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HomeMy WebLinkAboutBuilding Permit #1253-2016 - 27 HIGH PLAINS ROAD 1/1/2016 i A BUILDING PERMIT of ;�oT I TOWN OF NORTH ANDOVER �� 5 `'`- ,6 bow T o APPLICATION FOR PLAN EXAMINATION w � Permit,No#: � Date Received �qs RgrEo�Pa��S SACHUS� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print _ PROPERTY OWNER Print 100 Year Structure yes no MAP ��O PARCEL: ZONING�DISTRICT: Historic District y n Machine Shop Village y n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building CKOne family ❑Addition ❑Two or more family ❑ Industrial alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Flood flWetf antls r ® 1lllratershee stFrict f DES RIPTION OF WORK TO BE PERF MED: II s Identification- Please Type or Print Clearly OWNER: Name: �at, `(.i a.. Phone: 1"� �A t lD - 31--014 Address: Z pt �' ^ . 1 Contractor Name: a„JkK t r Phone: a Tre 3 S'k9 ' 34 Q, 3 Email i Address: b Cox '311-1 l wl h 1k 0 0 36 o2Sla L ' Supervisor's Construction License: � . Exp. Date.: Home Improvement License: 3 �J Exp. Date: ' t I I J ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2 r'S FEE: Check No.: 2C Rece No.: �} � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund a P € r `t � .� NO s eIsc rpt r . a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swbn'n'ng pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ � Private(septic tank,etc. ❑ pennanent Dumpster on Site ❑ • i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING.& DEVELOPMENT Reviewed On Signature_ COMMENTS _GONSERVATIOIV - Reviewed--on---_.._ - -- - - Signature... COMMENTS I HEALTH r Reviewed on Signature 4 a COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ' 1 d Conservation Decision: Comments Water& Sewer Connection/Signature� Date Driveway Permit DPW Town Engineer: Signature: Located 384 O FIQZE'�DEPAR+TNIE 'T ocanrs Osgood Street Temp'Du Aster o' ite ;aytes � ► no i Located at 124 MainStreet 1 � f .; t' x '^ g Fi�rle Department 2ignature/da � � � _ it �IjN ��,}y" ) a x •' 1i ky COMIVIENTS '' M "" 1 a 1 .."i.`"'�'25��`�,�._i�'�a'.ri>.��. S" t �". a :' f�4'= ��. .v. ���t'�'j"4� '7S» �. ,�,'s:..- •saes .:tR.�.a .,ate .� '� 1 Dimension Number of Stories: Total square feet of floor area, based 'on Exterior dimensions. i E' Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ly - DANGER ZONE LITERATURE: Yes No I MGL Chapter 166 Section 21A—F and G min.$10o-$1000 fine NOTES and DATA-- (For department use) IS ' Ll Notified for pickup Call Email Date Time Contact Name Doc.Buildin;Permit Revised 2014 s 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 4� Floor Plan Or Proposed Interior Work � Engineering Affidavits for Engineered products OTE: 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..Cop_y__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 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 Workers Comp Affidavit Building Plans One To Be Returned to Include Sprinkler Plan And ''Two Sets of I 9 ( ) P Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 a Doe:Building Permit Revised 2014 di 9 Location No: ! _ Date • - TOWN OF NORTH ANDOVER . Certificate of Occupancy Building/Frame Permit Fee $ —� Foundation Permit Fee $ �� Other Permit Fee i TOTAL J Check#Z 0 I� i 30445 Building Inspector � r1pRTiy __uown of / ®ver 2 o 4 4..K. h ver, Mass, A_ COC NICNl WICH y1' 7,9 A°R�►re o �`P�,��(y ' S U BOARD OF HEALTH Food/Kitchen P R LD Septic System a THIS CERTIFIES THAT .......... ... ... ...