HomeMy WebLinkAboutBuilding Permit #560-12 - 43 HIGH STREET 1/24/2012 BUILDING PERMIT o* "°oT" qti
`St,_ ._46.6 O�1
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: �b Date ReceivedArgo
ACHus
Date Issued: b"111*.'
IMPORTANT:Applicant must complete all items on this page
LOCATION Lt--s ytk Ch �', f -�lr-& i4-_ 13ai� � MPLAC.V i
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OWNER �.\�
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MAP NO: PARCEL: ZONING DISTRICT: Historic District y no
Machine Shop Village QeJ no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Additio Two or more family Industrial
Iteratio No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
�uKLV0Vttl CSV `—'ate � �t`� C3�— j.� V�Y �v0�s•N
Identification Please Type or Print Clearly)
OWNER: Name: ;a\NQ4F, YL c,-,k , Phone: �ft \-I
Address: ��\!S <O t1 N��L� \.e \ S S Q-L-N,
CONTRACTOR Name: Phone:
Address: 3 1) S's \.r-\- K,qZ�s
F
Supervisor's Construction License: LA bb"�3 4--_ Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER ST`1qh.j-T-5 C— Phone: t V - -� 3" Lt2-SZ
Address:"L O-1 -ST, Z OJ` f' ) Reg. No. � "O ORO .
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ i- �� Z FEE: $ e 'O Q x11
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Age en�����ignatureofcontractor
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
c
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
I
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 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
NOTES and DATA— For department use)
i
A
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
i
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 BuildingPlans One To Be Returned to Include Sprinkler Plan And
( ) p
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 DE PARTMENT:BPFORM07
Revised 2.2008
Location `
No. sd U Date 2 y _
TOWN OF NORTH ANDOVER
0
F
419
}�o Certificate of Occupancy $
CHU t� Building/Frame Permit Fee $ -, 00 '
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # � ��-2
24973 /1 Building Inspector
xAORTii
T0VM of
• No.
S60 ° �� .'„W -tib:`.. •�.��,;a.. �,
to , dower, Mass., e
Y LAKE I.
/2 X
COCMICKE W ICK
�dSDRATED p? C)
11 BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
s
IV BUILDING INSPECTOR
THIS CERTIFIES THAT........ ... .. ... 0 0��......................................................
Foundation
has permission to erect.............:. g
buildings on ...�� ....�/!... ...�) ... ll..................................................... Rough
to ba occupied as
Chimney
provided that the person accepting this permit shall in every respect conform to terms of the application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final
Buildings in the Town of North Andover.
PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTION TARTS ELECTRICAL INSPECTOR
fRough
�. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do- Not Remove Rough
Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRE.DEPARTMENT
Burner i
Street No.
SEE REVERSE SIDE Smoke Det.
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LL.
NO
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LLJ LJ!0
Co
CA,
17��117
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4 �
Standard Form of Agreement between Owner and
RCG LLC where the basis of payment is the Cost
of the Work Plus a Fee without a Guaranteed
Maximum Price
40
r e
Date: rua 1 , 22
Owner. RO {�ortl A �a�rer MlI LLQ ,
x71Qo Streete
Qierl<11e 110. 2143
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Contractor: �ro �^ �
, 3 9
Architect: ill"PII
. ` ���
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Project Name: �tlpclty
r3
The Owner and Contractor agree to the terms stated by this contract. This contract
supersedes any prior agreements, representations, or negotiations, oral or written. No
liquidated damages shall apply to this agreement. This contract consists of the following
documents:
1. Obligations of the Parties
2. Contract Sum
3. Project Schedule
4. Signatures
Exhibits
Exhibit A: Estimated Cost of Work
Exhibit B: Project Schedule
Exhibit C: Drawings
Page 1 of 6
1. Obligations of the Parties
Obligations of the Contractor:
The Contractor accepts the relationship of trust and confidence established by this Agreement and
covenants with the Owner to cooperate with the Architect and exercise the Contractor's skill and
judgment in furthering the interests of the Owner; to furnish efficient business administration and
supervision; to furnish at all times an adequate supply of workers and materials; and to perform
the Work in an expeditious and economical manner consistent with the Owner's interests and in
compliance with all applicable governmental codes and regulations.
I
The Contractor shall keep full and detailed accounts and exercise such controls as may be
necessary for proper financial management under this Contract.
The Contractor shall keep full and detailed records of all books, records, permits, licenses,
correspondence, receipts, instructions, data, and drawings associated with the Project including all
Subcontractor contracts, invoices, vouchers, insurances, lien waivers, and other correspondence.
