Loading...
HomeMy WebLinkAboutBuilding Permit #Exception - 18 HARKAWAY ROAD 5/1/2018 L NORTFj BUILDING PERMIT °`�,%-E76° ;6 6 3,r y�:,_ _.� OL TOWN OF NORTH ANDOVER o : ' 0 APPLICATION FOR PLAN EXAMINATION * ,� e o , ,> Permit No#: Date Received 7RA�RAreo gSSACHU`'�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION - Print PROPERTY OWNER _ Print 100 Year Structure yes no MAP _ PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition [I Two or more family ❑ Industrial [I Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic D Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: d i Identification- Please Type or Print Clearly � M OWNER: Name: Phone: ` E Address: _ I Contractor Name: __ Phone: Email: Address: Supervisor's Construction License: Exp. Date:. - . Horne Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 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 Signature of Agent/O er . �' Signature of contractor ! IN J Ir i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanniug/Massage/Dody Art El Swimming Pools ❑ Well ❑ F 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 i9natureCOMMENTS CONSERVATION Reviewed on Signature COMMENTS HE''ALTH 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/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE 0 -PAR�TMEN,T = Tem ��� . _ _ p Dumpster on site Located at'124<Main Sfreet yes no, _ v Fire Department signature/date _ COMMENTS 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 Doe.Building Pennit Revised 2014 — - - r 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 k ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract k ❑ 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/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 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 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 Location �tr r+����+ -�► `� 4., 4 No. 3�J ��1� ; Date �� `�� ! • - TOWN OF NORTH ANDOVER y Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ;'` Building Inspector Town of t _ sAndover O No. 3 _ q)61 h h ver, Mass O Iw KE 1, 7 COCMICNl WICK A04ATED S U BOARD OF HEALTH I Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THATMr , ., .�. BUILDING INSPECTOR ..... ...... ..... ...�.................. has permission to erect ............... ...... buil;i* g.s on ... . ...... .. .., ,� Foundation Rough tobe occupied as ................... .. ...... . ..�. E........................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRURough 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. I Smoke Det. nvtec'�'r Victor Roofing Expert 11 Huse Street 617-590-1064 Lawrence,MA 01841 Estimate Bill To: Estimate No: 206 Mountassir Lalami Date: 9/16/2016 16 Harthaway Road North Andover,MA 01845 tf 617 828 9123 ode 'Description Qty/Hours Rate Amount Strip Existing roof down to bare wood 1.0 $5,200.00 $5,200.00 If there are rotten wood,wood will be replaced up 50 ft. at no additional cost Supply and install 8"White Drip Edge to perimeter roof Supply and install 6' Grace Ice&Water Shield Supply and install Underlayment Synthetic Paper to entire roof Supply and install Timberland Architectual Shingles Supply and install Ridge Cup shingles Supply and install aluminum Roof Flashing to all exhaust pipes Supply and install Lead flashing around chimney Supply and install Step flashing around chimney Removal of debris from property,dumpster truck to be used. Indicates non-taxable item Subtotal $5,200.00 Tax(0.00%) $0.00 Total $5,200.00 Page t of 1 7'he Commonwealth of Massachusetts F Department of Industrial Accidents M _`' ~� 1 Congress Sheet,Suite 100 Boston,MA.02114-2017 .Vqr www mass.gov/dna Workers'Compensation Insurance Affidavit:Builders/Contxactoxs/Electritcians/Plum exs. TO BE FILED WITH THE PEp.A TTING AUTHORITY. please Print Le 'bl A '�licant Xnformation `r !, �,• ,�e�,�-�. Name(Business/Organizationft vrdual): V 2 yCw Address: u q Y Phone,4: tOII S�D" �D City/State/Zip: Are you an employer?Check the appropriate box: FM1'(N6Vd6nstr&fiOR f project(required): em to ees full and/or part-time).* 1.[�I am a employer with � P y ( 2.0 lam a sole proprietor or partnership and have no employees W01king forme in S. E]Remodel7.ug any capacity.[No workers'comp.insurance required.] 9, El Demolition 3.[:]I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10 F1 Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.QPlumbng repairs or addition$ 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13• of relia7Ss These sub-contractors have employees and have workers'comp.insurance 14.L 1 Other 6.F]We are a corporation and its.officers have exercised their right of exemption per MGL c. 152,§1(4),and v e leave no employees.(No workers'comp.insurance required.] *Any applicant that checks box#1,must also fill out the sectioabelow showing theirworkers'compensationpolicy information: I Homeowners who submit•thi affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this liox must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose enfiiies have they must provide their workers'comp.policy number. employees. If the sub-contractors have employees, lam an employer that is providing-workers'compensation insurancefor my employees. Below is the policy and job site information. end e mn i ^.