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HomeMy WebLinkAboutBuilding Permit #409-2017 - 18 LYMAN ROAD 10/18/2016 �IA� 11.BUILDING PERMIT" ' '� o ,0ED I TOWN OF NORTH ANDOVER0 ow APPLICATION FOR PLAN EXAMINATION _ Permit No#: l-_�— Date Received �SSACHU5�4 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ,� L %ma h ad rent PROPERTY OWNER Mc,FC Crt I 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 ❑Addition [ITwo or more family [I Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other Septic 11 Well ri Floodplain C Wetlands ❑ WatershedDistrict, Ll Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: .�- ti �rSS'•r S Identification- Please Type or Print Clearly ' OWNER: Name: Mo, r-C i' Phone:6)7-S-ifl'Vye Address: L meek N o4 Contractor Name: �t 1 tiJ' l f /A N ePhone Email: Address: aaS'T ,� h i 4c s i 0t.)I X3 5^ Supervisor's Construction License: /0& 017 _Exp. Date: Home Improvement License: Exp. Date: ),f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:B'ULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ vy, \4i90 .0 '0 FEE: $ Check No.: �� Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access th 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 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4, Floor Plan Or Proposed Interior Work 4 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 i 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 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 Doe:Building Permit Revised 2014 r Plans Submitted ❑ Plans WaivedCertified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/S.ales 11Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE,USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS O HEALTH Reviewed on Signature COMMENTS ` Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood FIREDEPARTMENT 3Te� j `` , ��, Street �. mp Dpsterx4or +site yes ia,� n`cj - ., Located at"124fMainiStreet •� ', �" Y��y * D Yepartmentsignature/date, 1- �,A�'Y �3ti:r'Y-.a .,--tom •.=9:�2T�-�5.5. Tz C®11/IMENTS e. 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.$Ioo-$1000 fine NOTES and DATA— (For department use) f Ll Notified for pickup Call Email Date Time Contact Name Doc.Bi lding Permit Revised 2014 r Location ev No.409'�� i � _ Date/O * ;?4114 • - TOWN OF NORTH ANDOVER , Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 'i 052 Building Inspe`ctor`s r , NORT1�/ - _ A- i ' - - ver No. 4oi.aon _ 0 .Keh ver, Mass, 0 1A q9146 coc NIc Nl WICK �1' �.9 gDR�1TED �`Pa�,�S S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR . M Foundation has permission to erect .......................... buildings on ..... 8.......... �40 ........ .. ................ Rough tobe occupied as .... .. .. ! .............................................................. 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 MONTH ELECTRICAL INSPECTOR UNLESS CONS I TRUeWN S T R gh ... .. .... ..., ......... final UILDING INSPECT JF GAS INSPECTOR Occupancy Permit Required to Occupy Buildin-a 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. Federal 1D S 06-0405629 RISE Engineering RI contractor Registration No 6166 j MAContractor Registration No 120979 CT Contractore Istratlon No620120 ISE60 Shawmat Road,Canton,MA 02021 p p��+ ENGINEERING CONTRACT 339-502-6335 TAX 339-501-634,5 Page 1 PROGRAM CMA-HES ENGINEE I CEt SUM FOR W AS DESORteED BELOW Ousmm PHONE DAB CUENTO WOMORDER. Marc Credi (617)899-8240 09120/2016 438684 23902 eERVME STREET wwma aWEET 18 Lyrnan Road 18 Lyman Road BERvtcE enY,SW E,ZP alum cnY,aTATE.zip North Andover,MA 01845 North Andover,MA 01845 JOB DESCRUMON HEALTH&SAFETY: $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against%asteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,.foams and other products. Primary areas for sealing include air leakage to attics,basement s,.attached garages and other unheatedareas(windows are not generally addressed.) This will require(12)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur;but the actual number of cfm is not guaranteed. At the completion of the weatherizat ion 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 the indoor air quality. $1,020.00 KNEEWALLS:.Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(336)square feet of knee-A211 area. $1,176.00 ATTIC ACCESS:Provide labor and materials to insulate(2) back of the:kneevmll hatch with 2"rigid Thermax board,and seal the edge of the hatch with weatherstripping. $120.00 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 Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your home's indoor air quality,ve wilt be conducting a bluvver door diagnostic of the available air flow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable,,watherization incentive is$3,110. , $90.00 SEP 2 2 2016 federal ID 8 OS-WS629 RISE engineering RI Contractor Registration No 8186 MAContractor Registration No 120979 CT Contractor Registration No620120 RI S 60 56awmut Road,NG' Canton,MA 02021 CONTRACT T ENGINEERI 339-502-6335 � FAX339-502-6345 C Page 2 PROGRAM 1 IS CONIRACTIS ENERED R1A BETWEEN REE C'MI A-M ENGINEERINGAND VIE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTCMER PHONE DAZE CJENTI WORI(ORDER Marc C Tedi (617)899-M 09/20/2016 438684 23902 SERVICE STREET BILLIN0.SREET 18 Lyn-an Road 18 Lyman Road SERVICE CTY,STAE,DP BALLING CTY,SWE,BP North Andover,MA 01,845 North Andover,MA 01845 JOB DESCRIPTION Total: $2,406.00 Program Incentive: $1,992.00 Customer Total: $414.00 W E AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WrrH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Four Hundred Fourteen&001100 Dollars $414.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERRIG.CUSUIER AGREES A REMTAMXWTDM IN FULL.INERESTOF 1%WILL BE CHARGED MONIILY UNPAID BALANCE APER 30 DAYS.SEE REVERSE FOR IMFORT [NFORMION ON GUARANEES.ROM OF RECISION,SCHEDULING{,AND COK=CMR REG181RA DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES A ISEE Q p. - CUS RAOCEPTANCE `Z-Z) S c I t ? LC NUE:1 IS CORMCTM1gY BE WMMWN BY US IFNGTP.XECUED Wi?RN DAE OFACCEPUNCE ACCEPTANCE OF CONitACT.IHE ABOVE PRICES,SPECIRCAIOMB AND CCNDIONS ARE 30 DAYS. ASFI REBY ASCDAIOREDJDDDIIE.WORKSPECID P YMEXTINILL10 US AND AREBEMAD A9CUIMOVE SEP 2 2 2016 F" 60 Shawmut Road, Unit 2 339.502-6335 Canton, MA 02021 RISE i � ENGINEERING` www.RISEengineering.com OWNER AUTHORIZATION FORM I, a C1 (Owner's Name) owner of the property located at: �Y Property Address) (Property Address) hereby authorize 1?0 -e0.� vl Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Ther Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municip ty at a completion of this work. l5 V t ti v E I O s Sitrhariuq6 SEP 2 2 2016 :Date 6.2016 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,JV4 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information --Please Print Legibly Name(Business/Organization/Individual): ls0 AR REAR WWI MM PO BOX 958 ��ddress:-- AiVt3 OVER,MA 01810 City/State/Zip: __ _ Pine : �I ��' 6�� 910 Are you an employer?Check the appropriate uox: Type of project(required): I Z I am a employer with_ 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors I 6. F1 Ne-w construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. i. ❑Remodeling ship and have no employees These sub-contactors have I g, F1 Demolition working for me in any capacity. employees and have workers' 1 9. n Building addition [No workers' comp.insurance comp. insurance.t required.] 5. We are a corporation and its IO.n Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have ex?rcised their 11.M plumbing repair's or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repair insurance required.l t c. 152, §1(4),and we have no employees.[Ivo workers' '3.[J Other1 comp.insurance required.] *Any applicant that checks box R1 must also 511 out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing al work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that cht.cl.this N:ax-must attached en additional sheet shewip_g the name of the sub-contractors and erste whether or ne:those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is provVing workers'cc,tuensati�n a:eseerarce for my 2 plgyv_ . �elo��is the poky tired jcb s#e information. }, Insurance Company Name:_ irl r. ( 4 h ff r o rvt�4 t/L}' Folic,#or Scl ins.Lia#: ROwC a.ZST Expiration Date: p1/bi /aa I job Site Address: Cityy,State/Zip: A-At,JO6,Yr, 1)1,4 stta:.h a copy of tha workers'compensation policy declaration 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 andlor 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 ttie Ofce of Investigations of the DIA for insurance coverage verification. do herEby 5in�Ecern 'under the pains and. enaltie ofperjury that i to in urination provided above is tree and correct Sienature: 'Date Phone#: q��' y��" 7& Of rcial use only. Do not write in this area,to be completed by city or town ofciat 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#: A 0RO® CERTIFICATE OF LIABILITY INSURANCE D6�io2oi6Y) 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 g NAME: Linda 80 daIIowiCz . Insurance Solutions Corporation PHONE . (603)382=4600 No).