HomeMy WebLinkAboutBuilding Permit #665-2016 - 183 APPLETON STREET 11/30/2015d gAw6:D /0-?-1,S-
Permit Yeo#: -w
Date Issued: 11
M 6CATI CNS
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
no
ED
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
El Addition
❑ Alteration
❑ One family
El Two or more family
No. of units:
❑Industrial
❑ Commercial
❑ Repair, replacement
❑ Demolition
❑ Se tic� ❑ Well ``�`
w r .✓
❑ Assessory Bldg
❑ Other
10 Flood arn" €l Wetlands "*.
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! Others:
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OWNER: Name: -
Address:
Identification - Please Type or Print Clearly
A- 5!19,4
P,pi-ota h 5
Phone: -0777 G Oc�f -O 1 1� �/
Sup,e.-hjd-ns Ctonstr�uc Toni Li ec rese r _(o _�t� _s�. Expt, ®ate k1
cr;�-._.fi��;;�,,...-.•r,-::+�tirF.r.�• - -/ .mac-1>'"�a-io � ... :. tFvy`n� Iflata� 7 /� ���i►
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125,00 PER S.F.
Total Project Cost: $ Coe), 0 a FEE: $ �f
Check No.: Z Receipt No.QQ_��
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fined
_gx--�-
I nature_of Agent/Owne,r SignaL of,contracto" -
Location � S --5 A02 --o" -� od -
No. (o (05 —2-d�o Date
1 1-7-1
Check# ILP I L—
r
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL $
29747 Milding Inspector
Plans Submitted ❑ Plans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body 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 m U FORM
PLANNING & DEVELOPMENT Reviewed On Signatu
COMMENTS
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/signature & Date Driveway Permit
DPW Town Engineer: Signature:
iEP RvTIMENLT)'.t;%mPDumpster,on"site' �
af1�24IVIainCSt�eet
eparttsignafure/dara
EIVTS'� 5�`,ro� i
Located 3d4 Usgooa Street
i1� i 11111!h �, ih
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
VOTES and DATA — (For d
® Notified for pickup Ca
rtment use
mai
Date Time Contact Name
Doc.Building Permit Revised 2014
C
T—
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
o 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
DTE: 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
ATE: 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
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Federal ro 0 06405M
RISE Engineering !m conaactor Reffistreaon ko 8186
MA cadraxtor /bat No IMM
A division of 1Llelseh Eagineering
RISE
ENGINEERING 60ShawmutUnit #2,Canton,MA0202I. CONTRACT
339-S02d�33S FAX 339.502-6345
Page 1
PROGRAM
.�'! �- 1� TxtscwfrRacrmt�mfoeETTrE�Rnae
CKA.WS TxeeuaroeaatfoRworucAs
CUSTOM r' PHOW mea i%tHfr. wolacoRoet
4�
David Saba (978)689-0194 10/06/2015 421160
00003
SGINICa SmWT .`' / tunas STREET
183 Appleton Street 183 Appleton Street
SERVICE enY.STAMZW �� Bttlar0 ary.STAW,ZIP
North Andover, MA 01845 North Andover, MA 01845
JOB DESCRIPTION
HASE O Proposal for this calendar year.
$0.00
AIR SEALING: Provide labor and matedds to seal areas of your home against wasteful, 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 bealtW level of
air exchange and indoor air quality. Mated* to be used to seal your home can include caullcs, foams and other product. Primary
areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally
addressed.) This will require (8) working hours. A reduction in cubic fat per minute (cf n) of air infiltration will occur, but the actual
number of cfiun is not guaranteed.
At the completion of the w ealherization work, and at no additional cost to the homeowner, a feral blower door and/or combustion
safety analysis will be conducted by the sub -contractor to enwit the safety of the indoor air quality.
$580.00
AIR SEALING ADDER (2) working hours.
$170.00
DAMMNCjr Provide labor and materials to last* a 12" layer of R 38 rmlheed fiberglass batts to (124) square feet for damming
per•
$254.20
ATTIC FLAT: Provide labor and materials to install an 8" layer ofR 28 Class I Cellulose added to (1096) square fat ofopen attic
Spam
$1,501.52
ICNEEWALLS: Provide labor and materials to install 2" FSK fitoed semi-rigid fiberglass board insulation to (194) square fat of
ksJneewall area.THiS IS THE KWALL OF VAULTS IS MASTER BEDROOWK]TICHEN AND FRONT ENTRY.
