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HomeMy WebLinkAboutBuilding Permit #657-2017 - 23 IPSWICH STREET 12/20/2016_-BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Ib &_ I — 90 Q Date Issued: ( 16 IMPORTANT: Date Received 19 yo �w i must complete all items on this LOCATION � � tet- p5w '5 r 00 f A Print PROPERTY OWNER P rkeAy r a �►Pr�*h4 i4 ✓► Print 100 Year Structure yes MAP PARCEL:_ ZONING DISTRICT: Historic District yes Machine Shop Village yes s I- Residential no no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg 9 Others: ❑ Demolition ❑ Other El Septic []Well Floodplain E) Wetlands E W tershed District El Water/Sewer W . DESCRIPTION OF WORK TO BE PERFORMED: RStKiteK► d{P� vne?moi �"t Identification - Please Type or Print Clearly OWNER: Name: kL6atcl Vmr` , 0% 5 �a 0Phone: i�f- 6�G -a��yo Address: a"5 5i Peter Leblanc Contractor Name: Phone: Email: Address: Supervisor's Construction License: /C760 I.Exp. Date: L Home Improvement License: Exp. Date: �>%a1/k 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: $ /,DO G0 FEE: $ J- Check No.: .7 F-) I Receipt No.: �,_g tt 3 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 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 TE: All dumpster permits require sign off from Fire Department 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) a Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products TE: 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 TOTE: 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ F Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS•FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH t Reviewed On Signature Reviewed on Signature Reviewed o Sianature COMMENTS at i��. ��e r F} .c Zo tying 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: Located 384 Osgood Street } M � ��Fii•e De artment si ' gnaturse/date. t-4 ; iVr , tP �s ;',�r7-cryr �COIVIMENTS-s �t i. �} �� .tv} ri i t.. _ a x t •._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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$10o-$1000 fine Doc.Building Pennit Revised 2014 Location S7 e J-0 d/v so tv No. (r, S 2 G r? Check #-777( 01364 Date 0 A) 0 0 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $- TOTAL $ Buildin" Inspector 9 �z CD O Cr 2) � s CL �. �O 00 C� cr CCD O CL O CO CD CD CF O A N 0 0 r_ U) n 0 S CD U) CD iv z �F CD O CCD O D O Z 0, m N 0 O� (O O S. EL CD cm O O cn O C: 0 ro ca=� < CD 0 N !D r- Lg 0 m o O N D TI O O CL �. I Ti -+, � O rt CO) CD CD 2 Q O N O o n �rt C'1 '"'C� 1 CD `° : w `ot 0 0 0 O O rtTot.Dp N '�Q 0 o E" : � 'A Q' = N 0 CL N :-_ o job CD CLQ CDr CD " 8, c� o, c :� CCD CD CD OV C (D 04 p .-f v� o as o a � . y 0 Ln N W T Za T Ln .Z7 T ;:D T 3 r+ c O 3 O O 3 O 3 3 O O rD O O (D 01 . C d C c D1 c N C C 'a O �p r* Sn Z (D d N n 0 0 s r- D m r m rl W 3 3 C O O 7o G1 '° N o v A Z v vH c O 9 � m V V m O 0 0 -- 0 0 O 2 70 Federal ID # RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thicisch Engineering CT Contractor Registration No h w 60 Shawmut Unit #2, Canton, MA 02021 CONTRACT 339-502.035 FAX 339-502-6345 Page 1 * R i S E PROGRAM I THIS CONTRACT IS £M1ITFAED INroaiSRVEEN RqE ENGINEERING CMA-HES O THE CUSTON1 Ii FOR WORK AS DEscRmEDBEL:ow DESCRIBED CuSTomst ._.__ PHONE DATE CLIENTIi WORK ORDER Richard Harrington ,:, (978)686-2880 08/10/2015 421273 LL. 00004 SERVICE STREET z�� C4 BILLING STREET �. 