HomeMy WebLinkAboutBuilding Permit #877-15 - 42 JERAD PLACE 5/5/2015t� BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Issued: 5
IMPOORRT(A.,NTj : Applicant must
LOCATION ` `--�`"'`w�\ �C12
Date Received
l&CA) o5�
all items on this page
V',�t Leo 16.�NO
0? 9` '•,, 6 0�
PROPERTY OWNER�JbvV \ P
Print
MAP NO:4 PARCEL: /L1 ZONING DISTRICT: Historic District yes no
Machine -Shop Village yes I 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
Watershed District
Water/Sewer
OWNER: Name:
Address:
CONTRACTOR Name
Address:
OF WORK T9 BE PREF RMED:
— c,,,Vc)ar02
F Type or Print Clearly)
(-� Phone:"7)21`
A,Cov� 140+�Ari . S
Phone.L4,f !U
Supervisor's Construction License: 10VA0 Exp. Date: -
Home Improvement License: a _Exp. Date:
ARCHITECT/ENGINEER 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: $ iQC�`�o FEE: $ -7JA
Check No.: /r`PZ Receipt No.:
NOTE: Persons contracting with unregi teYed contractors do not have access t e guaranty fund
Signature of Agent/Own Si nature of contractor
r
e
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/Crossection/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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2005
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 - Date
Doc.Building Permit Revised 2008
Plans Submitted Plans Waived 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
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:
FIRE DEPARTMENT - Temp Dumpster on s
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 3134
yes }C_ no
Street
o:
Location
No. �f 77- /5- Date
Check)&25-
d'� - — �
��. U I "!� /
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Building Inspector
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Submitted To:
John Distefano
42 Jerad Place Road
North Andover, MA 01845
Phone 4P 781-389-5456
Email: John@FirstFidelityAppraisal.com
Proposal date: March 13, 2015
Offices:
383(Rear) Lowell Street, Suite 2G
Wakefield, MA 01880
Tel: 617-571-9056
352 Main Street, Suite 3C
Gloucester, MA 01930
Tel: 978-559-7333
www.PeterRyanAndSonRoofing.com
Revised date: April 1, 2015 2°" Revised date: May 5, 2015
* �'
'' A
VV V ��,
Job Location:
42 lerad Place Road
North Andover, MA 01845
We are pleased to hereby submit this proposal to furnish materials and labor, completely In accordance with the below specifications.
(Additional charges may apply for any change's not included below in proposal either by request of owner, or if Peter Ryan and Son Roofing finds
unforeseen circumstances that will affect the performance, quality or integrity of this job). In the event legal action is taken to enforce any provision of
this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorney's fees. Not responsible
for debris in attic. ri�UsU1 �r1J� ilY����
• Cap ridge vent properly with manufacturers suggested cap (GAF Timbertex® or IKO Hip & Ridge 12)
• Properly flash any protrusions and all new pipe flanges, if any on roof
Clean Up:
• Will cover area with tarps to minimize debris and remove debris related to work
• NOTE: Please cover any belongings in the attic, as they will get dusty, if applicable
PAYIME T,TERMIS
CO tdetai. S:' Inciddes cost o rmit, It>b�br,,lulkn .8e mtaterial; -.
Strip MAIN a GARAGE roofs to bare wood and re -shingle: $6,010.00 (labor Onlyi
• Strip existing shingles down to bare wood
......
for rotted wood on roof decking, and replace as needed
• Nail down any loose wood
• Install ice & water shield to first 6 -feet, and in all valleys and around any protrusions
"
• Install premium synthetic underlayment (in place ofstandard 301b. felt paper)
g•
Install all new 8" white drip edge on perimeter and step flashing, where needed
• Install manufacturer suggested starter course of shingles
ama•
Install IKO or GAF Lifetime/ architectural shingles in color of your choice
• Install ridge vent
• Cap ridge vent properly with manufacturers suggested cap (GAF Timbertex® or IKO Hip & Ridge 12)
• Properly flash any protrusions and all new pipe flanges, if any on roof
Clean Up:
• Will cover area with tarps to minimize debris and remove debris related to work
• NOTE: Please cover any belongings in the attic, as they will get dusty, if applicable
PAYIME T,TERMIS
CO tdetai. S:' Inciddes cost o rmit, It>b�br,,lulkn .8e mtaterial; -.
w
- aYllllent$Clledu(e:'
ls` payment due upon signing: $1,821.00
Total Cost: SGAID.00
Total balance due upon completion: $4,249.00
Kindly remit payment to "Peter Ryan". Thank you!
