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HomeMy WebLinkAboutBuilding Permit #453-15 - 12 RICHARDSON AVENUE 5/21/2015 uI1 �� Xr BUILDING PERMIT NoFD 1 TOWN OF NORTH ANDOVER C) APPLICATION FOR PLAN EXAMINATION y ' A. ,�(\J/ T a h 7 Permit No#: Date Received 1sRADRArED / gsSgcHus�� Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION ��'t�� �rS�c-►�iq; Print PROPERTY OWNER �9- r I_(hl Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: 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 ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -77 ist® cSepti ❑Welle I 7 Y — __J �®W��ter//Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: &Q 1`; r r i'ci rr` cChi Phone: Address: J- v�e- Contractor Name: e-r t t-e l el ykC Phone: Email: Address: 11�- e-5r- TvLe Supervisor's Construction Licenser55L t /Q Co 01,E Exp. Date: Home Improvement License: (c7 Exp. Date: ae ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ -3 00 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund __-. - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiirining 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 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 I DPW Town Engineer: Signature: Located 384 Osgood Street AFIRE DEP'Ar N1E(VT rI" u. �, 4M- Ternp Dumpsfer�onisitez�y�es Lted at 124 tib,: < �• tr •y r �t � R- '�"�'b�., n �. ljiN/�` i ,a ;t w.t^},.ts t,,1.'�,.:t ai,�. SS,•ir 77�1'�; � ._ � 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) Ll Notified for pickup Call Email Date Time Contact Name 3 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 -t 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 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 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 4 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 Location No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupar)cy $ Building/Frame Permit Fee $ Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check#'�/XJ 1 C U + Building Inspector NORTH Town of E ndover No. 0 015s�.v * - ,� I � Zb000 C, h ver, Mass, COG..ICHI WKN TE 9) ►PP,�,�y S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .�1�.L.........Vits-iteckBUILDING INSPECTOR . . .... .... Foundation has permission to erect .......................... buildings on ....I..1......... ... .. !�i. r ........ Rough to be occupied as ..........fti...%lisalk .... .... .......................: Chimney provided that the person accepting this permit All 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 CONSTRUCTI STS S Rough Service ............... . .. ... ................................................ 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. i Smoke Det. RISE En ineerin Federal ID# g g RI Contractor Registration No MA Contractor Registration No A division of Thielsch Engineering CT Contractor Registration No ! 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 RISEPage 1 PROGRAM CONTRACTTHIS ENGINEERING ANTHUSTER CMA-HES ID CMFS ENTERED INTO OR WORKAS EN I SE ENGINEERING DESCRIBED SELOY/ CUSTOMER PHONE DATE CUENT N WORK ORDER April Varricchio (203)6714582 03/13/2015 410232 00002 SERVICE STREET BILUNG STREET 12 Richardson Avenue 12 Richardson Avenue SERVICE CITY,STATE,LP SILUNG CITY,STATE,LP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION BARRIER:A Blower Door Test will not be conducted at your home,due to the presense of asbestos. $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home 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 sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (8)working hours. 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 be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass baits to(66)square feet for damming purposes. $135.30 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class I Cellulose added to(792)square feet of open attic space.KEEP A 14X12 SECTION OF FLOOR IN ATTIC FOR STORAGE/ACCESSS STAIRWELL SLOP AND KWALL BY TEMP ACCESS THROUGH ATTIC FLOOR/I HAD NO ACCESS TO OVER REAR AND SIDE BUMP OUT ATTICS ASSUMMED SAME AS MAIN ATTIC. $1,085.04 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items blocking the installation of weatherization work in the attic. Removal must occur prior to the scheduled work start. $0.00 SLOPES:Provide labor and materials to install a 6.25"layer of R-19 fiberglass batts to 952)square feet of sloped ceiling area. Wherever possible baffles will be installed to the entire length of each bay to maintain ventilation space.KEEP A 14X 12 SECTION OF FLOOR IN ATTIC FOR STORAGE/ACCESSS STAIRWELL SLOP AND KWALL BY TEMP ACCESS THROUGH ATTIC FLOOR/I HAD NO ACCESS TO OVER REAR AND SIDE BUMP OUT ATTICS ASSUMMED SAME AS MAIN ATTIC. $105.04 KNEEWALLS:Provide labor and materials to install R-13 faced fiberglass to(92)square feet of kneewall. Then install 2"rigid board insulation.Seal all seams with FSK tape. $335.80 ATTIC ACCESS:Provide labor and materials