23 Ipswich Street 23 Ipswich Street SERVICE CrrY.STATE,ZIP BILLING CITY,: STATE, ZIP North Andover, MA 01845 �' North Andover, MA 01845 ru JOS DESCRIPTION PHASE TW _,- roposal for next 'ccs and program incentives not guaranteed. $0.00 BARRIER: We have discovered what appears to be a mold / mildew-like substance in your home. This is being broughtto.your attention to identify it as a pre-existing condition to the insulation and air sealing work planned for your home. Your signature is your acknowledgement of these conditions and agreement to procecdMARK SPOTS ON ROOFNDECK $0.00 BASEMENT CEILING: Provide labor and materials to install (90) linear feet of unfaccd fiberglass insulation to the perimeter of the basement ceiling at the house sill. $157.50 OVERHANG., Provide labor and materials to install 8" R-28 densely packed Class I Cellulose insulation to (34) square feet of exterior overhang lo6tcd below a heatedlloor area, by drilling holes in the overhang from below. 'Holes drilled will be plugged. Plugs will be scaled with exterior grade spackle and left in a relatively smooth condition. finish sanding and touch-up priminglpaindng will be the customer's responsibility. $133.62 GARAGE CEILING: Provide labor and materials to install 8" R-28 densely packed Class I Cellulose insulation to (440) square feet of garage ceiling located below a heated floor arca, by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be spackled and left in a relatively smooth condition. Finish sanding and touch-up priming/painting will be thc:customees responsibility. $87130 RISE Engineering will apply all applicable, eligible incentives to this contmcL 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 Scaling measures up to the first $680 and an additional $340 if savings arc justified by the auditor. For the safety and health of your home's indoor.-air quality, we will be conducting a blower door diagnostic of the available air now 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 weatherization incentive is $3.110. $90.00 QCT - � 2.015 M Federal 10 # RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of"Thicisch Engineening CT Contractor RegiStration No 60Shawrnut Unit#2,Canton, MUM CONTRACT 339-502-6335 FAX 339-502-6345 S E PROMAM Page 2 ENGINEERING THIS CONTRACT IS EATERM INTO BETWEEN FUSE CMA -HES ENGINEERING AND IWE CUSTOMER FOR WORK AS BELOW OESCRIBED ';;Tomet PHONE DATE CLIENT4 iW�TK ROeR Richard 14arrington (9 1 78)686-2880 08/10/2015 42,1273 00004 Se"CE STREET GILL"M Effr 23 Ipswich Street 23 Ipswich Street SERVICE CrrY, STATE, ZIP BILLwr CITY. sum zip North Andover, MA 0 1845 North Andover, MA 01845 JOB DESCRIPTION Total: $1,262.32 Program Incentive: $061.74 Customer Total: $290.58 WE AGREE HEREBY TO FURNISH SERVICES - COIAPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS, FOR THE SUM OF ***Two Hundred Ninety & 581100 Dollars $290.58 UPONFINALINSPECTION AND APPROVAL 13Y FUSE ENGINEERING. CURTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTERESTOF 1% WILL OF CHARGED MONTHLYONANY UNPAID BALANCE AFTER 30 DAYS. SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES. RIGHTS OF RECISION, SCNMUL!Nr� AND CONTRACTOR REGqTRXnON. DO NOTSIGN THIS CONTRACT IF THERE K SPACO Robw GvLn (Vt ORIZED SIGNATURE - RISE Enginming ACCEPT NOTE. THIS CONTRACT MAY BE WITHDRAWN BY US IF EXECUTED DATE NOT WITIM OF ACCEPTANCE 30 ACCEPTANCE OF CONTRACT THE ABOVE PRICES. SPECtFICATIOUS AND CONDITIONS ARE SATMPACTORY ACCEPTED. YOU ARE AUTHORIZED TO 00 WORK DAYS. TO US AND ARE K9198Y AS SPECIFIED. PAYMENT' WILL BE MWE AS OUTUNED ABOVE THE OWNER AUTHORIZATION FORM Richard Harrington (Owner's Name) owner of the property located at 23 Ipswich Street, North Andover, MA 01845 (Property Address) 23 Ipswich Street, North Andover, MA 01845 (Property Address) hereby authorize �)D 10, it 77y► S,j ( a�r S o o (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. - V., Eoro"' , rw�m' n'z' �0' Date OZ Z 0 100 �1 Sl The Commonwealth ofMassachusetis _ - Depoftent gflndustrialAccirl'en& Office of.Investigations 1 Congress Suet, Suite 100 Boston,.14YIA 02114-20,17 www-mass derWorkers' Compenation Insunce Afdavt: $uRiConiractors/�lectricr ark¢an._ Information . s/.l umbers Name Address: PO BOX 958 ANDOVER lA olejo a -______ Pkone #: arc you an employer? Check the appropriate box. - 1.0 I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. Q I am a sole proprietor have Hired the sub -contractors listed or partner_ on the attached sheet ship and have no employees These sub -contactors have working for me in any capacity-, employees and have workers' (No workers' comp. insurance comp. insurance.