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HomeMy WebLinkAboutBuilding Permit #1145-2016 - 176 VEST WAY 5/4/2016 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION s= r oR . ,. Permit No#;� Date Received 'ls A°R�reo 4y gSSHCHUS�S � Date Issued: 7 IMPORTANT:Applicant must complete all items on this page LOCATION7�o Ile I Prin PROPERTY OWNER_ " �C.l�tl�l USLnr'K Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside—l Non- Residential ❑ New Building ne family ❑ ,ddition ❑Two or more family ❑ Industrial 2'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ . D Septic 0 Well' ❑ Floodplain Wetlantls 0 1Natershed ®i'strict p Water/Sewer-- DESCRIPTION OF WORK TO BE PERFORMED: C c&11,14_ . 14#,-c - t-0 '41S Identific tion- Please Type or Print Clearly OWNER: Name: � a ra 1 S�6r-r Phone: q 7 '(17-,Zt-I/� Address: Contractor Name: Phone: 279-- ?WW-9/q,3 Me Email: Address: 1970 ` Supervisor's Construction License: 12-7 -7 —Exp. Date: t f�Z 3�/f Home Improvement License: W7,031 Exp. Date: Jh 1l� 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: $ 02 q6v FEE: $ �t Receipt No.: �b� O Check No.: p NOTE: Persons contractir2 with unregistered contractors do not have access to the guaranty fund --- ---- _ ^r. _66 -�Tn_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ E WERf�GE DISPOSAL ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ c tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Z,,lning 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 FIRELDEPARTMEN�T TempDumpster,onsite Y - Loeatediafti124;MamrSt�eet -- r Fiee0ep 0,hentsignature/date Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Suilding Pennit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4, 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 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 of Deeds. One co and proof of recording 'cant must then PY that the appeal period is over. The applicant get this recorded at the Registry must be submitted with the building application Doc:Building Permit Revised 2014 -7( r�r Location { V No. `� - C ' Date IIA, . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $�� TOTAL $ Check# /,J•r./D'���� jl1 1. Building Inspector r NORTFj Town of : EAndover ver, Mass, �aS a�reD NPp��S U BOARD OF HEALTH Food/Kitchen P E Septic System Tr L D THIS CERTIFIES THAT .......... BUILDING INSPECTOR ....... tl!'.... .................. .......... ................. .......................... . . ....... .. . .. t7( has permission to ereb1**'41Wj buildings o Foundation ..................... Rough to be occupied as ..... ..... .. .� .f`..� �t .. ..5.....�.. ... Chimney provided that the person accepting this permit shall in every respect conform to the terms o he 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 10 Rough Service .: .. ... .. .. .. ...... ..... Final BUILDING IN C OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinje 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. Tltis fmm j•�.,sact�n,Seas Rome Im rovement as 4 basiSam �e tract c regents �PrittthameoRn� ofdtesgOeat1111111111 Mesal mw tsC Guidetogpm ladWceifamessary-AaYPtasm a 142A).hutdoeanatmdn8e �ceofCoas�mcrAffairsaad Inpovmmrbdme PIffimloghimteimproy�� atr+ndard ��R*�Olatim's dgtoanYwmkonyomrWdMce.Yan d01��obtamacopyaf°A HDIFB aerIQfprMation ��0nerinfo�a0gatHoeat617-973-8787or2&�a free 7oro�o� W&gthe 1Vame Contractor rmation Ot Street Address t Companyp (doaotuseapestOmal Atlantic Idea 7G e f YV ' cs� theriY,�tttuii LLL CityR'aua I state;: ade-* � Avenue tL ausfi=Add,=(a=- DaYtimeFhone`.- --- ` Evetdo8 9 CityR un Mailing Address(Itdif event f above) ���' State 7aA Code $ phone yy— Fedaattatlr�IDorS.S_Nmnbrr Ls>.resaes+k,r�reee Nc°`�r/0'��+ea Rg:Nr�yR �,• rhe Cootractor ' rr#ftNonscl� e (Describe in detail to do the foUngwor$forthe wodctoeoarpletcd� Yingtbe Homeowner. / �a�and 8radeof rnztaiaktotxttud ¢itionils Sifar ) Required Pests_ThefoU andwiUbesecurIS owingbufl4ingpetmitsare (Owners who b1`thecontratxaaastheh®cowna's Pre startandC secure their own to tmlcss eiret a b ednte"7befQ0wia eselnded from the G hermits wip fie aymd the g whew arse MGL chapter142A,uaMlItY Fuad paovisians of imhactot's camLnl arise Date V&CM coutracrorwgl i begin contracted work. Total ContractPriceand