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HomeMy WebLinkAboutBuilding Permit #1163-2016 - 174 GREENE STREET 5/1/2018 BUILDING PERMIT of NORTH q t<`-`° ,6 do TOWN OF NORTH ANDOVER O .• �� y�`' , ti A APPLICATION FOR PLAN EXAMINATION- Permit No#: Date Received �gSsgcHus���� Date Issued: IMPORTANT: Applicant must complete all items oirthis 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 El Addition ❑Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other • Septic Well K0Flo d lain Wetlands 0 Watershed District Waterl_Sewer DESCRIPTION OF WORK TO BE PERFORMED: I Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date-_'- Home ateHome Improvement License: Exp. Pate: 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 accessio1 a guaranty fund 71001 llmff�_ Location ej No. r �� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ; o ✓ Foundation Permit Fee $� Other Permit Fee $ TOTAL $ Check# 3 f 4 Building�'lnspector F_ 1NORTH - - ve' 'o � f O h ver, Mass, 0 �.... 1. COCHICNewKN A°RATIO PeP� S %J S U BOARD OF HEALTH PERM T LD Food/Kitchen Septic System THAT `a ...... I�.� BUILDING INSPECTOR THIS CERTIFIES ............... .... .� ...................................................... has permission to erect ..... buildings on . r4....,a r. cI ......... Foundation ... Rough to be occupied as ....�•,i" +�. ..bW `t .. ..... . .. ... .... ....... Chimney provided that the person accepting this perm 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 t1le Inspection, Alteration and Construction of Buildings in the Town of North Andover. N• -40 joo4e ja41S PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Perml . Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .. ................. ..�....,.................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. CONTRACT FOR Conser atlon PRODUCTS / SERVICE WORK Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Micbsel Asselin Conservation Services Group(CSG) 174 Greene St Attn:RCS North Andover,MA 01845-3907 50 Washington Street, Suite 3000 Site IID:S00050111599 Westborough, MA 01581 Project iD:P00050127053 Reg. No. 173484 Customer ID:C00050112505 Federal ID No.222457170 Contract ID:20151027_WORK (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be perforated the following work on these'Premises'in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantfly t nation Insulate Rim Joist with 625'Fiberglass Batting 64 Living Space $153.60 Attu:Floor Open Blow Cellulose 11• 832 . Living Space $1,497.60 Propavent 2'or 4' 30 Attic $114.90 Hatch:Thermal Banter Polyiw 2 Inch(W) 1 Living Space $41.71 Insulate VIrgA Sided Wall With 4'Denise Pack Cellulose _ 2,004 Living Space $4,829.64 Damming 14 NIA $30.66 Replace Bath Fan Hose 1 NIA $24.09 Insulation Removal 832 NIA $9%.80 Enclosed Kneewall Cellulose Dense Pada V 84 Living Space $194.04 Netting with reinforced strapping 84 NiA $55.44 Install 2-Thermal Barrier o.1yW On,Kneewali 72 Living Space $316.80 Sub Total: $8,21528 Utility Incentive Share $2,000.00 Customer Contribution $6,215.28 C1s•C�J FT. O For office use only Printed:10127/2015 Page 2 of 2 II. PAYMENT r Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment 41:$ 2�i- 1, b as a Deposit payable to CSG upon signing the Contract(not tj S 1/3 of the total retail costs).Mail check&contract to CSG,Attn:RCS,50 Washington St_,Ste. 3000,Westborough,MA 01581.Final Payment:$ 41 -1_ • 'S7 as the final payment for the Work shall be payable to the independent Installation Contractor("IIC")upon satisfactory completion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of$ C `UC:C — .Changes to individual line items and/or previous incentives may increase or decrease the size of the.Utility incentive Share. III. DISPUTE RESOLUTION The iiC and Customer hereby mutually agree in ach ance that in the event that the 1IC has a dispute concerning this Contract,the iiC may submit such dispute to a ptivaie arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in NI.G.L c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. l'u�•m..-�L...1' C.c..�r��-• f f•�Z S��� /�...c�, 1.:�,c,ocy a<,(moi i r.5.,c1/L.�./:� Customer S to Date indicate yo r selected IiC here,i .pplicable ('R) initial here if you want (O�•� m� the Programicipa in C assign a 1� CO' Participating Contractor CSG Sign t 'e Date \ane o CS' epresentative rinted) TERMS AND CONDTCiONS APPEAR ON THE REVERSE. 2.310-2-1/I.} I tower Ap Oink mass save PAWWWA OR PERMIT AUTHORIZATION FORM I, michael asselin ,owner of the property located at: (Owner's Name,printed) 174 greene st north andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. f X �G1,✓� Owner's Signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Raj 5'p Di For office Us¢only Rev.12132011 i The Commonwealth of Massachusetts f Department oflndustria_lAccidents -__ - 1 Congress Street,Suite 100 Boston,MM 02114-2017 °t www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHOPJTY. Applicant Information Please Print Ledbly Name(Business/Organization/Individual): k4eAP_/ V/dam' Address: 4 S0jhV,41_) { City/State/Zip: Z<<J 1c4 60Y6�'- Phone#: Y7i'SHF"3 M' Are yo employer?Checkthe appropriate box: Type of project(required): 1. am a employer with0_employees(full and/or part-time). 7. E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.E]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 [J 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 I L❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.[�Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers_have exercised their right of exemption per MGL c. 14.E]Other 152,§1(4),and we have W.