Loading...
HomeMy WebLinkAboutBuilding Permit #265-16 - 35 MEADOWVIEW ROAD 9/1/2015 1 NORTH BUILDING PERMIT `A"°o TOWN OF NORTH ANDOVER 3 - - APPLICATION FOR PLAN EXAMINATION Permit No#: ' 1 Date Received oArED gSSACHUs�t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Ant PROPERTY OWNER Print 100 Year Structure yes o MAPPARCEL: 4- _ ZONING DISTRICT: _ Wistoric District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Y! Iteration No. of units: ❑ Commercial nl�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other O Septic I]Well ❑ Floodplain El Wetlands. ❑ Watershed District 0 Water/Sewer -- DESCRIPTION OF WORK TO BE PERFORMED: Iv�L�s S �t�,�st,�nc�� io�-�►c`�' a\\r S{cam i 1� r6a v-A m ita�. C 1��kt. �n 'LAI, r_ irr 4,S ���o .� C Identification- Please Type or Print Clearly OWNER: Name: \; N, C,Mw\y\2 Phone: Q91 -931-803 Address: 3S Contractor Name: .�u•I�M� Phone: _a Address: u 30 X Supervisor's Construction License:-I _ Exp. ;Date: Home Improvement Liconse 031 c 0 __ w_�_ a ._R_ Exp. Date:_ ARCHITECT/ENGINEER Phone: Address: Reg. No. x 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: $ GL Check No.: at� Receipt No.: �` J NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of.AgenYO:Wner Vie.OL ; _ Signature of contractor � � Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street .FIRE DEPARTMENT - Temp!Dumpster on site yes__4 no Located at 124 Main Street Fire-Department signatureldate 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 Doc.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. i 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 i 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 g-]c Location No. r Date j f . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Gw`) Foundation Permit Fee $ Other Permit Fee $ tTEUN r TOTAL $?_ i Check#al lit ' Building Inspector Y 25 20 7 NORTH ve- - O '�, ..�•, w.ry Nola LAK, h ver, Mass, coce"CNtw.cm �1' ��S R�TEO ►`PA,�,�y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...�.ll 4BUILDING INSPECTOR.f Z.�/........................�..��~�1. ....................... ......... Foundation has permission to erectbuildings on ...�.......... It ...... .......................... Rough to be occupied as ............ ... Chimney miW provided that the person accepting this permit shall in everyres ect conforto the terms oapplication 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 j MO HS ELECTRICAL INSPECTOR UNLESS CONSTRURTS Rough 4Service ...... ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. S ieo Federal 10# RISE Engineering R1 contractor Registration No MA Contractor Registration No A division ofThietsch Engineering cTconiracwrR"WbathmNo 60 5hmti ■i �war02 339-so' 5026345 CONTRACT R I S E Page 1 PROGRAM THlacorntvrcres�ztaortoea,vrae+aasa ENGINEERING tart CtVIA.}ES OMMEWO aTtrcaaDawDaxas CnsTnkSn.. PRONE _ DATE. CLIEWe woexonm Elizabeth CnI nlrine (6 17)939-814-1 0410912015 412433 0000.2 s>:avxa urrAEEr euuno ser 35 Meadowview Road 35 Meadowview Road SfRVOGE e1rv..iA111; •.•.� SUNG eiri,"ATt ZIP North Andover,MA 01845 North Andover;IIIA 01845 All j JOB DESCRIPTION 1� Aid SEAL Pmvi tabor erials to seal areas of your harne aainst ivastefut,cis air leakage.This work wilt be rai perfotrrted in frsbi*dte of speciat tails 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 seat your home can include caulks,foams and other products. Primary areas for seafing include air Ieakage to attics,basements,attached gmages and other unheated ureas(windows are not generally addressed.) (8)working hours. At the completion of the weathetiration wart;,and at no additional cosi to the homeowner,a final blower door andior combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. 