The Owner and Owner's Accountants shall have access to review, audit, and copy all Contractor
documentation. The Contractor shall retain these documents for a period of three years after final
payment.
The Contractor shall maintain insurance at the following levels with the Owner listed as a co-
insured:
Type of Insurance Limit of Liability
Coimmerc� l G�rreral L�ak��i $1s00�,Q8tl<Ot9
Upon request, and at the cost of the Owner, the Contractor shall obtain a performance bond up to
the total Cost of Work. Such costs shall be added to the Construction Volume.
The Contractor understands that the Project will be financed by a construction lender and, then, by
a permanent lender. The Owner may assign any of its rights under this Contract to the construction
lender and the Contractor hereby consents to any such transfer provided no such assignment shall
relieve the Owner of any of its obligations under this Contract, unless agreed to in writing by the
Contractor. The Contractor shall execute any certificates, lien waivers, releases, receipts, and other
documents as may be reasonably required by the construction lender or permanent lender including
a subordination of its mechanic's lien rights to the construction lender's and permanent lender's
mortgage or deed of trust. The construction lender for the Project will be:
,p
i
Obligations of the Owner:
The Owner agrees to furnish or approve, in a timely manner, information required by the
Contractor and to make payments to the Contractor in accordance with the requirements of this
Agreement.
Dispute Resolution:
Claims, disputes or other matters in question between the parties to this Agreement shall be
resolved by mediation or by arbitration. Prior to arbitration, the parties shall endeavor to reach
settlement by mediation.
Page 2 of 6
l
E
2. Contract Sum
Cost of Work:
The Contractor shall provide a detailed estimated Cost of Work to the Owner(see Exhibit A). The
sum of these costs, including the fee is as shown below:
Change Orders:
In the event of changes to the
The Contractor does not guarantee the Contract Sum in any form. e g
Contract Sum, the Contractor will present written changes to the owner for costs that exceed the
Contract Sum in the form of a Change Order. The Contractor will review all Subcontractor Change
Orders before submittal to the Owner and Architect and make a recommendation for payment or
non-payment. The Contractor's Fee will be calculated including any approved Change Orders.
The Owner, Architect and Contractor will negotiate disputed Change Orders in good faith.
Contractor's Fee:
15% of total construction volume up to$1 million, and 10% of construction volume over$1
million. This includes pre-construction and project management services, and field personnel and
associated management overhead. The fee is based on actual costs incurred, with final true up,
and is booked monthly in arrears. Specifically,
1. The cost of pre-construction and construction management services provided by RCG
personnel is booked monthly in arrears based on the hours reported by each employee.
2. Hours are billed at the standard hourly 9 billin rate established from time-to-time for each
employee.
3. The cost of pre-construction and construction management services provided by
independent contractors is booked when invoiced and carried within the fee.
4. RCG Builders personnel functioning as tradesmen outside their management duties will
be charged according to their hourly billing rate.
5. If a project is terminated or suspended by the Owner prior to completion, RCG Builders
LLC is compensated for the actual cost of services provided prior to receipt of notice of
termination or suspension from the Owner.
6. Total Construction Volume includes all construction trades, general requirements,
neou costs deemed necessary to perform the
insurance, bonds and miscellaneous ry
construction of the project, but excludes permits and fees. Permits and Fees shall be
paid directly by the Owner.
7. Construction management labor, standard tools and equipment, and labor-related
overhead are covered "within the fee". Specialty tools or equipment, trade labor supplied
by Builders personnel and approved transportation and meals costs shall be charged
directly to the Owner without a fee.
Subcontractors:
The Contractor plans to hire Subcontractors to perform the majority of construction associated with
this project. The Contractor shall provide the Owner and Architect information on all of the bids
received by Subcontractors and the names of the Subcontractors selected. Owner shall have the
right to reject a proposed Subcontractor; however, in the event that this leads to a higher Cost of
Work, the Owner shall pay for the difference. The Contractor reserves the right to reject any
Subcontractor, even if it is the lowest bid, and to dismiss Subcontractors from the job that have
been previously approved by the Owner.
Page 3 of 6
I
Payments:
The Owner shall make progress payments on the Contract Sum according to the Requisition
process described below.
