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HomeMy WebLinkAboutBuilding Permit #738-2016 - 28 MARBLERIDGE ROAD 12/17/2015`t=aBUILDING PERMIT TOW I N OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION /LN{•j `�,ORORT � 9 .�. x._........'.:!57 Permit No#: Date Received ii SSA Date Issued: 1�W16 IMPORTANT: Applicant must complete all items on this page LOCATION - /WAY -Z 196 / AWA9v6< 4414 a /ly?" — PROPERTY OWNER 13�i ,u _ - .-TUD/_ Print _ 100 Year Structure yes no MAF ,t 1 J - . 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 ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands E Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: A4 Identification - Please Type or Print Clearly OWNER: Name: LUPI L c.-&/ 4,r O -+- 8atA- ` 5•gr4ie—rPhone: Address: Contractor Name: /G`` _7 Phone:j ? `�__ c`3 SZ Address: 04L✓ �'�! _ l eO / a3?f- _. Supervisor's Construction License: ©_ o(' G_ -.Exp. Date:7 _ -p o t Home Improvement License:. _ /(0 s— r . - Wff® ARCHITECT/ENGINEER Phone: z 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: $ FEE: $ 190 -- Check 90 -- Check No.: 2-0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner T Signature of contractor 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 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 Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ --T—YP_EO.ESE-MTRA-GE DJS.P_O.S.AL_ 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 COMMENTS CONSERVATION COMMENTS r HEALTH COMMENTS Signature_ Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com 0 Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osqood Street FIRE DEPARTMENT - Temp-Dumpster on site yes no Located at 124 Main Street Fire`Department signature/date COMMENTS Qi.mensjon 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I t5 ana UA 1 A — I I -or department use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 No Location 2� 1p --i No. "' 24 Date Check #PASO 29833 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ M,— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 6 � Building Inspector N CD n, Z CD O Cr CL -• >cm a O O v CD CL a� CCD O CD =v CL CD U) CD O LwJ a 0 0 -v as CD CD CD U) O O CD O CD o % o _ y r yCL N C �' m n n CD m o? =' -0 N. � � L M �CL y 0 c CD C C _ ID U), o CC r. 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CD m CD 13 o < cQ 0 O v, . �,.5C 0 : %A- CL 0 co 0 Q N < N o CD `D CLr (DMM #* O to � � • 0 O 0 0 =r CD <D ;— y 0 C 0 N *� n rt o I sv o C Ln 3 O 77 (DD m N 1— m(D — Z W O m �+ m v M m -ZI TM 7 RL O DCO S G1 tDif y fm1 O T N V1 O 5 N m O W S m m A N 0 m "{ T j = m O DOC S M C t70 N 0 m T 3' RLOq (� S 3 7 N .0 O Or S T O O_ N 0 O O W C Z N m O un (D = n N N N 3 T O Q \ T n N W O 7D0 O 2 m 5 w rA Qm Is :'� J 6 d TMK Remodelling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Luciano-20015-050.5—Contract HIC 165887 978 852-4491 _ RRP LR000106 www.tmkremodeling.com CONTRACTOR AGREEMENT THIS AGREEMENT made this ©AX''_ 14 20' by and between Theodore Kelley dba TMK Remodeling, Construction Supervisor License # 105086, 214 Sutton Hill Rd, North Andover MA 01845 hereinafter called the Contractor, and Judi Luciano & Brian Seigel hereinafter called the Homeowner. WITNESSETH, that the Contractor and the Homeowner for the consideration named herein agree as follows: ARTICLE 1. SCOPE OF THE WORK The Contractor shall perform all of the work described in the specifications entitled Exhibit A — Statement of Work, as annexed hereto as it pertains to work to be performed on property located at 28 Marble Ridge Rd North Andover MA 01845. ARTICLE 2. TIME OF COMPLETION The work to be performed under this Contract shall be commenced on or before November 30, 2015 and shall be substantially completed on or before December 04, 2015 ARTICLE 3. THE CONTRACT PRICE The Homeowner shall pay the Contractor for the labor and materials to be performed and supplied under the Contract the estimated sum of Fifteen Thousand Eight Hundred Fifty Dollars and No Cents ($15,850.00), subject to additions and deductions pursuant to authorized change orders. The. contract price includes two components; Fixed cost of Fifteen Thousand One Hundred Ninety Four Dollars and No Cents ($15,194. 00) for the building materials and construction labor as specified in Exhibits A and B. Variable cost of Six Hundred Fifty Six Dollars and No Cents ($656.00) for the allowance items listed in Exhibit B Allowances and will be 110% of the actual invoice price paid by the Contractor to his suppliers. Exhibit B lists the allowance items and budget costs the Contractor will purchase for the Homeowner. Sales tax and freight are not inlcuded in allowance budget. Contractor will furnish and install all building materials, fixtures and finish items unless noted otherwise. Any Homeowner supplied materials will be charged a 10% handling and coordination fee based on actual invoice. ARTICLE 4. PROGRESS PAYMENTS Payments of the Contract price shall be paid in the following manner from the Homeowner to the Contractor: Payment 1: 50% upon contract acceptance and signature; $7,925.00 Payment 2: 50% upon door & window installation and completion of finish; $7,269.00 plus the actual contract price for allowance items as defined in Article 3; Budget:$656.00 The contract cost for mutually agreed to change orders will be paid 50% at time of change order signature and 50% after completion and Homeowner sign -off. ARTICLE 5. GENERAL PROVISIONS 1. All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 2. