HomeMy WebLinkAboutBuilding Permit #675-16 - 40 FERNVIEW AVENUE 12/1/2015san"NeD f 01% - I- IS,
BUILDING PERMIT O`SED 16�\
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received
Date Issued: Fc4- f -- C Y
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT
PROPOSED USE
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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
N PRA
❑ Septic ❑ Well
❑ Floodplain ❑'Wetlands
E Watershed District
❑ Water/Sewer
Supervisor's Construction License 009 Exp. Date: (P .
Home. Improvement License: )Alc--M �L) 'r Exp. Datel
ARCHITECT/ENGINEER 0 1'>' 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: FEE: $
Check No.: Receipt No.:�
NOTE: Persons contract th unregistercontractors do not have acce*)o the guaranty fund
Signature 1. of Agent/Owner tare of contrac
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Supervisor's Construction License 009 Exp. Date: (P .
Home. Improvement License: )Alc--M �L) 'r Exp. Datel
ARCHITECT/ENGINEER 0 1'>' 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: FEE: $
Check No.: Receipt No.:�
NOTE: Persons contract th unregistercontractors do not have acce*)o the guaranty fund
Signature 1. of Agent/Owner tare of contrac
rpoAaYl
Location U ' T !/i WV (/L
T�—r-�
No. � -- Date Ol " '` 149,
Check #4 j
2;750
TOWN OF NORTH ANDOVER
J
Certificate of Occupancy $
Building/Frame Permit FeeiiL
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
w
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools- d
Well ❑
Tobacco Sales ❑
Food Packaging/Sales D
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 Reviewed on
A
Signature_
Sianature
' COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
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 _ no'-.
Located. at 124lMain Street- -
Fire Department signature/date
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
NU 1 E5 and DATA — (For department use
❑ Notified for pickup Call Emai
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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o 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
o 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
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L. E. MORGAN CONSTRUCTION INC.
86 BILLERICA AVE., N. BILLERICA, MA 01862
PH: 978-670-4747 / Fax: 978-670-6477
PROPOSAL
Submitted To: Affinity Realty Management Date: 11-3-15
Address: 39 Rear Farrwood Rd., (Clubhouse)
N. Andover, MA 01845
Cell / Fax: 978-376-9687 / 978-685-0521
Job Site: Heritage Green Condominiums
40-42 Fernview Rd., N. Andover, MA, Approx. 5,179 SQ FT
WE HEREBY submit our proposal for the following scope of work;
1. Remove the existing shingles down to the wood deck and dispose of off- site.
2. Install 6' of ice & water shield at the leading edges and 3' in all valleys.
3. Install RHINO SHIELD synthetic underlayment to the remainder of the wood deck.
4. Install 8" white aluminum drip edge to the entire perimeter & mechanically fasten.
S. Install Certainteed Swiftstart shingles as a beginning course.
6. Install Certainteed Landmark Silver Birch architectural shingles & hurricane nail.
7. Install 4 new pipe flanges, 2 slant back attic vents, new lead on the chimney.
8. Install new ridge vent and matching cap shingles.
9. Remove the metal siding on dormers, & install 100% ice & water shield on the walls.
10. Install new white vinyl siding on 1 dormers with white vinyl corners.
11. Install white aluminum coil over all rake and fascia, and 100 % vented vinyl on soffits.
WE propose hereby to furnish materials & labor, complete in accordance with the above
specifications, for the sum of, Eighteen Thousand Six Hundred Twenty Dollars: $18,620.00
AUTHO ED SIGNA
ACCEPTANCE of P C
are hereby accept
P
: The above prices,
You are authorized to do the work as
& confit dons are satisfactory and
AUTHORIZED BUYER SIGNATURE DATE
THANK YOU FOR CHOOSING MORGAN CONSTRUCTION
The Commonwealth ofMassachusetts
Department of IndustrialAccidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
yt
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERAIITTING AUTHORITY.
Name (Business/Organization/Individual)
City/State/Zip b ..
7)D
Areo p oyer? Chec the appropriate box:
Type of project (required):
1. I am a employer with employees (full and/or part-time).* %. []New construction
2.FJ I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity. [No workers' comp. insurance required.]
