HomeMy WebLinkAboutBuilding Permit #596-2016 - 245 BLUE RIDGE ROAD 11/16/2015 BUILDING PERMIT of"0 RT"�ti
TOWN OF NORTH ANDOVER oy:,.•-
APPLICATION FOR PLAN EXAMINATION
41
n4� ery 1
Permit No#: 1516- ltj Date Received �� ,
�,9 A�'+ATEo rPp`,�'(5
SSACHUS�
Date Issued: I6� tl�11
IMPORTANT: Applicant must complete all items on this page
R®PERTY OWNER « � zt
th, Print a 06-Year'.S r11G u e y
MAP PARCEL ZONING DISTRICT. Histonc®istnct 'T' no'*'
OV-
Machine Sf1op Village `. y'8
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 ❑ Others:
❑ Demolition ❑ Other
�'Septie ❑1NeIlA ❑ Floodplan4 El Wetlands ❑ Watershed District ,
❑_-Wates/Sewer- _ . .
o-i3h e
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: J�Phone:
Address:"
Contractor Name ' , +,,« � ,✓.�, .4. r��� Phone: 9�� - � ,Zz.7
Email:
- ce se. Ex Date $m
Sue isors Construction Li ..n„ O � 7 _
p: �
j
Ex,p
•Home lmprovementLicense: l��_.�.1�� :` ' .�. Date :� - }��.
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ .PAO FEE: $ "2-�Ob
Check No.: ''S I Receipt No.: 2q 'C�-
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent%Own r gnature of co.ntrac
NORTH
BUILDING PERMIT oF�tLEo bgti
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION '
Permit No#: Date Received 4q
�RA7E0
1 �SSACHU`���
Date Issued: J
IMPORTANT: Applicant must complete all items on this page
LOCATION Y Pr
//,, rn in OVtr )l
PROPERTY OWNER�Jjj�ttll/ t �1hAYWN
Print 100 Year Structure yes no
MAP PARCEL:, tip—ZONING DISTRICT: Historic District yes o
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building XOne family
❑Addition ❑ Two or more family 0 Industrial
❑Alteration No. of units: ❑ Commercial
X'Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESC IPTION OF WORK TO BE PERF RMED:
kEff al
FK7-,e,f�2 � IM411
1 Id ntificatio - Pleas q,ype or Print Clearly
OWNER: Name: �JO ff& at Phone:
Address: 3Z1L5--' 1/-96f
Contractor Name: Phone:
v .
Address: I //� �D�L//) ,,ee/Qtl 05
Supervisor's Construction License: C� � Exp. Date: bo 141
Home Improvement License: / Exp. Date: _
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$,1''21.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $w)w� FEE: $ �Q
Check No.: �c 15P 2, Receipt No.:0 -
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contrac or
Location .
No. (P !�� Date
. - TOWN OF NORTH ANDOVER
ED
•
e .
Certificate of Occupancy $ ~
Building/Frame Permit Fee $3b0
Foundation Permit Fee $
Other Permit Fee $
TOTAL : _ $
Check#
i J
7 2Buil6ing Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOS L
Public SewerSwimming Pools ❑
Tannuig/MassageBody Art ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
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
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zaning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
r
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
__ _ o P Located 384 Osgood Street
FIREtDEPAR�TMENT T �Dumpster on site yes ___� _y r . _no d .
's=ocated}af it 041 ain^i Street
Fire DepartrYient signature/date __
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 - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
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
I
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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
Date Time Contact Name
Doe.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.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
VOTE: 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
a 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
DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
❑ Certified Proposed Plot Plan
o 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
o Engineering Affidavits for Engineered products
COTE: 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
Enter construction cost for fee cal- North Andover Fee Calculation
Construction Cost
30,000.00 m
$ - $ 360.00
Plumbing Fee $ 45.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 45.00
Total fees collected $ 550.00
245 Blue Ridge Road
596-2016 on 11/16/2015
Master Bath Renovation
NORTH
Town o 2 t_E : ,, Andover
0
No. 5 OSQA
.c verMassI
coch�C^Nceew.c
x.95
TE C) r
ll BOARD OF HEALTH uQ,
PER I
Food/Kitchen N
T T L D N
Septic System ` cv
THIS CERTIFIES THAT �..., ,,,, - � � BUILDING INSPECTOR f
............... .... ... M...... ....... ............. rn
nil
Foundation c
has permission to erect ...... uildin son S..... �. ,........... o.. . ... 0
Rough C .,
to be occupied as W� ...... ,,,,,,11\ r4:A%10�0.�1
......... ............................................................ Chimney N
provided that the person accepting this permit shall in every respect conform to the terms of the application Final o
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 v
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
a
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
ti
UNLESS CONSTRUCTI S.T RTS RoughCo
o
Service p
................................................... a
............................. Final
BUILDING INSPECTOR
GAS INSPECTOR c
Occupancy Permit Required to Occupy Buildinz
Rough �
I �
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 o
Street No.
Smoke Det.
D esmococti
nd nstruon, Inc.
a . �
All material is guaranteed to be as specified, and above work to be performed in accordance
with the drawings and specifications submitted for above work and completed in a substantial
workmanlike manner for the sum of$18,320.00
25%upon signing $4,580.00
25%upon start of project $4,580.00
50%upon completion of project $9,160.00
An interest charge of 1.5%per month will be applied to any balance due 30 days after
completion of this project.Any alteration or deviation from above specifications involving extra
cost will be executed only upon written orders and will become an extra charge over and above
the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.