# required, j 3. I am a homeowner doing all wori�c 5.0 Wre are a corpmwdon and its officers have exP.rcised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (requi m1p: 6. Q New construction 7. Pemodeling S. ❑ Demolition 9- [] Building addition Io.ElElectrical ragairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other TcPPlicant that chccls box :1 must also 0 out the section bellow showingtheir workers coni enation b Homeowners who submit this affidavit indicating the P policy 461mation. tContractors Char chP-el; this box m7st anaclted ,s y doing at work and theme bite outside contnie m most submit anew affidavit indicaln* g such. athey M sheet de thea �e ratne a: the sub�n!:amm and ato ; fiethz ar nathos: entities Save emp`oyees. If the sub -contractors have employees, they must provide their warps' comp. policy number. F. - - .T ina crrty¢e:vEr Fts t8 Br0?liftg N' OP�te,'.K'' C!>'+ IZ�pIZi(itle'f' :SSE[PG)t�e�oP 3Ity a jnye&3 �Elo::� !s tt�Ie ir_jorinQtBon, pay andjob SUe- Insurance Company Marne: � • + p in l- i L --r +� ..�iiAr 'q bre r, ttil �!s y� Y Polis; # or Scli-,ns. L.ic. #: ?© \.j fix-pirauon job Site Address: 3 .�.- � ► ch Si City/S!Z' attach a copy of th3 workers' compensation poliey deelarstioa a . sh:,wir, �n e vt P tM,q a as re p g' { g fire poli,,]' number and expiration date). Failure to secure coverage required under section 25A of MGL C. 152 can lead to the imposition of criminal penalties of a fine un to $I ,St)O.UO and%or one-year imprisonment, as well as civil penalties in the form of a S i OP W Gg� R and a fine of up to $250.Ot? a pay against the violator. Be advised that a copy of th=s statemFnt may be forwarded to fire ,Lce of Lrci�esiiga�aons of the DI for insurance coverage verification. B ao nerEoy Corti - under the mics and enakk ofperjury that gie inor nation provided above is true end correct Si mare: `L''�-'�"" °Date. Phone #: 7 & - M � i ccial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circie one): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumhina rne„e..e.,,_ 6.Other Contact Person: Phone #• Ailia�C<> E® CERTIFICATE OF LIABILITY INSURANCE 6/10/2016MM/ n 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(iee) 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 Linda danowicz NAME: BOg Insurance Solutions Corporation PHONE(603)382-4600 FAX No): (603)382-2034 Ell. lindaWisc-insurance.cm ADDRESS: o 60 Westville Rd INSURER AFFORDING COVERAGE NAIC A Plaistow NH 03865 INSURER A Mestern World INSURED - INSURERB:Nautilus Insurance (iron Polar Bear Insulation Company Inc INSURER C: PO Box 958 INSURER D: INSURER E Andover MA 01810 INSURER F: 1-uvErIAuE, CERTIFICATE NUMRERCL1632326134 RFVICInN1 MI IMRER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDiNG 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 ADDLSUOR POLICY NUMBER POLICY EFF Y POLICY EXP M YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx1OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 UPP8274967 3/24/2016 3/24/2017 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: g POLICY F_� ERC LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ accident BODILY INJURY (Per person) $ ANY AUTO ALL AUTOS OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peraccide $ $ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS -MADE AGGREGATE $ 1 000 000 DEO I I RETENTION $ Am026107 3/24/2016 3/24/2017 WORKERS COMPENSATIONPE AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORJPARTNERS(ECUTNE OFFICERIMEMBER EXCLUDED? N/A 17TH - STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) It yes, describe under