�- �l�r� I e Insurance Company Name: �rrsC "i( a , Expiration Date: Z b 2 d 17 Policy#or Self-ins.Lic.#: City/State/Zip: rt Job Site Address: Attach a copy of the workers' compensa ' policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requited under MGL e. 152,§25A is a criminal violation punishable by a foie up to$1,500.00 penalties in the form of a STOP WORK ORDER.and a fine of up to $250.00 a and/or one-year imprisonment,as well as civil day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. X do hereby certi un ie ai nd p nalties of perjury drat the information provided above is true and correct. Date: D�` 9 — r 6 Si afore: Phone#: official use only. Do not write in this area,to he 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 auy 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 enferprige,and including the legal representatives of a deceased employer,or the receivet'dr,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 ofthe 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 on to construct buildings in the commonwealth for any applicant whd has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(1)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 Ind-ustrialAccidents. 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-MASSAFE Fax#617•-727-7749 Revised 02=23-15 wwwmass.gov/dia GUTIERV103 DKULICK A�O" DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 9/28/2016 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 License#1780862 CONTACT NAME: HUB International New England PHONE FAX 299 Ballardvale Street Arc No Ext):(978)657-5100 1(Air,No):(97 8)988-0038 Wilmington,MA 01887 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE i NAIC# INSURER A:Penn-America Insurance Company 32859 INSURED INSURER B: Victor GutierrezdbaVictorRoofingExperts INSURER C: dba Victor Roofing Experts INSURER D: 11 Huse Street Lawrence,MA 01841 INSURER E: j 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 TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP L� INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE Al OCCUR PAC7097591 10/0612015 10/0612016 � E�RENrE° — PREMISES(Ea occurrence_ $ 50,00 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000:00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acadent _ ANY AUTO I� BODILY INJURY(Per person) $ ALL OWNED SCHEDULED P INJURY BODILY INJUer accident)AUTOS AUTOS ( ) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE 1$ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED RETENTION$ g WORKERS COMPENSATIONPERI AND EMPLOYERS'LIABILITY Y/N I STATUTE !EERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mountassir Lalami THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 16 Harkaway Road ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I DATE(MMIDD/YYYY) ACo CERTIFICATE OF LIABILITY INSURANCEF 09/28/2016 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 NAME: Diane Kulick HUB INTERNATIONAL NEW ENGLAND LLC PHONE Ext): (781)792-3238 FAX No: ADDRESS: diane.kulick@hubintemational.com 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAICs NORWELL MA 02061 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B GUTIERREZ VICTOR DBA VICTOR ROOFING EXPERTS INSURER C: INSURER D: 11 HUSE STREET INSURER E: LAWRENCE MA 01841 INSURER F: COVERAGES CERTIFICATE NUMBER: 89204 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 0 OCCUR DAMAGE T ENTED PREMISES Ea occurrence $ I MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ETH AND EMPLOYERS LIABILfTY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA 6HU66B12804616 07/20/2016 07/20/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mountassir Lalami ACCORDANCE WITH THE POLICY PROVISIONS. 16 Harkaway Road AUTHORIZED REPRESENTATIVE North Andover MA 01845 DCL"9, Daniel M.Cr�Y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD - i Construction Supervisor � Restricted to: Unrestricted-Buildings of arty use group which contain Mss than 35,000 cubic feet(991 tunic meters)of enclosed space. i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation'of this license. CAPS Licensing intormation visit:WWW.MASS.GOYIDPS ofPUVif et ElGird oaf f3c�i`dix q_ P c +sf�.y e tat+ons n Standards - t icy-- sse,,CS-077784'`. ' Construction.Supervis, ot MAXINOS NATZLILIADES 5 MADISON STREET; BELMOf�'T MA 02478 "- 4 ExiDi ration. Commissioner 09/2912017 r''/1r�1�inm»z�nurra�f�c f'"l�l�aun•��u;cllt Office of Consumer Affairs&Business Regulation -4OME IMPROVEMENT C9,NTRACTOR t"�_,{ • 'Registration: 176451 Type: ` ',Expiration: 823/2017 Individual VICTOR X.GUTIERREZ VICTOR GUTIERREZ 11 HUSE ST \t -= LAWRENCE,MA 01841 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plana-Suite 5170 Boston,MA 02116 Not valid without signature