��. ............ BUILDING INSPECTOR . has permission to erect .......................... buildings on . ............ .. ..... ... ... . .... Foundation o �. Rough s . • to be occupied as .......... . .... .. all i . . ect.c�........ .... .. .�. .. � Chimney provided that the person accepting this err�tit hall in eve respect confor the ter of thea plicat n P 9 p p p Final on file in this office, and to the provisions of the Codes and By-Laws relating to th Inspec 'on, Alteration and Construction of Buildings in the Town of North Andover. ir a. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ................................................................................ Final. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reouired 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. t Federal 10 g 05-0405629 RISE Engineering RI Contractor Registration No 8166 d1AContractor Registration No 120979 ���� Adi%ision of 7hiclsch IAginccring ENGINEERING' Company Address,t,'iq',\9A 00000 Lr®1`E l l nF9 CT 401-123-1234 F:1S401-123-1234 Page 1 PROGRAM 1HIS CCFMCTIS ENEREO DM BETWEEN RISE UNI A-I Ii.N ENONEERINGAND THE CUS' ER FOR%YORK AS DESCRIBED BEUNr CU111WER PHONE DAE CUENTa VI(MORDER Patricia?rlacphee (9753606 04F?7/2016 431012 00001 SERVICE STREET BIWND St3EET 27 High Plain Road 27 High Plain Road -SERVICE CnY.SL%TE.9P - BIWNG CnY,STATE,DP - •. North Andover.I IA 01845 North Andover.MA 01545 JOB DESCRIMON PHASE ONE-Proposal for this calcnu4tr year. S0.00 AIR SCALING:Provide labor and materials to sisal areas of your home against%vastefid,excess air leakage. This Rork will be performed in concert%Kith the use of special tools and diaptislfc tuts to assure that your home will Ix left mith a healthlid level of air exchange and indoor air quality.Materials to be used to scat your home can include caulks.foams and other products. Primary areas for scalM2 include air leakage to attics,basements.attached w< ages and other unheated areas t windows are not mnerally addressed.) This will require(9)%wrking hours.A reduction in cubic Sect per minute(cfm)ofair infiltration%till occur,but flee actual number of cfm is not guaranteed. At the completion of the%%caul erizadon work,andat no additional cost to the homeowner,a final blower door andror combustion safety analysis%vill be conducted by the sub-contractor to ensue the safety of the indoor air quality. t $765.00 STORAGE 13ARRIEIL Homeo%cner is responsible for the removal of the stored items blocking tlie installation ofweatheriration work in the attic. Removal must occur prior to the scheduled work start. $0.00 VENTILATION:Imide labor and materials to install(2)insulated exhaust hose milli r6of mounted flapper'wmt to exhatist esistingtuthrooni fan(s). $237.50 GARAGE CEILING:Provide labor and materials to install 9"R-32 densely packed Class I Cellulose insulation to(550)square feet of garage c6ling.located below heated"floor area.by drilling holes inlhe ceiling from below, Boles drilled will Ix plums Plugs will be sparkled and left in a relatively smooth condition.Finish sanding and touch-up priming/painting%%ill be the ct&omces responsibility. $1.094.50 RISI. Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Cohrabia Gas offers 75%incentive,not to exceed S2,000 per calendar year,and an incentive of 100%for the Air Scaling measures ftp to the first S680 and an additional$340 if savings are justified 1n,the auditor. For the.safety and health of your homes indoor air quality.we%till ty.conduct inga btouvr tk%ordiammostic or the available air flow in your home both l-rore the cork is begun,and after the wKatheri at ion x%ork is complete.We will also conduct a full assessment of the combust ion safety of your hinting systenu and%tater heater.T his has a value of S90 and is at no cost to you Total allownbic weaiheri7ati6n incctutivc isS3,110. S90,00 RISE Engineering will apply a credit of S 100 towards this contract,in ackno%dedgement oft lie de-posit you made to Next Step Living to%alyds your original%watheri-rat ion contract. $0.00 ��bZ Fri, Z 201 i i Federal ID 0 05-0405629 RISE Engineering RI Contractor Registration No 8186 IAA Contractor Registration No 120979 i� A division of1hiclsch FAgincering RISECompany address.City,:IIA 00000 ENGINEERING" CONTRACT 401-123-1234 F:IX 401-123-1234 Page, 2 PROGRAM IMS COMACTIS ENL-RED RMBETUEEN RIBS CAM-IMS ENGINEERINOANDINS CUSIMER FOR WORK AS OESCRIBEOSELOW CUSIMER PHONE - .. OAE - CRIEMII- WORK ORDER . Patricia Macphee (978)686-3606 04!27!2016 431012 00005 SERVICE-STREET .. .. ..: O WND SLREET _ 27 High Plain Road 271.119h Plain Road SERVICE Cm,SATE;IIP. - GIWND Cm.S'WLE.MP >. North Andover,AM 01845 north Andover.MA 01845 JOB:IDESCR IP110N Total: $2,187.00 Program Incentive: $1,954.00 Customer Total: $233.00 WE AGREE HEREEIY'TO FURNISH SERVICES-COMPLETE INACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "Two Hundred Thirty-Three&001900 Dollars $233.00 UPON FINAL INSPECION AND APPROVAL BY RISE ENGNEEMNG.CUSIMER AGREES W REMTALUWDUE IN FULL 11MERESTOF 1%WILL BE.CHARCz_D IUMLY ON ANY UNPAID BALANCE AFER 39 DAYS.SEE REVERSE FOR e•PDORRNrINF$RRfALON ON.CJARAHEFS.RIGIM OF RECISION.SCHEDUUNO.AND CO IRACMR REGISVtALGR. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES GC A', AVL10R D61 REAZW. nrN - - CU.^.TOI�RA - - - NOTE:TRG CO R.CTVAWN BY US IF NOT EXE CUED Wr.M1 DAIS OF ACCEPWNCE ACCEPLINCE CF CMMCT-LRE ABOVE PRICES.SPEMCAIONS AND CONDMONS ARE DAYE. SABSFACIOtY IOUs AND ARE HEREBY ACCEPE4 YOU ARE AUINORZED W OO LIE WORK AS SPECIFIED.PAYMNTIVILLSE MADE AS.CUBMED:ABOVE .:r.s f c' i i RISE60 Shawmut Road,Unit 21 Canton,MA 020211339-502-6335 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM C iCL 12-4a Ce Q� (Owner's Name) owner of the property located at: (Property Address) (Property Address) hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. wil L' Own r`s Sign ture V EN Date t1k i The Contmonwe:atth t>f.Vassachusetts Department of Industria!Accidents Qlice of Invesligations ; ► ' =5I Congress Street.Suite 100 Boston,.41A 02114-2017 t. www,mati ti.,gorldia Workers'Compensatian Insurance Affidavit:Builders/C'ontractors/liertricians.xPlumhers Applicant Information Please Print Legibly V tilCi +-ttas tract+ a€,riIrd:,tauai;: CAliMi'lC �A Mr,r}. T! LYk. Address.-So Owq 3°14 C"it`:'State7.i A. 9 -T l0 3'4 S 3 Are sou an employer'Check the appropriate boa: 7',pe trl'project drequircd;. t am a employer.>�iti _�� � �i=ant Ctit�T�i «�ttt n=t!t ���I € t' 6 ®Nc., ionsrriw.iort lrplove S i LIU,andeor part-tiTrIe7h :e hired he�iF etttrt iets 6 1P act#on th l ; _: e a icltt i}cct. Fietrrt.ticiinir 1 r -� am a;laic�.,. .rictc r it Pal-ale, .. P E -1 hose b;.ilt•l'i r tr'iYl't2't:--':h:7E's;- P shipand 1'ats•c na-.tiaplc?v�v �; i S pp-iyg i�cr13L`l5t!'ttt1. working Iter me to any capaciti. emploes and I avt wort.,Cn, (\ctwowki+rs' %comp. itIsaralice comp. rilraniic." ' rtt'IWItC,l.j ,' F XVC arc a ie rpur�ll wi wid its € 10.0 V lec Irical repairs or additions � 1 +. I am a r orriclti net cli)ing ail'vvork officcir i ha%7 RerC;'S d t}A-t 11.