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HomeMy WebLinkAboutBuilding Permit #267-7017 - 1532 SALEM STREET 9/13/2016 oa " oF,t..�o ,Qqa �j BUILDING PERMIT t U G ERM TOWN OF NORTH ANDOVER ►- ,o APPLICATION FOR PLAN EXAMINATION n � Permit NO: /// Date Receivedw`�9q A � Date Issued: vl SsgCHtlsE I ORTANT:Applicant must complete all items on this page LOCATION 1532 Salem St North Andover, MA 01845,; Print. PROPERTY OWNER Debra Arillotta r Print MAP NO: 1 _PARCEL: �' t f ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑Floodplain 0 Wetlands E Watershed District ❑ Water/Sewer r. cellulose insulation in attic Identification Please Type or Print Clearly) Y OWNER: Name: Debra Arillotta Phone: 978-777-8722 Address: 1532 Salem St North Andover, MA 01845 CONTRACTOR NameJoseph A Ryan, Merrimack Valley Insulation Phone: 978-408-7832 Address: 23A Sullivan Rd Billerica, MA 01862 Supervisor's Construction License: Exp.. Date: cs=075541 02/04/2017 Home Improvement License: Exp. Date: 180506 11/24/2016 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3828.88 FEE: $ Check No.: —I 5�16 Receipt No.: 36&kO NOTE: Persons contracting with unregistered contractors do not have access the ua anty fund Signature of Agent/Owner see attached Signature of contractor r + NORTF;. .q BUILDING PERMIT ° �tLEo o TOWN OF NORTH ANDOVER o , -. �'• APPLICATION FOR PLAN EXAMINATION _ OH �Qp cocnKn[wKn 4' Permit No#: Date Received �'�sSgcrED HUSE��y Date Issued: IMPORTANT. Applicant must complete all items on this rage LOCATION Print PROPERTY OWNER Print 100 Year StructureYes no MAP PARCEL: ZONING DISTRICT. Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg El Others: ❑ Demolition ❑ Other EYE =_�djg U.Wate�r�hed D7 61—t3 � � -� -�- OLW,ate /cSewe< — -- DESCRIPTION OF WORK TO BE PERFORMED: t i I Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone- Email: Address: s I Supervisor's Construction License: - Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING 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.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund � 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 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 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 4. 2012 I ECC 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/MassageBody 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 I 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/S nature& ®ate Driveway Permit APW Town Engineer: Signature: Located 384 Osgood Street FIRE;DEFAR;TMENT - Temp.Dumpster onsite yes, no.,_ Located af.124 11/Iain Street ,, xza "t''citlib '- ' ` Fire�Department COMMENTS ♦T >Z.i, I -- ---- --- - NORTH I Dimension Number of Stories: ---� Total square feet of floor area, based on Exterior ' Total land area, sq, ft,_ dlrnensions. ELECTRICAL: Movement of Meter location, mast o Electrical Inspector r ser�aice drop re Yes quires approval of DANGER ZONE LITERATURE- No MGL Chapter 166 Yes Section 21A—F and G min.$100-$1000 fine �® NOTES and DATA_ (For department use) t 1 i I I 1 I � I � ® Notified for pickup Call - Email Date Time _ Contact Name Doc-Building permit Revised 2014 --__ Location � I r`1 No. 1-2 (0 U 1� Date 7� � • • TOWN OF NORTH ANDOVER .,3 Certificate of Occupancy $ Building/Frame,Permit Fee $ "" Foundation Permit Fee $ *= Other Permit Fee $ TOTAL $ Check# % 1 Building Inspector Jt 30 NORTH own of 2 s _ ,, s ndover G 0 No. �1 y1#4 bJL ' h ver, Mass, IL COCNIc"awicK V ADRATED S U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT . ,..� �,,, ... BUILDING INSPECTOR Deble-14 . . . ...... .. . ..... ..... Foundation has permission to erect ............... ..... buildings on .151Z S ,. .... .. .. . .. Rough to be occupied as e�r. ` .......... � ... .... C .... .......................... Chimney provided that the person accepting 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 CONST TIO RT Rough Service . . .. ......... ................ ............. Final BUIL G INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin,:; 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 Federal ID#05-0406629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 Rils . A division ofThielseh Engineering ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-5024345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS OESCRISED BELOW CUSTOMER PHONE DATE CUENT a WORK ORDER Debra Arillotta (978)777-8722 12/14/2015 419721 00003 -SERVICE STREET ,�.T.•-���. .�~..�-•_. TW y BIWNG STREET 1532 Salem Street 1532 Salem Street SERVICE CITY,STATE,ZIP. BIWNO CITY,STATE,ZIP North Andover;MA 01845 North Andover,MA 0'1845 JOB IDESCRIPT,ION VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). $1!8.75 VENTILATION:Provide labor and materials to install ventilation chutes in(36)Taller bays to maintain air flow. $72.00 OVERHANG:Provide labor and materials to install 10"R-37 densely packed Class I Cellulose insulation to(48)square feet or exterior overhang located below a heated floor arca,by drilling holes in the overhang from below, plates drilled will be plugged. Plugs will be scaled with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up priming1painting will be the customers responsibility. $192.00 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 100%for the Air Seating measures up to the first$680 and an additional$340 if savings arc justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting n blower door diagnostic of the available air flow in your home both berore the Work is begun,and MOLT the Aveatheri7ation work is complete.We will also Conduct a full assessment of the combustion safeh oryour heating system and water heater.This hash value of S90 and is at no cost to you. Total allowable wratherization incentive is$3.110. $96.00 �, Total: $3,792.80 Program Incentive: $2,940.00 Customer Total: $852.80 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Eight Hundred Fifty-Two&801100 Dollars $852.80 UPON FINAL INSPECTION AND APPROVAL BY RISE ENORIEERIN G.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF I%WILL BE CtIARCED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGIITS OF RECISION,SCHEDULING.AND CONTRACTOR REGISTRATION. DO PNOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPAC A4CON.7RACT NYBE WIT14DRAWN DY US IF NOY EXECUTED WITHIN GATE OF ACCEPTANCE ACCEPTANCE OF CO - CT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE 4 r Federal 10#05.0405629 RISE Engineering RI Contractor Registration No 8186 ISEMA Contractor Registration No 120979 A division of T'hieasch Engineering RN ENGINEERING? 60 Showmut Unit#2,Canton,NIA 02021 CONTRACT 337-502-6335 IFA\339-502-6345 Page 1 PROGRAM THIS CONTRACT is ENTERED INTO BETWEEN ase CMA-HES ENOWEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSiT3MER PHONE DATE CUENTa WORKORDER Debra Arillotta (978)777-8722 12/14/2015 419721 00003 SERVICE STREET ¢ �\ yY BILLING STREET 1532 Salem.Streeter 1532 Salem Street SERVICE CITY,STATE,LP /'` BILUNO CITY,STATE,ZIP North Andover,MA 01845 � North Andover,MA 01845 ,f JOB DESCRIPTION PHASE ON£ Proposal for this calendar year. " S0.00 HAZARD BARRIER:We have identified[lint there are recessed lights present in your home.unless the recessed lights are certified as 1C-rnted(insulation Contact Rated)a-c will create a 3"clearance space around the fixture by using fiberglass blanket insulation as a damming material,no insulation will be installed across the top and closed cavities which contain recessed lights will not be insulated. $0.00 BARRIER:We have discovered what appears to be a mold I mildew-like substance in your home.This is being brought to your attention to identify it as a pre-existing condition to the insulation and air scaling work planned for your home.Your signature is your acknowledgement or these conditions and agreement to proceed. 