HomeMy WebLinkAboutBuilding Permit #142-2017 - 125 FLAGSHIP DRIVE 8/17/2016 NORT"
BUILDING PERMIT ,o��,.eO
TOWN of NORTH ANDOVER PLANS IN �_.�= ''°
APPLICATION FOR PLAN EXAMINATION 1,
Permit No#: �� Date Received
SSACOiU`�E
Date Issued: I
ORTANT:A licant must complete all items on this page
LOCATION 125 Flagship Drive
Print
PROPERTY OWNER WOR Associates
Print 100 Year Structure yesAno
MAP 25 PARCEL: 80 ZONING DISTRICT: Indus.1 Historic District yes
Machine Shop Village yes.:
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family Kindustrial
CXAlteration No. of units: ❑Commercial
❑ Repair, replacement C]Assessory Bldg ❑ Others:
Demolition ❑ Other
DESCRIPTION OF WORK TO BE PERFORMED:
3:#jy 2lo2 de*4ei-irncN ?eVL 1446VeL16etEA na�►wi►v6s �4 rECat�
i
Identification- Please Type or Print Clearly
OWNER: Name: WOR Associates/Robert E. Webster Phone: 978-988-9200
Address: 355 Middlesex Ave, Wilmington, MA 01887
Steven R. Webster
Contractor Name: Dutton &Garfield, Inc. Phone: 603-401-7601
Email: swebster@duttongarfield.com
AddresS: 43 Gigante Drive,Hampstead,NH 03841
Supervisor's Construction License: CS-039771 Exp. Date: 03-17-16
Home Improvement License: N/A Exp. Date:
ARCHITECT/ENGINEER Joseph E. Tatone Phone: 978-276-1960
178 Park Street, Suite 102
Address: North Reading, MA 01864 Reg. No. 9080
FEE SCHEDULE.BULDING PERMIT.$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ It 3 f 1&co FEE: $ 3�Ji
Check No.: -304-18 Receipt No.: ' 66
NOTE: Persons contracting with unregistered ontr etors do not have access to thegu x17ty fund
F'^•<+':�-r;�'-+c`�."':r.'F"_-'m:`. �';i. ..p+-."� C^�,�5'C" -r -+.. i?>t •'.)..'L r�. / iz+^4
Location j
F t "
No. 2,c)i� Date J 1y�
• - TOWN OF NORTH ANDOVER
•
' s Certificate of Occupancy $_
Building/Frame Permit Fee $ �
Foundation Permit Fee $ '�
Other Permit Fee $
TOTAL $ ,
Check#
Building Inspector
0
_i
Y Plans Submitted Plans Waived ❑ Certified Piot Plan Stamped Plans ❑
TYPE OF SEDGE DISPOSAL
Public Sewer Tmming/MassageMody Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packagmg/Sales ❑
Private(septic tank etc. ❑ Permanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORD
PLANNING & DEVELOPMENT Reviewed On--�
i �� Signature
V
COMMENTS lit/TLW biM6 60l j . No (-LM 1 1) ► �-\
J<
I
CONSERVATION Reviewed on Signature
COMMENTS.
HEALTH .viewed on Signature
COMMENTS
9
"• Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer ConneCtlon/signature&Date Driveway Permit �
DPW Town Engineer: Signature:
Located 384 Os ood Street
FI E DCPA tT ' F `t�"Trrl ``� mpser,Kainstt ��eyes , .11
gy
�
nt a 3 �4� ]i ::?7yS }t.5��r it;.f Tr'� ./`}{ice t°t`,-r�lt,• ;i1.�t tt xP',ix ) rf r. ?
