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HomeMy WebLinkAboutBuilding Permit #215-2017 - 21 PETERSON ROAD 8/30/2016 BUILDING PERMIT ,t?.'•` °.°oma TOWN,,OF.NORTH ANDOVER �. .: t APPLICATION FOR PLAN EXAMINATION Permif_NO.:. Date Received '� °9 •<a rev Date lssued : " �4SSAt� IMPORTANT:Applicant must complete lete all items on this page. t P � is(1'.wwy,+39"moin�a9:!?`�;` �`�'✓!3!'ft�4?:z�.,44.•y.�''�•kYd�kh� -, �.�s.+,i�•�Y3�,� a-w. � ,a>i•, `" 1"� '� �'"•a -i''?:.t �,(� e Y iwwsa* r' y d4f �naA. P3Tr��t .'i�;�".t� -:! r��fi.,�„�•5,9 r�� a�d '1����'�",.�, ��G��, :,.'J 1', 'Y.�l� .3� A'� ,'9 t7';P„R,GRER�TY®WNER �,' - TIUTA'�P#IV'�O���1. �jPARCEL"E � � ZON{NGk STRICT���� 5 •s'rHatksed"`'k� l`g,��+`$ � i�� z {+ � ':.$. ��iP'.. errs ,� �.�.,��vdhk.7.�s.-�.r. '� -.as �,..'. s tr�'n7 c•y ..,8'�,.�"s"' u�,. y ,a:, y + TYPE OF IMPROVEMENT PROPOSED USE ResVdntial Non- Residential ❑ New Building CYOne family ❑Addition 0 Two or more family 0 Industrial 0,Xteeation No. of units: ❑ Commercial Repair, replacement 0 AssessorT Bldg 0 Others: ❑.Demolition 0 Other 1112% VL<-1l��ntl�ey� x .Ti' Sr'`*•� .nesOrF,,h.Y '^aJ�" t3F t .n:4v »ti1Well ® FIoodp�ain CitWetiantlsstncWater/Sew,er� 5 �` � � �. � w Identification Please Type or Print Clearly) OWNER: Name: _ S� C IaP 1 �� Phone: '1 - 322— SIJ Address: yi Y n t y�sNU C®NTRfACTOR Narne �` �g�� � v2•�,�y, a'� ,> ,y �,t r >•�u�'IR S *� tx �g-��'�t�i "�-° �';e ( '+° r 1 S _ 11 '�,`,a3 't+y. a,e_A#`. fiP'• C3,Yf;> a .. si ` t , �1Address� , `� ` � �� _ 15upe oa: +''•'� �` ' 6 _�,�2 yYr •5 �gsi w, ^ _ + tL'..ctY ,.,��t �rvisor�s - onstctionFLicense 11, 411 f.E MEw,1t. E•j,n �#, ... ' 1 �+ ,r�"w,.r.,rte” cE-rrev d' uM#�.+ ',3L.`q'✓' 'Y.}, „ ;° - q # ,�, t' . i HomEVVm rovementriLicense� � Rl °ARCHITECT/ENGINEER Phone: 'Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO T BASED ON$125.00 PER S.F. Total Peoject'Cost: $ FEE: $ Check`No.:; Receipt No. NUTS: Pemsons.contracting with unregistered contractors do not have access to th` guaranty fund :ignaturebfAgent/Owner �;• ` .sanSignature of'contractor r Fir . .r OM Jun �4 0111 r . ;�I}r,. e a c tr,l^ ?:•ice., it r. . 1 �.,w i:') Jl J✓. C • t 1 1 a `a L 1 ' I ,r':.i. '{�,' S '7,1r; � .. ����. l t"orf• � . .*�" Imo' ,./ Q 1 I r'I t l i'' �� S• ! r /- t t' ` 7,� 1W, A,. .t ''1\tt .\VIWtSi 'it ._ '.l �`.. `. i ��♦ ` 1�.. _.. �- .t,( ,' �'I' � "\- -.._. _ _..._ _._-- ...._..... � ::car.•.l.1�li't. �'J t1'�r liD'1�'�Ci `Ar ! t NORTI� q BUILDING PERMIT tt�eO. b, �o TOWN OF NORTH ANDOVER a APPLICATION FOR PLAN EXAMINATION n0 ee Permit No#: Date Received ACHU Date Issued: IMPORTANT: Applicant must complete all items on this 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 ❑Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition -❑ Other D Septic o Well p Floodplain ❑Wetl'ands ❑ 1Natershed District 0 Water/Sewer _ l DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License.: Exp. Date: 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 access to the 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--Reha-bil.itatim 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 OTE: All!dumpster permits require sign off from Fire'''Departmerit prior to issuance of Bldg Permit Addition Or Decks 4 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 cheek 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 6 Workers Comp Affidavit 4 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 1 ECC Energy.code Engineering Affidavits for Engineered products OTE: All dumpster permits require uire si n 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 fhe'decision