50.00 AIR SEALING:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will be performed in concert with the use of spenini tools and diagnostic tests to assure that your home will be lett with n healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,roams and other products, Primary areas for sealing include air leakage to attics,basements,attached garages and other unhealed areas(windows are not generally addressed.)This will require(8)working hours.A reduction in cubic feet per minute(cfm)ofair infiltration will occur,but the actual number of cfm is not guaranteed. 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 Atc indoor air quality. $680.00 AIR SEALING ADDER:,(2)working hours. $170.00 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class I Cellulose added to(384)square feet of floored attic space. $683.52 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaccd fiberglass bans to(136)square feet for damming purposes. $278.80 ATTIC FLAT:Provide labor and materials to install a 10"layer of R-35 Class'1 Cellulose added to(864)square feet of open attic space. S 1,270.08 STORAGE BARRIER:Homeowner is niponsiblc for the removal ofthe stored items blocking the installation ofwcatheriaation work in the attic. Removal must occur prior to the scheduled work start. $0.00 ATTIC ACCESS:Provide labor and mnterials to install(I) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywood will be Created around the opening within AhC attic. 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II 'Lla I, Owners Signature I i Date i s i The Common-%edlth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington St. Boston,TMA 02111 www.mass.nom%dia Y'orker's Compensation Insurance-4111daidt: Builders/ContractorsiTlectricians/Plumbers Application information—Please Print Legibl- 1\ame(Bnsirtess/Orgazzizaon ndividual/Owner:�-• 'iK1C ll1 1,t;5ic� 7c�w Address: a� A Su-1 tell A Id, 12r, City/State/Zip:�i i i l; l cX, }.bra G I fsi�, Phone is i Are you an eraployer? Are you the homeo-wner? C{ieck the appropriate uuinber: \ i I. I am an employer withemployees(full andi'or Dart-time. l i am a sole proprietor or partnership&:Have no employeesv.orkin4 for me in an,capacity. 13. lam a homeo-:'ner doing ali::'ork rnvseli: (CN :workers compensation insurance required-) i 4_ I tine a general contractor& I hate hired the sii;�-contractors listed on the attached sheet ( hese contractor have workers comp.insurance and I have atmched a cony of their ins.) 5_ We are-a corporation and.it officers have exercised their right of exemption per;YIGL•c.1572S1 (4),.and we have no employees.(-o Yorkers comp.insurance required.) t s D -'iny applicant that ctteCiv"box=1 must also iii!act the section below showing their workers'.onp.policy information. i Omen?YP_r✓:S- o SS;I._I_ +�L vIQ:tY_C in:'iti:aLlng they.^.rte ut:irr=al'r'ari.. 0 tii::.s hire vt:caiva: .au.a.aa..a aT,i:St 5:1....... .,-•• 4 affidavit indicating scull. Contractors tract chr-k this bog miLst aivleh nn addiSanal useei showing the name of ti:e sub-copttacZirs a..d-their ivorker5�. i 1 i compensation policy information. Type os project(required): Check appropriate- t - - - ? a _ ?�e oligo 9_ Buiidina addition 6. ties• Construction _- Remodeling 8 rn. — i } Iectxic: 11. Plumb.12. Roof 13_ (3zher 10.- Latn an employer that is providin-g woi-iters'compensation insurance for my employees. Below is the oolic!&job site info_ -Insurance compan-y Name: policy r=or self-ins.Lie. Eipiration Date' _ Job Site 1 ddress: attach a copv of-rrarkers cor:ttiensanun policy declaration paLxe(sho.ving the policy anal:ber and e.piration date haillum to secura coverage as .quirad corder Section 25A of 1[IzLc_I52 can Iead to the imuosi=on ofcL'mina! pena.Itiec of a fine tip to SI.;00.(00 and/or one_year imurisoM11-ai,ties well as civil penalties in the form of a 'TOP WORK ORDER and aur:of alp toM250.00 a day against the violation. Be advised that a copy of this statement ma-v be forwarded to the OfEce of investigations of the DIA for insurance coverage verification. do hereby cert&l under the pains and penalties rif per3u; ,that the inf rmat-ton pro Aded abmz;is true and correct_ 'Simature: Date: Phone r /�� �i�k ���"3`!