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HomeMy WebLinkAboutBuilding Permit #660-15 - 224 SUMMER STREET 2/18/2015BUILDING PERMIT TOWN OF NORTH ANDOVER n A7PP FOR PLAN EXAMINATION Permit No#: V ✓ 1 , Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �'� ^A�- S� A j f Print PROPERTY OWNER ��%d 'y Print 100 Year Structure yes no MAP D 3 PARCEL 1 7.9 -ZONING DISTRICT: Historic District yes n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Rdne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial impair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic. ❑ Well El Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFO h /V"o OWNER: Name: Aririra-,-,- M ED: - Please Type or Print Clearly '/? S171 1,b Phone: Contractor NameJ'�t1'`t�° j�pR-"` Phone: G / 7 �4/ 2_ �f Address: ,�11 %�� ��slob Supervisor's Construction License: D 5 a �- S Exp. Date. Home Improvement License: l7� 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: $ 6 , 3 1�y• Ole, FEE: $ a2c� Check No.: l o Zky-� Receipt No.: c -k 4T,�p NOTE: Persons contracting with unregistered contractors do not have accAtuarantyfund to Signature of Agent/Owner Signature of contractor Plans Submitte TYPE`OF SEWERA Public Sewer Well Private (septic tank, THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS -0: Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE �D;EPARTMENT Ternp np9,e en site eyes_ no, T L0 -d _at 124 fl,/lam Street -- - - - -- Fire Depart -event signature/date____ - - - IC MMETTIL%. -- - Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. -,I 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 � ■ Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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) ❑ 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 , , ­ - —1 - Location No. Date r. W - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check it 28496 bu�lding Inspector = DQ CD . OC u \ -0 O LL d N V1 U Q N Q z Z m C O Y 'p 7 LL L to_ W C U LL OJ W z z Z d L 7 d' _ fG LL O W U W W t L 3 1' U Ln m LL O a z L j i2' LL W W a' LL N m O Z a+ N ` N Y 0 N O N In J 2 z m z W w CL W C W CL 5 W r_ 0 O R W L v O I .Q 4 Q. Qi 0 z N 0 C �EQ L • N w i �(ii •E m m E CD O = ami ' C � V � c� N � ECA! m a dLA � d � O) O = > O c Q a� Q l.0o Z C. H 0 Y1 O O N �CL :O O Ll) C C 0 cm =z c CL '0 � O VV/ ,A O • i C 'a C O H Q L = L cc O 2 1— O O CL S CA 2 m N m CO 4-_ W LL C m +�+ O a N C w O N •Q. tO � .Z W U L a� v 0-0 F- ti =O O 1=- t CL00 > 2 z m z W w CL W C W CL 5 W 0 W L O 0 z N 0 C •E m m ami O a Q a� Q 0 �CL 0 CD =z � O VV/ ,A i — r Am erse Rew�al,L byn, W#*Dow RAPLACtMEXI Renewal by Andersen Corporation 30 Forbes Rd. Northborough, MA 01532 (508) 351-2200 Fax (508)-986-7072 CUSTOMER WINDOW AND DOOR.REMODELING AGREEMENT 31 MA Home Improvement Cont License #170810 (Expires 12123) Federal Tax ID #,41.191 Buyer(s) Name Daw, CHRISTOPHER STAD - ------------- DECEMBER 204 2014 lBuyer(s) Street Address city State Zip Code 224 SUMMER ST NORTH ANDOVER PAA 01845 Email Address Home Telephone Number Work/Cell Teleahone Number STADCAOGMAIL.COM 1 (078) 258-888-7 1 (781) 475-2793 er() hereby Mrittly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation ("Contractor'), in accordance with terms and conditions described an the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this 'Agreement), er(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount $ 6,394 Deposit Received (1.3%) $ 2,131.00 Balance Stan of Job (33%) S 2,131.00 Balance on Substantial Completion of Job JV�') $ 2,132.00 Anamed $ 0 1 Est, Start