Respectfully Submitted by: Accepted by:
Our craftsmanship is 100% guaranteed t 10 -years. A warrantees are through the manufacturer. All wary t s will be null & v if job is not paid in full.
Peter Ryan and oofing, Inc. License #178871 —Thank you for letting erve you!!!
cc: Evan
The C"atttttro.trrt�ertltdt cif �11�r.ssrrclrttr�#1s
Del)artrrtf? rt af'Irrtlrrsti,ial cclydetiis
r office ofInI,eSfi (IH0tts
r: 1 C'angressStreet, Sul e 100
'
Boston, 11L4 112114-2017
10 01". trr (ISS' gory dia
Workers' CompetYm ion Inst r,utee Affidavit: Bail(]et,s/Cotitraetot,s/Eiectr"ici,iiis/Plxiinl)et":5
Milue (Business!argar iz tioti/It,drv.idiial): Peter Ryan and Son Roofing, Inc.
Address: 383 [rear) Lowell Street, Suite 20
Cityistattr/Zile: Wakefield, MA 0188.0 pllollC #: 617-571.9056
Are yovi an ernplover' Cl gcI. the appropriate box; T'Te of project (recltrl:rTcl):
1. ❑I I turn a employer wit -11 4• ® I am a getreral contractor anct I
err11)Ioyees (firl'.l'. and/or part-tarue).
'F 111 e .lured the strb-contractors 6. ❑ New construction
. ❑ I am a sole proprietor or parttaea°_ lister on the aatta.claed sheet. 7. ❑ Reniocleling
ship and. have no enrployee.s These sub -contractors have S. F-1 Demolition
working for me in any capacity. errrployees and latave vvorkers' C). F-1Barilding addition
[No wo kers' conala, irr.stir•atrce corrrla. irrsurance.l
reC111ir'Z&j 5. F -] Weare a cor>onatio.n and its 10.❑ F:lcctrical repairs or additions
. ❑ I am a bomeommer doing all vvo:rk officers lt1we exercises) the r• 11.7 Plurrrbin� repairs csr additions
myself, [No workers' comp. right of exemption per IvfGL 12.F-1 Roof t'epai.r's
insurance recltdred.] t c. 1.52 51(4). and vase lirave no
employees, [No vvorkers' l:i.❑ Other
coraaT7. iTiSlr'arlce 'equrt"ecl.�
Aily must also fill out the WC:tioll Below shovi'hig their workers' C. nipe.tisation policy in -formation,
t l' cmieoT vmers who sub -mit ;ire doing fill work inn thea)lire outside contractors tlltl,st submit i flew affidavit indicating such.
1' Contractors that check this box niiist attached an additional sheet showing the name, of the scab -contractors and state vvhetlrer or not those enlities have
eniployees. If the sub-contxictors haveemploye.es, they most provide their workers' coin- policy, number,
In in an enrplgyet, t car is providing )t"orkem' compensation nr iii,frtrce fot, rrry employees. Below is the policy andjob .rite
trrforrnaHon,
Insuratice Conn-nnnyNaalie: N/A (I am not required to carry W.C. as I have no employees) Please seethe Sub -Contractor's W.C. affidavit attache
Policy # or Self -ins. Lic., ;�; N/A1~xpiraatinta Date,
Jot) Site Address: (�a
��dd� � C p� '
... /. �_. -. _ C:'in.'GttitejZip;&. o
Attaarli a copy of the ai,orker°s' cornpensart#ori policy tleclar;ation page (showing the policy rniml)er and e-,piration elate).
