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HomeMy WebLinkAboutBuilding Permit #586-2017 - 27 PARKER STREET 12/2/2016 1. BUILDING PERMIT OpoRTy �,tLeo 16q"bA Le TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * 2 ti Permit No#: Date Received �SSACHLl Date Issued: 0'01 IMPORTANT: Applicant must complete all items on this page LOCATION 7 �G(�� T 5-r re e 7- Print Print PROPERTY OWNER_Cher r^ltvt e C iov?P Y 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 ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other we-47J, r o o ❑ Septic ❑Well 0 Elooclplairi 0 Wetlands Q, Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ��SYti f S/D Pe 5 #rd MrV&191/ [� 1M Te 5-7- Identification iIdentification- Please Type or Print Clearly OWNER: Name: C LA(-I ev% a r10 h e y Phone: 5>F—���• Address: A7 Pei /.1{f' 5F y7gr7k f a✓el- Contractor Name: POS BWINSULA1M Phone:MBOXWS Email: Address: ' Im Supervisor's Construction License: )o 6 0 17 Exp. Date: yb!p Ap Exp. Date: Home Improvement License: �a�-��G 7�a�1y s 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: $ /900-oy FEE: $ Check No.: 7 7 Y Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces o t e guaranty fund N5—nature of Aqent/Ownpr —f cant J i `f - V 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 Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 1 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I r Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPA -. Located 384 Osgood Street -t- O R�TMEN-. Temp Dumpster�kontsite ,yes .� "��,'� no t Locatediaf'r12411UlamcStreet tg' Fir`eDepartment�signature/date, COMMENTS: 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 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 Doc.Building Pennit 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 Copy of Contract Floor Plan Or Proposed Interior Work 4 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 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 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 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 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 Doc:Building Permit Revised 2014 I I � NORTIy Town of _ Andover tat 04p,% 7 h ver, Mass, 1 ► a 0/ �qScocNIc«ew"cotR 'MIT T 1. R^TES U BOARD OF HEALTH LDFood/Kitchen PE Septic System THIS CERTIFIES THAT ...'A%L04. 0AA....l.I�.�L.�I✓. f�09 �,C'ON'S�, BUILDING INSPECTOR ............... ............ ...... Foundation At 9 A to ....... has permission to erect .......................... buildings on ......�..0 ........................................... Rough to be occupied as .... .� •....5.0 ........ t .M!A � ... .............................................. Chimney provided that the person accepting this permit 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough Service ................ ..... . ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. r RISE60 Shawmut Road, Unit 21 canton, MA 02021 1339-50M335 ENGINEERING" www.RISEengineering.com r.> OWNER AUTHORIZATION FORM 9b DAVM Glr C (Owner's Namd) owner of the property located at: (Property Address) IV� A YE n�A 21 g 4,5- (Property Address) 17 hereby authorize 0 i7 a n V T iT`I 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. 1� 1�, (191(aIL12, Owner's Signature Date CLO Del Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thielseh Engineering CT Contractor Registration No ENGINEERING 60 Shawmut Unit#2,Canton,MA CONTRACT pT RpC T (401)784-3700 FAX 4 710 D V � Hage 1 PROGRAM THIS CONTRACT t3 ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER �Vl/� LU:I�__._. PHONE DATE CLIENT WORK ORDER Charlene Cloney (978)682-6304 02/22/2016 429602 00002 SERVICE STREET -.. _ __..,. ...-. _ ........ SILLINO STREET 27 barker Street 27 Parker Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE.ZIP North Andover;MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful.excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,.foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(2)working hours..A reduction in Cubic feet per minute(cfm)of air infiltration will occur.but the actual number of cfm is not guaranteed. At the completion of the weadteri7ation work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $170.00 KNEEWALL SLOPE:Provide tabor and materials to install R-19 unlaced fiberglass to(170)square feet of wall. Then install 1" rigid board insulation. Seal all seams with FSK tape. $697.00 KNEEWALIS:Provide labor and materials to install R-13 faced fiberglass to(170)square feet of kneewall. Then install 2"rigid board insulation.Seal all seams with,FSK tape. $620.50 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(28)square feet of kneewall area. $98.00 