from the Board of Appeals that the appeal period is oyer. The applicant must then get this recorded at the Registry of Deeds: one copy and proof of recording must be submitted with thle_building application Doc:Building Permit Revised 2014 1) J _ k- 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 Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature r COMMENTS HEALTH Reviewed on_ Siqnature COMMENTS r 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: z",�r Located 384 Osgood Street FIRE DEPgR,TMENT Ternp Dumpst �e ` -� °n site, y� }Located at11�2�4 11"/lain Street• r a � •l:' F.'w`�. !-?'�u.r- ►"`ahs .!1'! ,ytttt+ . ,. 4 �r-?S e C+,3._ �a;:.rye..K F ,r�e Departmentsignatur.6e/dater a +7.-_ v n r r -a L' ..t-r !_.L.... c_�l'f.:.a.tr._.!a':. �r �`'t t � li .1.p4,a� Frr x+� � � •(' rr.ti' i d+: i. 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 N® DANGER ZO 4r- LITERATURE: Yes No MGL Chapter 1,66,-Section 21A—F and G min.$10o-$1000 fine NOTES and DATA— (For department use) I - i E Notified for pl ckup.Call Email Date--__._.___.__-- Time Contact Name Doc.Buildin;Pennit Revised)2014 Location f ' No.2 f J r. "T Date • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL : $, Check Building Inspector ��ow r s NORTp. Town of ? ? _ s ndover O . � 0 No. S5 .-:1611 - � Z ti oh ver, Mass,joeCOC LAK 'k- A0R�TEO S U BOARD OF HEALTH -PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ... '. .. .. .. ........ . BUILDING INSPECTOR . .,....... Foundation has permission to erect .................. .... buildings on �4...... W.....&­(" Rough op tobe occupied as ...4 ....... .... ,/. Q ............................................................... Chimney provided that the person accepting this ermit 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR_.. UNLESS CONSTR ION 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. Craig lacrosse-owner 'S CONTRACT Po Box 728,Tyngsboro MA 01879 ; August 31,2016 97&580-7376 craig@roofingkinginccom Customer: Satish Tkalapia0i Address: 21 Peterson Rd,North Andover MA } Postal Code:0184S I I � Phone: 508324-4713 } Email: tsatishchandra@gmail.com Thank you for allowing Roofing King Inc.the opportunity to work with you. Here is a listof the work to be Lmpleted,the agreed price and payment structure. Please feel free to contact me with any questions or concems at the number listed aboa e. t SCOPE OF WORK: Full roof replacement -House will be covered with roofing blankets to prevent any damage and for easy cleanup -Remove all shingles right down to existing wood and re-nail and prep before installation process begins -install up to 96sq ft of rotted plywood(3 sheets 1/2 roof plywood)at no charge on any full to replacement&$50 per additional sheet if needed -Install 6 ft of GAF Storm Guard ice and water shield leak barrier along base of roof and areas listed below -Cover all valleys,snow load areas,under all flashings,wrap all penetrations including but not limited to chimney's and sky lights -Remove and re-install new plumbing flashing on soil pipes vented through the roof -Install Felt Buster on any exposed wood before shingles are applied -install new 8" (color)drip edge on all edges of roof for proper protection -Install GAF Pro Start starter strips around entire perimeter of the roof to create a 1/2 J1 nch-overhang for proper install -Install GAF Architectural Timberline HD LIFETIME Ltd.Shingles will be storm nailed with 6 nail per shingle 130 MPH resistance -Cut 11/2 inch opening on peak of roof if it wasn't previously done for proper installation to meet building code(on full replacements) -Remove