The Contractor shall, at the conclusion of each calendar month on the project, present to the
Owner an application for payment(Requisition) for costs incurred during that month. The
Requisition shall include all invoices, vouchers, partial releases of liens, expense reports, and any
other evidence to support the validity of the Requisition amount. The Contractor may requisition
for completed, but unpaid work based on an expectation of payment upon receipt of funds. The
Owner, the Architect, or their representatives shall be afforded five (5) business days to review
such application and question the Contractor about its contents. In the event there are no
disputes, the Owner shall pay the Contractor within 10 business days of receipt of the Requisition.
Payment by the Owner does not represent that the Owner or Architect have made a detailed
examination of the documentation, inspection of the work, or verification of the accounting.
At the completion of the project, the Owner shall make a final payment to the Contractor based on
a final Cost of Work with a truing up of fees. If further corrections to work are required that are not
covered under warranties with Subcontractors, or that are not the outcome of negligence or poor
workmanship by the Contractor, the Owner shall pay the Contractor for any work associated with
performing the corrections based on the hourly rate agreed to in this contract.
Retainage:
The Owner shall not hold back any fees to the Contractor to ensure completion of the work. The
Contractor will be expected to hold back fees from Subcontractors to ensure their performance
based on the terms below:
1+D°I°of balled;-oss'`ur
WOW
csve ,,b ;>Gfi+ewner
Termination of Contract:
The Owner shall reserve the right to terminate or suspend the Contract at its sole discretion.
Within 15 days of termination or suspension, the Contractor shall present an accounting of all its
costs incurred for reimbursement by the Owner. If the Owner elects to proceed with the project
without the Contractor, the Owner shall have the right to assume the Subcontracts and
agreements related to the Project.
Working Capital:
RCG Builders shall not bear the costs of Working Capital for the project. If the Owner would like
the Contractor to gain beneficial pricing on its behalf by paying subcontractors ahead of the
Requisition schedule, the Owner shall either(1) put on deposit with the Contractor a sufficient
amount of Working Capital for the Contractor to pay these Subcontractors, or(2) make immediate
payment upon request from the Contractor outside of the normal Requisition process. Provision of
Working Capital shall entitle the provider to all discounts and savings associated with that capital.
Page 4 of 6
3. Project Schedule
Date of Commencement:
The Contract Time shall be measured from the date of commencement. The date of
commencement of the Work shall be the date of this Agreement, unless a different date is stated
below or provision is made for the date to be fixed in a notice to proceed issued by the Owner.
Contract Time:
The Contractor shall provide to the Owner a Project Schedule (see Exhibit B). This Schedule is
based on assumptions reached prior to the signing of this contract, which assumptions the
Contractor shall attempt to clarify in the Schedule. However, the Schedule always assumes the
Owner and the Architect respond promptly to requests for information and do not request any
significant changes to the construction program. In the event that the Owner or Architect find any
discrepancies with the Schedule or its Assumptions, they will promptly notify the Contractor, who
shall make adjustments to the Schedule as necessary.
According to the attached Schedule, the Contractor shall achieve Substantial Completion of the
entire Work as follows:
flate,a#;Sbstat�at Com let�otte,n;< afer. aaillfarchi 3't, 2t�1'2 z
The Contractor does not guarantee the date of completion. However, the Contractor shall not be
entitled to additional fees based on delays in the project unless those delays can be shown to
incur extra costs for the Contractor and were caused by the actions or requests of the Owner or
Architect.
The Contractor shall present an updated Project Schedule to the Owner and Architect on a weekly
basis for their review.
Page 5 of 6
4. Signatures
The Owner's representative is:
Dav�d,Ste�►ab f f tt'a
RCG I`lorfh ddo�ra�r 141�t11`s L,LC
17 Iveloo Stre�eSk�ie 1 }0.
Somerville,°I,A- 43
§ 14.4 The Contractor's representative is:
K�eranWhela�
Constiuct�or�''Silry�so
RCG LLC:
Iwaloo Street Suite
Sommerville,iVAA fl21A3
This agreement is entered into as of the day and year first written above and is executed in at
least thre original copies, one for the Owner, one for the Contractor, and one for the Architect.