$679.00
ATTIC ACCESS: Provide labor and materials to insulate the backs of (1) attic habit with 2" rigid Thefmax board. Weatherstrip the
kms -
$60.00
VENTILATION: Provide labor and materials to install (4) insulated adumst hose to existing bathroom fan(s).
$200.00
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% ineendve, 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 arejustified by the auditor.
For the safety and health of your homes indoor air quality, we will be conductkng a blower door diagnostic of the available air flow in
your home both before flee work is begun, and after the weatltaaation work is complete. We will also conduct a h1l 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
weatiterh ation incentive is $3,110.
$90.00
I, /-1 ety
r'^N
OWNER AUTHORIZATION FORM
Name)
owner of the property located at
(Property Address)
/V, lg 1jeo vq,✓. Jog . 4 1,? ,
(Property Address)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property.
Owner's Signature
4C� Date
Federal lD # 0"405628
RISE Engineering RI Ca ftdor Regi *Ww No ai6S
RISt UA CwdMCf or RBgiatratton No IMM
A dvidon of Thidseh Enginaft
ENGINEERING 60 SMwmnt Unt #X Canton, MA 0=1
CONTRACT
33402FAX339659UNS
Page 2
PROGRAM
CoUrRwrCMA-HES SEI OxmTHE FORW0WAAB
cescamw
RRELow
CUSURM PH= CAM MEWS YMgIKORDER
David Saba (978)689-0194 10/06/2015 421160 00003
SERVICE BTFIMT Balm gnaw
183 Appleton Street 183 Appleton Street
SENILE Cfl , STAMZP i#I LM CFM SU MZP
North Andover, MA 01845 North Andover, MA 01845
JOB DESCRIPTION
Total: $3,634.72
Program Incentive: $2,861.04
Customer Total: $673.68
WE AQRW HEREBY TO rURNW SEMON - COWLM 01 ACCOROANCEVM ABOVE BPEWMEON6. FOR THE Sum OF
*"Six Hundred Seventy-Three & 681100 Dollars $673.68
UPONFWAL=PECRONXWAPPMAL6YRRSEEHO UMMCLCUSTOMAOREEBTOFVWMOWMMWFULR-INTERESTOFt%VMLBECHAROEORmMTH1.YOMAMY
IWAS/BALANCEAF'TERTAOAYB.SEE REYERBEFORMW0WAMWVWAT=CW GUARAWEMRISM 0FR 8CTIEDUI.SW,ANO COITTRACTOR QTR im
ov�— D NOT SIGN THS CONTRACT IF THERE ARE ANY BLANK SPACES
StONATURE- /
NOTE:THIBCONIRACrISS/BEUSTHORA9YNBYuaiFt�TEIEgRE)WfUQ1V OATEOFACCMAUM
ACCEPTAMCEOFCONTRACT-TREASOYE PAICE8,8PECOTrOMMAMOCDRO> mm ARB
30 ppyg A8 PAYUMYTLBEUMASCl1 MM AMIItARII�lOOO THB tNNt1C
J f.
j �r
The Commonwealth of Massachusetts
�- Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
ivwtv.mass.-ov/ilia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
rma
e Print
' arne (Business/Organization/Individual): F0 "tf- A ft r rni V 14 r-'ovt
Address: Y. D til 0 X 11pr
Phone #: Q
Are you an employer? Check the appropriate box:
1. rX I am a employer with --
4. ❑ I am a general contractor and I
employees (fitll andlor part-time)."
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached, sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.
required.]
5. ❑ We are a corporation and its
3. ❑ I atm a homeowner doing all work
officers have exercised their
myself. [No workers- comp.
right of exemption per MGL
insurance required.] `
c. 152. S 1(4), and we have no
employees. [No workers'
comm insurance reouired-1
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
S. ❑ Demolition
9. ❑ Building addition
10. [:1 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repairs
13.&Other SAS -J% iA6 Nt
'Anv applicant that checks box =1 must also fill out the section helow showine their workers' compensation polio- information.
r Homeowners who submit this aftidavit indicating they are doing all "ark - and then hire outside contractors must submit anew affidavit indicatine such.