old lead around chimney and reinstall 12 inch lead and reseal joints(if applicable) -Install Cobra exhaust vent on peak of roof to allow proper ventilation and meet building cod -Hand nail Seal A.Ridge caps on peak of roof with 2 inch nails to complete installation I -Blow off entire roof,driveway and all walking surfaces and clean any loose nails with 3 ft rolling magnets daily or on completion -Existing roof will be removed and recycled at Roof Top Recycling(Certified Green Roofer) Job S ecific ,and Up-grad es on full roof replacements) lD ( p ) Weather watch upgraded to Storm Guard Ice and Water Shield $0.00 Included -Remove skylight ky ght flashing kits to install ice and water on all 4 sides(reinstall existing kite $0.00 Included -Deck Armor In place of Felt Buster $250.00 Not Included Warranty Roof comes with 50 Year Weather Stopper System Plus LTD manufactures warranty Promotions Military,Veterans and Retirees receive a$250 Rebate through GAF when purchasing aGAF Li�time Roofing System. Y PAYMENT STRUCTURE: This price includes labor,material,trash removal,building permit if required and contraci may act as signature for permit. (Any additional work will require separate pricing) Make all checks payable to hoofing King Inc. Total: $8,000.00 4500 Act Fast Coupon(126.8139) $71500.00 Deposit(due at signing): 1 (913) $2,500.00 2""Payment(due when material is onsite): $0.00 Final payment(due upon job co letion): i (213) $5,000.00 SHINGLE COLOR: S( Initial: l ACCEPTANCE OF PROPOSAL The included specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above and accept all terms included.All discounts on all work to be done must be presented to Roofing King Inc.representative before contract is accepted.If rotted wood is discovered AFTER removing the existing roof,or it could not be identified at the time of sale an additional charge of$50 per sheet. If this account is collected through legal actions,customer wiil be responsible for all attomey fee d court Posts.Dsure: tomer responsible to cover any valuable items in the attic to protect from debris.Roofing King does not assume responsibility for acts of Mother Nature. Owner/Contracto Prope Owner Craig LaCrosse Satish Takalapalli i q I i l i� r .' t. t � :".. ` ,_ . ` i � r �.. .. � L 1 � � ' _ , I ` 1 Y �_ .i The Commonwealth of Massachusetts ulDepartment of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual):Roofing King Inc Address:Po Box 728 City/State/Zip:Tyngsboro MA, 01879 Phone#: 978-580-7376 Are you an employer?Check the appropriate boa: Type of project(required): 1.❑I 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 for me in ❑ 8. ❑.Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.a 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 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.R]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no 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. t 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 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 thepolicy and job site information. Insurance Company Name:Star Policy#or Self-ins.Lic.#:WC 0742797 Expiration Date:08/20/16 Job Site Address: City/State/Zip: 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#:978-580-7376 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4:Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ' aat i a �,.t. 1t s v,s i .-. , 1, .. 'r,,a ;5: .. I .. D- ,o,)lw., �. + a',, i`., 1. i'. r". 'x,s, art,hi,e. rt i'31 9 ti`tr�£!t tr'3 'r It-1 1 j sy -; CI i��,.,,. ' -,, .''�F t'!z ." .n ;4'i ., .'. .. t. _ ". .._— ,'t,.S:Rs:-.