HomeMy WebLinkAboutBuilding Permit #366-2017 - 20 HAROLD STREET 10/6/2016 �.►ORTFi BUILDING PERMITo� 7 ,b;6+ TOWN OF NORTH ANDOVER 6 op APPLICATION FOR PLAN EXAMINATION e Permit No#: t Date Received ` �t �R"�A,rEo gSSAC HU`-+�� Date Issued: 10 IMPORTANT: Applicant must complete all items on this page LOCATION d _ t Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL:?-// ZONING DISTRICT: _ Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ,e'bne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District Water/Sewer DESC PTION OF WORK ERFOR � vc G G ur c' GaK S v /I/svTD��� /NS v��T �2i�sL sti✓�j� �f/�rD�®' w� 73� c ell'14- Identification- Please Type or Print Clearly OWNER: Name: Phone: i Address: Contractor ame: C' ` 441( Phone: Email t4 - _ Address Supervisor's Construction License: ±tZ1r Exp. Date: �r 6 Home Improvement License: ZJ 3�pO Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PE MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEDON$125.00 PER S.F. Total Project Cost: $ q7 Z FEE: $ Check No.: 3�Sr Rec NOTE: Persons contracting with unregistered c ntrac r v ess to the guaranty fund Signa ut re of Agent/Owner _�_ g - ctor 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 0 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 i r dONSERVATION Reviewed on Signature a COMMENTS HEALTH Reviewed on Signature COMMENTS I, Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes x Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Tem Dum"ster on site _ p yes_ _ no Located- at 124 Main Street a Fi,re Department signature/date _ COMMENTS T _ 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 NOTES and DATA— (For department use) ❑ Notified for pickup Call Email f_Date _ — Time Contact Name Doc.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 ❑ Workers Comp Affidavit ' ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ 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) o 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 No. 3l0 C- • aC?� '? ~1 Date G . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 17 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# y 3ff r f !` �; ,',Building Inspector ttORTH q Town of s_ eAndover o�hy ver, Mass, I f� ` O♦ COCHI HeWICa 4' X1,9 Ar S U BOARD OF HEALTH PERMIT - T LD Food/Kitchen i Septic System THIS CERTIFIES THAT BUILDING INSPECTOR Ai�R V` Foundation has permission to erect .......................... buildings on ......Av............................... ........S.T..... Rough .N til ,tt to be occupied as .......................A............... A..........�..... l.................................................. 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI START Rough 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. Smoke Det. I Work Order z GREATER LAWRENCE COMMUNITY ACTION Job Number:20093975 COUNCIL,INC. Work Order Date:6/24/2016 305 Essex Street Ownership:Owner Lawrence,MA 01840 Phone:978 681-4956 HEAT QUEST INSULATIONS COMPANY LLC Auditor:Keith Young 142 HALE ST UNIT 2 Email:kyoung@glcac.org HAVERHILL MA 01830 Cell:978 857-7841 Email:heatquest@aol.com Phone:978 6814955 x4793 Phone:978 361-6091 David Licciardi Columbia Gas $6,425.22 20 Harold St Total $6,425.22 North Andover Ma 01845-3411 978-337-3724 Safety Issue(s):Lead Paint Possible AuthorSzed Actual Measure Descnphon Comments `; Pnce Total Total WM Atdclnsulation Kneewalls R-12 cellulose behind 80 $2.04 $1.63.20 80 $163.20 gable end walls in knee wall permeable membrane R-18-20 restricted-slopes/floored 366 $1.63 $596.58 366 $596.58 slopes fill w/cellulose R-20 behind membrane cellulose 644 $2.16 $1,391.04 644 $1,391.04 Net&blow slopes in knee wall open rafter R49 unrestricted-settled cellulose 270 $1.89 $51030 270 $510.30 Mzsc Measures Attic/basement blower door guided 1.5 $73.50 $110.25 1.5 $110.25 Seal under sinks,chimney,plumbingelectrical sealing with one-part foam and all air penetrations to the living space. Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests Cut/close attic-kneewall access 2 $92.40 $184.80 2 $184.80 in front of house speak with client Recessed Light Enclosure 1 $34.65 $34.65 1 $34.65 1 in bathroom Permit Other 1 $0.00 $0.00 1 $0.00 Date:6/24/2016 Page I Work Order: Job Number: 20093975 ..WallInsulation;{ Wood clapboard/shakes/shings or 1614 $2.10 $3,389.40 1614 $3,389.40 vinyl(dense pack) Total $6,425.22 $6,425.22 Contractor Instructions: Before Startin the a Job: Duringthe a Job: 1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead safe practices are 2.Obtain required building permit. required. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. Additional Contractor Instructions: Attic Inspection form attached? Yes N/A (Circle One) Certificate of Insulation posted? Yes No (Circle One) HEAT QUEST INSULATIONS COMPANY LLC hereby certifies that this job was supervised and completed in compliance with all Department of Labor Standards and Lead RRP regulations. Contractor Signature: Date: RRP License#: 1 hereby acknowlege that all work has been completed and inspected. Customer Signature: Date: Energy Director: Date: Fiscal Officer: Date: Date:6/24/2016 Page 2 Work Order: Job Number: 20093975 FOR AGENCY USE ONLY Pre Post Language Other than English needed? Yes No (Circle One) Dryer CO 0.000 If Yes,indicate language: Stove CO 0.000 Occupany change in last 18 months? Yes No (Circle One) H2O Tank CO 0.000 Comments: Heating System CO 55.000 Number of windows Ambient CO 0.000 Number of rooms Blower Door 0.00 Date:6/24/2016 Page 3 Pr C a Greater Lawrence Community Action Council,Inc. Weatherization Assistance Program 305 Essex Street Lawrence,MA 01840 WORK PERMIT Certify that I am the owner/authorized Agent for the grope at: 42U, �_ - (Address) I further certify that I have given my permission to allow work on the property listed above in accordance with the following provision: 1. Weatherization 2. HeatingSystem Work 3. I will allow GLCAC.Inc. and the Contractor access to the property to install weatherization measures,system repairs and inspect the quality of work completed. GLCAC will give the client a one hour window for the purposes of scheduling inspections.If you do not allow access you will be required to reimburse the contractor for all work performed in your house. I certify that I do not owe any property taxes,water or sewer taxes to the municipality that the property is located in: 4. and such other particulars as may be attached to this agreement. Signed: Date: Owner/Authorized Agent Greater Lawrence Community Action ,ditor: Keith Young Phone: 978-857-7841 rob#: 5519 Date: 6/13/2016 Client 't First Name: David Last Name: Lucciardi Address: 20 Harold St. City N.Andover,Ma. Zip Code: 01845 Phone 1: 978-337-3724 Phone 2 House Type: _Cam J Ranch Split 1 fan 2 fam 3 fam duplex 4 family Victorian Colonial Tenement Siding Type Woo Vinyl lumn Asb Single Asb Dble Condition Good Fair Poor Vin l over Asb T111 Brick/Stucco Asphalt Comments: Roof Type Gable Hi F t Gambrel sphalt Slate Rubber Tar& Gravel Condition ood ' Fair Poor Age of House: 940 Heating System Manufacturer: HTP CAZ Base Reading : Pre-;(LPosf: Print Out Oxygen4.6 CAZ Worst after zeroing out : Pre 1:1,t. Post: CO 55 No subtraction needed Efficiency 89.2 CO 2 House Draft limit in Pascals according to CAZ depressure limit Stack temp 132 Draft needed in Pascals vs acceptable draft range per temp Air temp Draft INWC = in Pascals xcess Air Go Free air FHW Steam FHA Space Heater Flame o or Oil Gas Electric Wood Pellet Age Treated Ducts: Yes No Pipes: Yes No m ten mo a Heading Domestic Hot Water Tank Referred to HWAP yes no Gas Oil Electric Tank less Date re erre a ons Temp t a e Draft pl a e Yes o raft - rr► ac Add 6 Feet of pipe wrap CO detectors: Yes/No oca Ions: ommen s: Number of occupants `-1 Number of smokers O Number of pets Ambient*CO Readings . Stove O Oven-j— Broiler 0 Dryer **" House draft limit is based on System type Draft needed in Pascals is based on outside temp. ****** #REFI 20 Harold St Doom Sweeps Location Kits Auto Reg Caulk Caulk Repairs Replace Drape Solid Hollow Comments IN OUT Front to out 1st flr Front to Hall Rear to out side to out i To attic To Basement Basement to out rear to hall to front porch 1&2 to rear porch 2&3 Location Condition Damper Yes/No Fire place damper closed Space Heaters Asbestos Blower Door Pre Post one by contractor Multi Family plcs of readings needed. Vermiculite Knob and Tube Yes NO) Locations Date inspector called Blower Door Air Sealing Make sure bath fan is vented Fans Bath 7 w/light w/o light Cfms = Bath 2 Might w/o light Cfms CO detector yes no The Commonwealth of Hassachusetts r. Department of IndustrialAcciden.ts M w _ X Congress,S`treet,Suite 100 02114--20X7 -»>F Boston,MA ti y�< www mass.gov/dia �tH 5Y1 Workers'Compensation Insurance Affidavit:Buildexs/Coutxactoxs/Electricians/Plum ers. TO BE FILED WITH pERNIITTING AUTHORITY. lease Print Le 'bl A '-licaut Information I Name(Business/(jrgal"zation/lndividual): U V Address: � 1��- � / A,,) �(O h 0 Phone#: ���� Y6( 0q/F City/State/Zip: x h Are you an employer?Checktlie propriate box: Type of project(required); em Io ees full and/o art-time). 7. El N&W'donstX lion 1. am a employer with P y 2. lama sole proprietor or partnership and have no employees working forme in $, Remo delitug any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ]1E]Electrical repairs airs or additions ensure that all contractors either have workers'compensation insurance or are sole 12.