5b80.00 AIR SEALING ADDER: (4)working hours: 5340.00 DAMMING:Provide labor and materials to install a I2"layer of R-38 unlaced fiberglass baits to(50)square feet for damming purposes. $102.50 ATTIC FLAT;Provide labor and materials to install a 6"layer of R-21 Class l Cellulose added to(1478)square feet of open attic Spam SI,862.28 KNEEWALLS:Provide labor and materials to install I"FSK f=d semi-rigid fiberglass or similar rigid board insulation to(312) square feet orknetA211 area. $319.20 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair_ A small flat surface orplywood will be created around the opening within the attic. This will allow the covers integral weather-stripping to restrict air leakage. $237.65 VENTILATION:Provide labor and materials to install ventilation chutes int( )48 rafter bays to maintain air flow. $96.00 BASEMENT CEILWG:Provide tabor and materials to install(85)linear feet orR-19 anfacrd fiberglass insulation to the perimeter of the basement ceiling at the haute sill. $149.75 OVERHANG:Provide tabor and materials to install 10"R-37 danscly packed Class I Cellulose insulation to(72)square feel of exterior overhang located below a heated floor area,by drilling holes in the overhang from below. Holes dulled will be plugged. Ptags will be seated with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up primingtpainting will be the customers responsibility. 5288.00 GARAGE CEILING:Provide tabor and materials to install lo"R-35 densely packed Class t Cellulose insulation to 460 square feet of garage ceiling located below a heated floor area,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 priminglpadnting will be the customer's responsibility. $952.20 {{ Federal 10 RISE Engineering MConti-actor RegisvauonNo MA Contractor Reglctration No A division of Thielsch Engineering CT Contractor Registration No 60 Shawtout Unit-47,Cancan,MA 01021 CONTRACT 339-502-6335 FAX 339-502-6345 DISEPage 2 PR{7C,RAM CMA-HES SNGtNRWI cx MM eus>M FOR WORK AS ENGINEERING DESCRIBED SELM CUMW-R PIWfa DATE CLIENTa WORKORCER Elizabeth Cminrine (617)939-8143 04/09/2015 412433 00002 SaImce$TRW coma 35 Meadowview Road 35 Meadowview Road SUM=CnY,srATLZW =940 em.STAMZP _......._._.__� North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net mount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed 54000 per calendar year,and an incentive of 100%for the Air Seating measures up to the first 5680 and an additional 5340 if savings um justified by the auditor. For the safety and hearth of your homes indoor air quality,we will be conducting a blower door diagnostic ofthc available air flow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of Me combustion safety of your heating system and venter beater.This has avalue of$90 and is at no cost to you.Total allowable weatherization incentive is$3,110. 540:00 Total: $5,116.58 Program Incentive. $3,110.00 Customer Total: $2,006.58 WE AC,REEHERMY TO FURNISH SERVICES-CoMp ETE IN ACCOROANCEWrM ABOVE SpELIFH:ATION&FOR THE SUM OF —Two Thousand Six&581100 Dollars $2,006.58 UPON FMK.OISPE#:1LO41 AMD APPROVAL DY RIIE E,ty1MEERMC.CUST0144,:RAOAF7E�i SO RE1AM,ROM Fd PULL.D,TERFST OF t%Wp.L HE CiiARtlaD MON'„iiY 047 AxY IMAM APTPJC 1a DAYS.IEEtiEXFASE POROSPORrAN!'a7PORMATMU ON OWBANS R EFSr t4Nftt OOP RECMTWk4CKE0Dt,alm.ANOCW1rpA0PORREt7iSTRAtk>TL .� 00 NOT SIGN TM CONTRACT tF MiME ARE ANY BLANK SPACES S,ONAtrlpe.raSE EADttxnAnS etr9TOMER >rCEP',%IN7� f�4,ObL��— DASB OF AccMANCE "' � � •f xOrE Sxk1 CONTRACT MAY BE WiTHORAWx By US RF NOS 6%ECUFED Yflr>tW , ACCEPTAWE OF CONSML`r-SIM AUOVEPRtCe5,$KCfMAnDN.i'AND LxYxO"n An 30 DAYS. s SPEC PAYi W W l was YAGM AUntDRffE3S YD oa tN6woptc I'i'i P°"01 W.2 OWWA AUTHORMATION FORM Q tzab eiih Drurm rLt c &mar of the property be mad m 35 K.&a.aowvic w Road s Korth Wovvr, KA ofb45 fftcp" ) an ar&mioed mscomacwr for FM Enoneeft m acct on my behaff to obm a ttrdWM peWt and b peftm www an my property. �&A Date JUN 3 0 2015 loom, Ir.1� " a I M MEN lRolM PENAMINIMMMIN Isms I ■ calls. 