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HomeMy WebLinkAboutBuilding Permit #618-15 - 40 MEADOWOOD ROAD 1/21/2015Permit N BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: A i IMPORTANT: Applicant must complete all items on this paize PROPERTY OWNER ' MAPPARCEL: rnnt 1 u Year Structure DISTRICT: Historic District Machine Shop Vi yes no ye no ye , no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial XAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well Floodplain. ❑ Wetlands 0 Watershed District Water/Sewer OWNER: Name: Address: Contractor Name: Address:2 Supervisor's Co Home DESCRIPTION OF WORK TO BE PERFORMED: I - Please Type or Print Clearly Phone: �I�-X35-00 1'ruction License: Exp.. Date: _ nt License; _ _�1�!_,._ __.Ex p. Date:;` 1 �' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. • $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $L1454 -7 FEE: $ 3/_ Check No.: ��(� ,� �oZ o'� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the n d Signature of Agent/Owner�C-r Signature of contractor 77a Plans Submitted ❑ Plans Waived D 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 Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS { r- Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments "Nater & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea M4 usgooa Street FIRE DEPARTMENT - Temp Dumpster on site yes_ _ _ -no Located at 124 Main 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 I t5 and UA I A — wor 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. 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 '40 fed. Location Date I � 2-, 11 v5 - No. -0 1 �r— I (�- Check # 6 t I 2G439 as TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee TOTAL Building Inspector ON i V W • : a .0 z O Q c z * 0.- 0 o N V J d tr 0� Q m I Y C. W _ i rQ! 0o It Y' je— Z N ,NGS �P C0.1 i O Q Cc E p y J L Zw Lu oo 0 �'H^ N a v+ _ Q C / Z N a_t� O LUQ E c c c V a �, z Q �, N O C y a W s N 3 W J c �i r , (Dcom . v ... C I- L to p •N tm o c AR c L L .a 'o o W C -a t o o .r LL (n C O .N H N • = �Z. Z. O W v N C i • u G) O a_ a. Q 1 O > J (A = O O H t . cLo0 I s E H Q W LL O cl: O CG ai Y \ 0 LL E +w.+ N U a fn OFuu W O. z O m C •° "a 0 LCL t W C c U LL O W H Z C7 z co d t z c LL O W N Z a U cc v W NJ t z 41 U N 0 LL oC Q U a Z N -� d' c LL H z CW c Q a Oz O LU LL i c 3 m z Y 41 Ln +' cu o Ul Y 0 In ON i V W • : a .0 z O Q c z * 0.- 0 o N V J d tr 0� Q m I Y C. W _ i rQ! 0o It Y' je— Z N ,NGS �P C0.1 i O Q Cc E p y J L Zw Lu oo 0 �'H^ N a v+ _ Q C / Z N a_t� O LUQ E c c c V a �, z Q �, N O C y a W s N 3 W J c �i r , (Dcom . v ... C I- L to p •N tm o c AR c L L .a 'o o W C -a t o o .r LL (n C O .N H N • = �Z. Z. O W v N C i • u G) O a_ a. Q 1 O > J (A = O O H t . cLo0 I s E 0 -next step tiving,. This agreement Is made by and among Miao Ding 40 Meadowood Rd North Andover, MA 01845 Site ID: A682174 Next Step Living, Inc. ("NSL") 21 Drydock Avenue, 2nd floor Boston, MA 02210 phone: (866) 867-8729 23 -Dec -14 1. )ESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customer's address above, in a professional manner and in accordance with the terms of this Contract. including the attached recommendations/work order describing the work in detail (the "Work") which are incorporated herein by reference: )ascription Quantity Investment lir Iing Recommendations $675.00 Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 9 $75.00 Hr $675.00 Work Location: Attic Flat Hatch: Thermal Barrier Polyiso 2 inch (Attic) Damming Vent bath fan to soffit exhaust Propavent 2' or 4' Attic Floor Open Blow Cellulose 8" 2 48 2 30 552 $60.00 $2.05 $118.75 $2.00 $1.30 Each Lnft Each Each sqft $120.00 $98.40 $237.50 $60.00 $717.60 Work Location: Knee Wall Install 2" Thermal Barrier Polyiso on Kneewall Install 2" Thermal Barrier Polyiso on Kneewall 96 12 $3.31 $3.31 sqft sqft $317.76 $39.72 Work Location: Misc Sheathing Access 9 $31.31 Each $281.79 100% Airsealing Incentive up to Program Max $600.00 75 % Weatherization Incentive up to Program Max $1,404.57 Air Sealing Remainder as 75 % Weatherization incentive up to Program Max $56.25 Estimated Annual Energy Savings from the Above Improvements $151.00. Dec 24, 2014 Customer Signature Date Starr 23 Dec 2014 RU igria`tore Date Andrew Carpentier Name of NSL Representative A682174 The Terms of this Agreement are contained on both sides of this page Next Step Living - 21 Drydock Avenue - 2nd floor <, Boston, MA 02210 (866) 867-8729 inquiry@nextsteplivinginc.com www.nextstepliving.com TERMS OF AGREEMENT 3, PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the t^.'ork at a mutually agreeable time, subject tO the availability of subcontractors or materials; or to delays attributable to the weather or other events beyond NSi_ s control. 