g�Ei ^.t3� f 1 t c t + t a rst a r, , r .ter �F ^r;' r, , •�
rk y til., �y 4 ;t y Yi ��c :_S•`S•x s
;
X
_ tivy(IEhrt V{ � .1'F.;£i.�ti'S•f 1.'i..e Z�; ,r��t .x .�Y.'/J ,. f ft � •�k.:r{i�i'Feak ft•��iY .,
� w• i'.,
r. �3
}u J
�z:...;,a,;. �'3�ntt+2.h_ rcr�• , -�-p : 1. •:: _ .5::'t:'',i Syti; > i � �
� �i ry r( � f ,.,t t �_� •. .._..r_. .r � .t} : ,^t}°"7'd` r1, ZY�Kr 'rf � t.s '.Y�{�
_i4.. ..';..., _.: •. ... ...-. -(' .._i._ r _ e 6„4.'• ,ta .h, .t•.S1•.L7t�Y �.ea {�i P
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)
s
® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
I�
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
A. 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)
I
Building Permit Application i
4, Certified Proposed Plot Plan
4. Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit 1
Plan And
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler
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
I Doe:Building Permit Revised 2014
JJJ
.� 1
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
31 ,600.00 m
$ - $ 379.20
Plumbing Fee $ 47.40
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 47.40
Total fees collected $ 574.00
125 Flagship Drive
142-2017 on 8/17/2016
Interior demo
F Plans Submitted PI" Plans Waived ❑ Certified Plot Plan Q' Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer 11' Tmming/Massage/BodyArt ❑ SWh='ngFools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tang etc. ❑ penuanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On-� g '
t Si nature
COMMENTS-JAI7-_ 4-7d-A- biMf) 601 Ivo
CONSERVATION Reviewed on Signature
COMMENTS.
IHEA,LTH eviewed ori Signature
II
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
f'..p .. - - -{r.:.: 'rr --ei'... ^��r,.�•;�,_,� rq• •�, ev. 'r,•.•
!4n � 1 - _ _ _ i'�•:r.�t�>:..::, �jG f.•Yr) :'{',tom- ��2'f•. �.t,Y1:�:
FI E DSPARiTME-NiX' Tern` �Dum"ste o...'s t . :... •... ;',:= E' °� no t
=t. 'i¢ P. a P _t,r.rt�,,i
!. � '.'".G"°' S+..S p.>S..�;»,i,�, s4. ,yi.a\� ;:`;i+;%'`•4.. 't:�:.,Y��•;'.'._'>','t�'ri#�->}��i,�i:•;r�F��?.�esw. t. •p ';,a
_:�orated at ".2,.p
au
i
1r�'��•tL:..3f,a-�. n Y.fl 5.s .�.�+ l5._1` „n ..1 a':�
Fi,e Depart yent:st!g. r�e,datei ���t5��s� z t .,� .t•..F : ;.. ,4rn � '
y� _ ';RY„:'i,.,,f;. ;;1...-;.N'.'('n^ei:.`-:Rz�? :;moi.- •-.x•'P.vh.. �,'('•Sa
..�{..5..�i•.y�i.'-�Sti;t J.���5•� Z; ,^`�i: .:I•� "t�a�Rh• ••-t,,4.7..,1•:^.��c�.c:c—•F.T r., ..�. t i.:..>K..F >i("...,. .5 :'� t-•.
iv?�tz•1'.zt.a.:='l_ ere GGcK77��tt.7. - _ .::;.' ,.h.a.+ _ '.. ..'•{':5:..�•_..Cr:.' .t. ,r .i•ta;t � ,la }i•....�. at -j• ., :t.i:k;�.
r'�.!'. -.•�•2`rpt n•1'il,'.•;�,4J+s: �j;;t:N"'tikp;,.i:.a.i:;f'S!'-.e'✓�4'1 r:.'' ,?y.,.�.,;.. SS- "n cr.' yi'”
?:': - „; t `t::•},:!... ''-" .meq
'$T..
D
- — !C:'St��:'.. .:lY• 'I� _,�..er•��{: .�y:!S=rv.i Y
�ti'>`:.t•;Y a'Ria• at;:. - .,e1:•. a*1.
,.ri. _2).> -�4�`.�rF•`1""h� ,•��'�t _ ,e:7.1:`=_�'. ;',e{:t} i - �I!, ld Y•k"��,.
..Y� .>s•'i i=.e..4�Y.:t:•:�.:<y3:'�.i,�:=.':3-':.Yn" t..�x:Fs.{.::1:�.T.f.t'3 r}S.�
�l'.7Q M '•{ •'�: !:r z1'_-_ - ..r;:. �:['r•• 3:• �' <.t1`•. �:�:^ :� �'"••'c' r-'i�»',a.t
} t
f111 ANTS
NORTH
Town ofndover
� s
O - 0
No.
o h ver, Mass, Al.'M4 22AI(
COCHICHIWIC« ��•
pDRATED PP�,��y
s U
BOARD OF HEALTH
Food/Kitchen
PERMI LD Septic System
THIS CERTIFIES THAT ..........0..:.. .4. ' � BUILDING INSPECTOR
.... ......L... .........�...... ..
has permission to erect ................... buildings on .. T A ,� �1 Foundation
... .�Z ............ ........ .. ....bei........