Pa Bate"Oleo cotrtracted"OmkwUi be subst_t aII The Contractor agrees to At+form�fhcScbednte Y completed wOrk frmisb tbeaa( 0ri5edabovefiorlhe fatal sam o> Payments will bemade a�0�g to UtefoDowingsclealote. �%�• — M 5 upoasigning r,ontract(nottoeweedil3oftbe �-- -- by/ /---or upon Completion of total u� otFrice or thewstofspacial o ,afiicleverisg m) by Sa�j� o1 upon ompletion of -a--:upon completion of theeontraM rhefolloMo �t4�ibldsdaatandia SrnataiaL { gfoII entuuhtcoahactis ord�d hefotriltc conpac edW, �" int S lobe �nPleted to both party s ggpbpion) to mea the compl con luc eld UV �j�m m°� �— (�//' for N©TFS;C)lccludiag all 6aanx not Meed elfRM("iLaw whichmautbes��'yl�afdinaadd� rotd c*nbwPricear(bacW ofthe y deposit Ord.. ��bYthcmnftacwrbeforcvmr h meertheEz recsWa _ a conVE6anschedale �s lequipment OTCUstom myteriat made Snbcanhvctee.cantmigor e`An heia agrees ` the con 1� gid I r a to be sold tra Y�otmbleforcompl o ofbe�" ofthe mast6e aterials IrYtheco _ Con iractAcCeptaaoe-Ufrisa >ratorfortberaga tobasoleld�jWre��softheactioasof to contract sh Pan y that y lien o this dal aaaeut r�AonsrbleforaU paYmtats to all for carefullybeforesign gthis lien or as 'gcon. lumadwl CODS Platxd fhe m''Unless otberwise noted within ° DonYbepn�d- residence RevietvfhefoUowmgrittti� the ° Make sure the oo mLo�gomg Ute r�ntr'a Take notices SMUtorhas a valid$Date trate FO read and foU erstand it r ors to be theDbector entCoatractorRY- 'on.lbetaw9aestionsifsomethin - unrde," Does the� uor�ttave!lr�e�Blreaos �1'adcPtaza,Room 5170,Boston, taay inrptFo about e� o S °fHO��4naVMeotConhaetarRegh&aft idirsmosthomeimAmvem cn cWrsand ° Know Copysee a a Of0 ce?Ask ocimm���orforhisihsmanceW 02II6orbym%g617A�787or888-28 57. Y0 8hts1dt>;+F�stb"ities.Read the AmrYinfutmation so thatyou can confmt co Glide to iheHome lmFrovement Coairactorl important Iote .or ask to You may cancel this mtatioaondtereva sfdeofihLsfarm aadget aCopy oftbaConsumer In V4itiug at M �tifithas thirdu'Ms(lay followin armaino$�s�edaraplaceotberUtanthe rrrbraachafa imahactor'snouaa( gthesig�gof S`0�►atyrrtaU Placeofbn DO NOT ST tfnsagteemmt Seatheatta hedno�h�of letagramsentmbydelivew�I you notifytlte Tim is ar�orrao NT) Sip ,�1,� 'aacella±foafamitozaneuplaaatienoftbisnmght��tofthe ten»and ARE ANY B ajaeit tlaewpys) go�we 1NKSPACES!!! Homeownat's rgnatrar Contractor's Sign Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individtial): Attanti� W"Eticrltc IA01l,LLC 61 R e orsor, Avenue Address: 1 070 City/State/Zip: Phone#: Cf 7 k' 7,�Ll' Are yoylffi,employer?Check t�propriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance."+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 i.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑�therr pairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. :LK/.Sc. k w> comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all wort:and then hire outside contractors must submit a new affidavit indicating such. *Contractors 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. ) Insurance Company Name: r,C Policy#or Self-ins.Lic.#: !O6,27 0 12- / Expiration Date: 3A0 Job Site Address: L76 Ve- City/State/Zip._& 14,4,, . Attach a copy of the workers' compensation policy d laration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided abov is true and correct. S i ature: Date: 3 3 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#: i ACORV DATE(MWODNYM `.� CERTIFICATE OF LIABILITY INSURANCE 3/9/2016 THIS CERTIFICATE IS ISSUED AS A OTTER OF INFORMATION ONLY L 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 islan 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). PRODUCERi CON ACT NAME: Construction Eastern Insurance Group LLCj PHONE (800)333-7234 FAX IAIC-No C o: 233 West Central St E-MAIL INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURERAArbella Protection Ins. Co. 1360 INSURED INSURERS-Nautilus Insurance Co Atlantic Weatherization INSURERC: 61 Rear Jefferson Avenue INSURER D: INSURER E Salem MA01970 INSURER F: COVERAGES CERTIoICATE NUMBERNaster 2016 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 ISUBRI LTR TYPE OF INSURANCE A POLICY NUMBER POLICY EFF MNUD Y EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE a OCCUR 500042816 /20/2016 /20/2017 