9. ❑ Demolition
3.FJ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition
ensure that all contractors either have workers' compensation insurance or are sole 11. ❑ Electrical repairs or additions
proprietors with no employees.
12. Plumbing repairs or additions
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13. of r p S
These sub -contractors have employees and have workers' comp. insurance.$
6. FJ we are a corporation and its officers have exercised their right of exemption per MGL c. 14. Othe 1
152, §1(4), and we have no employees. [No workers' comp. insurance required.]
*Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information.
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors 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, ley must provide their workeis' comp. policy number.
.tam an employer that isproyding workers' compensation insurancefor my emloyees.' Below is thepolicy and job site
information. I
Insurance Company Name:_,
Policy # or Self -ins. Lic. #:`% 'A _ 1 Expiration Date:
Job Site Address: V \ VO �4City/State/Zip: N , a,4 ► 1 `
Attach a copy of the workers' compensation policy decl ration 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 th iolator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage ver fiction.
Ido herebylbotify under thepains
I provided above is true and correct
use only. Do not write in this area, to be completed by city or town of)MaL
or Town:
Permit/License #
Issuing Authority (circle one): i
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Information and Instructions
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. However 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 fillout the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
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 Depaffinent of Industrial
Accidents fol• confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit 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 or if you *are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should'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 sure 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 "Job 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 homeowner 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-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
CERTIFICATE OF LIABILITY INSURANCE 'DATE mwma/�n� nw?ni#;
1444-ERTIFICATE 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 CFRTIFICATF MOI nFR_
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 and
endorsement. A statement on this certificate does not confer rights to
the Certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
PHONE
FAX
BALDWIM)NTELSH PARKER INS
131 COOLIDGE ST. SUITE 4100
(A/C, No, Ext):
(A1C, No):
E-MAIL
HUDSON, MA 01749
ADDRESS:
27KLD
INSURER(S) AFFORDING COVERAGE NAIC #r
INSURED
INSURER A: AMERICAN ZURICH INSURANCE COMPANY
L E MORGAN CONSTRUCTION INC
INSURER B:
INSURER C:
INSURER D:
PO BOX 75
INSURER E:
NORTH BILLERICA, MA 01862
INSURER F:
COVERAGES CERTIFICATE NUMBER:
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
ADD
SUB
POLICY EFF DATE
POLICY EXP DATE
LTR
TYPE OF INSURANCE
L
R
POLICY NUMBER
(MMIDDIYYYY)
(MMIDDIYYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
s
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F-1 OCCUR.
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY is
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY a PROJECT LOC
ENERAL AGGREGATE
S
PRODUCTS -COMP/OP AGG
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE
�$
ANY AUTO
LIMIT (Ea accident)
BODILY INJURY
�$
ALL OWNED AUTOS
SCHEDULE AUTOS
(Per person)
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
I$
PROPERTY DAMAGE
$
(Per accident)
UMBRELLA UAB
EACH OCCURRENCE
is
EXCESS LIAB
[]OCCUR
CLAIMS -MADE
AGGREGATE
g
DEDUCTIBLE
Is
RETENTION S
is
A
WORKER'S COMPENSATION AND
EMPLOYER'S LIABILITY YIN
UB -5B738312-14
12/1412014
12/14/2015
X
WC STATUTORY
LIMITS
OTHER
ANY PROPERITOR/PARTNER/EXECUTIVEn�
OFFICER/MEMBEREXCLUDED? 1" 1
NIA
E. L_ EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
1$ 1,000,000
.DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS
CERTIFICATE HOLDER
CANCELLATION
TOWN OF NORTH ANDOVER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
1600 OSGOOD ST, BLDG 20, STE 2035
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
NORTH ANDOVER, MA 01845
AUTHORIZED REPRTATDVE---
AI.VKU GD (2u7 u/Ub) 1 rte AGUKU name ano logo are registered marKs Or AGURU 1988-2010 ACORD CORPORATION. All rights reserved.
