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HomeMy WebLinkAboutBuilding Permit #864-15 - 153 MILL ROAD 4/30/2015 110RT 6• O 1 BUILDING PERMIT of -OAD , qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: �� . Date Received 'Is q�a�reo�Pp �5 gSSACHUS�� Date Issued: 4 IMPORTANT:Applicant must complete all items on this page LOCATION I6 1 ' I�� t F'�C1 - C�rt'Y1 1 �. `( U���V " I ) ,V q / Print' . I V PROPERTY OWNER —'�fj) h� Print 100 Year structure yes no MAP _PARCEL:`ObIO. ZONING DISTRICT: Historic District yes no Machine Shop Village ye 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 0 Septic ❑Well Floodplain: ❑Wetlands D Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: -6,u0F Identification- Please Type or Print Clearly `� jj OWNER: Name: L� `� V Phone: Q7 �l' Address: r Contractor Name: 2.. Phone:'. 74 Email. ii l w--a% : . ry _ Address: I&[ r("1e��h 5+- M y t/`nt� o t-`7 S Supervisor's Construction Licensea,5 �� � Exp.'. Date: / / / �Q4) Home Improvement License: Exp.. Date: 5 05'y 6 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. I Total Project Cost: $ I �-i �a FEE: $ Check No.: GZ�j Ct (�� (�®1 ?.�[� Receipt No.: 21E�-l�Z NOTE: Persons contracting with unregistered contractors do not have ace ss to the zar ty nd i Bug p Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits i 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 4 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 j 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 ❑ I i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ � COMMENTS CONSERVATION Reviewed on Signature COMMENTS r HEALTH'- Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 1N Conservation Decision: Comments 1 Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: 3 FIRE DEPARTMENT Temp ®urnpster on siteLocated 84 Osgood Street Located at 124 Mairi Street �r';; -' , Fire Departmentsi gnature/dater v � '.-,"4.r�'�f r���i � ,��3 f�" �7t �.�. ..x ,.. L �• '�".�'a � - � �,ysv�.$..��.�..i..��.�-.oe���� �, .� /'�}^.�'-f'�"3''L` `� j .�.'. � ,e �. 1.�# �., v?ar.%1� v :'fe�'i,'d'��,,r�i�.?*t tgft,: 4 ,5��, 'i+ � s�; : s r.�, _ •�,. i - l 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 i NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name i Doc.Bnilding Pennit Revised 2014 i - r � H11Location , No. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ �, Building/Frame Permit Fee ,) Foundation Permit Fee $ �.- n° ` Other Permit Fee - $ • t"��a :o�y� TOTAL $ Check# Off.71 2 - uilding Inspector NORTH Town of . ndover . 2 . _ . , Y. No. 864— - 5i y � h ver, Mass, &ri O COC 04IC"2WIC0( ��• S V BOARD OF HEALTH PERMIT L D Food/Kitchen Septic System 0 BUILDING INSPECTOR THIS CERTIFIES THAT •..... • •• . ....... 1153Foundation• •• •,...••• has permission to erect .......................... buildings on ..... ..............................'.............. Rough .. .�...�01-14 tobe occupied as ............ ..... ................................................. ............... Chimney provided that the person accepting t is permit shall in every respect_conform to the terms of the application Final e 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC 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. Smoke Det. NORTH Town of . O to f C' No. _ z o h ver, Mass, Ilk COC.41AAL N yQ. 7�A�RflTED S U BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR . . ...... .. .. .. Foundation has permission to erect .......................... buildings on .....15..3....�............................................ p . Rough tobe occupied as ............ ......... ... . ................................................................... Chimney provided that the person accepting t is 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN LATHS ELECTRICAL INSPECTOR UNLESS CONSTRUC ,f 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. Smoke Det. 1 CORITr2ACT. I 0396014 SERVICES.SOLUTIONS INSTALLED SALES CONTRACT" ,OW%S AUTHORIZEo REPRESENTATIVE hU.18l.P CUSTOEri —m ', 5TrJRE i SFR E7 fiG7R SS 15'r!>r,FT ;Eliot'SS 7 .rf1,. trrr rplP�g rt E^a r z� .. .—__„_...... RI F A.',K RF )A .�T;.Rgs,ME CV rrinF 1.CN THE REVERSE SiaE OF'r,4 S PAGE AW,S R--LOWING PAGES 8IF.rC RE SIG141NG - -. _ ....................................................... '------_STt.N nz ... ._.....z #3) �...8 .. �A r e.., p) .,_._..�.................. i ^°-r .� E�t7 iL E„ "til.1 y�i. p..r�.,i'k'- ",.", = f ............................................... NOTICE TO CUSTOMER-PRICE CALCULATIONS.In order to properly,perform the installation of cenain Goods'the Contract Price may include more Goods than actually will b,installed basedon the measured square footage of the Project Area.As a result " inC t riles acree that the lump-sum Price stated in this Contract is calculated-upon both the Value of estimated Cads required to fulfill the.Contract(including waste),wh"'cri,may. exceed the actual square footage of the Project Area,and the labor which may be estimated based on ,he amou ti of Goods required to fulfil,the Contract(including waste)..By signing this Contract below,Customer acknowledges receipt of this notice Contract Total m t•- g� and agrees and understands that the Price includes these costs which;nay not be 4 i t refunded once the Installation Services are performed. applicable taxes iitClUded ............................................. .. NOTICE TO CUSTOMER: Federal taw requires Lowe's to provide you with the pamphlet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure front renovation activity to be performed in Customer's dwelling unit. NOTE.If rotted wood is discovered during.installation additional charges will apply,You will be given a quote and a change order I must be completed and signed by the customer for any additional charges Z-`" Customer must initial. Tiny work or material not-st.edlin is riot ine udtid in this contract.Any changes or ad."<itions wit.tui at ap addihonat charge for the materia€and tabor. :-.._ ..._. .. . ...... PH010 RELEASE:_Customer grants to Lowes,and Lowe's employees and Independent contractors the right to take photographs of the Premises'where Installation Services wii be performed and all work performed at the Premises related to this Contract,and rtreuocab:y grants to Lowe's at right,t€e'and interest in and to the photographs for use in all markets and media worldwide,in perpetuity.Customer authorizes Lowe's to copyright.use and:publisn the photographs in print am:for electronically;and agrees that Lowe's may use such photographs for any lawful purpose,inch{'dding,but not limited iu marketing, advertising,publicity.illustration,training and Web content,By iniliwing here,Customer agrees to the foregoing:Ye,,,. :€ .