6EEOMEMO � ■ in ��Yv tl No Mo egg �a NJi ME1 The Commonwealth ofMassachuseus Department of Industrial Accidents Opke of Investigations I Congress Street,Suite 00 Boston,MA 02114-2017 wwwin ass gtt WorkeW Compensation Insurance Affidavit:Buil+Viers/ an ttors/Electrician lum ers pant Irrrxna . nem Print LyIbty Nwne usinewtC3 anay. ow[t vidual): QwftcrJ dress: ` Ci /stagy : llt Phan Are you an' lqJ ". Check the app vprb to box: of project f }: 1. 1 am a employer-Aith S `t- ®i tart a general conta actor asset 1 employ (full and/or pwt-time);* have hired the sub-contraetttrx 6 �New construction 2.0 1 am a sole proprietor Or partrscr listed on the attached shit. 7. ®Remodeling ship and ha,6v no crnployecs These sada-connactors have S d3txnctlitiort working for me in any capacity. employces and have workm' 9. �Building addition [Nit wo `comp.insurat €onslr.insurancc,= required.] - We are a corporation andits l�lea€rical stirs or additions of om dune exercised their 3.C11 hest a wiser doing a]l marls 11.[3 lrltssshlsistg repairs or additions f right of cse tion M 1. rYs} lt'r�10 vs�rlt comp. �' � 12.[3'Roof repairs imumncc required.]t C.1521,§44),and we have no nploy w[No Nvvr€�ers' 13.� comp.insurance uireil ' "Any a�+la"exast tbatCb&1s box 91 mugaW fell cyst the ti€m ba:tas,�c�milng tr as m"mnVm5mim pdtcy 6fzvnnition, t H -ACM wbo Marta this affirlmi mc,ac'" sting thcr arc doing all w&k a nd 4h=hire mdt contrmon nwa subn*a new afn&vit indicating such, onxaacturs*31 box Must=-dwd an additional Abd xhmiog the nanw,of The sub-cane= ';MA itak whehLf or not*4se cnli havc empkiyvm If the tr mosses have they moatpm s'dc th e a ewk 'c sls, ttcti°nuctt r. Ian an emp*sertJ�il t isprow " %vikers,canwMation imatrenCe for xry employee& Mew h the porky orad job site inVorl",riom Insurance Company Nam: t� a��r;;. s t..,Co P€slicy b or Self-ins.f ic. 0 7, 4 fita 4 � a Fxpitation Date;_ _�_ 7 b Job Sim Address, Attach a copy of the workers'compensation policy declaration page(Showhsg the policy number er and expiration date). Failure to sectare coverer as required under Section 23A of MGL c.152 can tead to the imposition ofcritninal penallics of a One up to$1,500.00 and/or ogle-year imprisonment,as well as civil penalties its the forns of a STOP WORK ORDER and a fine ofup to S250.00 a day against the violator. Be advited that a copy of this,statenxent may be forwarded to the Office of Investigations of the D1A for instzrance coverage verification, I do hereby rent;fy amkrtht pawand gene rs ofpe'rjwy tlrrit the inffdrrrtrtdon provWd owe is true and correct: siofitljrehc��� 61.1 ' Datg- EbMA; !An Iry Offen sir use only,D©not write in this€req,to be completed by dq or toYsw offkiar. City of Town. FWwwUlcense a Issaing Authority(circle o ).. I.Board of Health 2.Building Depaftment 3,CitytTown Cleric 4.Metrical Inspector S.MmOWng Inspector !3.Cls contact Pers. Phone I A6 Rte® CERTIFICATE OF LIABILITY INSURANCE F —DATE YY) 7M2U 5 11 1 TE 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 CONTACT Nancy Usher Martin J Clayton Insurance Agency, Inc. acNN No. (413)536-0804 Fvc No:(413)534-7874 1649 Northampton Street ADDRESS: P. 0. BOX 989 _ INSURER(S)AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURER B: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. (NSR TYPE OF INSURANCE ADDL SUBR LTR POLICY NUMBER POLICDY EFF (POLICY EXP LIMITS MIDDIYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 A CLAIMS-MADE OCCUR PREMISES(Ea 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 F7 PRO JECT ❑LOC PRODUCTS-COMP/O_PAGG $ 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 NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000 1900 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 11900 1900 DED I I RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATIONPER 0 - AND EMPLOYERS'LIABILITY Y/N STATUTE I. I ER _ ANY PROPRIETOR/PARTNER/EXECUTIVEE.