to make(1) access opening from one attic area to another by cutting a passage through sheathing. This access will be left open as it is between two common unheated non firewalled attic areas. $31.31 ATTIC ACCESS:Provide labor and materials to make(1) temporary access to an attic area through the roof. The opening will be closed with materials similar to those existing.Roofing will be sealed properly when insulation work is complete. $92.42 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-stripping to restrict air leakage. i $200.00 . c ' Federal ID# 1 RISE Engineering RI Contractor Registration No k MA Contractor Registration No 1\ A division of Thieisch Engineering CT Contractor Registration No 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 R I S E PROGRAM THIS CONTRACT 1S ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTO WORK ORDER April Varricchio (203)6714582 03/13/2015 410232 00002 SERVICE STREET BILLING STREET 12 Richardson Avenue 12 Richardson Avenue SERVICE CRY,STATE,LP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). $237.50 VENTILATION:Provide labor and materials to install ventilation chutes in(62)rafter bays to maintain air flow. $124.00 VENTILATION:Provide labor and materials to install(8) 8" X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. Specify color:White or Gray. $200.00 WALLS:Furnish and install blown in Class I Cellulose to(45)square feet of shingle and/or clapboard exterior walls.The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed,will be the customer's responsibility. Invoicing will occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will return when weather permits to check for any voids with an infrared scanner. Any major voids that may be found will be filled at no additional cost. 1 $83.25 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items blocking the installation of weatherization work in the basement. Removal must occur prior to the scheduled work start. j $0.00 BASEMENT CEILING:Provide labor and materials to install(110)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $192.50 BARRIER:Homeowner is responsible for the removal of any ceiling tiles blocking access to the sills. i $0.00 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 1000%for the M Air Scaling measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your home'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 complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. " $90.00 t Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thielsch Engineering CT Contractor Registration No 60 Shawmut Unit 1112,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 R I SPage 3 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUENTM WORK ORDER April Varricchio (203)671-4582 03/13/2015 410232 00002 SERVICE STREET BILLING STREET 12 Richardson Avenue 12 Richardson Avenue SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,592.16 Program Incentive: $2,770.00 Customer Total: $822.16 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Eight Hundred Twenty-Two& 161100 Dollars $822.16 UPON FINAL INSPECTION AND APPROVAL BY RISE EN EERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 70 DAYS.SEE REVERSE FO PORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION,SCHEDULINO,AND CONTRACTOR REGISTRATION. LDO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 4 AUTWIMIUD SIGNATURE•RIS 01 g CUSTO ACCEPTANCE ` NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE `y ' ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE 1 C�tL DMC I APR 2 7 2015 OWNER AUTHORIZATION FORM I (Owner's Name) owner of the property located at oo (Property Address) (Property Address) a hereby authorize , (Subcontractor) an authorized suboonbactor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. r--- Owner's Sig re ( tu, Date i M f 7 1.� i I _� The Coinnionlvealth of Massacliusetis Department of Industria/Accidents Office of Investigations f 600 R'ashington Street -+ -�. Boston MA 02111 tvsviv.nnassgov/ditt t_- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lel:ibh Name (Business./OrganizatioNlndiridual): Address: ox o X _fs Ci1ty1State/Zip: J p M Phone#: Q 7 ff- Are you an employer?Check the appropriate box: Type of project(required): �i. am a contractor and I I.(�I am a employer with_�_ � I general tt6_ ❑\ev 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 3 Demolition working for me in any capacity. employees and have workers' o workers' comp.insurance comp.insurance 9. ❑Building addition required_] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3_❑ 1 am a homeowner doing all-work officers have exercised their 1 I.El Plumbing repairs or additions myself. No workers'com right of exemption per VIGL � p• 12.[:] Roof repairs insurance required.]} c-152§1(4).and we have no employees. [No workers- 13_ [�Other 'SAS*J/4 i 1✓► comp.insurance required.] *Any applicant that checks box=1 must also fin out die section belowsho+.ing their++orkers-compensation policy information. l lomeo+Vaers+rho submit this affidavit indicatine tht.