BOX 344 IPSWICH, MA 01938 Update Address and return card.Mark reason for change. Address F-:I Renewal ! Employment +, } Lost Card SCA 1 0 20M-05111 '/lr Yjr ruvrr rrtnr•utrf�r f'^f✓<r.+:lrrrlrr.;r/l s Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ;.t p iration date. If found return to: ',f1OME IMPROVEMENT CONTRACTOR before the ex t3 registration: 173410 Type: Office of Consumer Affairs and Business Regulation r ` Expiration: 1 011120 1 6 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 41.t4.iid4 44 ESSEX RDIPSWICH,MA 01938 4iout'Zign.tureUndersecretary