- .s2y F:i<•'D 4:i a";tj 3S-a7�{;D •i ;t' c. f] ..r, 34i.r 1 � •.Jt ' i .. t ;.° �.d - fi i': !t � ? -. ...f .;tt €7?((e3':.'�. ,r7 { `4, , '," � .,t' .. � ;\N�1'r�D�rir'=r°. t. 1i::lt`*•t. .e i S!t }, s '',tt?: t'�",t,:a` _ ,s,;�iEs` i .'i 4 4�,•t{„'it s3'�t� ,f.. .,>. DS+r' ! 5 ...ii, ;,.t t tl "tivi D..+.! its W\ la �! { a O'r'zaa! ffil0d)51 ';W,t F is 'tft,'J}3-.. ,�.i$� .«. .ri�Fi"A�A . . I ACORCERTIFICATE OF LIABILITY INSURANCE12/10/2016 DATE(MMIDOIYYYY) O 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 endorsemen s. PRODUCER CONTACT NAME: McSweeney&Ricci Insurance Agency, Inc. PHONE FAX 420 Washington Street E.MAIL E"c - - ac "°' 8 - Braintree MA 02185 ADDRESS: dcc INSURERS AFFORDING COVERAGE NAIC# INSURER A:Berkley Regional Insurance Corn 29580 INSURED ROOFK-1 INSURERB: r n I 14788 Roofing King Inc INSURERC:Star Insurance Craig LaCrosse INSURER D: P.O.Box 728 Tyngsboro MA 01879 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:680795776 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. I�TR TYPE OF INSURANCE �gR WVD POLICY NUMBER MMILSUBR DD/EFF MMIDDY EXP LIMITS A GENERAL LIABILITY CGL0059562 12/11/2015 12/11/2016 EACH OCCURRENCE $1,000,000 TO X COMMERCIAL GENERAL LIABILITY AMA ES(RENTED PREMISES Ea occurrence) $100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $5,000 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 PRO LOC $ B AUTOMOBILE LIABILITY MIT5776F 8/20/2015 8/20/2017 Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDrx SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A UMBRELLA LIAB X OCCUR 000071022 12/11/2015 12/11/2016 EACH OCCURRENCE $1,000,000 REXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC0742797 8/20/2015 8/20/2017 X I WC STATU- OTH- AND EMPLOYERS LIABILITY Y/N DRY LIMITS I I EEL ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? N� N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Roofing. 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 Street North Andover MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i pn 1 9 Sy9. MA91IA18A, E `t,..n.�� ` �• �` Y!°'.\Y.�i• ^P 011 P , •'AA« '.ii 11, ;I� r.si^1. _ _-a 1'I TAA' A Zn '131:6.'! Li A, I7`3i ) Citi{ 1 l.t .'A031, r:r TUN V(N. TIP—A-1-T91, f 2?00 73SUawl 10 31+ Wo :3 ri it4J'• `JjHTrJl4A.L13�'I'iZn AC3ti''tAT-Iii?�rit13.' 1 �.r t7a,;('~ 1' �tt'1 +�-/t,)-1 -^J�S;EIUG it •1^ u ,r ,:I,r. , '•r. - \ i 1Tb r i_ � }...._. r°: •� `,i:1. [?�+.',t,.;i: 1" L� hAJ a'itli rC h1'it+`. ,L il,n. .1 na •,�,r..r `. •1 �. .. ,, i2'7 YJdriti BF';t'J�naiS2A2hc; h..rf. . . '.l':rr• '+n F.'t ,, ^x:a i�L•Iil nt •n��,?It�tE.,'IRn� I 1 .. •r •111{3{:'-,!-r.'•I Sn'•lu'^, ..,)1/{ ._, rdtEC4. '� •r� �l CAP r. LjFtIm v ti 7h'„3u�tS i9t� 1 •i IT� v r I .A1- 22 i';.9 r tJY1W r ..,h•, .:.- .. �. ,. .0 � L' - ,. n „)'H3~.�. •A.,U 1• .N.. r•1`;O ')aC,•-., , ( r I c. . . „ I .�,•�r�, ..:t�,;iA- 0 1 IC91�sa: (IF100Aort QsiOOA�: ■I,r La• t2 RST `1>�'' nu nrn6n� U^4 9riT (c!0I QS)BS QAOJA VC� Office of Consumer Affairs and Business Regulation - 10 Park Plaza - Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration n r: Registration: 173117 a f Type: PrivateCorpora on -�, Exp ration: 9/4/2018 rr# 290665 ROOFING KING INC. CRAIG LACROSSE = F P.O. BOX 728 ` �� 4 h �- TYNGSBORO, MA 01879 Update Address and return card.Mark reason for change. SC97 a'} 20M-05111 E] Address n Renewal Ej Employment n Lost Card Massachusetts Department of Public Safety Board of Building Regulations and Standards ;` License: CSFA401415 Construction Supervisor 1 &2 Family 4 CRAIG A LACROSSE 18 HIGHLAND STREETS 4s TYNGSBORO MA 01879 f r�i is Expirati n: ' Commissioner 06/25/2018 i •Y