Failure to seduce coverage as recliairecl rurder Section 25A of .MOL c. 152 can lead to the irnpositi.on of crirrrinal penalties of ai
fine tip to $1,500.00 Ind'or one-year in.rprisonnaent, as we.11 ascivil penalties in t1le fo:rin o,f.9 STOP WORK ORDER and a fine
of ftp to $250,00 as clay against the violator- Be advisecl that a copy of this statement may be .forwarded to the Office of
Irrvestigations of the DIA for insurance eoverlge -"cribration.
I do hereby cf,'v r j- rr.rrder it epft: rrs frtrd pelfalties ofpeljury Nr:at the Infornrntlon pi,oi,lded nboi-e ft trrle (1111) rcanre t.
r �r-
Phone 4': 617-571-9056
Official rr c=ttonly. Ito not )-vl,ite in th.ls' area, to be ronipleted, Al' ei)" or• towl.1 offrrifrl.
City or Town.
Per nutiLkense H
Issiting .i-icr'thority (circle one).
1. Board of Health 2" Barilding De.parftnent 3, City/Town Clerk 4, Electrical Inspector 3, Plt1111. iirg Inspector
6. 'Other
Contact Person;
Plaotr:e #;
The C:'oin, m.onwealth ofMa,sstichit sells
17
T eptirtinent gfIndiistrl'alAccr'tlenIs
Uft fce of.Investigtrtrons
1 Co tigress Street, Sidle 100
Boston, 111.4 02114-2617
` s tr�ivly, fi•rrrs-s.govAlltr
Workers' Compeiisation I.rrsmmice,Affi.Atavit: Bid Id ers/C mi tr-,i ctoVEler.tririnns/PhiJnbeI'S
ApIlItcant Inforination. Plerlse Fri rt Legibly
Na111e
Lema Construction, Inc.
Atidt'ess: 7'I Prospect Street
C1
Biockton, MA 02301 Pllulle #: 508-232-1194
Are you all employer? Check the appropriate
boli:
1, ❑■ I am a elllployer with 10
4. ❑M I am a. oerleral collti'actor acid I.
einploym (Rill and. of part-tlllle).1'
Inve hired the sub-contrnctors,
2. ❑ I dill a. sole Proprietor or partner.
llstec.I on the attached sheet,
s . anti have no employees
These su 7-eolltractors have
working for me 111 any capacity,
employees and have t orktrs'
[NTo lvorkers' conn), ilmirance
colllp. illsurmlec't
required.]
5• ❑ We are a corporation slid its
3. ❑ I am a hollleomler Joint; all Nvork.
officers have exercised their
myself. [No workers' comp.
right of cxenlptioll per h•ICfL
insurance rc uired.j t
c. 152. §'1(4), and Nve have n.o
employees. [No ivorlsers'
i01111). illsui-mice reallired.l
Ty1re of project (required):
6, E] Ne\v construction
7. Remodelirig
S. ❑ Demolition
9. ❑ Builc-lirig addition
10,0Electrical repairs or additions
11.7Plumbill?, repair or additions
12,7 Roof repairs
131-1 Other
*.arty applicant that thetics bore #1 inust also fill out the section below showing their workers' compensation policy inforrnation_
t Homeowners who submit this affidavit indicating they are doing all wovk mid then dire outside contractors must siAnnit a:tiew affidavit indicating such.
'Contractors that check this box must: attached an additional sheet shotviug the name of the sub-coutractors and :state whether or not those entities have.
employees. If the: sub contractors have employees, they must prvvide their workers' comp. policy number.
