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HomeMy WebLinkAboutBuilding Permit #711-2017 - 36 COLGATE DRIVE 2/24/20171 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: A / '� /7 i Date Received Q00e-q10 RTly �TLED r6� rED h4F� &n-.- . TYPE OF IMPROVEMENT PROPOSED USE Address: Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg Others: ❑ Demolition [IOther L✓ /4 %1- 4>tea - Septic,FVNeII q Floodplain D 1Net[ands D Watershed ®tsfficfi --- DESCRIPTION OF WORK TO BE PERFOKMLL): i to A Id T—,iC�. V (fn �� Q7 i!/ L4 OWNER: Name: Address: Confr-act©r Narrie -. Identification - Please'I r rL. a t upervisors Constru`ct�ori:Lic _ ,. �Nrama�Imnrn�ir�mr�nt'l;I�'PnsP. ARCHITECTIENGINEE or Print Clearly' r- h ir"d c Phone: 7� G/0-�1�0 Phone: Address: Reg, No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $9000,00 OF THE TOTAL ESTIMATED COST BASED ON $925,00 PER S.F. '-___,Total Project Cost: $ �00. 4 0 FEE: $ 3 D 00 Check No.: Receipt No., 7' NOTE: Persons contracting with unregistered contractors do not have: acee to ' e guar ty f d Location 17 l 611A r J No. �' `- C`1 Check #6�0 C/ Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Plans Submitted ❑ Plans Waived 11 Certified Plot Plan ❑ Stamped Plans ❑ 13, F SEWERAGE DISPOSAL 4 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, COMMENTS Reviewed on Signature ® ...lit- r-' .. r 4 Zoning Board of Appeals: Variance, Petition No: - Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments 11 Comments Wafer & Sewer Con nectionlsignature & Date DdvewaV Permit DPW Town Engineer: Signature: FIRE DEPARTMENT- -.Temp Dumpster on site yes Located at 124 Main Street Fire Department signatureldate -Located 384 Osgood Street no -imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: - x- ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$10041000 fine IM 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. 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 SectionlElevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products V®TE: 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 PIot 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 act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 10TE: 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 Q L=L O OZ O as U Y \ O LL E vc N U Q N _ O Z co O m -0 = LL t R' v C E U N LL _ OLN Z Z � d t 00 d' LL _ W Z U U � W b W NZ •` N LL O Wcc N Z H Q C7 �pO d' _ I.L W F- Q W C W cc: LL Co N N V ) +' cu Y O LI) W W 0 am U) T F— :4 _0 'M O O v O yr 0. d � r.a 14% 0 o O op:r CL N � o 5 V L � V y d � RL J L ` m CD > m ' � L o -o O H . to O = c +w V = U, a .0 C) ` O 0- = O o t 'y = .> 3 CQ L O v0CD i = _ L L ca CL 2 � N m _ O '0 O _O d O N = .w 0. O V "O rr V L 0 (D-- 0 --0 fA - .O "— _ t � O-oU Z CO C _Z U) LLIw U) CL X Z LLJJ �0+ CO az Ho Yo I I Federal ID N 05-W5629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 W. CT Contractor Registration No620120 �- R%0C. 60 Shawmut:Road, Canton, MA 02021 ENGINEERING' CONTRACT 339.502-6335 FAX 339-502-6345 Page 1 PROGRAM THO COMPACT M ENTERED INTO BMWMN RISE CMA -HES END/NEERWOANDTHECWTOMERFOR :WORKAS- DESCRIBED BELOW CUSTOMER PRONE DATE CLENTR WOWKORDER Michael Hoye (978)618-9209 02/07/2017 400298 23906 SERMCE 37RM OLUNG STREET 36 Colgate Drive 36 Colgate Drive SERVICE crty, STATE; Zip Baum Crm sTATE: aP' North Andover, MA. 01.845 North Andover, MA 01.845 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 scaling include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed,) This will require (3) working hours. A reduction in cubic feet per minute (afro) of air infiltration will occur, but the actual .number ofelm is not guaranteed. At the completion of the weathcrimion 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 NOTE : RIM JOIST CHIMNY CHASE BASEMENT AND TOUCH UP IN ATnC CHASE. $255.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unlaced fiberglass batts to (20) square feet for damming purposes. 1541.00 AT IC FLAT: Provide labor an&m,aterials to install an 8" layer of R 30 Class 1 Cellulose added to (108) square feet of open attic spaceNOTE; GO OVER FLOOR/ KEEP CAT WALK. $155.52 ATTIC ACCESS: Provide labor and materials to install (t) easily moved, insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within the attic. This will allow the cover's integral weather- stripping to restrict air.ieakage. $237.65 VENTILATION: Provide labor and materials to install ()),insulated exhaust bose with roof mounted flaPPer vent to exhaust existing bathroom fan(s): Broan'model 4 636 or equivalent. $118.75 C'n t . 