[] hlrn>lr'.w rcri37.r i5fi:f: Ftrtit#.,7 nLh o CtCat tion r MGL titti:� tt {Oct at,:rkcr< a€rt . 17.0 Roof repairs. ,:ts Tance required] .. 15' S Iii 1 arid ac hi c ax? p^q ernpitixyees.[No workers' comp.i73:+t1ii11xCc i§d itr�4l, ' rt4 sat ttsn ;rte t�F : Kv' z? ri ,asv..iI At[0— j,,7 _a':s 14r.:,:.�;v...�<1r n rr a.,rr ,,.., txt r ecu ,`i stat .4Jrt..s sett. ti+t cr,Fx a r.t2.as;aci a,�'�_t ;.cry aP,4ra >01c,,a " i,,`.::.e.�.�.,:.-a.s.5„s a r-,t,5ae��Fr>-13r1't t t7„r--3,10-c 1fhx 811t-1 ronj s txvc 'r—a,'n..:” r gnus,pr i.. tNCF. F x !ant can empki}e>r that is providing warkem'compensation inr ante frtr mi-employees. Below is the lkifitly and jtrb site information. Policy or S. a i,8,t,.ie. Expit r`,4l Date: —_ iu#a Site Aaaze4s;3 � 1-�'!. �� �Utz .�t�����1�.1�10+-�►�rr��vU-r�v�- o��►w :attach a copy of the workers'compen4ation policy,declar3thm page Ishowitar the policy number and expiration date). _' l'391ttrc .0SCi,sYc:txR` ?�_@ 35 required¢t3-tclt°r'4z`4tlttt'i :5.r1 ofhlt. :?_s•;3r1 lc�!U tic.StttF?tt4lLiii7 U{Cfftt)If:n:l pt,tiilltic .3ii fitieupwSE30'0.00and!0r on car itt: �;sn racasa,as penaftie.s In it}c forin of a tip OP WORK ORDER and tt fw of n'to S2,50-00 t&J)°aglitw+it`violator. Be advised that a copy!4+'hiss kimtctitc,:tt ut te'lt:!'cirri�tdcd'40 the f 3fEice of Itt4 +#t Ciazr=of the DIA for rt,uaanr cute:i c r er.i<c iif=ri, 1 do hereby cent�y ander the paint and penalties ofpeijwy that the informulion provided abore is true Official rise natty. Ua rint Write in this area..to be complrte.d by rittr or town riffieial. E"in or Tasrn: ._ ,,. . PerntittlAcense 1,,wing:authority teircle ones: 1.Board of health _.Bufldin;#Department 3�.t'igfl'own E'ierA 4.F tectrical Inspector 5.Mumbing i .pertar 6.Other ntact Persetn: CoPhone#t AO 1 V CERTIFICATE OF LIABILITY INSURANCE F DAT 7/201TE(MWDDN"5 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 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 CONTANAME:CT Nancy Usher Martin J Clayton Insurance Agency, Inc. PHCNN xt: (413)536-0804 LFAX No;(413)534-7874 1649 Northampton Street E-MAIL ADDRESS: P. 0. BOX 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURER C: 44 ESSEX ROAD INSURER D: INSURER E: IPSWICH MA 01938 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE QU POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR DAMAGE (RENTED 50,000 PREMISESSEa occurrence $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY E PRO- JECT D LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 1,000,000 B CLAIMS-MADE B EXCESS LIAAGGREGATE $ 1,000,000 DED I IRETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NI STATUTE E ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON -STREET WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POMMMd With pdfFactory trial version www.Pdffactory.com ACb & CERTIFICATE OF LIABILITY INSURANCE CA-VA-Tmvt �r...•-- 911Es 7DI5 , , [ THIS CE RTIFIC-+,TE 15 ISSUED AS A MATi'ER OF itiFopyA110U ONLY AN[Y CONFER.S NO RIG S U=Ou -fE CER-,V,ICA7{ HOLDER-Tk15 CERTIFICATE DOES NOT Af,1RP4ATIVEi.Y CR t%E ATWELY AMEW),=XTERD OR ALTER TME COVEP_kU AFFORDED BY T4E POUCIES BELOW.THIS CERTIFIG1Tc Of ti4SuRA.MCe ODES.';QT CO;iS-,ITUTE A CCINTRACT B'ETWEEM'pfE ISSlt1Nw INSURfR(S),AUT'-iOP;ZED REPRESENTATIVE OR aRODUCER,Aid"TME CEATI.FICF T-.'HOLDER IMPORTANT:It the certi°icate;olOi�i is an ADDITIONAL INSURED,the OO1WV(€;s)mugs ba endorsed.