I aart an ernj)h vei, that isprovidhig rt!oriGm" conipmnsration Insrarnrree fvr my, era4pioYee.s. Below i's the polfry and job site
111f01'11tatlon,
I11stlrance. CorlapanyNallle: Insurer A: Northland Insurance, Insurer B: Arbella Protection, Insurer C; Travelers A/R
Policy it or Self -ins. L c. ; 6S60UB-5886069-2-15 Expinition Date. 03-01-2016
jot) Site Add1'eSS:,..`*.,J. ty��'
Statea`Zll)'
�1
Attach is col)y of tine `corkers' cornpeusatioil policy declaration page, (sho:lj7ug the poiic)- uumbel, anti e-NPIratiolt clatte),
Failure to sectile coN`erake as requil'ed linder SCction 25A of MGL c. 15.2 carr lzad to the imposition o:f crullillal penalties of a
tine 111) to $1.500.0{1 ca1.l.CI%or' One-year illipris"nilllellt, t11; Nvell as civil laemilties in the form of a. STOP W OP\K ORDER imid a fide
of tip to $250,00 a da.y agaillst the violator. Be advised that a copy of this statement may be :forwarded to the Office of
Investigations of the DIA for insurance coverage verificat.iorl.
I do herebh certify if Mer the praim
Phone 508-232-1194
that the hi/orrriation provider/ above Is trate mid correct.
Official use only. Do nor tprite In dais area, to be completed by city of, town vff`rciaL
City or Town:
Per mIt/L:iceus:e 4
Issuing Authority (circle vire):
1. Board of Health L Building .I epartineut. 3. City/Toavir Clerk 4. Eleetric.aI Iuspec:tor 5., Plumbing Inspector
6, Other
Contact Person:
Photle 4:
E (MM/DDrYYYY)
�? � CERTIFICATE OF LIABILITY INSURANCE �DAT04/09/2016
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 pollcy(los) 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 cortlflcato does not confer rights to the
cer(Iflcate holder In Ileu of such ondorsement s ,
PRODUCER CO TACT Jo e M Keller
MassPay Insurance Services, LLC PHONE —JoW Fax
27 Garden Street, Unit 16 U (878) 774.4338 x115 i (Arc, Nc): (978) 774-1318
DamerS,MA01923 ADDRESS: Joyce@masspaftsurance,com
INSURERS AFFORDING COVERAGE _ NNC N
_ INSURER A: Northland Insurance: NOR
INSURED Lema Construction, Inc INSURER B : Arbelia Prolection —�-- 41360
Jesus Lema TRAVELERS A/R TRC
71 Prospect Street INSURER C : —� _
Brocldon, MA 02301 NsuRER D
COVERA(;Pc CERTIFICATE Nl1MRFR- Pr;\IICIn AI All IAARPR,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW I.1AVF BEEN ISSUED TO THE INSURED NAME() ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMEW, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AfFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE .TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN RFD_UCF.D BY PAID CLAIMS,
:NSR7U1317
LTR
TYPE Or, INSURNVCF.
ACCORDANCE WITH THE POLICY PROVISIONS,
SUER
—
mom' POLICY NUMBER —
POLICY EFF POLICY EXP
(MM/DD/YYYJI (MMIDD/YYYY
_
_ LIMITS
A
GENERAL LIABILITY
WS236181
01/31/2015 01/31/2016EACH
OCCURRENCE
$ 2,000,000
\ COMMERCIAL GENERAL LIABILITY
CLAIMS•MAOE F71 OCCUR
DAMAG E NT _—
PREMISES (Ea occurrence)
$ 100,000
MED EXP (Any one person)
S ' 5,606
_
PERSONAL & ADV INJURY
$ 2,000,000
'
GENERAL AGGREGATE
$ 3,000,000
j
GE/NL AGGREGATE LIMIT APPLIES PER:
PRODUCTS • COMP/OP AGG
S 3,000,000
I
V POLICY PRO• LOC(
$
6
AUTOMOBILE LIABILITY
1020009274 _
11/2812014 11/2812015
CEOMBINEO,SINGLE L Mrr
11000,000
BODILY INJURY (Per person)
$
ANYAUTO
ALL OWNED V / SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accidonl)
$
HIRED AUTOS AUTOS �OWNED
A
PROPERTY t) MAGL
(Per accident)
UMaKELLALIAB OCCUR
EACHOCCURRENCE
$
AGGREGATE
$
EXCESS LIAR CLAIMS -MADE
DEO RETENTION
(!