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. i Homeowners who sub6if 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-ecnlractors 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. Insurance Company Name: �>✓ J �"F �'Y Policy#or Self-ins.Lic.#:(a Ax b- D &0 gill- g'-is Expiration Date: Job Site Address: ��T �� City/State/Zip: N` IZMJ(�'u- e✓ 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. Ido hereby certify under the pains anppd penalties perjury that the information provided above is true and correct. Sign e: l G Date: S Phone 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=contractors)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 foi•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.4 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 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=contractors)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 foi•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' compensatioii'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 www.mass.gov/dia The Commonwealth of Massachusetts z Department of lndustrialAccidents =__• : d I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Elee.tricians/Plumbers. TO BE FILED WITH THE PERMTTING AUTHORITY. Applicant Information f/ Please Print Legibly Name(Business/Organization/Individual): Ue l V Address: a3 ,4Sa-My,/IrJ City/State/Zip: ZiILS«C(} U 6/YL�'- Phone#: / 7i'ooiff.3 Y75' Are yo employer?Check the appropriate box: Type of project(required): 1.0 am a employer with _employees(full and/or part-time).' 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working forme in 8. []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 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole I L[]Electrical repairs or additions proprietors with no employees. ' 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.F1We are a corporation and its,officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employers.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who sebnuf 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-contraciors have employees,they must provide their workers'comp.policy number. Iain an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: iJ�K�lJ �"E � Policy#or Self-ins.Lic.#:(a — Gr 0 1///— 9—6J Expiration Date: 60 Job Site Address: l t T lam! 45�- City/State/Zip: N` 6gmd 1 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. Y do hereby certify under the pains and penalties o perjury that the information provided above is true and correct. Signature: �^ Date: S Phone#: r ' 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.PIumbing Inspector 6.Other Contact Person: Phone#: A>V CERTIFICATE OF LIABILITY INSURANCE DATE(MMMOff" 02/24/2016 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 WANED,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 ac Not P.0.Box 10 E-MAIL _carolyn@coughlinins.com T Dracut,MA 01826 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURER B: Safety Standard 39454 23A Sullivan Road INSURER C: Torus Specialty Insurance Company A0159 N. BOlerica,MA 01862 INSURER D: Travelers Indemnity Company of America TPC 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 I ADDLISUSTYPE OF INSURANCE R POLICY EFF POLICY EXP LTR TYPE POLICY NUMBER MM1D MMIDD LIMITS A COMMERCIAL GENERAL LIABILITY WS274182 01/21/2016 1/21/2017 EACH OCCURRENCE S 1.000,000 CLAItuISavIAOE OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 J POLICY ECOT LOC I PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 6205006 11/25/2015 11/25/2016CI _OMBINEosINGLELINpT $ 1,000,000 Eaacddora ANY AUTOll BODILYINJURY(Perperson) $ ALLOS �WN �I SCHEDULED BODILY INJURY(Per accident) $ � / NON-OWNED PROPERTYDAMAGE -V- V HIRED AUTOS I J�AUTOS Per accident_ $ } I $ C V UMBRELLALWB �j OCCUR 875931-161ALI 01/21/2016 01/21/2017 EACH OCCURRENCE $ 1,000,000 EXCESS UAB j CLAIMS-MADE AGGREGATE g 1,000,000 1 DEC) , RETENTION$ 10,000 $ D WORKERS O KER EMP°COMPENSATION O YIN 6HUB-0009111-9-15 06/18/2015 06/18/2016 \/ STATUTE ERIK ANY PROPRIETORIPARTNER/DECUTNE I I E.L.EACH ACCIDENT $ 1.000,000 OFFICERIMEMBER EXCLUDED? N r A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 1,000,000 If yes,describe under ---- - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H 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 Community Teamwork,Inc.,ABCD,Inc.and EVEn O TCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrTH THE POLICY PROVISIONS. .. AUTHORED REPRESENTATIVE - 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD &X e !iQ�1l/?Yl�'ll�(1Q fiL Q � 11C1��1.2�1,1P. Office of Consumer Affairs and Bus' ty Business Regulation 10 Park Plazg-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 180506 Type: Corporation MERRMACK VALLEY INSULATION CORP Expiration: 11/24/2016 Trx 260624 JOSEPH RYAN 23A SULLIVAN RD �`------'- BILLERICA, MA 01862SCA -- -- -- -- - Update Address and return card.A4ark reason for change- Address a `01O " J Address r Rcuewalt Em to P Yment ` Lost Card Y't/N/11I./r/rr`n���I/�l(r/!.f/r�.!I,r�� •_ �• Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: �9%istration: 180506 Type: Office of Consumer Affairs and Business R piration: 1124/2016 Corporation 10 Park Pt=-Suite S170 egulatioo MERRMACK VALLEY INSULATION CORP Boston.MA 02116 JOSEPH RYAN 23 A SULLIVAN RD BILLERICA,MA 01862 Undersecretary _—_--.- outsignaturc Massachusetts-Department of Public Safety Board of Building Regulations and Standards C'oastrui.it,n Supenisor License:C"75541 JOSEPH A RYAN= ' 200 Mug Rail Dr.Apt`2Q}'�Y' � Lyttnfield MA 0140 Wy Expiration Commissioner 02/04/2017