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HomeMy WebLinkAboutBuilding Permit #192-2017 - 45 BOSTON STREET 8/24/2016 ✓ FORTH (� �( , (� fro I/rJ BUILDING PERMIT ®�4t�E� .6��0 '1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * z 001 �omy� 1> Permit No#: Date Received qss?ATEDUS Date Issued: IMP RTANT: Applicant must complete all items on this page L�OC /agTl O�N] L• 4PRO,PERIT�Y ®41NNER¢. v _ f. 99 z OOZY Sfruc ure .yes, tno, PARCEL WvQ_�� Z®NING(DISTRICT 1Historic�®ist� ctt a es o i(MAS F`1` Z, k.��_. _ !_ t k w _ VAI Y h a AacA- Shop, 9.&,; y Ss, _ . n`y TYPE OF IMPROVEMENT PROPOSED USE Resid4fitial Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑8Kration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0{{Septic ® Wellp ����_ R �® FI©odplan� ®;�iWetlands. ®Watersied District ❑Water/ewer - DESC F �OR BEP RFORM Pon lit) Identifica ' n- ease Type or Print Clearly OWNER: Name: Phone: Address: cContracfor Name. � � A"dd�essdo -V1, U4 _ 4Supen/isor's Constructs.©nllLicense `C _. lE�xp, ®ateK.___1� � 1 tHorrek�Im rouementLicense� -_ __ _ _ _ xp 1®ate;__ �� E ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $1-0Q FEE: $ Check No.: WO I Receipt No.: NOTE: Persons contracting wzth un�egiste d contractors d naha, a ess to-the guaranty fund Location No. Date ( ti I • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 4 Foundation Permit Fee $ ,, Other Permit Fee $ TOTAL $ Check# Building 'Inspector, Plans Submitted ❑ Plans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumning 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 WEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes w� Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located _. DEPARTMENT s AFIRE D f ,A„I I Temp�tDum” ster,,oritsite^ yes 384 Osgood Street _ p 'tLocatedlatFil24iMainrStreet« Fire�tDepartmentsgnature/date - - - COMM ENTtS<._ j 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.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email IDate 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 o 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 JOTS: 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 o 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 TOTE: 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 TOTE: 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 NORTH Town of ,t 6 ndover O y" M No. a- l +� �'� t as _ o i. h ver, Mass, C9412A (6 COCHICHNW1CK '►. �•9 �R-tTEo I'Pa�,�S S u BOARD OF HEALTH Food/Kitchen PER IT LD Septic System THIS CERTIFIES THAT f %";,,,,,,,, V��C BUILDING INSPECTOR ..................................... .... ... .... ...... ............................................ has permission to erect ..... ................... buildings on As......... .. .... S*Q.Ai. Foundation R" Rough to be occupied as �r ,,,,,, +, � y p ............ A ........ .......... ...................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 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 ELECTRICAL INSPECTOR UNLESS CONS TIT Rough Service ..... ... ..... ....... ..... BUILDIN SPE OR.. Final GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. MA Reg 9 146589 20-2625129 CT Peg#0605216 P,I Reg 026J63 - -aATHIS GCNTRACT MADE THE_ N tho"n" Of M— .:I�- — A V:tnlilll-'i0l�- " use,("111) the"OIvre'CINJ • NEWPRO hereby agrees!hat It V"f4 for tnis 'd furnish;a:'latOf and mat slat neoasra Y!0 frillovor . d at,describeG Welk me Vy'g.ses Ca qP- � at -The+.vb address is a Condominium ........................ r. eir-, I Nc Y ES: L-; WINDOWS lsE-'--,S �rm T"L�4 L. C0\111%x QTY I nd'; C1 F�P Window color QT Screens: I vent latches' 1r ` E - -- i - 9. Ext QTY El'�1111 I., DOORS Canoin Colo, .5 PVC 5 NnMar 1 r 140 Cap, IVIE MODEL# Colo, in, ME NA Double rivag DWR: -N PIP UGE W 7;i H iWN r,- sae 2 Lite Slide., F-itry Doo- tYlt 3 Lite Slider Color in. 3 tAe SiAer FOW —"e Cas.rrej,j Ilt;ngej'WnhV HDWR: SN AGP S;delttes Style Tv,,,n cj53ernen! icirg,j, Slalior.zi, cart C-A'5�I • Storm Door to rliO COICT , jn� "ipfo HOWR: �,N A li Vicl VY INIM), I ME— vINANCF Le noa Rin t H;m 0 swif-I Orilv Entry Dooms Hopper color tn.. Cm AwningTOTAL thef6;;ns $1001 "D AC�Q All, Gja�e,en W;ndo�'----4---- RS CASH &1y Vjindow I,,af - PRICE SE Color In DPOS Other HOWR; WITH Other ORDER DESCRIBE WORK 8 ppoIV,0 TIONS APPLIED TOTAL Li Ve 0 Esr-Sten 03le :a of this Agreement. ' caner Gcrryp D-' owner ties r-zad and agrees to ji-le.terms and conditions on the front and the rever owner Total Cash Price.