Date algr*V $ 0.00 1 16 weeks I Checkr-ash AIS".ardal C -V -r*- $ 0.00 Check # Est. Install Time Credit Card 1-2 days if credit card Is sakcted:, pleaii SM CrOlt Card ftmw, form �Auyerjs) agrees and understands that this Arearnarit constitutes the entire understanding between the parties. and that there are no verbal understandings !changing or mortifying any of the terms of tills Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent 'of both Buyers) and Contractor Buyer(s) hereby acknowledges that Buyer(s)1) has read this Agreement, understands the terms of this Agreement, and has 1 ,received a completed, signed and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT StGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. f:Renewalby Andersen Corporation Buyer (s) gvyer(s) (L Signature of Consultant Signature Signature X BRIAN JACQUES CHRISTOPHER STAG --------- — --------- PnrttwJ Narne of Gon-,%ultard Printod Narne Pfiled hlarne YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION ATANY TIMF PRIOR TOMWM*tfT Or- THE YNIRD BUSINESS DAY ATMA THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOME OFCANCELLATION FORW FORAM EXPLANATION Of THIS RIGHT ------------------------------------- N(YRIZE OFICANCELL-ATION ------------------------------------- N0110E Of CANGFILLAUON Date of Tranxiled" ):WN You ulay Cancel this i Date of 1ransartlatt W-Wi't You may caftod tills 4ramaetloub without any petutiq or otdigstion, vAthla three business days Irrom the tellassetion, without say penalty or ofillgation, Within three business days fivm the ;above date. It you caaeol,. Any property traded in, any payments mAd* by you )ouler i show date. If yam canco.l. any property traded it-., any payntems made by you under 4he Contra" of Sate, And any negatiable Imarument esecuted by you will he r the Contract of $Alr; and an byyetis wUlher iresurned within 10 days following rvvelpt by the Coutrac-un, ("Seller"j o(yourofyour notice, and any security Interest arising out of the traneact" %illb. cacw*. Bating nosire, and sayaoral4ty lmer"t "tag oul of the, nano anion Will be araac*led. ffyru csatet, you tua,4trualle available to the Srlle.rat *aur rvstdvace,hl I Canceled. If you macrl, you mwm matir avallable L16 the seller Aty"ar "deate, in its when recelv*d, auv;oo& dell%"d to you under I 4uhstandallyasgond Condition aswilearecelveti, saygoods tlefiveredi* you under Alds Contract or Saft; or you may, if you velshcompliv -kith the Instructions of the I this contract Or Sale-, Or you may, it you wish, comply with the itultruWass of the, Seller "ardfal the return shipment of the pods at the Seller's espese and risk. 1 Sell" regarding the, returnship—ant of the goods at the Seff"'A espenror and risk. I 'If vou damake the goods available to the Selt&r and the Seller does not p" them up If Iva do make the goods avail able to the Seller and the Seiler does not p" them up �Withln,lo Aay* of 0tr date of your Notice of cankellation, you may retain or div-palit, within 20 days of the date of your Notive of Cancebtalau, you may retain or dispose 'Ofthe #W&Widiontattyfurther obl*tim. of the goods veidavat any further Obligation. If you A" to make the otlooleltvai6thle :to the Seflrir, or it you a gree to return the goods to the Sell—sad fail to do sa,:Ihen to the Seller, or ifwat agree to return the goods, to the SeRer and fail to do so, then i 1W reasain liable for performance of an obilgailom, under the Contra". To cancel post re.main flaille. to, pert"namee. of an olAig tions muter the contract. To cant's I this