E.L. DISEASE - POLICY LIMIT J $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) Town of North Andover 1600 Osgood St, Ste 2032 North Andover, NA 01845 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 th Maglia/SJA����--- O 1988-2014 ACORD CORPORATION. All riahts reserved_ ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 r7n14n1t 6/10/2016 Preview: Certificates of Insurance CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYY1r) THIS CERTIFICATE IS Il IED 0611 0)2 01 6 CERTIFICATE DOES NOT AFFIRMATIVELYIOR NEGATIVELY MEND, EXTEND OR IS NO, THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREII AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: c the certificate holder is an ADDITIONAL INSURED, the 11111 11 must be endorsed, If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this :: iI kale does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ;AD.DRESS: Automatic Data Processing Insurance Agency, Int.1 Adp Boulevard o. E e : (AIC. NoRoseland, NJ 07068 __...�......� NALCO INSURERA: NorGUARDInsuranrcCompany 31470 POLAR BEAR INSULATION CO INC INSURER a: PO BOX 958 INSURER C: Andover, MA 01810 INSURER 0: INSURER E: COVERAGESINSURER F: CERTIFlCATE NUMBER: 503587 THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDEN MIEO ABOVEFOR 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. LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER COMMERCIAL GENERAL LIABILITY MMIDDIYYYY MIDOIYYYY) LIMITS CLAIMS.I.Ill r OCCUR EACH OCCURRENCE S DESCRIPTION OF OPERATIONS I LOCATIpNS I VEHICLES (ACORD 107, AdddbrW Remade; SchMute may ye attaetad a morespam is rcquhetl) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood SL 1 suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATNE iu— ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AIED EXP (Any one per—) S GREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY S ICY ECT LOC GENERAL AGGREGATE S OTHER, pPADUC75 - CCAiPlOP AGG 5 BILE LIABIUIY S ANYAUTO � fEaauJtl91I1 S YeMED SCHEDULED t BOOILYINJURY PffS S AUTOS(p"tson! D AUTOS NOtOS^.MED AUTOS BODILY INJURY ti s[ideN} S Wer zcddmil S RELLALIp6 OCCUR S SS UAB CLJdMS-MADERETENTIONS EACH OCCURRENCE S - AGGREGATE S COMPENSATIONS OYERS' LIABILITY YIN tit XA ANY PROPRIETOR 11EREXECUTIVE STATUTE ER OFFICEFULEMBER EXCLUDED? (Mandatory in NH) NIA N POWC772258 01101/2816 01101!2017 E.L EACH ACCIDENT 5 11 yc, de uibc ender DESCRIPTICN OF CPERATIOl bn_ E.L. DISEASE -EA EMPLOYE S E.L. DISEASE -POUCY 11 S DESCRIPTION OF OPERATIONS I LOCATIpNS I VEHICLES (ACORD 107, AdddbrW Remade; SchMute may ye attaetad a morespam is rcquhetl) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood SL 1 suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATNE iu— ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD -� wommomViocas, 0 Office. of Consumer Affairs and Business Regulation 10 Park Plaza. - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA Expiration: 7/2/2018 POLAR BEAR INSULATION CO. Vincent LeBlanc _ P.O. BOX 958 ANDOVER, MA 01810 Update Address and return card. Mark reason for change. . SCA 1 w 20teE-0S/tt Address ❑ Renewal ❑ Employment ❑ Lost Card Trir 419291 plc Yar��n�ai�rnerill� o�G'iPla's3ri�rite!!S Office or Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Reg'sst aiion: 102726 Type: 4 Expiration: 71212018 DBA POLAR BEAR INSULATION CO. . Vincent LeBlanc _ 51 SO. CANAL ST -#5A''' LAWRENCE, MA 01841 Undersecretary License or registration valid for individual use only before the expiration date..Hfound return to.- Office o:Office of Consumer Affairs and Boshms Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 wxxtvad without signature Massachusetts -Department of Public Safety S Board of Building Regulations and Standards Construction Super;!sur `specialty _rcerse: CSSL406017 PETER A LEBLANC 2 :EAST PINE STREET p Plaistow NH 03843 R - ExPIrati0n Commissioner 04128/2018