MED EXP(Any one person) $ 5,000 X CONTRACTUAL LIABILITY PERSONAL BADV INJURY $ 1,000,000 X CG0001 10/01 FORM GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY ROM aBINdeMSINGLE LIMIT 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 020015871 /20/2016 /20/2017 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-0WNED PROPERTY DAMAGE AUTOS Per accident $ PIP-Basic $ X UMBRELLA O }[ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS 10,000 1600058654 /20/2016 /20/2017 $ WORKERS COMPENSATION I WC STATU- OTH AND EMPLOYERS'LIABILITYANY PROPRIETOR/PARTNERMXECUTNE Y 1 N ER OFFICER/MEMBER EXCLUDED? E-1NIAE.L.EACH ACCIDENT $ (Mandatory in if yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B POLLUTION PL200378614 0/1/2015 0/1/2016 EA POLLUTION CONDITION $1,000,000 GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) I CERTIFICATE HOLDER ( CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER 1 ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET 1 NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE John Roegel/SME ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgrrrnns%rrl I a A(t(1On n2ma 2nrl Inn^*m ranicfamrl mftrire of Arnpin ••" ' '•�. c.i Zvi c.V.LU 13..2 .6'2 tir7 t_t%%Jz G/VVG raA ariz-VCI- CERTIFICATE OF LIABILIT YINSURANCE DATE(MMIDDIYYYYI TIFICATE 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 O PRODUCER. D HE FHOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 W CENTRAL STREET (A/C,No,Ext): (AIC,No): EMAIL NATICK,MA 01760 ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE MAIC# INSURED t INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERVATION LLC INSURER 8: INSURER C: 61 REAR JEFFERSON AVE INSURER D: SALEM,MA 01970 INSURER E, 1INSURERF: COVERAGES CER*CATE 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 PAD CLAIMS. If INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MNMDIYYYY) (MMJ)OIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE F]OCCUR. DAMAGE TO RENTED $ REMISES(Ea occurrence) 1 MED EXP(Any one person) $ GEN'L AGGREGATE LIMB RSONAL&ADV INJURY $APPLIES PER:J ENERAL AGGREGATE $ POLICY PROJECT❑LOG RODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY ANY AUTO C LOMBINED SINGLE $ ]MIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS Per person) HIRED AUTOS DILY INJURY $ NON-OWNED AUTOS (Per accident) ' PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR []OCCUR , EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ $ A WORKER'S COMPENSATION AND ( WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-5B270121-16 03/20/2016 03/20/2017 X i WC ST ANY PROPERITOR/PARTNER/EXECUTIVE TS OFFICERlMEM9ER EXGLUOED7 MN NIA E.L EACH ACCIDENT $ (Mandatory in NH) 500,000 i E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,desvlbe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS 'PHIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTITICATE HOLDER AFFECTING WORKERS COMP COVERAGE. i CERTIFICATE HOLDER j CANCELLATION TOWN OF NORTH ANDOVER j SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST 1{ BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR N.ANDOVER,MA 01845 � s�..: 3 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988=2010 ACORD CORPORATION. All rights reserved. Massachusetts Department of Public Safely Board of Building Reguslauions and Standar_ Construction Supervisor t Restricted ta: License:CS-087577 _ Unrestricted-Buldings of any use group which co in less than 35,000 cubic feet(991 cubic meters)of _ r . enclosed space. ERIC W PALM '< 3 HILTON ST SALEM MA 019.70 n/I ZC CA, expiration: Falure to possess a current edition ofrthe Massachusetts Camnzissiglrer 04/23/2018 State Brrild'mg Code is cause for revocation of this license_ OPS Licensing mforrnationvrs:WWW.MASS.GOVIDPS i "1�r.c�tn»�utnitrr+tr�rA a��' f r�irr. :r � License or registration valid for ind'ividal use only Office of Consumer Affairs&Business Regulation before the expiration date. if found return to; OME IMPROVEMENT CONTRACTOR Oiiiee of Consumer Affairs and Business Regniatioa gnstration: 142089 Types 10 Park Plaza-Suite 5170 lrat3on: 3F7?1Z01& Ltd Liahlidy Corpar Boston,MA 02115 ATLANTIC WEATHERIZ- TION-.LLC. ERIC PALM 61R JEFFERSON AVE Not valid without signature SALEM,MA 01970 Undersecretary E