€e SL15ROGATTON 15 WANED.subpart to he terms and conditions of the polity,rertam,poticves may rrquL�- A statcrosnt onthis vertJAca+e doer riot ccr«er rights to the C&-triicam ho?der In Ifeu of sum endo:-�erner:t(�). Clayton Martin J Ins Agency Inc i ;_ ' Berkley A.MSigrved Risk Sdrvites 1649 Northampton St PO Box 989 ' . . C 1 >s c�29 -T-7, {65512 15 P.IIE Holyoke MA 01041 ;o aoirSetSa+�Ieyrsl`con �e�trY'4 . _ _ U(✓:1r4F&'�..- Ar�••a 3fSS:-JIJGP.GG _- 3 NJl5. Gauthier Insulation Inc we ,-<b. PO Box 344 s > r: IpsvdCN NPA 0193$ COVERAOES CERTIFICATERTM-BER. REVIVON NUMBER: THIS IS TO CERTIFY Tl+.;THE?GLUES GF WSUA.ANCk USTEC)8FLO%V'MAtr E-:--04 JMcO au T;-E MSUNED&AMED ABO',--FOR K PIXICY PERIOD LNG-JCAiTP&Kj.eATASTANDING ANT REQUIREMENT,TERM?OR M',Tla*N OF 4W CO.N" RACT OR 07 KR DOC121.Eh'T WIT RESPE' T TO V"C"THIS CERTIFICATE MAYSE iSSUEOOR MAY PSA-,Ain.TH7 1USURAME ACFORDE{i'BY TU'c.PLlt:tC!P-S ccs Stf5Ec?;, iE -7o*1S tUS.1EC:-T TO AU,T4?'c.7Et3!."S.. E3CCLL1,StONS CCSB c7eCta:S OF SUCi h FK7tIv`IE:t.UMITS SO%T7,MAY A,,tVE BE- _a.ECJC:ED SY PAID\,I.t, . TIDE in"t,RJJr;;E -i+r.^.Jt v fm 'J'e�.l:'w,�£C -n e_ c::> •v�� �,.,. rst': RA.i L,1ASK:itw I 'EACT++3C'QR1,`Jr..c .. - ❑CLADAS10CA757�s .� ''hr35E5f�s ocesx-ear: S E:r.Sri�fi b KJV AJiA_'Y wEA"\.,�G�"ea�aC+Porl?IRJJY.', r.: =paoi--R--P.."e.Wti"..Woo $ - �� j ACAS ..'ECT ❑roc 1 . A6r1.'tSy4OLttE tlAHLL37Y 1 J €a 99 j Am AL.D AVTO'AW1 P.fX.d;+fliJL"1'iCl:ss•aY- 5 ry A'v.us ❑SG-.ED_nes$ I z AjA.- c Aar=a_ ;EL.x�cveer.J 15 4..a 'afCY.t.Kw.tl�nstN.r FXEFS<UA6 C:,Aa*4�WJS c tfw's l i j J'D i;tmzw de's AND r"LOYERSALAWN jjWp tX L:,h r•�ef'*vm�c 1. ^s D e t t Eac.A�'t.7.Nf 5-. A C�?tCt.'frca+t#P�Exz..ns..? u4 � 64A1?R.,"sG'�73<i ',3,'aCI,20i.. . i4.'" ` _ .om sr cm r�rFr K+e}, rn 5 5c .tlp: 4v—"& ❑ n a: _CA 11"e!wt I V;L' FLL42-wt',it*1 £ffitUnr. ,tAes Ki'Y' A+V.! TS�,TL^�6i$. CERTIFICATE HOLDER CA EtLA'CIOtd i she v- A-W OF;r A sn E a sc c ra.a ae E7-C.ArxZIxE;F KFORE Cledresult THE ESC 0tAT#0N.iATE swRE04''.BICE Sti'U BE fiEi1'Vfki-O V COntractorSvcs ACCOrrk'rc 1Y :T4„?OLCYZp0,ASI:J'ti:5. 50 Washington Stneot Westborough,MA 01581 ia;Iattire_ ACORD 25{20IMS) 8-w 3130 i ti. 'Massachusetts pC parirrrent of public Safet Board of Building Regulationa,and Stany dards f"'r+rr tru #.iesrk 4aklk rk rknsr r±A eiall License;CSSL.102582 EW p. .so,344 III-Switch MA (1192 ExpMttion . l'.dPFTir1TlS.$��klt. .{ 0.r &2017 ,s C�/I'LG Ca Il1IJ'I n Z 112 Office of Consumer Affairs and Business Regulation: 10 Park.Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10/1/2016 Tr# 257812 KURT GAUTHIER w KURT GAUTHIER P.O. BOX.34474 IPSWICH, MA 01938 _.____ ...... Update Address and return card Mark reason for change. t Address Renewal ( ? Employment Lost Card SCA t G 20M-05N 1 »fRittr:rn/r� .Office of Consumer Affairs&Business Regulation License or registration valid for individul use only V SOME IMPROVEMENT CONTRACTOR before the expiration date. If found'return to: egistration 173410 Type: Office of Consumer Affairs and Business Regulation Expiration 10'/112016 Individual10 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER a' KURT GAUTHIER 44 ESSEX RD �6---�HHe�' _.— . IPSWICH,MA 01938 Undersecretary of valid wi out signature