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 1$ DESCRIPTION OF OPERATIONS/LOCATIONS 1 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(2014101) The ACORD name and logo are registered marks of ACORD MP?rdrd5tbd with pdfFactory trial version www.pdffactory.com r,10 1•111A 12/10/2014 1 :21 :37 PM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE ' THIS CER12i 10/24CERTIFICATE IS iSSUEO AS A MATTER OF INFORMATION ONLY AND C014FERS 110 RIGHTS UPOU THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES HOT AFFIRMATIVELY Olt IJEGATJVELY AM£!II), EXTENT? OR ALTER THE COVERAGE AFFORDED HY THE POLICJES BELOW.. THIS CERT1rICATE OF INSURANCE DOES NOT C011STITUTE A CONTRACT I REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOU)ER, BETWEEN THE 1SSUIIIG 1tJ51J1tElt(S), AUTHORIZED lh11'ORTAl1T: if the cert,Ificate holder Is an ADD111011AL INSURED,the Pollc)(les)must:be endorsed. If SUBROGATION IS WAIVED,subject to the Lerma: and conditions of the policy, certain rollcies may rehire an endomemerIL. A r.Aal.ement On this certificate does not confer rights to the Cen:iflcate hulderin lieu orsuch endorsement(s). NA A.L'I Berkley Assi ned Risk Services 1 Clayton Martin J ins Agency Inc ! 1649 Northampton St IAA,N°E.I 800 634-4589 tini. ar.; A66 215-8.1 Ift PO Box 989 A'X",_Ss. PolicyServices(llherkfeyrisk,aim ! HaiOke MA 01041 Asut Rr, n?"oNUNcccvElrAc;?, N.vr;a I NsuReu 31325 Gauthier Insulation Inc Ns mER P... PO Box 344 INS UReaC - Ipswich, MA 01938 f"LRERO !NSU;ERE .COVE RAGESINS LAER r CERTIFICATE NUMBER: REVISION Nl1MBER: THIS IS TU CERTIFY THAT TFIE POLICIES OF IRCURANCE LISTED BELOW HAVE BEEN 13SLED TO THE INSURED NA&IED ABOVE FOR THEP( INDICATED, NOTW ITHST'ANDINQ ANY REQUIREMENT,TERM OR CONDITION l . )L ICY PERIOD 0 >F ANY CC} DOCUMENT WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB ECT TO ALH RESPECT L THE TERMS, EXCLUGIONSAND 0)ND11IONS OF SUCH POLICIES.LIdrrS SHOWN h9AYHAVEBEEN REDUCED BY PAID CLAIMS. � TYr'G OF INSII qAk�Fn- IRR CTR - INJR h'VU Pf:!!f,1'NIIMAFR !r• I r GENERAL LIABILITY Ar 0.1!(IU/WVrY) (0.1M!()nrY1'YY'" IIA41S AUTOMOSILE LIABILITY i WORKERS comrr NSAT1ON S AND EMPLOYERS'L/ASIUTY NN jj()130120*lr) LANYPROnRis,ioRil'ARiNEgASXEItUTIV♦' Y ., 11 A orru isuL,*mp't:GXr:'LJnl:n� ❑ tNf✓-24-20.001661-04 10/30/2414 E C(:AC11 CTI:)FNI 5 500,000 - Sa.0 MP E Is 500,000 crrgr•rplrl r_N ar atEgaucNse,m„ urscr,Ir �)N or a!'E Aa!aus lL(Tr_nT!oN ! ':.ulrc ..(marl,w:or n I aEl L)IF.ASE-r^Li:Y' Mn 500,000 b1. EEiiiCn al R«,iw rM;ScLn E•:::,(i,;n...Var.n is rr�,'a«Ei Coverage Election Category Elect.Status Name 5tatr(s) All EntitiesJLocations Officer Exclude Kurt Gauthier MA Officer Include Brittnie Aiello Gauthier Insulation Inc 44 Essex Road Ipswich, MA 01938 CCANCELL ION Str)ULD ANY OFT14E ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE EXPI14ATION DATE THEREOF,NOTICE WILL BE DELIVERED it.) Mass Save Program/Conservation Services Group,Inc AC(:ORDAIA:E WrrH T..P(.)LI(.Y PROVISIONS. 50 Washington Street West Borough,MA 01581 [Signature: ACORD 25(2010105) BRAC 3139 (d- Txe leowvmloznevealllkel�' YJ Office of Consumer Affairs and Business Regulation, g 10 Park Plaza- Suite 5170 Boston, Massachusetts 02,11:16 Home Improvement Contractor Registration Registration: 173410 Type: Individual 1 Expiration: 1011/2016 Tr# 257812 KURT GAUTHIER 4 � KURT GAUTHIER P.O. BOX 344 IPSWICH, MA 01938 Update Address and return card'.Marts reason for change. Address Renewat - Employment i Last Card SCA 4 4 20M-W11 17 .. f l fti� Ff'tvrxt fxxra'!Y#fsC�G�l't G.'��<�Gtr6hEY.;/Lff.;N�IS j Office of Consumer Affairs,&Business Regulation i License or registration valid for individul use only DOME IMPROVEMENT;CONTRACTOR before the expiration date If found return to: registration 173410 Type: Office of Consumer Affairs and Business Regulation x iration.i 40f F/201t3k Individual iQ Park Plaza-Suite 5174 p Boston,MA 02116 KURT GAUTHIER Y, f KURT GAUTHIER 44 ESSEX RD IPSWICH„MA 01838 _._.. _ x Undersecretary 4.1 valid 4wieut signature Y. Pubil c# � euf aidCSSL turd X Kit" ImT . � jt" P-(X Mft 344,