.� .� Rough
/✓O
to be occupied as ...... ... .... ....... ..... .......... �. ... ....... � ............ . .. ..�.� )Chimney
provided that the person accepting this permit shall in every respect conform toe terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
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 CONST ON Rough
Service
.. ........... ............... ..... .. Final
BUILDING IN CT
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.
JDL Construction&Aggregate, Inc.
Estimate
45 Route 125
Kingston, NH 03848 Date Estimate#.
7/20/2016 300
Name/Address
Dutton&Garfield,Inca RECEIVED
43 Gigante Drive
Hampstead,NH 03841
JUL 20 2016
Duff on & Garfield, 1W.
Project
Description. Qty Cost Total
125 Flagship Drive,North Andover,MA-Roof top units after made 28,700.00 28,700.00
safe by others.Lift work,;rug removal,block walls,all abandoned
electrical,water and air.Perimeter trees less stumps to.be ground by
others.
Additional work 2,900.00 2,900.00
Page I of 2
Total $31,600.00
Customer Signature
Dutton & Garfield, Inc.
CONTRACTORS
August 8, 2016
Town of North Andover, MA
1600 Osgood Street
North Andover, MA 01845
Attn: Donald Belanger, Inspector of Buildings
Re: 125 Flagship Drive, North Andover
Dear Don,
Per our meeting last month, we have assembled the enclosed package for the demolition permit
at the subject property.
It includes a plan signed off by Lt. Robert Bonenfant, Fire Prevention Officer at the Fire
Department.
Please feel free to call me if you have any questions.
Thank you in advance,
Steven . Webster
SUTLER
BUILDER
43 Gigante Drive• Hampstead,NH 03841 www.duttongarfield.com Tel:(603)329-5300 Fax: (603)329-5368
JOSEPH TATONE & ASSOCIATES , LLC
ARCHITECTURE PLANNING INTERIOR DESIGN
July 13, 2016
Town of North Andover
Building Department
1600 Osgood Street, Building 20
Suite 2035
North Andover, MA 01845
Attn: Mr. Donald Belanger, Inspector of Buildings
Re: 125 Flagship Drive,North Andover, MA 01845
Dear Mr. Belanger,
I am working with Mr. Steven R. Webster of Dutton & Garfield, Inc. on the renovations at 125
Flagship Drive,North Andover, MA. I will be the design professional involved with the architectural
design and building code review moving forward once they acquire a new tenant.
Please feel free to contact me should you have any questions.
Sincerely,
Joseph Tatone
Registered Architect
I
178 Park Street , Suite 102 , North Reading; , Massachusetts 01 864
voice (978) 276- 1960 fax (978) 276- 1961 email: jtatone@jta-architects.com
COPY
The Commonwealth of Massachusetts
u
Department of Fire Services
Office of the State Fire Meftshal
P.0.Box 1025 State Road,Stow,MA 01775
PERMIT Date:
Permit No
City of Town) If Applicable) Dig Safe Number
In accordance with the provisio of MG.L. Chapter 10 as provided in section 5 2 7 C M R 3 4
Start Date
This Permit is granted to: l it T�n Y �9il�t f
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of
workday
at
(Give locate by street and no.,or describe in such manneras p provied ade ate identification of location)
Fee Paid S a� O /
This Permit will expire Signature of offical granting permit) Offical granting pennit (Title)
TWI.6 PRRMIT MI tCT RF C`_f'W-QP1("_I IC11 ICI V PnQTi=n I IPnKI THP PRPMICFq
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
e
Boston,MA 02114-2017
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
N1.TTle (Business/Organization/Individual):
Dutton & Garfield, Inc.
Address:43 Gigante Drive
City/State/Zip: Hampstead, NH 03841 Phone#:603-329-5300
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. 1 am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. El New construction
2.ElI am a sole proprietor or partner- listed on the attached sheet. 7. .❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
�
9. ❑ Building addition
[No workers' comp. insurance comp. insurance5. .
required.]. ❑ We are a co .
oration and its 10.0 Electrical repairs or additions
corpora
3.❑ I am a homeowner doing all work officers have exercised their 1 L Plumbing repairs or additions
myself [No workers' comp. right.of exemption per MGL 12.❑ Roof repairs,.