Owner to carry fire,tornado and other necessary insurance upon above work. Workmen's
Compensation and Public Liability Insurance on the above work to be taken out by Desmond
Construction, Inc.
Respectfully submitted .,A
per Matthew Desmond
NOTE:This proposal may be withdrawn by us if not
accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices,specification and conditions are satisfactory and are hereby accepted.You
are authorized to do the work as specified. Payment will be made as outlined above.
Signature: Date: '1114/z�
3
Signature: Jv Date:
Desmond Construction,Inc.,P.O.Box 41,North Andover,MA 01845 Phone:978-682-2279/FAX.-978-682-2279
bm-desmond@comcast.net
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): �LiSL�'y' G4,✓l��,i►/�i Or .yNG'
Address:
City/State/Zip: WV O&W— 04,4, Phone#: P-7,F-0). -A3..71
A ou an employer?Check the appropriate box: Type of project(required):
1 I am a employer with . : employees(full and/or part-time).* '7. New construction
2. a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
9. Demolition
3.FJ 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 FJ Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs
These sub-contractors have employees and have workers'comp,insurance.#
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q 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 anew 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 Mat is providing workers'compensation insurance for my employees.•Below is the policy and job site
information.
Insurance Company Name: �, ✓dat'rJ L,pf�nt� ,✓J, cm
Policy#or Self-ins.Lic.#: Expiration Date: � 2 3 A.
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 a pains and penalties of perjury that the information provided above is true and correct.
Signature: 44.4.11 Date: >J" /
Phone#: �Ul" ��20 - 7 247
Official use only. Do not write in this area,to be completed by city or town off ciar'.
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#:
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
receiver or 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,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 be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local 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
applicant who has not produced 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 sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be 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
Industrial Accidents. Should you have any questions regarding the law or if you are 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"Job 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-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
ACGOR& CERTIFICATE OF LIABILITY INSURANCE 71-1/312015° Y)
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 pollcy(les)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 CONTACT Victoria Lowes, CISR
MTM Insurance Associates PHONE (978)681-5700 No,(978)681-5777
1320 Osgood Street AD E-MAILESS•Certificates@mtminsure.com
INSURER AFFORDING COVERAGE NATO t
North Andover MA 01845 INSURERA.Travelers Casualty Ins cc of 19046
INSURED INSURERBd•ravelers indemnity Company of 25682
Desmond Construction Inc INSURERC:
19 Upland St INSURER D:
INSURERE•
North Andover MA 01845 INSURERF:
COVERAGES CERTIFICATE NUMBER:15-16 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.
INSR POL10YEFF POLICYEXP
LTR TYPE OF INSURANCE Im POLICY NUMBER LIMITS
R COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTE17—
A CLAIMS-MADE ❑R OCCUR PREMISES Ea occurtenoe $ 300,000
6803AS233671542 7/7/2015 7/7/2016 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X PODGY❑PRO-
JECT F7LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: Blkt Add Ins Contractors $
AUTOMOBILE LIABILITY COMBINED SI GLE M $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident) $
AUTOS AUTOS ( )
HIRED AUTOS AUTOSOWNED PaOPccdTY DAMAGE $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION $
WORKERS COMPENSATION Beatrice and Natthear E STAT E ORFI-
AND EMPLOYERS'LIABILITY ._
ANY PROPRIETORIPARTNERIEXECUTIVE Y/N Deeawnd are excluded E.L.EACH ACCIDENT $
B 1,000,000
OFFICERIMEMBER EXCLUDED? O N/A
(Mandatory In NH) IBUB3A83166515 8/23/2015 8/23/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,D00
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 1$ 11000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addebnal Remarks Schedule,maybe attached N more space Is required)
This certificate of insurance represents coverage currently in effect and may or may not be in compliance
with any written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS.
N Andover, MA 01845
AUTHORIZED REPRESENTATIVE
L Mancinelli, CIC/SAM d.."G///42>{A�C«
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS026 nmmn
From: Charlie Kurkjian charliek@mtminsure.com
Subject: Desmond Construction Inc,IEUB3A83186515
Date: November 3,2015 at 10:23 AM
To: bm-desmond@comcast.net
Hello,
have attached the certificate of insurance that was requested.
If you have any questions or concerns, feel free to contact me.
Thank You,
Charles Kurkjian
Charles Kurkjian
Assistant Commercial Lines Account Executive
MTM Insurance Associates, LLC
1320 Osgood Street North Andover, MA 01845
Office Phone: 978-681-5700
Fax: 978-681-5777
Website: www.mtminsure.com
Office Hours: Monday- Thursday: 8:30 AM- 5:00 PM, Friday: 8:30 AM- 4:00 PM
MTM :
INSURANCE
ASSOCIATES,LLC
*Please be advised our agency cannot bind or alter coverage via fax,voicemail or Email"
a d7lie
_- Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
" Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 143109
Type: Private Corporation
Expiration: 6/18/2016 Tr# 254059
DESMOND CONST. INC.
MATTHEW DESMOND
19 UPLAND ST
N. ANDOVER, MA 01845
Update Address and return card.Mark reason for change.
E] Address F] Renewal F� Employment F] Lost Card
SCA 1 0 20M-05111
C�/re` a�n�urz,uaea�l/o�,CY ��r�ac/rruetL License or registration valid for individul use only
Office of Consumer Affairs&Busihess Regulation g y
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 143109 Type: Office of Consumer Affairs and Business Regulation
to xpiration: 6/1812016 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
DESMOND CONST:INC.
MATTHEW DESMOND
19 UPLAND ST
N.ANDOVER,MA 01845 Undersecretary r Not vali without signature
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