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HomeMy WebLinkAboutBuilding Permit #576-16 - 15 BRADSTREET ROAD 11/10/2015 c9G'l�st�✓rrED //-/�-/5r BUILDING PERMIT NORTy 0F�t�Eo ,bq'tO TOWN OF NORTH ANDOVER a� J APPLICATION FOR PLAN EXAMINATION Permit No#: , Date ReceivedA�` R 7Rq�R.{TED �SSACHUSE� Date Issued: r0 , IMPORTANT:Applicant must complete all items on this page. LOCATION t e !9 G V- ✓' DD P int PROPERTY OWNER 1 rrCk d� i�c^na�► Print 100 Year Structure yes no MAP PARCEL: 2-3 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 KOthers: ❑ Demolition ❑ Other w ❑ W te= r/S ® Floodpla nr etland=is ®_WrateedDstrct0MM-M 75 ®U1eSptii ewza DESCRIPTION OF WORK TO BE PERFORMED: �;I` S tg f i r/�G I�7-T r� t- �v�S�l a r 1'o►� - rb �- Y �j 4 Identification- Please Type or Print Clearly OWNER: Name: ? ' Phone:c % tea Trv�Gh Phone: . a Address: /,1' ,�I'�c�ST�`�z°7� �� 1-9fldo✓� ''� Contractor Name: Pe -rel-14 f t l�I'qKC Phone: Email: Address: -)- eq -57- i o-e -57- , /-4►'� e �•� M Supervisor's Construction License: lG a Exp. Date: Home Improvement License: lc) Exp. Date: I , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT."$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ -- Check No.: Receipt No.: � C5-) NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund A J W t Location No. ' - l_; Date . - TOWN OF NORTH ANDOVER , • Certificate of Occupancy $ x Building/Frame Permit Fee $-4;- ' Foundation Permit Fee $, Other Permit Fee $ TOTAL $ Check# _/f?(` —7 29650 ,Building Inspector 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 FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 1 WEALTH Reviewed on_ Signature 5 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: RED Located +384 Osgood Street EPgRTN1EiVT { � cTemp�Dumpster �' x � r ¢ } Loatedrat�124 Main StreetA< _ b i `Y ., ti -, r1 $� a ; Fire�Deprtmdhig $� r�ature/date c.,��. +1 3TC' s' COMMENTSt �t � "' , ' x.. ... ._ ._.. ,:r._ar.-.....:«,wt-...nQ011 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 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" 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 4. Certified Surveyed Plot Plan 4. Workers Comp Affidavit � Photo Copy of H.I.C. And C.S.L. Licenses �6 Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) 4. 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 Application Permit A lication Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses iL 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 NORTH Town of 2 . � E . Andover 0% ;S16- 2ol Z L^Ka h , ver, Mass, 10 241C O coc"Ic Kl WICK RATED) S U BOARD OF HEALTH Food/Kitchen PERMT T LD Septic System THIS CERTIFIES THAT ................... .../..�...... 1 !Y............................................................................ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .... ......R............... � Rough to be occupied as �........ ..... .. "'�... ti' I� SV � �i/1 / ............................. Chimney provided that the person accepting this permit shall in every respect conform to the ter sof 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 CONSTRUCTION T TS Rough Service ...........:...... .... ... ............ .. ..... :.:�.................. Final B ILDING 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. i RISE Engineering fficontmowitegId ORM K%c r No 120979 A divldon of TMdKb Engineering CTConbuutor ReglobM n No 630 M 60SI, Carron,MAotozl CONTRACT 33949x2, " FAX 339�0?.6345 Page 1 PROGRAM cm-M rum MAN CUMT9 Patrick BarmanI Z!M1 (978)108-1582 09/27/2015 413289 00007 15 Bredshvet Road 18fill C= 00 15 Bradstreet Road N 0. North Andover,MA 01 () awn Nath Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor your lie wusstaHrl,a air leakage. This work will be perfmosed m oomxrt with the use of special