4, CONTRACTOR REGISTRATION P,lassachusetts law requires home improvement :ontracors and suucontra tors to be registered t;ith f'ie Dire kor Of Nome Imprc cement Contractor Registration. You may incuire about contractor registration ;y viii iting to: Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116, 617.973.8700 5. PERMITS NSL will obtain ary necessary permits as the Customer's agent. Customers who secure their own permits Ordeal with an unregistered contractor will be excluded from the Guaranty and provisions of the "orae Improvement Cort, actor Law. 6. PERFORMANCE OF THE WORK AND CHANGES. 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy Of Agreement to the Customer 6.2 This Agreement may be supplemented, amended, or modified only by the mu,{;al agreement of the parties. No supplement, amendment, or modification of this Agreement shall be binding unless it is it writing and signed by all parties. 6.3 At times. our vreatherization team discovers situations in the structure during the course of the Art'crk that indicates a r sk fora health or safety concern for residents. Such concerns can include but are not limited to ventilation. potentially hazardous materials such as mold or asbestos, or structural concerns. In the case of health or safety concerns being identified, NSI. reserves the r'ght, per section 9.2 of this contract, to communicate concerns tO the Customer and halt work until such concerns have been addressed. 6.4 1 -he rebates and incentives available frorr the Nass Save, Home Energy Services Program and amounts due from the Customer are base: on the best estimate of the situation in the structure by the NSI. home energy advisor. '.sowever, at time,,; our weatherization team discovers situations in the home during the course of ;he Work that impact the availability of rebates and incentives from the Mass Save Program. In such situaticns; NSL will communicate such changes to the Customer; including any impact on amo-rnt the Customer would be expected to pay for the ifork. The Customer will have the option to remove trom the Contract the work elements that need adjustment, or set up a separate contract for perfarn?ing the adjusted work, 6.5 NSL represents and warrants to the Customer that a) the materials and equipment furnished tinder this Agreement will be cf good gsality and new; ;b) that the Work will be free from defects, and 10 that the Vdork will conform with the description of the U^Jerk described in Paragraph 1. 7. INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractcr Registration (No: 162111; and the necessary insurance required by applicable law and normally mairtained by prudent contractors if) NSL's field, includ:ng. `ox not lin;ited to, leVorkers Compensation Insurance for all earployees whowill perform the W'crk. 8. QUALITY OF WORK. NSL agrees that the Mork will be performed in a good and workmanlike manner, and that NSL will repair and replace, at its um expense, and promptly upon Customers request, any defects in workmanship and materials provided by NSL which appear up to (1) year after completion of the Workor wi bin any longer period .as permitted or rec;uired under applicable law. of NSL Inas received final payment as provided herein. 9. PRE-EXISTING CONDITIONS & PROPERTY PROTECTION 9.1 NSL shall rot be responsible for any damages as a consequence of the VVcrk performed in the trot ie due to pre-existng conditions. These corgi tions include but are not limited to poorly fastened or broken drywall; moisture damage. ron-code construction, cracked Or fragile siding or shingles. old pipes and fittings: retfin Eciood. etc. 9,2 NSL reserves the right not to po^orm .Nock upon the discovery of asbestos, mold or any other potential health risk to the CLISMmer. in tins evert, the Customer is responsible for remaOymg the at-rislk situation including any necessary removal of hazardous materials and all bills for services to date shall be card emmediately. Vvork cannot resume until remediation is complete. 