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items blocking the installation of weatherimion work in the knecadll areas, Removal must occur prior to the scheduled work start. �'i �N� i - <j J7 i S q1 e q ('�rt c] 7—�i ! $0.00 REMOVAL: Remove(170)square feet of batt style insulation from the kneewall area. $127.50 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thennax board.Weatherstrip the perimeter. $60.00 BASEMENT CEILING:Provide labor and materials to install(116)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $203.00 q'7( �� s Federal 10# VO&Z RISE Engineering RI Contractor Registration No RISP� CT Contractor Registration No " A division of Thielsch Engineering CT Contractor Registration No i ENGINEERING 60 Shawmut Unit#2,Canton,MA CONTRACT (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE -... DATE CLIENTS WORK ORDER Charlene Cloney (978)682-6304 02/22/2016 429602 00002 SERVICE STREETBILLING STREET 27 Parker Street 27 Parker Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 .TOB DESCRIPTION - Total: $1,976.00 Program Incentive: $1,428.88 Customer Total: $547.13 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Forty-Seven&13/100 Dollars $5473 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN.FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION.SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SIGNATURE-RISE Engineering CUSTOMERA CEPTANCE NOTE:THisO a 2l� l C NTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OFAN ACCEPT CE .�.-.. ..�— 17 ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE ?'D DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE r D cc. OCT 3 1 2016 1 I The Commonwealth o f Massachusettsmom --_-- Department ofIndustridAccidents Office oflnveWgations 1 Congress Street,Suite 100 Boston,AM 02114-2017 www-nMs gov/dda Workers' Compensation Insurance Affidavit:Buffders/Contractors/Electricians/Pinmbers A licant bformation Please Print Le 'biv Name(Business/Orgawntion/Individuai): Address: PO BOX 958 %1= flAA 0181{# Gt//Mate/Zip: Phone#: Y u an ampioyer?Check the appropriate box., — Iam a employer with_�_ 4. Q I am a general contracto7ndl �e of project(required): employees(frill and/or parttime).* have hired the sub-contractors 5. 0 New construction 2.Q I am a sole proprietor or partner- listed on the atmehed sheet. 1' t. Remodeling ship and have no employees These sub-conuact~r;have working, for me in any capaci f. employees and have workers' 8. 0 Demolition [No workers'comp.insurance comp.insurance.t 9. Q 13uilding addition 3.0 required] 5. Q Rre are a carporation and its Io.Q Electrical repays or additions I am a homeowner doing all woj i officers have ex - ised their + D myself I -1. Iamb" M [No workers comp. right of exemption 0 mg repairs or additions erne" per MGL insurance required.]t c. 152, §1(4),and we have no ' 12.0 Roof repair.- employees. epairemployees.[No workers' 13.[J Otho_ I comp.insurance required] *AnY aPPI icant that checks box al must also sill out the section below showing their workers'corriperuatiun policy information Homeowners who submit this affidmug nit indicating they are doing alt work�,d outside contractors const submit a new affidavit indicating s�,c>~ Contractors that check itis �x m!tst attached 2n additior3 sheet it emPi ees. If the sub-contractors have e I ees theymust provide their worlds'camp. okenumber. fie~or not rhos,e�i,N r� P Y �,oy If rtm an empl?ver that is pr of-'A tg tporke:v caewiver�surance or iyinformatcnptoyeeBoha oel : isty?nd}cb str Insurance Company Name:_ in 0 t t jyh k A �Y1 S U ('4 t1 C f D 3yl�lf t/!.Y Policy#or Sc1f-ins.Lic.#. ?Ot,JC - ' �� Expiration Date: 4P.-AL-70-0 Joh Sitc Address: �' ? Poker 157– City/State/Zip: . d rtA vY r ! 7A ( s tt2ge Lh a copy of the workers'compensation policy declarationpage shown; Failure to secure covers as re g Oto poli;y number and expirafion date). gaited 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 intprlsonment,as well as civil penalties in the form ofa STOP�tp_> rJglj R an a fine of up to$250.00 a day against the violarcr. pe advised that a cozy of this statement may be forwarded to Me 01fice of Lrcve-stigations of the DIA for insurance coverage verification. I do herEb tefflit-underihe -[tins,Ind enak&_v of erjuty ttrrtt iite � ab�ove is ree and torre st.stProvided at-are: Phone#: 3 Ojj<cial use only. ;moo not write in this area,to be completed by city or tewit official City or Town: Permit/License# t Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 6, Other 5.Plumbing Inspector Contact Person: Phone#: 6/10/2016 ---—___-- - -------- Preview:Certificates of Insurance A�Rte® CERTIFICATE OF LIABILITY INSURANCE DATE MM(DDAIYYY, 16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INF0611012016 ORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER 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 WANED,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 NAME: Automatic Data Processing Insurance Agency,Inc. Pae x.E:t 1 Adp Boulevard AIC.No Roseland,NJ 07068 ADDRESS: INSURERIS)AFFORDING COVERAGE NAIC C INSURED INSURER A: NorGUAlminsu ooCompany 31470 POLAR BEAR INSULATION CO INC INSURER B: PO BOX 958 INSURER C: Andover,MA 01810 INSURER D: INSURER E: COVERAGESINSURER F: CERTIFICATE NUMBER: 503567 REVISION NUMBER: gT 7HE POIiCIES OF INSURANCE LISTED BELOW HAVE THIS IS TO CERTIFY THBEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_NOTWITHSTANDING ANY REOUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR 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 INSO WVo POLICYNUMBER COMMERCIAL GENERAL LIABILITY MMIODIYYYy MIDDIYYYY) LOM CLAI.&MADE ❑OCCUR EACH OCCURRENCE S PRF},IISES(Ea o=nonce) S ACED EXP(Any one person) 5 GENL AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY 5 POLICY❑JEPRO ❑LOC GENERAL AGGREGA76 S OTI--R: PRODUCTS-COMP.'OP AGOG 5 AUTOMOBILE LIAMUTY S ANY A UTO (Ea uccwenp S' ALL OYcNEOSCHEDULED BODILY INJURY(Per person) 5 AUTOS AUTOS f'ON-OWNED BODILY INJURY(Per wdderY) S HIREDAUTOS AUTOS weracddeml S UMBRELLALIAB S OCCUR EXCESS UAB CLAIMS-MADE EACH OCCURRENCE 5 OED RETENTIONS AGGREGATE S WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY X _ My PROPRIETCR'PARTNEREXECUTI4E YIN STATUTE ER A OFFICERL€LIBER EXCLUDED? Y❑NIA N POWC772258 E.L.EACH ACCIDENT (Mandatory in NH) 0110112("6 0110112017 S 1,000,000 II yyes,RdescriTICbe undeF Or El DISEASE-EA ElJPIAYE 5 1,1000,00t)OESCIPN OPERATIONS bdow E.L.DISEASE•POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS I LOCAnONS I VE)eCLES(ACORD 101,Atlddiowl Remarl¢Schedule,maybe attached if morespaco is required) 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 st 1 suite 2035 North Andover,MA 01845 AUTHORRED REPRESENTATIVE ACORD 25(2014101) The ACORD name and logo are registered marks of ACORDORD CORPORATION.All rights reserved. �I DATE(MMIDD/YYYY) AC RD® CERTIFICATE OF LIABILITY INSURANCE F6/10/2016 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(lee)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 Linda Bogdanovicz Insurance Solutions Corporation PHONE (603)382-4600 FAX No:(603)362-2034 60 Westville Rd E-NIA"' lindab@isc-insurance.com ADDRESS: INSURER AFFORDING COVERAGE NAIC 9 Plaistow NB 03865 INSURER A.Western World INSURED INSURER B Nautilus Insurance Group Polar Bear Insulation Company Inc INSURER C: PO Box 958 INSURERD: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER CL1632326134 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. ILTR NSR TYPE OF INSURANCE D POLICY NUMBER POLICY yDD1 EFF POLICY EYXYP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑$ OCCUR DAMAGETORENTED 100 000 PREMISES Ea oaurrerrce $ � aPP8274967 3/24/2016 3/24/2017 MED ExP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 g POLICY❑JE° [7]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ IF aaddeM ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Paraccide $ $ R UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B ExCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/D(ECUTNEEL.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES(ACORD 101,AddlOonal Remarks Schedule,may be attached H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORRED REPRESENTATIVE ,A A Reith Maglia/SJA `- 7— - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025/7nuon wow Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration - Registration: 102726 r Type: DBA Expiration: 71212018 Trd 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOY.958 ANDOVER, MA 01810 _ Update Address and return card.Mark reason for change. scar -0 2oM-0s111 Address [:] Renewal ❑Employment Q Lost Card J/re`�a»rn+ai�nrrdll af'G%�`las;n�nte!!s fOMee or Consumer Affairs&Business Regulation License or r gistralion valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: - 102726 Type: Office of Consumer Affairs and Business Regulation Expiration::`71=018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION CO.'. Vincent LeBlanc _y 51 SO.CANAL ST.45A ;`- :a,c=_._:_t:•<z •:—o"�r—� LAWRENCE,MA 01841 Undersecretary ltiot valid witlI siguatm I L Massachusetts-'Department of Public Safety Board of Building Regulations and Standards Cisnstructiun Superzisur Specially �Jcerse: CSSL406017 ¢g ` PETER A LEBLANC 2 EAST PINE STREET Q Plaistow NH 03845 �? Expirati0n Commissioner 04128/2018 c Location No. 5ho 2 917 Date � ." )L • TOWN OF NORTH ANDOVER `� • h Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ eqS` , Check# - :�I r -� n 4 6 Building Inspector