LEMORGA-01 BBOYER
'%c-� v CERTIFICATE OF LIABILITY INSURANCE
DATE(MNI/DDnIYYv)
7/7/2015
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
Welsh & Parker Insurance Agency, Inc. / Hudson Office
131 Coolidge Street, Suite 100
Hudson, MA 01749
CONTACT
PHONE g78 562-5652 FAX ( )
Arc No Ftl: ) Alc No): 978 562-7120
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
MI POLICY EFF
INSURERA:Western World Insurance Company
LIMITS
INSURED
INSURER B: Safety
INSURER C: Scottsdale Insurance
LE Morgan Construction Inc
INSURER D:
PO BOX 75
Billerica, MA 01821
INSURERS:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION rdl IMI91=0
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 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.
INSR
LTR
TYPE OF INSURANCE
iNSD
WVDRF-
POLICY NUMBER
MI POLICY EFF
CY
MIOWUDD P
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,00
CLAIMS -MADE ® OCCUR
NPP8237995
0411312015
04/1312016
-PREMISES Ea occurrence s 100,000
tTntractual LiabilitMED
EXP (Any one person) S 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE S 2,000,000
POLICY 0 PROEl -LOC
JECT
PRODUCTS-COMP/OP AGO S 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident S 1,000,0011
B
BODILY INJURY (Per person) S
ANY AUTO
COM6230688
10/13/2014
10113/2015
ALL OWNED X SCHEDULED
BODILY INJURY (Per accident S
)
AUTOS
TNON-OAUTOS
HIRED AUTOS X AUTOS
PROPERTYDAMAGE S
Wer accident
5
UMBRELLA LIAB
%(
OCCUR
EACH OCCURRENCE $ 5,000,000
C
X
EXCESS LIAB
CLAIMS -MADE
XLS0096729
04/13/2015
04/1312016
AGGREGATE S 5,000,000
DED I I RETENTIONS
S
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS! LIABILITY y I N
STATUTE ER
E.L. EACH ACCIDENT S
ANY PROPRIETOPIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
N / A
(Mandatory in
If yes, describe under
ntl
E.L. DISEASE -EA EMPLOYE S
E.L DISEASE -POLICY UMIT 5
DESCRIPTION OF OPERATIONS belrna
DESCRIPTION OF OPERATIONS; LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Proof of Workers Compensation coverage will be sent directly by the carrier.
r•C�TIt•If.AT1-'t,n, 11,-r.
Town of North Andover
1600 Osgood Street, Bldg 20, Suite 2035
North Andover, MA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
v _R100 -/U14 ACUMU CURPORATION. All rights reserved.
ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD
..
Massachusetts - Department of Public Safety
f`.Svwru of if:ifufng Reguiations and Standards
License: CS -079476
LAWRENCE E
86 BILLERICA AVE_
N BI7,LERICA NFA 0186 a
S• �
Expiration
Commissioner 06/0312017
err �, o����r
S -k L9 E-1. 2 -EE -L. -
This
�1 � aamtv�y�g,,,
This card acknowledges that the recipient has successfully completed a
30 -hour Ocbupational Safety and Health Gaining Course in
Construction Safety and Health
r r _J0 .
(Trainer name - print or type) (Course end date)
» �Jo�+Lit G�e�,/�
Office oflCorisumer'�ffatrs &''Sn nefiaaon 1
C _—�egii
,_,�f,?,HOME IMPROVEMENT CONTRACTOR
Registration: 137913
Type:
=-1 Expiration: 112712017 IndividualYP
LAWRENCE E. MORGAN jR.
LAWRENCE MORGAN JR.
86 BILLERICA AVE UNIT 1
N.BILLERiCA, MA 01862
Undersecretary
O&mss
;1.5. G�.artme^t of �Cci
Occurationar Safest• and 'reaith A�Ccfr ;x,irai:en
i�A RRY MOR&AtJ
A&
,,as successfully completed a 1t7 -`:cur Occupaticnal Safety and Health
Training Course in
Construction Safety & Health
Lows RV1'JD J S OSAU&
Drainer! ,9
'Cate!
L�
ROOF MP RECYCLING
R.ecyclers of Asphalt Shingles
SEAN ANESTIS
PRESIDENT & CEO
369 CODMAN HILL ROAD TEL. 978-263-1899
BOXBOROUGH, MA FAX- 978-263-1879
EMAIL: R00FT0P1@vERIZ0N.NET CELL- 508-726-5341