9.3 `A/h le NSL will make best efforts to protect any propcty of the Customer; it the Customer's responsibility to remove or protect, including dust protection; any personal property including the home itself. NSL &ill not be responsible for damages to or losses of any of the above mentiored property not properly protected prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the right. the extent permitted by apptcable law, to have. file or mairtain a mechanic's or material meas fen. or to file a notice of intention to lien and to take any other steps to perfect and enforce such a lier, if Customer faits to pay NSI._ as provided herein. 10.2 This Agreement shall be construed in accoi Oark;e iiv.6 fife laws of the Commonwealth of f::iassachusetts. 10.3 This Agreement forms the complete integre .d agreement between NSL and Customer. The parties represent and warrant :hat in executing this Agreement, they are not relying on any represertalions, warra sties or terms other than as expressly contained herei i. f his ,Ag reerrient superse^es all prier agreements between he Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. You may cancel this Agreement it it has been signed at a place other than the NSL`s normal place of business, provided you notify NSL in writirg at its mair office or branch office by ordinary mail posted dy telegram sent or by delivery; not later than riidn ght of the third bus ness day following the signing Of this Agreement, See the attached notice of cancellation form, for an explanation of this right. 11. ENERGY BENEFITS. The Sponserrrg Utility Company (t)e Utility) is entitled to 1100% o'the energy benefits associated with all Energy Conservation Measures, ex::luding the value of energy cast savings by the Customer; but including all rights to all associated ISO -NE Energy. Capacity and Reserves °roducts, NSL agrees to provide the L;tlity with such fu then documentation as the Utility may request to corfirm the Utility's owmershOf such benefits and Products. 12. NOTICE CONCERNING SPONSORSHIP, Customer understands and acknowledges that NS_ is not an agent, vendor or sub -vendor of he Sponsoring Utility Company the Utility) with >espect to the installation of an energy efficiency measures. in the evert O the ?ailure of an energy conservation device to perform as expected, Custom ler's sole recourse is to Contractor and not to Conservation Services G'oup (CSG) or to tine Utility, The 'flry and. its operating companies shall not mar tic n, remove or perform any worK whatsoever on the energy conservation measures installed. Gwome understands and acknowledges th their pa: tijdpaton in the Vass Save Home Energy Services Program is voluntary and that they have co isernted for Contractor to install the proposed energy conservatior measures. Customer agrees that it shall not hold CSG. the Utility, their affiliates or operating companies fable for Contractors to perform: its obi!gations ui der this agreement, for failure of the energy conservation measures to function, for any damape to Customers Premises caused by Contractor or for any and all damages to property or injury to 13. LIMITED TIME OFFER. The prices and incentive offered. in this Contract are subject to change in accorO :ice ,vitt, The Sponsoring Utility Cornpany Mass Save tome Energy Senv.ces Prc;gram. offers. 14. CONTRACT CANCELLATION Under Massachusetts law, you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or a branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. ^., fit Mass Save Planview Diagram Customer MIgo �)i�a Advisor Name: j44drUt) Address '-to �e�Im�vad �� Advisor Number: 01:19 R yrs -ss�.f Town Al 0/19y6r Any limitations to access by truck? Site ID g 6% Z 1 7 y �® NOTES — 2`.fely sa - 2 � �-�Z �L - g�'Dl3G^ s52 t� V14+Tib i-� so 3 — 2 ® ICjJ-2 L.J JG r►+►* 1�,.. � $ 7 � �✓1 S �'�1�h - 2''� p ��' i Sa '_ 1 2 7' q 5��cc h 3o y A&c q -I tD 0 lJ g 1®nL roo H.9j t: 00 41 Arr er g 013 -a Me Commonwealth of Massachuselts Department of Industrial Accidents ®ice of Investigations I Congress Street, Suite 100 Boston, MA 021142017 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Awficant Information Please Print Legibly Name (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave Boston, MA 02210 Phone #: (866)867-8729 Are you an employer? Check the appropriate bozo 1. [] I am a employer with 850 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' come. insurance reauired.l Type of project (required): 6. ® New construction 7. ® Remodeling g. ® Demolition 9. ® Building addition 10.[] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.® Other Insulation *Any applicant that checks box #I 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 affidal 'it indicatbig 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 fob site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy # or Self -ins. Lic. #: AWC-400-7030025-2014A Expiration Date: 9/30/15 Job Site Address: 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 WORD ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage y6ytion. Ido hereby certify under the pains and en es perjury that the information ormation provided above is true and correct Si tune: Date: A ®/ 11/1 Phone #:46)71 -9_7ael Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/ Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: __ Phone #: NEXTS•1 OP ID: EL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYM 10/0112014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON�y AND CQNFE116 NO RIGHT$ UPON Pig WRTIFIRATF HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOVY. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), 4gT"ORIZER ROP FSENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMR RTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) merit be endorsed. If SUSROGATION Iq wAlV9Q, QBII.LB3 !19 the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to #IPp certificate holder in lieu of such endorsement(s). PRODUCER McLaughlin I surance Agency 828 Lynn felps Park oy Melrose, MA 02176 John E. McLaughlin 4r. CONTACT Erin Lyons PHOONE FAX fAIO. No ExI :781.665.2775 A/c No): 781.666.02 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL # INSURER A: Nautilus Insurance INSURED McXt Step �IVing, Inc. 21 Drydock Avenue, 2nd Floor Boston, MA 02210 INSURERS: Commerce Insurance Company 3475 INsuRERc:A.I.M. Mutual Insurance Co. INSURERD:AXIS Insurance Company 15610 INSURER E: INSURER F: LABVEt+tstt9E21 t9Ertt arIGAI E rttUMRER- WSMIRtnwr hatIMOLID. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYCERI D INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIF� Try®& 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. TR TYPE OF INSURANCE ® POLICY NUMBER PPAflOrILDD EFF fl9fl0A pCDP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR E;P2010198=12 09/30/2014 09130/2015 EACH OCCURRENCE $ 1,000,000 DAMACE TO RENTED PREMISES (Ea occurrence) $ 190r000 MED EXP (Any one person) $ 0,900 q PERSONAL &ADV INJURY $ }r A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECTPRO- F LOC OTHER: GENERAL AGGREGATE $ MP0104 PRODUCTS - COMP/OP AGG $ $ S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS 14MMOOKKOM 0913012014 09/30/2015 Ee ace den SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY Per accident $ ( ) _D PROPERTY GE $ Per accident $ ® UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS MADE EI,U783647012014 09130/2094 09/30/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 0.009 1,400 0 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYSTATUTE ANY OFFICERIMEMB R/PAR UDEy I N ECUTIVE ❑ (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N 1 A O BE ISSUED BY CARRIER 09130/2014 06/30/2015 X PER 0TH - ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FOR INFORMATION ONLY INFO -01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rinhlt; ra-rantarl ACORD 25 (2014/1) T(!fi AQQRP r(FIgIo q0 IRg>a¢® f, as g 9.f ACORP Massachusetts - Department of Public Safety Board of Building Regulations and Standards Coastruction Supervisor Specioitt License- CSSL-102811 ROGER A ®V1 LLYE T 55 STAIM®1R)Id Ili�A `�wamck IU 028"89 Commissioner Restdoted To: CSSL lC e [InsuWon Contractor Expiration 0901372016 Failure to possess a current edition of the Massachusetts Mate Building Code is cease for revocation of this licansee p,orr DPS 6Acensing infaffnzVon eiduEo ePMA9- ass.GAVMPS 0 CCf �0 W CA o r -i Fr -t ch �COCd 'V . Enaoo Cd 0 u 04 0 U 4-. 0 to 0 N P N 0 Lf O O UV- r- � o P (D P Co N 'r - a. > 4 tp C Pa.P O a0 c H M NX W m m LL Z t— (D O Z Z w> N >,r �QYQ wo� U LL> -p � LL wwr_0 ZCDc%jm mi 010 J a w X w Z