tools and diagnostic tests to—m that your borne will be left with a h=WM level of airmbange and indoor sir quality.Materiels to be used to seal your borne can Mede Wft foams eod aft produxts. Primary arms Hr salhug includo air lmlorge to attics,basements,attached garages and other uarlod areas(vviadows are not generally addred)This well roquire(8)working Lucius A reduction in cubic feet per mauls(c8n)of air in5ltratimu will cc=,but due actual mm►ber of cfm is not pm dw& At the completion ofthe weathabafion work,and at no additional cost to the homeowner,a ftd blower door andlor oombustion safety analysis will be conducted by the to ensu m the safety ofta indoor air quality. $68D.00 AIR SEALING ADDER: (2)wmkmg home. $170.00 ! ATTIC FIAT:Provide labor and materials toirroan a6"layer of R 21 Class i Cellulose added o(U4)square fed of Soared attic spar $L,537.92 ATTIC FLAT:Provide labor and materials to WSW a 10°layer of 1L 35(lass 1 Cellulose added to(196)square Sed of aper attic space. $288.12 SLOPES:Provide labor and maoaials to mill a Ur layer of R 35 Class 1 Cellulose added to(128)square fat of slope ane VAwaver possible,bates will be irtitalled to the cum tw*of each bay to maintain veatrMM spaces $249.60 ATTIC ACCESS:Provide labor and materials to iawbft the back of the attic door with 2-rigid Thamax board and seal the door's edge with waadmrsuipping torasa F-air leakage. $73.91 VENTILATION Provide labor and mdtWiWS to hUM(5)r diaooeer roof vans)to i vermlafm in attic areas. The vent con be supplied m(circle color)black brown,gray or mull Sni* $427.50 VENTILATION:Provide labor and mwxWs to install vamWon chutes in(64)rafter bays to maintain air flow. $128.00 RISS will apply ail applicable,eligible is to this couftwL You will only be bilked the Net amount. C wwdy,far d*Ve meamea,Columbia Lias o!£eem 7596 incentive,not to exceed$2,000 per calendaryea,and=moartive of 100!6 for the Air Sealing measures up to the first$680 and an additional$340 ffsavings are ju stmed by the auditor. For the safzty and haft of your hands lecher air quality,we win be conducting a blower door dimoW of the available air How in your home both before the work is begum,and after dw weatleniretion work is eomplow We will also conducta Hdl smasme t of the combustion safely of your heating system and water heater.This boa value of$90 and is st no cost to yea Total allowable wea&erintion uaxadve is$3,110. $90.00 f Fadw ID0054405629 RISE Engineering M C0nb=or Re al No 8188 MA CGnbRGtw Regktratlon No 12091 A dWM=oTTMdKb Cr Contradw Resbtratloo No 82012 60shawmal;Caalaa,'w►02M1 CONTRACT339-SM197 FAX 339$01.6345 Pap 2 M=R" CMA-M Patrick Bateman (998)208-1582 09/272015 413289 00007 WROM on= -1110 OW 15 Bradstreet Road 15 Bradstreet Road -BERME-CM. ZIP UUM aw.uffillur North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,"LOS Program Incentive: $2,940.00 Customer Total: $705.05 1NEAORMeratEarmFUMMSERVICE$-C=KETEMACCo wneAeovE sAllONLPORlaEUNof "*Seven Hundred Five&06H00 Dollars $70S.OS MBPIAMAFM >> ar utruiraPm�an ."a�uaew,om D0 NOT 8M 7M CONTRACT THERE ARE BLANK SPACES Ml lTftds=(S@p 27.1015) ArA;ck ZLnrAr. sl g ""*tMW 2%2015) sots=taosaoomi►ar�araewnaurwer��ume reownow - Ernali: bateman.pftr 1all.coin 30 VAYL 8P PA�� LLUERA�YA80tIItD! "---" IIIOWf OWNER AUTHORIZATION FORM Patrick Bateman I, (Owner's Name) owner of the property located at 15 Bradstreet Road, North Andover, MA 01845 (Property Address) 15 Bradstreet Road, North Andover, MA 01845 (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. 