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HomeMy WebLinkAboutBuilding Permit #002-2016 - 120 STAGE COACH ROAD 6/29/2015 L:F A444 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued. complete all items on this I IMPORTANT: Applicant must page s. LOCATION - Q Print. PROPERTY,OWNER _, _ - _ _ ar_. Print 100°YeOld Structure, yes Fn MAP NO: PARCEL-61.5i ZONING QIST�RI.CT: Historic District yes, Machine.Shop Village - yes_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition El Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic El Well, ❑,Floodplain Wetlands ❑ Watershetl District 0 Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: I Identi cation Please Type or Print Clearly) n r OWNER: Named \_� Phone: l Address: C CONTRACTOR Name: Address: ( \`n .� - - - S'u ervisor's=Construction License. Exp. Date:. -_ Home Improvement License - Exp. Date: I Lo 1:'�' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING 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.: 2�c`2 NOTE: Persons contracting with unregistered contractors do not have access farantnd Slgnaturesof A end w0 Herr SI nature,of confract_ _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The foh-awing 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 ❑ 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 Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 NOTE: 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 apo.-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Buhding Permit Revised 2012 4 Plans Submitted-0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OP SEWERAGE:DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc._ ❑ . Permanent Dumpster on Site ❑ it THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i DATE REJECTED DATE.APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS -CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r !Tanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Tow;! Engineer: Signature: -- Located 384 Osgood Street FIREDEPAiRTM�aNT - Temp Dumpster on site yes no Located-at Q4tMain Street Fire Departmerit�snat /d "t ig - e COMMENTS r. 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.s1oo-s1000 fine NOTES and DATA— For department use ® Notified for pickup - Date I Doc.Building Permit Revised 2010 Location Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ j TOTAL $ Check#-71T 2899 Building Inspec or NORTH - . w: 1 . t E .c ve' 'o O 0 No. W 2 ?'a � � z o TL h , ver, Mass, (A m 26 11�A_ Acoc«ic"twock y1. 7,4 RRA TE O I? S V - BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ..................................................... &.............................. ............................ has permission to erect .. ............. . buildings on ...�. ....s .. ,... 0: Foundation �. � Rough tobe occupied as ....... .. .. . ...... .... �. S...................................................................... Chimney provided that the person acceptin 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 CONSTRUCTIO T RTS 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. Smoke Det. �Jwu 1/0 i/7 tt«- T. EIN#51 050-3313 Haverhill MA 978.374.9224 Amb Lawrence MA 978.687.7339 MA Reg.HIC#149221 T MA Lic.UCS#78130 Hampton NH 603.929.9224 fi�9 Hampstead NH 603.329.8200 BBB. Single-Ply License#1711 " sCo, Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 A *Licensed :Insured ;=Factory Trained Factory Certified Name: 0 Io rc Date: Telephone: Alt.Telephone: Email: Billing Address: \'Z-0 y a {'O c� City: �� ,i- A n pjx/klu State: 004,% Job Address: City: State: Scope of Work Strip and Re-roof ❑Re-roof Approximate Roof Area: ❑ Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. ❑ Remove existing layers of shingles down to roof deck and dispose of in a legal fashion from the job site.per LF for roof deck boards.If ❑ Inspect wood deck,if we discover any rotted wood,replacement will will performed at*$ _p substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$_ �2-0 -per SF.If individual sheets are found to be rotted/or de-laminated,removal,disposal and replacement will be performed at per sheet.If any trim boards are rotted, replacement will be performed at*$ �z' per LF for new pre-primed pine.Inspect siding at roof he and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at*$ _•If wood deck,siding,and flashing is sound,we will re-nail any loose wood to rafters,sweep deck,and prepare for roofing. ❑ Install 8"drip edge to all rakes and eaves.Color (�)h\-� . ❑ Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or ❑ Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. ❑ Re-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. ❑ If upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$ '• ❑ Install a new: 412 Year ❑ Traditional �Architectural ❑ Designer Color ❑ Furnish and Install a new shingle over style ridge vent system ❑Soffit vent system*$ �-cv ❑ All debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job site in a legal fashion.Under no circumstances will the watertight integrity of the building be comprorm' ed.