Owner
Contractor-
ignature K I Signature
Printed Name and Ti Printed Name and Title
Page 6 of 6
43 High Street Suite320
Simplicity Salon
Schedule of Values
RCG Cost
1 General Conditions $2,500.00
1 Dumpsters $525.00
6 Carpentry $3,500.00
8 Doors&Windows $500.00
9 Drywall and tape $2,000.00
9 Prime and Paint $3,500.00
9 Standard Flooring $5,062.50
9 Custom Flooring $2,028.00
9 Kitchen Cabinetry $1,000.00
15 Plumbing $9,500.00
15 Sprinklers $800.00
15 HVAC Replacement $10,000.00
16 Electrical $2,000.00
Sub-total $42,915.50
CM fee $6,437.33
Total $49,352.83
Permits& Fees $600.00
Total Construction $49,952.83
`l.uissstcttt vl 10lur[ Mal ACClaents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aaalicant Information Please Print_
Le`
Name (Business/Organization/Individual): f Z 'L 6- (�
Address: 1 VV A V I Q
City/State/Zip;, So ",S� l 1 b Y9. Phone #: b 1-7 — b LJ
Are you an employer?Check the appropriate box:
1.r�I am a employer with 4. Type of project(required):
❑ I am a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance.
[No workers comp. insurance 5. 9• Building addition
' p. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.[] Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no
insurance required.]t l2.[] Roof repairs
q ] employees. [No workers'
comp. insurance required.] 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.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for
information. my employees Below is the policy and job site
Insurance Company Name: l5 C,•- a ��
Policy#or Self-ins.Lic.#: 4J W -3 0L k S
t I Expiration Date: S Q� ' -0 `A—
Job Site Address: °t lAt Crit <i N " /Iwo c��/u�
ity/State/Zip: tJO\U 19•&s
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 yp 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.
dd hereby cera y under the pains andd ppennaldes of perjury that the information provided above is true and correct
Si nature: ✓�f Date: 8
Phone#: -
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#•
ClientlF:29552 RESOD
ACORD- CERTIFICATE OF LIABILITY INSURANCE �JTE
=0118,M►1Irr,m
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSURANCE MARKETING AGENCIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
306 MAIN STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Worcester,MA 01606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
508 753-7233 INSURERS AFFORDING COVERAGE NAIL 8
IND INsuRERA: Philadelphia Insurance Companie 23850
RCG LLC INSURER B: Wesco Insurance Compan 25011
171valoo Street,Suite 100 �
Somerville,MA 02143-3656 IrLsuRFxC
INSURER :
INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EKPU-WW
LpIM
A GENERAL LIABILITY PHPK697768 03/20111 09/20/12 EACH OCCURRENCE $1,000,000
MCOM
MERCIAL GENERAL LIABILITY DAMAGE���N ED $100,000
CLAIMS MADE a OCCUR MED EXP one $5,0W
PERSONAL 6 ADV INJURY $1.0w0.0
GENERAL AGGREGATE s2 000 000
GEbrL AGGREGATE LIMIT APPLIES PER: PRODUCTS-CoMProP AGG s2.000.000
POLICY MPRG, Loc
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea aodd-)
ALL OWNED AUTOS
' BODILY INJURY f
SCHEDULED AUTOS (P-P—)
HIRED AUTO$
BODILY INJURY :
NON-OWNEDAUTOS (Perms)
PROPERTY DAMAGE $
GARAGELUBILITY AUTO ONLY-EAACCIDENT $
ANY AUTO EA ACC S
OTHER THAN
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
s
DEDUCTIBLE $
RETENTION S $
B WORKERS COMPENSATION AND W WC3021598 05115111 05/15112 X "'cTORV LIMIT anI
ANY PR EHHS'LIABILITY
IY E.L.EACH ACCIDENT $500,000
PR /PARTNERIEXECUTIVE
OFFfIICERIMEMSER EXCLUDED? EL DISEASE-EA EMPLOYEE SSOO OOO
SPECIAL PRO IVIS ONS EL.DISEASE-POLICY LIMIT 4000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATHOH
Town of North Andover DATE THEREOF,THE ISSUING,INSURER WALL ENDEAVOR TO MAIL -20- DAYS wrurTEH/
1600 Osgood Street NOTICE TO THE CERnIRCATE HOLDER NAMED TO THE LEFT,BUT FAHLURE TO DO so SHatL
North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABIJTY OF ANY KIND UPON THE INSUFAK ITS AGENTS OR
REPRESENTATIVES.
A REPRESENTATIVE
ACORD 25(2001108)1 of 2 a ES218272/M218270 GCE a ACORD CORPORATION 1988
Massachusetts- Department of Public Siufet%
Board of Building; Re!„ulations and Standards
Construction Supervisor License
License: CS 66334
KIERAN T WHELAN
31 RICHMOND ST
WEYMOUTH, MA 02188
list
v--
JExpiration: 9/26/2013
Commissioner Tr#: 6168