1,902CMM Owner's Signature 9/28/2015 Date i `\ The Continonivealtli of Massacliusetts Department of Industrial Accidents Office of � • Im esti aborts E 600 Washington Street Boston, NIA 02111 www.inass g ovIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Almlicarit Information Please Print L,eaibly 'Name (Business%Oreanization/individual): �0 iq f- t �✓�r rn s L' •r�- Address: Cit)-/State/Zip: yza JO M Phone #: Are you an employer?Check the appropriate box: Type of project(required): am a employer with—_ 4. E] I am a general contractor and I employees(full and/or part-time)." have hired the sub-contractors 6_ ❑\est construction 2_❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S_ ❑ Demolition working for mein any capacity-_ employees and have workers' comp. 9• E]Building addition [No workers' comp.insurance p.insurance.a required.] 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all stork officers have exercised their 11.❑ Plumbing repairs or additions myself.[\o workers-comp. right of exemption per MGL 12❑ Roof repairs insurance required.]" C. 152_S 1(4),and we have no employees. [No workers- 13_[ROther rA;-J/q 1 9 til comp.insurance required.] °:\m'applicant that checks box=l must also fill out the section hi•lo',v sho�cine their workers compcmation policy infornation. I tomeowiters;who submit this affidavit indicating they are doing all work and then him outride contractor most submit a new affidavit indicatinE such. =Contractor that check this box must attached an additional sheet shon•ine the name of the sub-contractors and state whether or not those entities have entplovees. If the sub-contractors ha+e enhployeo_they must provide their porkers'rnntP.policy number. 1 ant alt employer that is provitling workers'compensation insitrance for nit•entplotrees. Below is die poliorind job Site information. Insurance Company Name: v u 4 Policy'_or Self-ins.Lic.4k p We- " ep& j Expiration Date: t I�p Job Site Address: �— A S i�'e e 7- City/State/Zip: I' • All h vt r— Attach a copy of the workers'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 S 1,500.00 and/or one-vear imprisonment.as well as civil penalties in the form of a STOP WORK ORDERand 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 certif•ander the pains and penalties of perjrrrl•that llie information provided above is true and correct. Signature: Date: Phone Official use onit: Do not write in this area,to be completed ht'city or town offrcirri City or Torn: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3_City/TO-ti-n Clerk -t. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone m: I � i OP ID:SS CERTIFICATE OF LIABILiTY IiVSURANCE DA�E(MM,D� 03ft3/2015 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 certificat®holder is an ADDITIONAL INSURED,the policypes)must be endorsed. if SUBROGATION IS WANED,subject to the terns 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 NAME..cT Durso&Jankowski Ins Agcy LLC PHONE FAIT 198 Massachusetts AvenueftU North Andover,MA 01845 ADD FSS: Durso&Jankowski ins.Agcy. ARODuca1 POLAR-1 INSURER(S)AFFORDING COVERAGE MAIC:* INSURED Polar Bear ns ation .Inc. INSURER A:Penn America 32859 P O Box 956 Andover,MA 01810 INSURER e:Safety Insurance Co. 33818 INSURER c: INSURERD: INSURERE: INSURER F. COVERAGES CERTIFICATE NUMBER: 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. LTR TYPEOFR�SURANCE POLICYNUMBER POIDUnrV F POS Ul4rS GENERAL LIABILITY EACH OCCURRENCE S 1100010 A X COMMERCIAL GENERAL LIABIUIY AC7052023 03124P1A95 03/24/2016 PREMISES Ea Muren) S 50,00 CLAIMSMADE ®OCCUR MED EXP(Any are person) $ 510 PERSONAL&ADV INJURY S 11000,00 GENERALAGGREGATE S 2,000,0 GENIAGGREGATE LIMIT APPLIES PM PRODUCTS-COMPiOPAGG $ 11000,00 POLICY P=RO- lOC S AUfOMOBiLE UABILLTY COMBINEOSINGLE UMIT S 1,000,00 B ANY AUTO 2100926 01/04/2015 01/0412016 BODILY INJURY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per acaderd) $ SCHEDULED AUTOS PROPERTY DAMAGE S X HIREDAUrOS (PER ACCIDENT) X NON-OMEDAUTOS S 5 UMBRELLAIJAB X OCCUR EACH OCCURRENCE 5 1,000,00 EXCESS LiAB A