� Special Notes r s '�1 UPO COMPLETION AND PAYMENT IN FULL,ROO SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF-142- YEARS F_142-YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE l The Contractor agrees to perform the work,furnish the materials and labor specified above for the total sum of: $A 6) (Dollars) Payment will be made according to the following work schedule: $ deposit upon signing contract $ by_/_/_or upon completion of $ upon completion of contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram or by delivery,not later than midnight of the third business day following the signing of this agreement.See attached notice of cancellation for for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acceptance of the Contract Proposal Home Owner(s)Signature(s): Date: 0 /03/(I U /d3l Contractor's Signature: Date: .lambertroofingxom (Please see reverse side) Compar y Insurances TGLRC Inc.DBA Lambert Roofing Company will provide certification of insurances,demonstrating that we are fully insured for worker's compensations, general liability,automobile liability and an umbrella policy.This documentation will be sent through the US mail to the above named party if not already provided. TGLRC Inc dba Lambert Roofing Company agrees to• • Commence the described work on or about • Complete the described work in approximately days. • Not be held liable for delays due to circumstances beyond our control. • Not be held liable for any damages to landscape and or fixtures due to circumstances beyond our control. • Not be held liable and not covered under the workmanship warranty,for pre-existing conditions including but not limited to: • Mold and or wood rot,defective,faulty,rotted or worn building counterparts such as,but no limited to:siding,roofing,masonry, plumbing and windows,all of which may jeopardize the watertight integrity of the structure. • Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. • ss a signed Change Order has been executed between TGLRC Inc.DBA Lambert Roofing This contract is the complete contract unle Company and the Homeowner/Business Owner or Agent. J? rmi A building permit may be required to remove and replace your roof.It is our obligation to secure these permits if required as the home owner's agent.Note: istered contractors are excluded from the Guaranty Fund provisions of MGL c.142A. Homeowners who secure their own permits or deal with unreg Accelerated Payment A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financiallyinsecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds t would require the f funds from said account w account as aprerequisite to continuing the contracted work.Withdrawal o t escrow ed in a'om not et due be lac I Y P signatures of both parties. PaMent Terms A finance charge of 1.5%a month(18%per year)will be added to all invoices on the 31'day.All legal and or collection fees will be paid by the binding holder of this contract. • The law requires that any deposit or down payment required by TGLRC Inc.dba Lambert Roofing Company before work begins may not exceed the greater of- 0 1/3 of the total contract price or: o The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule. Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event,that the contcactor.has-a dispute concerning this -- contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Re atio and th consumer shall be required to submit to such arbitration as provided in MGL c 142A. Owner: . Date:_ =P Contractor: � 0 Dater Contractor Reaistmdon All home improvement contractors and subcontractors must be registered,any inquiries about a contractor or subcontractor relating to a registration should be directed to: Contractor Registration: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place,Rm. 1301 Boston,MA 02108 (617)727-3200 Home Improvement Contractor Law: Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulations 10 Park Plaza,Rm.5170 Boston,MA 02116 (617)973-8787 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 Cancellation You may cancel this agreement if it has been signed by a parry thereto at a place other than an address of the seller,which may be in the main office or branch thereof,provided you notify the seller in writing at the main office by ordinary mail posted,by telegram sent or by delivery,no later than that midnight of the third business day following the signing of the agreement I ITIALS The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA.02111 www.mas.s gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeaiblY Name(Business/Organization/lndividual): kc) Address: (� _��\� � - City/State/Zip:\�O. j2r k )\ w hone#: Are you an employer?Check the appropriate box: Typo of project(required): 14?rl am a employer with aQ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ElDemolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.E].Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. �e. Policy#or Self-ins.Lic.