=Contractor that check this box must attached an additional sheet showing the name of the sub -contractors and state oilether or not those entities have
employees. If Elie sub -contractors hav-e employees- they must provide their workers' comp -policy number.
1 run an employer that is providing workers' compensation insuraitce for it:y entplgrees Belotu is file police, anti job site
information.
Insurance Company Name:
Policy -# or Self -ins. Lie i s 90 & $ Expiration Date: I Iy
Job Site Address: t f '� A 1/ P10 0 V-, Sr City/State/Zip: ) • 14liko4puor✓'
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of ViGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 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 S250.00 a day against the violator. Be advised that a cop; of this statement may be fonyarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certf • tiinder the pains and penalties ofperjurl• that the information provider/ above is true and correct
Official rise onll•. Do not write fir this area, to be completed bt' citr or toren official
Cit' or Town:
Permit/License #
3a)/5
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. Cit,.•!fo«-n Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone 9:
®® CERTIFICATE OF LIABILITY INSURANCE
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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. 1 SUBROGATION LS 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(sl
PRODUCER
AL
NMIE:
Automatic Data Processing Insurance Agency, Inc.
O
(A.0 NO.EIU: (AL tw):
ADDRESS:
1 Adp Boulevard
Roseland, NJ 07068
IVSURER(S) AFFORDING COVERAGE NAM
INSURER A• NorGUARD insurance Company 31470
06URED POLAR BEAR INSULATION CO INC
INSURER B:
INSURER C.-
:PO
DBA: Polar Bear insulation CO Inc
POBOX gSB
Andover. MA 01810
wSURER D:
WSURER E:
INSURER F:
PRODUCTS-COWPAP AGG s
�WVMK c.rb CER1IFICATE NUMBER: LVV1bA9 RFIncl MIIMQCQ-
THIS IS TO CERTIFY THAT THE POLICIES OF 114SURANCE LISTED BELOW: HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED_ NORWITHSTANDING ANY REQUIREN.ENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER AAS.
EXCLUSIONS AND CONDITIONS OF S UCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
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two
POLICY NUMBER
RdILOD YYYV)
MIDDYYM
LIMITS
Cranston, III M910
COMMERCIAL GENERALUABRrry
CLABA-MADE [:] OCCUR
CENL ACGREGATE Laity APPLIES PER.
POLICY❑ ra
JECT Loc
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EACH OCCURRENCE 5
PREf.ASES tEa Lv.umxct) S
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PERSONAL EAM U.) URY S
GENERAL ACCRECATE 5
PRODUCTS-COWPAP AGG s
5
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DEO RETENTION S
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[DESCRIPTION
/PORKERS CQUPENSATION
ANDEMPLOVERS' LUIBILRY
ANY PROPRIE70R.PARTAER£ucult41: YIN
OFFICER MEMBER EXCLDDEp? �N
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DESCRIPTION OF OPERATIONS !LOCATIONS lvEH CLES (ACORD IDI AtUtia„d Remar6 5chedele. may W attached if m spa is req,fireM
Columbia Gas massachusevs
LLKI1FILA7E HOLDER rnhir'Fi 1 AMnW
Aw 1ytRs ullctALOKD LORPORATIOM All ngnts reserveo.
ACORD 2S (2014,01) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ThPAISCh Engineering, Inc.
ACCOROANCE.LW17HTHE POLICY PROVISIONS_
195 Frances Ave
AUMORUEDREPRESENTATIVE
Cranston, III M910
Aw 1ytRs ullctALOKD LORPORATIOM All ngnts reserveo.
ACORD 2S (2014,01) The ACORD name and logo are registered marks of ACORD
OP ID: SS
CERTIFICATE OF LIABILITY INSURANCE
TE OnWD111"
�03R3=15"
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 bolder Is an ADDITIONAL INSURED, the poticypes) must be endorsed. ff 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 endorsemerrt(s .