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. Copyright TMK Remodeling 2014 Initia§� All Rights Reserved Page 1 TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086' North Andover MA 01845 Luciano-20015-050.5_Contract HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com 3. Contractor may at its discretion engage subcontractors to perform work hereunder, provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this Contract. 4. Contractor shall furnish Homeowner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 5. All change orders shall be in writing and signed by both Homeowner and Contractor. The cost for mutually agreed to additional work, required due to unknown conditions or substantive change orders, will based on the current bill rates for the actual time used. Additional materials will be billed at contractor cost. All change orders subject to 10% markup for overhead. 6. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees and subcontractors. 7. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 8. Contractor agrees to place all debris in an on-site trash receptacle (dumpster) and leave the premises in broom clean condition. 9. In the event Homeowner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10. The Contractor and the Homeowner hereby mutually agree in advance that in the event that the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a'private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the Homeowner II be req ' submit to such arbitration as provided in MGL c 142A. (x-�- UP (r— Homepy4er/ , ,� /� ® Date: Notice: The signatures of the parties abo% apply only to the agreement of the parties to alternate dispute resolution initiated by the Contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed by the parties. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials, or inclement weather. 12. Contractor warrants all work for a period of 12 months following completion. 13.. Contractor may post small signage (18x24") on property advertising services during the duration of the project. 14. The Contractor and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617) 973-8700 << r Initial��_ Copyright TMK Remodeling 2014 All Rights Reserved Page 2 TMK Remodeling 214 Sutton Hill Rd Contract CSL 105086 North Andover MA 01845 Luciano-20015-050.5—Contract HIC 165887 978 852-4491 RRP LR000106 www.tmkremodeling.com 15. The Contractor or Homeowner may terminate this contract at any time for any reason by giving 3 days notice in writing to the other party. If either party terminates the contract as provided herein, then the contractor will be paid for work (labor and materials) completed as of the date of termination plus any materials or equipment that are backordered and not delivered. Payment is defined as actual job costs for the project plus 10% overhead charge. The contractor will provide a written report detailing actual job costs plus overhead for payment. The Contractor will refund any funds paid by the Homeowner that are a remaining balance for the labor and materials used as of the date of termination, plus any materials or equipment that are backordered and not delivered, plus 10% overhead charge. The Contractor will make arrangements for the backordered items to be delivered to the Homeowner. 16. The Homeowner is responsible for maintaining adequate access to the property including snow removal, personal property storage, and working doorways, stairways and walkways. In the event the contractor is required to provide access or repair to the doorways, stairways and walkways, then the Contractor will bill the Homeowner at the hourly bill rate for same. ARTICLE 6. OTHER TERMS ARTICLE 7. ACCEPTANCE Signed this A_day of.njvz�20 NOTICE: The signatures of the Varties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The Homeowner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Initial`IV Copyright TMK Remodeling 2014 All Rights Reserved Page 3 T w [a m A AA �C:]CDO�VOCTA 1 W W W W W W W WN W WC'•1NNNNNNNNNN -••OCO(b V OCYI W N-�OCDODV -ate ..a OCTA ..,�,� W N-�-0W �� 0-4004 W N-+ w o o w G'G {N�f h{ o� n wfo C� O T'.Q " A O Qro 7 C q Nm -, 1 to n. NNEO,a .. 'w <. 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O 1 O�1 O i1 1 CD CD a N +oo } i �} �� n => 1Cl '� O �69 t+fA itA�t!►it4fl 4�aki 1Hi!yfi 1 k 1 I 69�� ..