4x wal %`N Federal 10 # 06-0405629 RISE Engineering R1 Contractor Registration No else MA Contractor Registration No 120979 4if f CT Contractor R"Istration NoG201M RISE60 Sbawmut Road, Canton, MA 02021 ��++ ENGINEERING CONTRACT 339-502.4335 FAX 339-502-6345 Page 2 PROGRAM TMs CONTRACT M ENTERED INTO BETWEEN RISE CNA -HES ENGINEERING AND THE CUSTOMER FOR WORK AS OESCRM BEAM! CUSTOMER PHONE.. DATE CLIENT# WORKOROER Michael Hoye (978)618-9209 02/07/2017 400298 23906 SERVICE STREET BUJ" STREET 36 Colgate Drive 36 Colgate Drive SERVICE OTY. STATE; ZIP BWMG CnY. STATE,ZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION RISE Engineering will :apply all `appiicable, eligible incentives to this c,Ontract. You will only be billed the Net amount. Currently, foreligible measures, Columbia Gas offers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 100° for the.Air Sealing measures up to tate first $680 and an additional $340 if savings are justified by the auditor. For the safety and health of your home's indoor air quality, we will be conducting a blower door diagnostic of the available air flow in your home both before the watt: is begun, and after the weatherization work is complete. We will also conduct a full assessment ofthe combustion safety ofyour beating system and water beater. This has a value of $90 and is at no cost to you. The Permit will be secured by the insulation contractor. This has a value of $75 and :is at no cost to you. It is the homeowner's responsibility to close out this pdemit by contacting their municipality at the completion ofthis work. Total alloumblc weatherization incentive is $3;1115. $165.00 L q .N . • .1 0 1 Total: $972.92 Program Incentive: $834.68 Customer Total: $138.23 WE AGREE NOWSY TO FURNISH SERVICES - COMPLETE IN Aceomw NCE vmm ABOVE spwnCATONS. FOR THE Sum OF ***One Hundred Thirty -Eight & 231100 Dollars $138.23 UPON OVAL BY RtBEEmwwe wo. cusTomER AOREEs To REMIT AMOUNT DUE W FULL INTEREST OF 1% WILL BE CNAROED MONT"LY ON ANY UNPAW SEE REVERSE FOR IMPORTANT WORNATdoN ON GUARANTEES. RIGHTS OF RECISION, SCHEDUUNO, AND CONTRACTOR REGMTRATION. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES A MEDS .TORE -RISES y`.: - CUSTOMER ACCEPTANOV CONTRACTiAAYBE WUTNORAVMI48YUS lF NOT EXECUTED`VATHIii OATEOFACCEPTANCE ACCEPTANCE OF CONTRACT- THE ABOVE PRICES. SPEaPICATMM AND CONDRGDNS ARE 30. DAYS. SATISFACTORY TO US AGO ARE HEREBY ACCEPTED. YOU ARE AUTHMMED To DOME WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE i Ay" RISE�a ENGINEERING EMc1.-►tq En--rCk0t 60 Shawmut Road, Unit 2 f Canton, MA 020211339-602-6336 wwwRISEengineering.com OWNER AUTHORIZATION FORM I MIKE H OYE (Owner's Name) owner of ,the ;property located at: 36COLGATE DR. (Property Address) N.AN010VERNA. 01845 (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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly POLAR BEAR N Name (Business/Organization/Individual): PO BOX 958 ANDOVER, MA 01810 Address: Phone #: P- Cr6-S"/?5- Are you an employer? Check the appropriate box: 1. N I am a employer with _( 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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 a new affidavit indicating such. tContractors 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 that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: q) r t; M A t 71n S v f A W r Ce bh Q4 In Policy # or Self -ins. Lic. #: Powe P%f 01/ Expiration Date: 6 ► .20 4? I Job Site Address: G �P7 �_QT0 7—C r 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 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 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. Be advised that 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 tl:Tpain% and penalties of perjury that the information provided above is true and correct -(,..��i 4_J__ Date: a- / 3 Ll Phone #: F%r 1/6;>- i63, Official use only. Do not write in this area, to be completed by city or town official 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 #: 1/3/2017 Insurance Services AC Ro� CERTIFICATE OF LIABILITY INSURANCE �o X03 TYPE OF INSURANCE n1 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 endorsemonL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER CONTACT NAME: Automatic Data Processing Insurance Agency, Inc. 1PHONE . Esi : IVC, No ADDRESS: 1 Adp Boulevard Roseland, NJ 07068 INSURERS) AFFORDING COVERAGE NAIL R INSURER A. NorGUARD Insurance Company 31470 PERSONAL & ADV INJURY S INSURED POLI R BEAR INSULATION CO INC INSURER B: PRODIiCTS - COAdRiOP AGG $ PO BOX 958 INSURER C: INSURER D: Andover, MA 01810 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 595370 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. LTR TYPE OF INSURANCE INSD rX POUCYNUMBEROILD"CMIot"CINYYY 120 Main st LIMITS North Andover, MA 01845 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F1 OCCUR —fie. �11 I1L,- EACH OCCURRENCE $ ENILU PREMISES Ea occurrence) S MED EXP (Any one person) S PERSONAL & ADV INJURY S GENt. AGGREGATE LIMIT APPLIES PER: POLICY a PET- 0 LOC OTHER: GENERAL AGGREGATE $ PRODIiCTS - COAdRiOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AAuros ED (Eaaccident S BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acadenl S $ UMBRELLALLAB EXCESS UAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS S A WORKERS COMPENSATION AND EMPLOYERT UABILnY OFFICCEERIMEEMBEREXCLUDED�?ECUTIVE YIN (mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below N POWC840361 01101/2017 01/0112016 X I PER STATUTE ER E. L.EACHAcaDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE - POLICY LIMIT S 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Contractor License: CSL 106017 HIC 102726 I CERTIFICATE HOLDER CANCELLATION AV 1983-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD https:lladpia.adp.comlISExtemal/app/index.html7ctientid=2037315&requestFrom=run#lhome 1/1 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. 120 Main st AUTHORIZED REPRESENTATIVE North Andover, MA 01845 —fie. �11 I1L,- AV 1983-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD https:lladpia.adp.comlISExtemal/app/index.html7ctientid=2037315&requestFrom=run#lhome 1/1 AC40 '0® CERTIFICATE OF LIABILITY INSURANCE6,20( 2oi6Y) 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 polloWee) 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 Linda Bogdanowicz Insurance Solutions Corporation PHO(ArNE (603)382-4600 FAX No): (603)382-2034 ADDR.lindab@isc-insurance.com 60 Westville Rd INSURER AFFORDING COVERAGE NAIC 4 EACH OCCURRENCE S 1,000,000 INSURERA.YdOStern World Plaistow NH 03865 INSURED INSURER B Nautilus Insurance thou Polar Bear Insulation Company Inc INSURER C: PO Box 958 INSURER D: INSURER E: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOSP AUTOSNON-OWNED Andover MA 01810 INSURER F CILIVERAUES CERTIFICATE NUMBERCLI632326134 RPVLRION NIIMRFR- 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 TYPE OF INSURANCE POLICY NUMBER POLICY yy POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑$ OCCUR NPP8274967 3/24/2016 3/24/2017 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence)$ 100,000 MED EXP Any one n $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 8 POLICY ❑ jgp� M LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOSP AUTOSNON-OWNED COMBINED SINGLE LIMIT $ accident BODILY INJURY (Per person) $ BODILY INJURY Per accident) S PPROPERT DAMAGE $ B R UMBRELLA LIAROCCUR EXCESS LIAB HCLAIMS-MADE IAN026107 3/24/2016 3/24/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DIED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A PEROTH- STATUTE I ER _. E.L. EACH ACCIDENT $ EL. DISEASE- EA EMPLOYEES E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACOR0101. Adddional Remarks Schedule, may be attached I more apace Is required) Town of North Andover 1600 Osgood St, Ste 2032 North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Maglia/SJA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 rmmenn Office of Consumer Affairs and Business Regulation ,- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home improvement Contractor Registration - _ - Registration: 102726 Type: DBA Expiration: 7/2/2018 Tt4 419291 POLAR BEAR INSULATION CO. Vinceni LeBlanc P.O. BOX 958 ANDOVER, MA 01810 Update Address and return card. Mark reason for change. SCA 1 w MA-MIAddress [:]Renewal ❑ Employment Q Lost Card ✓fIC `�r-i�i»�nntncal/l of �'%fF�.L'�i�nic!/S _ Office of CousumerAffaiis & Business Regulation HOME IMPROVEMENT CONTRACTOR { , Registration: 1©2725 Type: Expiration: -7/2%2018 DBA POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO. CANAL ST. 45A LAWRENCE, MA 01841 Undersecretary License or registration valid for individual use only before the expiration date. If found return to.- Office o:OSce of Consumer Affairs and Busmen Regnlntion 10 Park Plaza -Suite 5170 Boston, MA 02116 fiat valid without signature Massachusetts S - Depar 3;aE n Sa atv S Board 3` Sufliding . Regu'taua;ls dlC; Standards ^se: CSSL406017 PETER A LEBLANC 2 EAST PINE STREET Plaistow NH 0388 v�- r1,ss�:;nPr 04/28/2018