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors 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-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site
information.
Insurance Company Name: Firemen's Insurance Co. of Washington
Policy#or Self-ins. Lic. #:WPA517670311 Expiration Date: 11/1/16
Job Site Address: .125 Flagship Drive City/State/Zip: North Andover, MA 01845
Attach a copy of theworkers' compensation policy declaration page(showing 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$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 may be forwarded to the Office of
Investigations of.the DIA for insurance coverage verification.
I do hereby certify der the pains and penalties of perjury that the information provided above is true and correct
Sijznati Date: g->g•Z.ol 4
ell
Phone#: 603 295300
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
Contact Person: Phone#:
DATE
A�!eO® CERTIFICATE OF LIABILITY INSURANCE 10%27/2o 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
QEPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
;PORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 CONTACTNAME: Pauline Proulx
In£antine Insurance PHONE , (800)937-0704 FAX :(603)669-6831
P. O. Box 5125 AiL
ADDRESS:pproulx@infantine.com
INSURER(S)AFFORDING COVERAGE NAIC A
Manchester NH 03108 INSURERA:Fireman'a Ins. Co.. of Washington
INSURED INSURERBAcadia Insurance Group, LLC 31325
Dutton S Garfield, Inc. INSURE RC:
43 Gigante Drive INSURERD:
INSURER E:
Hampstead NH 03841 INSURERF:
COVERAGES CERTIFICATE NUMBER:15/16 Master 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.
INTSRR TYPE OF INSURANCE DD POLICY NUMBER MLSUBR PMO/LOICY EFF POLICY EXP LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A CLAIMS-MADE F_x1 OCCUR LII§E§ Ea occurrence $ 250,000
X CPA517669911 11/1/2015 11/1/2016 MED EXP(AN one person) $ 15,000
PERSONAL&ADV INJURY $ 1,000,000
GEML AGGREGATE LIMIT APPLIES PER I GENERAL AGGI-GATE $ 2,000,000
X POLICY 0 JECOT- F LOC PRODUCTS-COMPIOPAGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
aaklen
A X ANY AUTO BODILY INJURY(Par person) $
ALL UTOS OS AUTOS X SCHEDULED
AUCAA517670111 11/1/2015 11/1/2016 BODILY INJURY(Per accident) $
X R NON-OVuI�O PROPERTY DAMAGE $
HREDAUTOS AUTOS Per
X UMBRELLA LIAR IX OCCUR EACH.OCCURRENCE $ 5,0;0,000
B EXCESS LIAB CLAIMS-MADE AGGREGATE $ S'000'000
DEO I X I RETENTION 0 X CUA517670211 11/1/2015 11/1/2016 1 . $
WORKERS COMPENSATION 3A States: MA, HE X P O
AND EMPLOYERS'LIABILITY YIN
STATUTE ER
ANY PROPRIETORIPARTNER/EXECUTIVE NIA
E.L.EACH ACCIDENT $ 11000,000
A OFFICER(MEMBERiandatryInN )EXCLUDED? a WPA517670311 11/1/2015 11/1/2016
(Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000
Ifyes,describe under
DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000
A Leased/Rented Equipment CPA517669911 11/1/2015 11/1/2016 Ltrnit $100,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORO 101,Add(Oonal Remarks Schedule,may be attached if more space is required)
MASTER WORDING FOR CERTIFICATES:
It is agreed and understood that ( } is included as additional insured on General Liability,
Business Auto and Umbrella when required by written contract. General Liability applies on a primary and
non-contributory basis when required by written contract. Includes Completed Operations Coverage for
Additional Insureds. Waiver of subrogation applies to General Liability, Business Auto, and Umbrella
when required by written, contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
f� Dutton b Garfield, Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
43 Gigante Drive ACCORDANCE WITH THE POLICY PROVISIONS.
Hampstead, HH 03841
AUTHORIZED REPRESENTATIVE
Charles Hamlin/PP3
m 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
INS025 go14o1)
4
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-039771
construction Supervisor
STEVEN R WEBSTER «
26 PORT WEDELN RD `
WOLFEBORO NH 03894 .
---- Expiration:
03117!2018
Commissioner
Cody