WORKERS COMPENSATION
5S60U6.5686069-2-15
03/01/2015 103/0112016WCSTATU•
. JOTH,
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORUPARTNEWEXECUTIVEE.L.
OFFICERIMEMSER EXCLUDED?
(Ni andaloryIn NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
EACH ACCID EM'
E.L. DISEASE • EA EMPLOYEE
$ SOO,000
$ 500,000
---
E -L, DISEASE • POLICY LIMIT
S 500,000
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Romarks Schedule, I( moro space Is required)
Proof of Insurance
_..._._._..J
(;PH nFIRATF wnl nFR r'`Anir`9I I ATW)hl
(D 1988.2010 ACORD CORPORATION, All rights reserved,
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIFS BE CANCELLED BEFORE
Peter Ryan and Son Roofing, Inc
THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN
383(Reer) Lowell Street
ACCORDANCE WITH THE POLICY PROVISIONS,
Suite 2G
AUTHORIZED REPRESENTATIVE �c�
—I
a
Wakefield, MA 01880
I
(D 1988.2010 ACORD CORPORATION, All rights reserved,
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
HIC#: 159106 Jesus Lema
_._... ..._ _.. C�o `Gr.mrnnnnr�i/I/ �%6i'�r.i;,ra/K:•I/i
Office or Conwrner .friths A Bu+lucsa ltegulnnuu
1 OME.IMPROVEMENTCONTRACTOR
ooislration: 189108 Typo:
xPlration; 3131/2010 Private Corporatic i
LEMA CONSTRUCTfON.INC.
JESUS LEMA
71 PROSPF'Cf ST.
HROCKTON, MA 02301 – zr—
llnderseerchury•
LICENSURE
Lema Construction, Inc.
Llconse or registrntfon valid for indh•idul use oni}•
hetero the oxpirntlon date. iffound return to;
orrice of Consumer Affairx it lftill noss 13cguln1iml
10 Park Plats - Suite 5110
Boston, MA 02116
Not valid without signature
V1-".'v'RExpbatlon':
ffairs A• Ossluess Repnlallou License or rcglstrntionvalid for hulivldul list, only
ME IMPROVEMENT CONTRACTOR. before. till, espiratga dale. Iffound return toe
Office of Consumer Affai s and 8usinesit Regubition
o0iatratio189106 TYPO' 10 1°ark 1'Iaza - Suite 5190
313112.018u fontent✓artl
VP Boston, Al 02116
LEMA CONSTRUCTIOWNC.'
,LAMES 0ONERTY
71 PROSPECT ST. rss,.✓•- y�l__...._
BROCKTON,MA02.301i – --
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LICENSURE
Peter Ryan and Son Roofing, Inc.
H11C#: b788,71 Peter Ryan;
,�,u ltlricr of Clnnxumer kfGWirs & ILnincs RrUnlanan
pMEIMPROVEMENT CONTRACTOR
olstntion: 178871 Typo;
xplrallon: 012 812 01 8 Corpore0on
PETER RYAN & SOWROOFING. INC.
PETER RYAN
383 (REAR) LOWELI.ST. SU1'lF 2 ;,✓..-...e;kdi�.....-
CIAKEFIELO, MA 01850 ' Undersecretary
CS Ucens,e# CS, .104,865.:
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Const ucliun Supervisor
License: CS -104889
CLINTON A GALV4i s•
j
229 W-01 SttrooC i
I
Wakefield 5l Of880
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Expiration
Colmnissioner
07/01/2016
Uecaso or reglsn•nllon valid fm• indivldul use onh
befere itio expiration ttate, if found return lo:
()flicc(if Cousnmer Afrill I's tool Ilusiucss Ilcgulath,n
10 I'nrk 1'Inxn • Sutrc 5170
130s10n, MA 02 fl6
Nnt satlld Willy tsignnturc.
AM'SORMATION FROM COM?,ACTORS FOS, SEs' FARnW TO
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COWANY c�^
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DATA !
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