• O OD N Oto f9 ffl tR. N.A O1 (T tT',O N O 0.01.0 N�.O N.N�Uf'CT SIN N!N �iO {CT �OD'{p 11 4 tr QCT j.a�Of iA �ffl �• iCT�O �'OOf I0 N Vi ,. O V 0 Ni.N -0-0 VVOiA l 1 ![� &1111 EA '— W fA iA 1 A Ot 01 V7tOi Efl, d! -� tD W r. �i x V.VtO. 010 OI V. CTi C"i 01• CD ASA CT,OF. N OD'�, cnIIIIII�N A COp ;0M0r- CD ;0 Ell OODOy O V � 0 CA z 0 ? N -1 x CO (1) 30--�o W CL a fD A S CD .o oAc O O n (C O 3 cm The Commonwealth of Massachusetts z. Department oflndustrialAccidents i I Congress Sheet, Suite 100 ti< Boston, MA. 02114-2017 www mass.gov7dia ' yJ� Workers, Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers. TO BE PILED "PVITH TEE PERMITTING AUTRORITit'. Applicant Information Please Print Legitbly_ Name (Business/Organization/lndividnal): T///l 2�A4of 64 A,GI C� C Address: Z l y S V770,Jr h� � U City/State/Zip: /U /D L /" Areyou an employer? Clieckthe appropriate box: 1. l am a employer withemployees (full and/or pari tune) * 2 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ T 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. l will ensure that all contractors either have workers' compensation insurance or are sole 5.FJ lam a general contractor and l have hired the sub -contractors listed on the attached sheet. These sub -contractors bade employees and have workers' comp. insurance.t 6. Q We area corporation and its officers have exercised their right o£ exemption per MGL c. 152, §1(4), andwe have nq pmployees. [No workers' comp. insurance required.] Type of project (Tgquired): 7. [] New construction 8. 0 Remodelbig 9. ❑ Demolition 10 [( Building addition 11.❑ Electrical repairs or additions 13.E] Roof repairs 14�thar �itlYulOvy� *Any applicant that checks box #1 must also £ill. out the section below showing their workers' compensation policy information. i Homeowners who stbi if this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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 nnust provide their workers' comp. policy number. ' X am an employer that is pi ovidirig works rs' compensation insurance for my employees ' below is the policy and joie site information. Insurance Company Name: /7 C Policy # or Selfins, Li c, #: lwI(,C. !"b0 5-2) 1 7 1) Expiration Date: fob Site Address: Zd MV (31-1 IV A' f & City/State/Zip: P \,fZ L44L W 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 Investi 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. Ho•w+iever 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=contractox(s) name(s), address(es) and -phone number(s) along with their certificates) of .— usuranse.—Limited-L-iabiiitreompanies-(LLC)-orLimited Liability Putwrships {LLP) with no em ogees o er thaniha 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'af idavit 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 ox if you'are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self insured companies sbould'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 sue 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 "fob 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-MA.SSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia AC ®" OP ID: C CERTIFICATE OF LIABILITY INSURANCE DATE `M= "" THIS CERTIFICATE IS ISSUED AS A MATTER OF IN1211712016 FORMATION 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 oii 4 mu be en .the terms and conditions of the policy, certain policies may require an -e dorsement A statement onthis certificate does not WAIVED, ri�ghtsJto the certificate holder in lieu of such endorsem s , PRODUCER Segreve 8, Hall InsurAssoc.inc CONTACT 305 North Main St SNE FAx Andover, MA 01810L ac No Lawrence J. Hall Ann..... INSURED 214 Sutton Hill Rd North Andover, MA 01845 E: Ins. 11 IES 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 TYPE OF INSURANCE ADD 3M F EXP GENERAL LIABILITY POLICYNUMBER W22 MM2 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,0 CLAfpgS MADE TOITRTED- 1-71 OCCUR PREMISES Ea occurrence $ 100.0 MED EXP (Anyone person) S 5,0 8520037133 03/0812015 03/0812016 PERSONAL BADV INJURY S 1,000,0 GEITL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,0 POLICY PRO'. LOC PRODUCTS - COMPIOP AGG S 2,000,0 AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT ANY AUTO (Ea accident) 5 ALL OWNED AUTOS BODILY INJURY (Per person) S SCHEDULED AUTOS BODILY INJURY (Per acddenl) S HIRED AUTOS PROPERTY DAMAGE $ (PER ACCIDENT) NON -OWNED AUTOS S UMBRELLALIAB OCCUR S EXCESS LIAR CIgIMS MADE `EACH OCCURRENCE $ . DEDUCTIBLE F1 AGGREGATE S AND EMPLOYERS' LIABILITY YIN B ANY PROPRIETORIPARTNERaMCUTIVE OFFICERIMEMBEREXCLUDEW INI (Mandatory In N111- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional TOWNOFN Town of North Andover 1600 Osgood St. North Andover, MA 01845 04/01/2016 04101/2016 Schedule, If store apace Is regWrbM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPREWA Lawrence J. Halt , ©1988-2008 ACORD CORPORATION. All rights reserved. ACORD 26 (2009103) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -105086 Construction Supervisor THEODORE ' M KELLEY ��l'' 214 SUTTON HILL R ". NORTH ANDOVER Nj `Oil YY fes_ nis�� mC Commismissioner Expiration: I --- 10/08/2017 i License or registration valid for individul use only j before the expiration date. If found return to: !I Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid hout signature Tporn�noouaealm o/ AWaaclu�e t ffice of Consumer Affairs &Business Regulation i F ME IMPROVEMENT CONTRACTOR gistration: 7g5i3g7 Type: xpiration: 5120'16- DBA TMK REMODELING r i F THEODORE KELLEY 214 SUTTON HILL RD.4`. NORTHANDOVER, MA 01845 Undersecretary