tt-ms .idoa, as,"I or deliver a signed and dated copy of this cau"Rathea nottee i this transaction, mail or drlivrr a signed and dated copy of this cancellation andee Or any other written amice, or send a telegram to Contraotort Re"" by Andersen,. I or any *titer Wratten notice, or send a itteg, rant to tiontractort RenewldhvAndersen ,� °.:90l'nrttes did. NorthhotaughMA 01532, BY NOT IIA11ATRAN MIDNIGHT' OF 1V12W11 I HEREBY CANCEL TIRS TRANSACTION. Pal Na�, nx. P49 IM, ......................... - ............................................. ..... ... ... ... -- ............ .......... .......... - ......................................... ........................................... - - .................. ......................... Renewal by Andersen Corporation MA Home Improvement Contractor 30 Forbes rd Northborough, MA 01532 License #170810 (Expires 12123/2015) (5081351.2200 Fax., (5081-986-7072 Federal ID #41-1918413 Provia Door Specification Sheet CHRISTOPHER STAID 20.2014 '"c buyd-r,t listed al)(Av herdry,joindy aod'Awc.rally agrt,t, to purr hwe 0,(, &pock (Ind kir liqA'd lwlow. ill accordiltive 96th ill(, prices and wryni dc;ctihiid (Hi 0)v S -tic ed p stweirwatilin sficrt 1� part. ENTRY DOOR DETAILS Foyer ir'I EIS W 3 Imubda"th 49116 49/16 49116 49/16 49/16 49/!6 Leg /006 IA,r 10015 Gific (Irraill Otli&kk 041101 Sa t I tltul n l. S 12" ("'Iffi Cwam Chnsidr. Color Sanifstoriv. Cicar-w/lo%vL Smooth HLFO Add,(' oille No GaiAeatlluiFs Nolic In, Mr. Mrs Oul'ideColut Im Lwk-,Eq G Satin Nick Lxl. hic&,md Georowl fat I` Lit`sfi Sarin Ni(+, Siivcr No No White 1`faSikSilSii Hifi - - -- ------------ ------ STORM DOORS —E-1 —slyk. st(wril Color ...................... -,Sxiii Nick, Additional Job No 0wrw is a"re that Contractor does not do any pairifikplslalninq of ramovaflinshatlatton of alarm system and door treatments1hardware. it is the responsibility of the homeownerto have the alarm System and door Lraatn*rftslhardwarefemovedpffor toinstallation. VNIa make no guarantee as to whetheratarms, door tmlnwts or hardware will fit alter replacement. Customeris also aware in some cases there will be glass loss, if nacre is, the amount will be de -pendent on the type of existing doors, ow ofinstellatton and windows". ft make no guartinitee as to the amount of qfm loss. Ctistomeris aware and understands any and aft unseen rot is not included in this contract. Should any sot be found them ?Ai bean additional charge for fte and materials unless so stated M this contract. Iles C�miuwuv '01 -oilk -mo scal %Iodflkvi �6111 woetg7 til ilivve1W V givv 'mid �1�i jtiumD if. and disqu�,-ql of, :411 jfA3 trfillv(i cchik- domi� morot lick'n mid V.1cilmll ni yes wxjuii*,A w thc 6)1 it, ill tic 14i th6i tics. Utf�::k # I ye,- All dim lit -I Ye" Xc) 0%vilf, r ilgrFr!� to IV- tin-vitt: on (tic.. finai t' ay EEf iiisudialioll for jital im"jii't tion mid to ile1krr fin -,d 1l,,iytnruf I fifianre fbrm' A "wi, Muk, Fmmfiixg latc P,mi�s, alm, 41-te, x, m s'-.0mi C.Lmgiug, .w A' %13.cw-.. Tbin St- ifi, sh'tt. tlsay ",q I.: dmng",I or n, rr<A;rV'A "T iii im, wm Renewal by Andersen Corporation Signature of Consultant Signature Signature ------------------ BRIAN JACQUES CHRISTOPHER STAR -------------------- Print Print Name of Consultant Print Name Print Name '.2 1• `'i.}.rl.z.me, 1.i��P9� _n..c�,-z�..2 ...,yam y. d{�".i'Y•�`'. �_—__. •....' � ,ya:.T�:::.:?:'"mac'_.._-..�.,..I�C'__.nZ�.... T-buank You for choosing PrOVia Door produc4s, Thist�q oducf has been specifically designed to improve energy efficiencyan '. tfIe. a earance of our.Thdms_..; . -.. Dns �tllS ffQar-.eneft.th6.GiC$6C6 Ye fChecEt°anty m bQzl; For U-fack¢r - SFGC' _-.