{Customer to iri is to,the len). Work is to commence upon^reasonable availability of Contractor and/or any special order or customer made Goods)which is anticipated to be a {fill in date).Estimated completion date is _ [fill in date[. Said estimated sabstantiai completion date is not of the essence:A statement of any.corlingenc"ses that would materially change said estimated substantial completion date,is as folloh'S:— — —_..---. .......................................................___�. ,it applicable,Insert a statement n Stichye'ntdngencies), _. I This Contract provides that all claims by Customer or'Lowe's will be resolved by BINDING ARBITRATION_Customer and Lowe's GIVE UP THE RIGHT TOGO TO COURT to enforce this Contract(EXCEPT for matters that may be taken to SMALL CLAIMS COURT).Lowe's and Customer's rights will bet determined by-a-NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING_But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RUIX%APPf CABSaE>IN COURT.Arbitrator decisions are as enforceable As.any court order and: are subject to VERY LIMITEDREVIEW BY A COURT.FOR MORE DETAILS:Review the section titled ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract, DO NOT SIGN THIS CONTRACT UNTIL COMPLETE.AND YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON ALL 1 PAGES OF THIS CONTRACT,BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ.UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON ALL PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE- WITNESS OUR€'tANDfS)AN'D SEAL(S)BELOW'';HIS _DAY OF i 1 L/o e s Home C6nters 'LLC y Onen ................................... ... .... .. ....... ....................__...._ tnwe's A,ho,am".I4tepr senta Iva Go-owner or Witness Customer acknowlerfliles receipt of'a true copy of this contract which was completely filled inpriorto Customer's execution hereof You,the buyer,may cancet this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation fortis for an explanation,of this right.. 55094 REV, 211311 FILE COPY g vn The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 � M SV• www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 1 / MCAkn City/State/Zip: Wfi "' f 0 t 1 Phone#: J ! q`' a Y7—a 9 o 2 Are you an employer?Check the appropriate box: Type of project(required): 'Lfemployees(full and/or part-time).* 7. E]New construction 1.�I am a employer with 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. D Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12._0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof rep/airs These sub-contractors have employees and have workers'comp.insurance sV� 14.[ then,/ W 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'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. tContractors 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 the policy and job site information. /1�� Insurance Company Name:--A LX f l35 I 7 Expirationate. Policy#or Self-ins.Lie. [ Job Site Address:1_53. X11 ( 4(V p"l RA�VAW I City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u der tlr pains nd penalties of perjury that the information provided above is true and correct. Si nature: Date: �� -� Phone#:7� r —Q2 0 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#: 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 employer 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=contractor(s)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 LLC 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 in any given year,need only submit one affidavit indicating current policy information(if necessary)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. A new 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSA-FE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia ov/dia i CERTIFICATE OF LIABILITY INSURANCE DATE 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 Kenia Silva NAME: Marketing Associates Insurance Agency, Inc. PHONE (617)964-5340 acNo:(617)96s-1843 150 Wells Avenue E-MAIL ADDRESS:ksilva@telamonins.com INSURERS AFFORDING COVERAGE NAIC# Newton MA 02459 INSURER ANautilus Insurance Company INSURED INSURERB:COMMerCe Insurance 34754 Wilson Valdez, DBA: Master Roof INSURER C: P.O. BOX 83 INSURER D: 151 Main Street INSURERE: Milford MA 01757 1 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 14/15 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 DLTR TYPE OF INSURANCE POLICY NUMBER MLSUBR M DDYNYYY ILICY EFF MMEXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE Fx_1 OCCUR NN419532 /10/2015 /10/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 rGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED identSINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED BWQ71 /29/2015 /29/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical payments $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION Will be issued under WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N eperate cover within E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N I A (Mandatory in NH) 4-48 hours E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Siding Installation is subject to $500 deductible per claim.Roofing is subject to $2,500 deductible per claim. See Attached for Additional Information CERTIFICATE HOLDER CANCELLATION VendorInsurance@Lowes.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lowe's Companies, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. and any and all subsidiaries AUTHORIZED REPRESENTATIVE Attn: Vendor Insurance P.O. Box 1111 N. Wilkesboro, NC 28656-0001 Michael Susco/FPIT ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 ontnn..m nt Tho A(()Rr1 nnma 2nd Innn 2ro roniefororl m2r4e of A(`npn I r Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction aupei v isoi ' License: CS-102403 WILSON R VALDZ `= 151 MAIN STREL'1 v _ MILFORD MA (F175 )l 1 i 7 �,. -w�tJ Expiration Commissioner 11/20/2016 X Office of Cousuiner Affairs&Business Regulation WxplraMEIMPROVEMENT CONTRACTOR gistration: 150577 Type: tion: 4/1112016 DBA MASTERROOF fir j Sr WILSON VALDEZ 151 MAIN ST MILFORD,MA 01757 Undersecretary