#:��( �,� a��°` j � ' �. �Expirafion Date: cam'a (o Job Site Address: CmrhLJ City/State/Zip: PMofQr Ma Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of 'Investigations of the DIA for insurance coverage verification. Ido hereby certify under the p p altie Fury that the information provided above is true anti correct. Signature: Date: ca lotp t Phone#• `'l� ;,��`-1 ' c0aa 4 Official use only. Do not write in this area,to be completed by city or town official. 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 - - d'nnfarf.Parcnn� Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all 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 of hire, express or implied,oral or written." An employd is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee 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 of public 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 the boxes that apply to your situation and,if necessary,supply sub-contractors)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 LL C or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for 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 you 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications"Many given year,need only-'submit one affidavit indicating current policy information(ifnecessary)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. Anew 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Commonwoaltl ofMassarhv.sP s Department of J dustrial.Accidents Office ofIn,-Vestigatiol s. 604 Washingtoxi Street Boston}M.A.02111 Tel,#617-727-4900 ext 40E or 1.-877,MASSAk'E Revised 5-26-05 Faze#617-727-7749 DATE(UlwuonmYY) C® (CERTIFICATE OF LIABO TY INS ��� 04t07115 CERTIFICAT R. THIS HTS UPON THE THIS CERTIFICATE IS ISSUED AS A MATTER OF NINFORMATION EGATIVELY AMEND, EXTEND OR ALTER AND CONFERS NO TIHE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR N ORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. bject,to iMPORTANT: It the certificate holder is arta DPDp IO es may require•an endorsement A statemen'thepolic lies)must be e t certificate 5 Adoes not cconfeerDrights to the the terms and conditions of the po Y, certificate holder in lieu of such endomement(s). CONTACT Jerrold Ramerae TAE: FAX ,(978) 795-5483 -RODUCER PHONE (Q78) ?�5-5905 r►I,LAN INSURANCE AGENCY INC- EMAIL -,7erroldelallaninsurauce-coal 53 1/2 Jefferson Avenue 2nd Floor NAfcff INSURER 5 AFFORDING COVERAGE p.o. BOX 511 NIA 01970-0511 msuRERA:Assoicated Ind Ins Co SALEM insurance Cc INSURED INSURER C.NatiOnal Union Fire Ins Co TGLRC INsuRFRD-.Ace America" Insurance Co. dba: Lambert Roofing Co. 265 Winter Street INsuRERE:Ace American Insurance CO. MA 01830- INSURER F HaverhillREVISION NUMBER: OD COVERAGES CERTIFICATE NUMBER: THIS IS TO D CERTIFY THE POLI ANY Es 0 REQUIREMENT. TERM ORCE DCON[ATION OFBELOW HAVE BANY CONTRACT ED OR OTHER THE EDOCUMENT WITH RESPECT TO W41CHTIHIS INDICATECE CERTIFICATE ONE AND CONDITIONS OF S CH PORKIES.LHMITS SHOWN MAY HAVE BEEN EEtd REDUC DI BIY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS S POLICY EFF POLICY EXP LIMITS I STYPE OF INSURANCE POLICY NUMBER I MMMDnr MM ! 1,000,000 TR ! / FJ\Ctt OCCURRENCE 5 GENERAL LIABILITY / / ! ! D TO R S 50,000 PRE ISES Ea octurrent e X COMMERCIALGLNERALtIABILITY 1/12/201811/12/2015 MED EXP(Any one Person S 1,000 CLAIMS MADE X OCCUR 51028029 11000,000 A � PERSONAL;,ADV INJURY 5 X Per Project Agq 210000000 I / / / GENERAL AGGREGATE S I ! ! t f PRotwcTs-COMP1QPAGG 3 2,000,000 GENT.AGGREGATE LIMIT APPLIES PER I ! / J ! s POLICY X PRO LOC 1i ! ! / ! COMBINED SINGLE LIMIT 1 ooa ooa AUTOMOBILE LIABILITY / ! / / BODILY INJURY(Per Psmm) S B ANY AUTO ! / / / BODILY INJURY(Pe•aocident) S AA WN X AUTOOS�ED 6203819 7/16/2014 07/16/2015 ROPERTYOAMAGE 3 X X NON-OWNED PC axtd�n }{(RED AUTOS AUTOS ! / / / m I ! ! / ! 5,000,000 818930331 EACH OCCURRENCE S X UMBRELLAUA13 X occUR 1/12/aai4 21/12/2f►as AGGREGATE s 5,Doo,000 C EXCESS UAB CLAIMS-MADE ! / / / 3 DED RETENTION S / ! f X WC S'TATU- OTH WORKERS COMPENSATION / / ! / AND EMPLOYERS,LIABILITY EL EACH ACCIDENT S 1 000 000 ANY PROPRiErORIPARTNERIEXECUTIVE(�'I NIA3/25/2015 3/25/2016 EL DISEASE-EA EMPLOY $ 1 000 000 OFRCERIMEMBEREXCLUI1 D? (�J S62US-2509875-2-14_ I+UL D (Mandatory In NH) ! ! / / E L DISEASE-POLICY LIMIT S 1 000 000 IfyaS.describe under DE SCRIPT ION O(OPLRATIONStekm 2/22/2014 2/22/2015 same turas as 1,000,000 TAT Worker's Compenstaion NH 16S62UB-SD81311-6-1a- NR 1,000,000 utmtl) DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES (AUeeh ACORD 101,Additional Remarks Schedule,V mots SPaco IS Mq CERTIFICATE HOLD-- CANCELLATION _ BOV SHOULD ANY OF THE AE DESCRIBED POLICIES BE CANCELLED BEFORE TGLRC dba Lambert Roofing THE EXPIRATION X IRATIACCNCE WrrH THE PPOTHEREOF, NOTIC LICY PROV15 oIdSE Will BE DELIVERED IN 265 Winter Street AUTHO REPRESENTATIVE Haverhill MA 01830- ©1988-2010 ACOR15 CORPORATION. All rights reserved. ACORD 25(2010105) ° INS025 a010041 01 The ACORD name and logo are registered marks of ACORD C&MI30 t - RICHARD J LAM�MRT 26S B EWM STREET HmrhM PAA 01930 06[0212016 Office.of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 TYPe: Private Corporation Expiration: 12!6/2015 TIC 246813 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. 0 Address C] Renewai ❑ Employment ❑ Lost Card