(603)382-2034 60 Westville Rd E-MAIL ADDRESS:liadab@isc-insurance.com INSURERS AFFORDING COVERAGE NAIC k Plaistow NH 03865 INSURERA:Western World INSURED INSURERB:Nautilus Insurance Grow Polar Bear Insulation Company Inc INSURER C: PO BOX 958 INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBERCL1632326134 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 DDL UB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYY MM/DD/YY R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGES( RENTED 100,000 PREMISES Ea occurrence $ MPP8274967 3/24/2016 3/24/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 x POLICY❑PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peracc.Zt X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 BEXCESS LIAB CLAIMSMADE AGGREGATE $ 1,000,000 RDED I I RETENTION AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION I PER OTH- ANDEMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNEWEXECUTNEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/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 Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/SJA � �— - @ 1988-2014 ACORD CORPORATION. All rights reserved. The a ed marks ACORD 25(2014/01) h ACORD name and logo re register mak of ACORD INS025001401) 6/10/2016 Preview:Certificates of Insurance A`dR0® CERTIFICATE OF LIABILITY INSURANCE DATE os/10 01"6"" 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: PHONE AX Automatic Data Processing insurance Agency,Inc. ac.No.Ext): 1FC. No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 Andover,MA 01810 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 503587 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 nJUUL hUdK POLICY EFF POLICY LTR TYPE OF INSURANCE INS•p VN0 POUCY NUMBER MWOD1YYYY MfDDIYYYY LIMA COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S CLAIMS-MADE OCCUR RrEIY PREMI SES(Eaoccurrence) S MED EXP(Any one person) S PERSONAL&ADV INJURY S GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY 0PRO- JECT 1-1 LOC PRODUCTS-COMP.IOP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINFO SINULLS' (En occidenq ANY AUTO BODILY INJURY(Per person) S ALL DINNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NO"WNED PROPERI Y DAFJAGk HIREDAUTOS AUTOS (Per accident) S S UMBRELLALUIBOCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS•MADE AGGREGATE Is DED I I RETENTIONS S WORKERS COMPENSATIONX STATUTE ER AND EMPLOYERS'LIABILITY YIN A OFF(CANY CEERRAIE BER EXCLUDED?�� � N i A N POWC772258 01/01/2016 01/01/2017 E.L.EACH ACCIDENT s 1,000,000 (Mandatory in NH) El E.L.DISEASE-EA EMPLOYEE S 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B morospaca is required) 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 ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St./suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD https://adpia.adp.com/icertcf/#/run/preview1503587/900012975 1/1 Office of Consumer Affairs and Buslness Regulation 10 Park Plaza. - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA =r. -_- -_''' ' Expiration: 7/212018 Tr# 419291 POLAR BEAR INSULATION CO. - - Vincent LeBlanc " P.O. BOX 958 . ANDOVER, MA 01810 Update Address and return card.Mark reason for change. sca 1 0 2oM-05111 Address [:] Renewal ❑ Employment Lost Card /3ea»rrna�rrrcri�(f aU'fjnJJnc�riJe!(s Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 102726 Type: Office of Consumer Affairs and Business Regulation Expiration:;-712/2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION Cd _ . Vincent LeBlanc __ - - 51 SO.CANAL ST.#5A ......- LAWRENCE,MA 01841 Undersecretary W�xMtvalid without signature I Massachusetts -'Department of Public Safety Board of Building Regulations and Standards Construction SupertisorSpecialty License: CSS -106017 PETER A LEBLANC <r 2 EAST PINE STREET - Plaistow NH 03865 P Expiration Commissioner 04/28/2018