[�"Plumbing repairs or additions proprietors with no employees. 5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 11[]Roof re�air5 These sub-contractors have employees and have workers'comp.insurance.t 14.a6ther IJ L 6.n We are a corporation and its,officers have exercised their right of exemption per MGL c. y�`lLC% 'e 152,§1(4),and we have,no employees.[No workers'comp.insurance required] *Arty applicant that check's box#1,must also fill out the section below showing their workers'compensation policy information, i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this Bok must attached'an additional sheet showing the name of the sub contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providingworkers'COm enation insurance for my employees. Below is the policy and job site information. /u,C044f-*f`1' Insurance Company Name: _ - � � a ExpirationDate: 0 Policy#or Self-ins.Lic.#:. �� City/State/Zip: Job Site Address: 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 11 as civ' nalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the vi or c of e nt may be forwarded to the Office of Investigations of the DIA.for insurance coverage veri a X do hereby er n true ai a penalties ofperjury that the information provided abo is tr.e and correct. Date: 16 Lev Si atur 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: 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 receivek br 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,m,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 b6 deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or Iocal 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 applicaut who has hotproduced-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 ly subcontractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the e xn mbexs oxartnexs are p not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 fndustrialAccidents. Should you have any questions regarding the law or if you axe 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"fob 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-MASS.AFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia ACOR TM CERTIFICATE OF LIABILITY INSURANCE 09/19/26' PRODUCER (978)373—S623 FAX (978)S21-2751 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ANTHONY 84. MALCOLM INSURANCE AGCY., INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 3 SO. CENTRAL ST. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BRADFORD, MA 01835 INSURERS AFFORDING COVERAGE NAIC# INSURED Allan Veilleux, Jr. d/b/a INSURERA Phenix Insurance Co. Heat Quest Insulation Company LLC INSURERB: Safety Insurance 1.42 Hale St. Unit 2 INSURERC: The Hartford Haverhill, MA 01830 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION OMITS GENERAL LIABILITY CPP07132S3 12/27/2015 12/27/2016 EACH OCCURRENCE $ 1,000,00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ S0,00ol CLAIMS MADEOCCUR MED EXP(any one parson) $ S'000 kncw A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY 5021421 12/26/2015 12/26/2016 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) 1,000,000 1,000,00 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 6S60UB9609L39015 11/08/2015 11/08/2016oRV TATU- OTH- EMPLOYERS'UABILITY E.L.EACH ACCIDENT $ 1,000,000 C ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERJMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE,$ 1,000,000 Urs describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS insulation work - eneral liability code #96410 rkers' compensation code #S479 CERTIFICATE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of North Andover Inspectional Services 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1600 Osgood St. Bldg. 20 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Suite 2/36 OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Frederick Malcolm Jr. JA �. ACORD 25(2001!08) FAX; (978)688-9542 ©ACORD CORPORATION 1988 i IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) i Massachusetts Department of Public Safety Board of Building•Regulations and Standards I License: CSSL-099215 Construction Supervisor Specialty ALLAN M.VEILLEUX,JR 142 HALE ST UNT-2.,^', HAVERHILL MA 01830 �� I CA Coissioner. E mmxpiration: 08/49/2018 "J l't Ci r Mt rrtG�r+i N7iX r rt7i::rt" i� Office or Consumer Affairs&Easiness Regulation ff'OME IMPROVEMENT CON usinesOR �~h 4� egistration: 153660 'tx Type.- N piration: 12/21/2016 , ..DBA HEAT QUEST INSULATION CO LLC tte' ALLAN VEILLEUX. 1� 5 SHAWSHEEN RD. I LAWRENCE,MA 01843 11nderseeret4ry _..