`e Opaque s 0.21- 2X or Yz Lite 0.27 ^.5'-``' 114 or Full Lite �.t'�•�_-_w:iG=?TL...•y.�y 'TC+��u�rt2G-:•i+�, " ' - _�;: 2 ...:,.`M1'• -!. =yam �`:�°,'��t"- �%.;=�: __ �:� .':`iiifY'"ry F`rc•=':t��:'�"�."•'J' �6i�1'L.6�� 'r NFRC "�:'� `��.•, ,V` Steel v�/Fib Channel Entry Do"or. ,_;.�;_ ,,,, • � ��. Wood Frame .Y` M1laBonaCFenestrabon ODo Style No G12ss `;: Rafing CouncliP ny: w� .ti •' fes_ ��7�� � -_:PR •-�2-000D�i'' AIERGY PERFORMANCE.RX w, ��' � R � ^iia' - ��yTc'•�iy ,.- �4;_ _. e::�%"_._-�,.F - : - •=:� --'�;^�_=-mss: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/State/Zip: NORTHBORO, MA 01532 Phone #: 508-351-2200 Are you an employer? Check the appropriate box: 1. Q I am a employer with 30 4. E] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.$ 5. E] We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reauired.l Type of project (required): 6. ❑ New construction 7. Remodeling 8. Demolition 9. Fj Building addition 10. El Electrical repairs or additions I 1.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other *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. ;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: OLD REPUBLIC INS. CO. Policy # or Self -ins. Lic. #: MWC 30293800 Expiration Date: 10/01/1155 Job Site Address:_ ' SM. -M 4AV1 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration ate). 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 X and penalties of perjury that the information provided above is true and correct! Date: 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 ANDECOR-01 YADAVYO .4`Co�RU CERTIFICATE OF LIABILITY INSURANCE FDAT D/YYYY) 10O/1il/122014 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 Willis of Minnesota, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 37230-5191 CONTACT NAME: certlflCateS@WIIIIS.COm PHONE $77 94 FAX Ic No): (888) 467-2378 AIC No Ext : ) 5-7378 AIC, E-MAIL ADDRESS: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Old Republic Insurance Company 24147 10101/2014 INSURED INSURER B: INSURER C: Renewal by Andersen Corporation 30 Forbes Road Northborough, MA 01532 INSURER D: INSURER E: INSURER F: $ CUVERAGES CERTIFICATE NIIMRFR• ocUlelnki U11"Mcm. 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 LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MWZY302940 10101/2014 10/01/2015 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTE PREMISES Ea occurrence $ 500,00 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PROT- F] LOC X POLICY ❑ JEC OTHER: GENERAL AGGREGATE $ 4,000,00 PRODUCTS - COMP/OP AGG $ 4,000,00 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS MWTB302575 10/01/2014 10/01/2015 SINGLE LIMIT $ 5,000,00 (Ea BODILY INJURY (Per person) $ P INJURY ( BODILY INJUer accident ) $ PROPERTY DAMAGE Per accident) ccident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ g A WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A MWC30293800 10/01/2014 10/01/2015 OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 013i1rf di";X11 i.L•1-19-1.1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 13 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -090125 JARKE L MORIN = 86 GARDINER ST LYNN MA 0190.57r. Expiration Commissioner 10/0612016 free of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR ..170810, Ekpiraitidn" 12/23!2016r 5' Supplement I RENEWAL BY ANDERSON-IC&OORATION JAIME MORIN 104 OTIS STREET NORTHBOROUGH, MA 01532 -------------- Undersecretary N