%-are doing all u-urk and then hire outside contractors mast submit a new nifidmit indicating such- lC'ontractors that check this box must attached an additional sheet showing due name of the sub-contractors and state whetheror not those entities have emplovets. If the sub-contractors have emplocees_they must provide their workers comp.policy number. I am an emploJ'er chat is providing tporkers'compensation insurance for nn,enrploj!em Below is t/ie policy and job site information. Insurance Company Name: A o>r�V Q Police t or Self-its.Lic_#: PO Wc—$�,�Lib $� Expiration Date: l/I-- Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(shox%ing 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 S 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 S250.00 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 herebr cert•under the pains anti penalties of perjurj•that file information provided above is true and correct. Signature: +''^ Date Phone< C1��'• D�• lA Official use onll: Do not write in this area,to be completed br citr or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.Ci"/Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person- Phone#- ACORO CERTIFICATE OF LIASILITY INSURANCE F °"'�('"�°°"""� 01106=15 THIS CERTIFICATEIS 18SUED AS A MATTER OF INFORMATION ONLY AND CONFERS N�� � DR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER CIE IMPORTANT:If the certficate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION iS WAIVED,subject to the tensa and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsem rd(s). PRODUCER GUNTAIGY PE Automatic Data Processing Insurance Agency,Inc- No: I AdR Boulevard � Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAICB 09KIRERA- NorGUARDInsurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURERS: 51 S CANAL ST INSURER C: PO BOX 958 INSURERO: Lawrence,MA 01843 INauRER E: IN urmF: COVERAGES CERTIFICATE NUMBER: 295670 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 LTR TIPS OP INSURANCE POUCY NUMBER U18i5 COMMINWIAL GENERAL LIABILITY EACH OCCURRENCE $ OAMAGETDRENIftu CLAW"ADE D OCCUR PREMISES om MW- $ MED EXP(Ary ale person) S PERSONAL 8 ADV INJURY S GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY Q J� M LOC PRODUCTS-COMPIOPAGG S OTHER S AUTOMOBILE UAIMJTY NGLE UMrf $ ANYAUTO BODILY INJURY(Perpeman) $ -- AAUTOLL O,SWNED A SCHEDU� BODILY INJURY(Per acdaw) b HIREDAUTOS0-- -AUTOSPerms S S UA03RELLA UABHOLcAcuMR.4,AE EACH OCCURRENCE $ EXCESS UAB AGGREGATE S DED RETENTIONS S WORKERSCOMPENSATON X AND EMPLOYERS'UABIUTY STATUTE ER YIN ANY PROPRIETORIPARTNEIMMECUnvE E.L. ACH ACCIDENT S � � 1.000,000 A aER�DED7 a NIA N POWC650990 0110112015 01/01/2016 - rcyes(t In NH) EL.DISEASE-EA EMPLOY S 11000,000 DESCRIPTION OF OPERATIONS balm EL DISEASE-POLICY LIMIT S 1,000.000 UM DESCRIPTION OF OPERATIONS I LOCATIONS/YELUCLES(ACORD 101,Additional Rsmarb Schede,may be etadhed If more space Is rem CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CPLUMBIA GAS ACCORDANCE WITH THE POLICY PROVISIONS. 195 FRANCIS STREET Cranston,RI 029'io AUTHORIZED REPRESS NTATME ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD r,...1 OP 1D:SS CERTIFICATE OF UAI3UTY INSURANCE TM CERTFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CMFWATE HOLDEL THIS CEMMWA7E DOES NOT AFRROAATNELY OR NEGATNELY ASID, EXTEND OR ALTER THE COVERAGE AMMED BY THE POLICIES BELOW. THIS cemv7CATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSMG BMRERM AWHORMO REPRESENTATIVE OR PRODUCER,AND THE CERTIRCATE HOLDER. DAPORTANT: it the conwite holder is=ADDRTONAL WSURE%Dm pofty(ies)must 1e embm d- if SUBROGATION 18 WANED,subject to Ute teens and condlU ns of the pOtloy,owMa PORGIMMaY MqUIMan walorsenteM A AM I ton this a doss M ooMet rights tO UM GwMGM hokler in lieu of such wMo PROtwaIM OaM&JuntOMMM Ins Agcy LLC 198 Avenue North Andover,MA 01845 Durso&JwdoiNsM ins.Agcy. ZME&POLAR-1 NUMMMAFFOROM NALCa UMIED Polar Best CE 016- wsmeaA YWm Amed= P O Boat 858 Ue e; 1nSttrancB Co 8 Andover,MA 01810 LNsu at oLSLUtt3�0: E: F- COVERAGES CER'iIRCATE NUMBElk REVISION NUMBER! 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AR r obb moved, A00RD 25(B ) The ACORD time and logo am eegmer ed mance of ACORD v usiness Regulation Office of ConsumerkAf�a and to 5170 10P Boston,Massachusetts 02116is�tion Home Improvement Contractor Reg Registration_ 102726 Type: DBA Tr11 252249 Expiration_ 7=016 POLAR BEAR INSULATION CO. - — Vincent LeBlanc - p.O. BOX 958 1810 .Mark reason for change. ANDOVER, MA 0 Update Address and return card, Epsployment Lo Card ii Address Renewal J OPS.CA1 ES 50M404/04-G101216 1 Massachu setts Board o d n9 Regulations and Standards Construction Supenisor Specialt) License:CSSL-106017 t PETER A LEBLOC 2 EAST PINE STREET Plaistow NH 0386 „ Expiration �. 04/2812018 commissioner