�� A Official use OIiiv: Do not vi i e it this zu�a_-to be Coinpjeted'b by Cit'Or torr,!offliC18!. n:L_ — IJiLy l)i-Tl�'J'%Li. Pv'�iiit-[ IdceaY'—se issu irCg Authorit- (chock O:ze) (._Hoard of Health 3_Building Dept. 3__Cit•.plTo.'in Cier: ?.Electrical linsp. 5. Plumb&Gas 6. Other _Contact Person: (print) _ Phone f j ACC> CERTIFICATE OF LIABILITY INSURANCE °oti24120016 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. C 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 Carolyn A Coughlin Charles J Coughlin Insurance PHONE (978)957-3588 FAX 14 Dinley Street c P.O.Box 10 A aI _ carolyn@coughlinins.com .�------.----- -- — -- ---- Dracut,MA 01826 INSURER(S)AFFORDING COVERAGE NAIL it _____ INSURER A: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURERS: Safety Standard 39454 23A Sullivan Road INSURER C: Torus Specialty Insurance Company A0159 N. Billerica,MA 01862 INsuRERn ' -------- ----- - -�- -- --- INSURER E: _ 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. INSR rypE OF INSURANCE DL S BR POLICY EFF POLICY El(P LTR 1 POLICY NUMBER MM/D - MMUD LIMITS A COMMERCIAL GENERAL LIABILITY WS274182 01/21/2016 101/21/2017 EACH OCCURRENCE S _ 1,000,000 CLAWS-MADE �OCCUR PREMISES(Ea�occurrence) S 100,000 MED EXP(Any one person) $ �— 5.000. PERSONAL&ADV INJURY $ 1,000,000 GE/N'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE IS 2,000,000 POLICY JEC LOC 1 PRODUCTS-COMPIOPAGG 1$ 2,000,000 OTHER_ i is B AUTOMOBILE LIABILITY 6205006 11/25/2015 11/25/2016 -1 COMBINED SINGLE LIMIT )$ 1,000,000 1(Ea accident) _ J,.ANY AUTO BODILY INJURY(Per person) S S ALL OWNED SCHEDULED 1-AUTOS ^_v. AUTOS BODILY INJURY(Peraccident) $ NON-OWNED PROPERTY DAMAGE _Y j HIREDAUTOS _V $AUTOS Per accident C V1 UMBRELLA LIAB vi OCCUR 18759311-161ALI 01/21/2016 01/21/2017 EACHOCCURRENCE S 1,000,000 EXCESS LU16 `CLAIMS-MADE I AGGREGATE $ _ 1.000,000 DED ,RETENTIONS 10,000 S D WORKERS COMPENSATION -� ( ( ., J PER 1OTH- AND EMPLOYERS'LIABILITY YIN v STATUTE ER ANY PROPRIEfOR/PARTNER/EXECUTNE E.L:EACHACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N l A (Mandatory in NH) E.L_DISEASE-EA EMPLOYE $ 1.000,000 If yes,descr(be under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORO 101,Additional Remarks Schedule,maybe attached if more space is required) JOB DUTIES:Insulation Installation:Additional insured companies respectively are Action Inc.and National Grid USA,its direct and indirect parents, subsidiaries and affiliates in addition to Comrrainity Tearnwork,Inc.,ABCO,.Inc.and B/G;�&UkE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN t ACCORDANCE WrrH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE- I p 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are:registered marks of ACORD F" _ �-l' "�� •-rF'-t:s'�`�� �;f=nl trf rl'--Z +�1�y •f r �, Office of con UM er A- lairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home[mpr0tkement Contractor Registration Registr2fion: 150506 TYPe:. Colpoi25an MERRMIACK VALLEY INSULATION CORP Explration: 11t2Et2016 Tr' Wa24 JOSEPH RYAN 3 A SULLIVAN RD BILLERICA. MA 01862 Update Address and return card.iltark r=son for cbang� Address _" RencuaI - Employment `-Lost Card �O1Lce a:Cartsnnrr_1lfairs S 8utiu s Fir ulaGon License or r visiration valid for indh idui use on 4y h7 IS 1P.IPROVEFrENT CON,RkC TOR bcfore the expiration data If found return ta: `,' t�sglstr3tion: i8D5DS Type: Office of Consumer-Afa Expiirs and s;usiness Ite�lgtion ziTon_ :t24t2016 Corporztian i4BarkPtar�._Suites C PfERRilrACK L'ALLEY INPULATION CORP I305t0n.MA 02I I6 JOSEPH RYAt.j 23 A SULUVIv:RD SILLERICA,faA 0186,- Undc.•Kcrulari iv3t valid:±ii i,.lJ f euE sidnafurc I - 1 eittSEIM- �JJiic S2 et _ •;tiz.v. i 'se:CS-07554-1 JOSEPHA RYA_r1 . 200-Kin_g RAI Dr_�pt 2131 -: " e' "° { Lynnfield 114.4 01'940 02/04/20 i7 0 I