PRODUCER
Durso & Jankowski ins Agcy LLC
198 Massachusetts Avenue
North Andover, MA 01845 Durso & Jankowski ins. Agcy.
CONTACT
Ro
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LA:
'POLAR_1
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INSURER(S) AFFORDING COVERAGE NAiC S
Cranston, R102910
INSURED Polar Bear Insulation Co. Ine.
P O Box 958
Andover, MA 01810
EERA:Penn America 32859
Icsumn 0. Safety Insurance Co. 39618
DOURER C -
IdSURER D
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INSURER F:
AC7052023
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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 CLAPAS.
L F
TYPE OF INSURANCE
IMUL
POLIVVKUMBER
WO H
FO
LIlErTS
GENERAL LIABILITY
AUTHORIZED REPRESENTATIVE
Cranston, R102910
A nr
EACH OCCURRENCE S 11000,
DAMAGETOKCNIEV PREMISES nccurrenee 5 50,00
A
X COMMERCIAL GENERAL LIABILITY
AC7052023
03/241x015
03/24/2016
MED EXP (An one Person) 5 5,00
CLAIMS MADE IX OCCUR
PERSONAL BADVINJURY S 1,000,000
GENERAL AGGREGATE S 2,00010
GEMLAGGREGATEUMITAPPUESPM
PRODUCES-COMPIOPAGG S 11000,0 00
$
PRO LOC
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AUTOMOBILE LIABILITY
ANY AUTO
21W926
01/04/2015
01/04/2016
COMBINEDSINGLE UMIT $ 1,00010
(Eaem
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ALL OWNED AUTOS
BODILY INJURY (Par awdent) S
X SCHEDULED AUTOS
X HIREDAUTOS
PROPERTY DAMAGE
(PERACCIDBM S
S
X NON•OWNEDAUTOS
5
UMBRELLA LIAR
X
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1,000,00
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AGGREGATE s
5
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LUIB
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PAC6906M
03/24/20155
031'242016
DEDUCTIBLE
DEDUCTIBLE
S
RETENTION S
WORKERS COMPENSATION
VYC STATU-
AND EMPLOYERS LiABILITY
ANY PROPRIETORIP� YIN �
OFPICERIMEMBEREXCLUDED4
(Mandatory in NH)
N/A
EL EACH ACCIDENT S
E.L. DISEASE- EA EMPLOY S
EJ- DISEASE -POLICY Li MIT S
If yes, describe under
DESCRIPTION OFOPERATiONS belmi
DESCRIFnONOFOPERATIONS /LOCATIONS/VEHICLES(AtmdrACORDICI.AddonalRemwimSeWWo ifmaresimcefaregubuM
Insulation Work - Mineral; Additional insured forenerai liability, wdh
eespe I togwork performed an their behalf by thl above insured Is Thlelsch
reran o,Avc unt n=o r Ard[-FH_r_A-rinN
% TUoo-rau J AWR5 rr0t'{V0K^1lum. hu nH/aaa rwcrvcv
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE DATE EOF, NOTICE WILL BE DEWERED IN
OWITH
ThielsCh Engineering
ACCORDANCE THE POLICY PROVISION
Columbia Gas
195 Francis Ave
AUTHORIZED REPRESENTATIVE
Cranston, R102910
A nr
% TUoo-rau J AWR5 rr0t'{V0K^1lum. hu nH/aaa rwcrvcv
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
•sand usiness Regul�`on
office of Consumer Affau
10 ParkP1�' suite 5170
assachuseo 02116
Boston, M Regisixafion
HomeroVeYnent ContraA -- = Re9on: 1oz6
Tvpe:. DBA 1'r# 252249
�cpiratiom 7YL12016
POLAR BEAR INSULATION CO-
Vincent LeBlanc
p -O. BOX 958 _Mark
reason for change.
ANDOVER, MA 01810 =y' yment
ppdate Address and return cap o Card
1 Address Renewal
OPS.CA1 iu
01216
Massachusetts - nepariment of public Safety
Board of Building Regulations and Standards
Construction Supeni'or Speci:tit** T
License: CSSi-106017 yy
PETER A LEBLANC
2 EAST PINE STREET- _
Plaistow NH 03865
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04i2&2018
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