CLAIMS-MADE AC6906385 03/24/2015 OX24=6 AGGREGATE $ DEDUCTIBLE S RETENTION S $ WORKERS COMPENSATIONWC STAT, Rr ANDEMPLOYERTLIABILITY T RO _ ANY PROPRIETOWPARTNERiEXECUT1VEYlN El EACH ACCIDENT S OFFICERiMEMBER EXCLUDED? F-� N/A (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE S If yyes,desaibe under OESCRIFr10N OF OPERATIONS below E-L DISEASE_POLICY OMIT S DESCRIPTION OFOPERATIONS/LOCATLONS/vElacLES(AVech CORD 1101,AddHorrelRematoSoedue,ffrn m mceiaquineMInstookMinontherleayorliability.with performed ibhl bthabo a Insured Is Thiei Engineering CERTIFICATE HOLDER CANCELLATION T'HIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thielsch Engineering THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave AUTHOAO�REPRESENTATNE Cranston,8102910 01OW2009 ACORD CORPORATION. Ali rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD -�1 A�& CERTIFICATE OF LIABILITY INSURANCE �un81L014 Y) THIS CERTIFICATE 15 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,ANDTHE CERTIFICATE HOLDER. { IMPORTANT.I the certificate holder is an ADDITIONAL INSURED,the policy(es)must be endorse 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 CONIALI NAME: PHONE Automatic Data Processing Insurance Agency.Inc. ((Ar_N EXR: (k_Kok 1 Adp Boulevard AtTDREss: Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAIC INSURER A: NorGUARD Insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURER B: DBA:Polar Bear Insulation CO Inc INSURER C: PO BOX 956 INSURER D: Andover,MA 01810 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 291629 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS UEDTO 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 SUBJ ECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE !NSD WVD POUCYNUNBER (MMODIYYYYJ MIDD:YYYY) LIARTS CERCIAL GENERAL UABILI V EACH OCCURRENCE S LMIAL't lu REM ED CLAMISAIADE El OCCUR PREMISES(Ea uuunence! S MEDEXP(Nryuneperwn) S PERSOM'%L&M.'INJURY S GENT AGGREGATE LIMIT APPLIES PER. CENERALAGGREGATE S POLICY OPRO- a PRODUCTS-COA(PAP AGG 5 )ECT LOC OTHER: S AUIOMOBLLE Lt48iLrTY LDINLLEUMIF Ilia 2LLidem1 S ANY AUTO BODILY INJURY(Per person) 5 ALLOWNED SCHEDULED BODILY INJ DRY(Per acidem) S AUTOS AUTOS HIREDAUTOS t.0 -01 EU i i S AUTOS O'er accident) S UNBRELLALIABOCCUR EACHOCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE 5 DEC) I tRETENTIONS S WORKERS COMPENSATION x I PE STATUTE ER ANDEMPLOYERS'LIABILITY ANY PROPRIETORRARTNEREXECUTI(•f Y JN EL EACH ACCIDENT 5 1.000.000 A OFFICER MEMBEREXCLU0E0? aN!A N POWC660990 O1JD7/LOlS Olpl/LOdb (Mandatory in NM EI-DISEASE-EA EMPLOYEE S 11000.0 II Yes. tPTIOe under OESCRtPT10NOFOPERATIONS blm� E1.01SE AS E-POUCY UWT 5 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD IOL Additional Remarks Schedule,may be attached ilmorespace is requned) Columbia Gas massachuseus CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Theitsch Engineering,Inc. ACCORDANCE WITHTHE POLICY PROVISIONS. 195 Frances Ave Cranston.R)02910 AUTHORIZED REPRESENTATIVE l � A©1988-2014 ACORD CORPORATION.All rights reserved. f ACORD 25(2014,01) The ACORD name and logo are registered marks of ACORD � I i I I Of usiness Regulation er Affairs and Office of Consumer plaza-Sure 5170 Boston,Massachusetts 02116 rovement Contractor Registration 140me imp Registration: 102726 Type:. DBA Tr# 49 `- Expiration: 7!2!2016 POLAR BEAR INSULATION CO. - Vincent LeBlanc -- P.O. BOX 958 1810 Marts reason for change• ANDOVER, MA 0 Update Address and return Employment D Lost Card L1 s Renewal :-j d res d � A I 101276 OPS-CA1 a `�M"�'C' 1 t ti v Massachusetts 'Department of Public safety Board of Building Regulations and standards Construction Supervi")r Spcfiait%' License:C—SAL-106017 IL PETER A LEBLANC 2 EAST PINE STREET,' - Plaistow NH 038CS FV Expiration V12.-. •tJ 04/28/2018 commissioner