(2)work being performed:and(3)work not being performed made by NE'p,PRO. Cwl`101 has b---?n specifically?igns'es to the attachments contain all of the PrOmis'es ,. understands that this Agr"mant and any att-, .prio,b I midnight c the third business d0Y after the saction at any tir-1' � orally advised Of his right owtjer vias to cancel this prtranoyided-,Iith two(2) Ries of a sancellati:A'frrM expl:,;ning this flght da,,.of this L,ansactiOn and DO NOT SIGN THIS CONTRA-=T If THERE AP1 ANY BLANK SPACES.a Agreement if any of the spaces intended fort e Notice to buyer: (i)Do not Sign this ,1py 0,this (Rhode Island Sales Onlyk;of then avai(ohle Infor,11 are iei;blank, V-ij at"-;ltitle'%to a C, o€this agreed termi,to the exten*, belance due under t y at pny time pay off the full Unpaid t Agreement at the time You Sign it, 113)you"A's the linanre and Insurance charges. (1)The sellar and in So doing YOU may be entitil-d to receive a p..,rtial rebate 0,f repossess goods purchased snter your promise-s or commit any breach of the peace to -richt al'i-Ce has.10 right to unlawfully - ithas not he-n slanqd at tte main office zr bra .you ma.-j canccl this Agreement if _1,,,-,vn sit the Agreement by cf under this Agreement. (5) his Or 1,,,r main office 0 r vo.,r h off 1,q the seller,provided you notify the sellernt a thli-d calendar day aftor the day On it.which shall be posted I iat later than midni(;nt Of th which reg,qtered or certified ma Agreement,excluding Sunday and any holiday on IN , regular malt deliveries arc riot made which the buyer signs the notice of cancellation form')r an explanation of buyees rights- See the accompanying no iedge$receipt Of required Contractor's Registration and Licensing (Rhode Island Sales Only)-, owner acknow Board consumer education materials. (Owner's initials) -T�%D W r/ Product Specialist(p(mied Narn*) 8y / ��Olure) rg,LLC iPINK.File COPY GOLD Foance COPY RlIT14 - ,TV Rmnr"Copy CUSIOn"ers C4PY qfm 6001 Wight 39.zott4 0,7111 C0MPeM2:t-rfjn Iza-UrameeA' ffidalriftlt: Eli uz tI a fo Matt rint L&9LbjI Address- t/11 Areyo all employer? Chftkue'ippropriatebor. I. Type of project(required): 1 am a Mayer with 4. 111 am a vencral contmewr and I =3Pb'j`eM C&II=d/orpart-tft=)-1, havehfred ie-mb6. ❑New cownctjoxL -coutra=rs 2. 1 a-m a sold proprfe=or partner- listed on the attached sheetI 7. ❑ Remodeling 3h# and have no employeesemployeesThese mb-con&actom have j S. Demolidon wormer forme in my capacity- WO&M2 crance 5- We a OMPOration and its ,.NLO wort=' comn.lcu- M officers have=M-cised teir Building additkm offc 10-0 Electrical repair or adclitions 3.❑ 1 am I!Mmeovmar doing all wore right Of=Mmton per MGL 11.0 Plumbing repari s or addftk= m�-z,elf QN0 wwkers' comp. c. 152, §1(4)2 and wt have no 12 -:nice .0 wags cam. t CM3PI0Y=- N_, o Wolk=l 'Az JMP-Mnumce requil q•izoIic=t7:hjj I==also du am The secricM10clowshowke 4- a:aeo�ne��a��it�Sis s�asvit iadtceti�rbel'3tc 3oiag elI'pork�d thea lure oamide mrttractoss�vst submit a na?v aaaavit it�cat�g� vm=ze=mpms=,,policy bE==xtiaM- �a t7.c ors fix:t fie:;;Itis ocz axu�morsel 3d anal s$ectsfioar�g tTze ami ofthesah-camzlndots =dtheir-orkewco .Poke}'mfetraalioa I arc an anplayer that&F-Drav&Lng workers,comp=m!EoA Lruurancefcr my mnPLayeez- Below is the inJormctrBarz poLi?- and job site laz-umce CO=0 any Policy-r or Self-in.Lic. Expiration Dm: Job Site add=: j7 citystat&Zkj 2)1'40)60c -- Attach a copy of the workQre coi-, - ratty<< Page(showing the poffcy ammbx and Wh-aUeff Failuremsecure coverage as required tinder Secdou25A of MGL c-452 can lead to the ffilpodidon of criminal penalties of a and up to$1,500,00 and/or orte-year imprisonment,as wtH as dvil penalties ia the form of a STOP WORK ORDER and a find if up to MOM a day against&e viola= Be advised-dw a ODPY Of ft Mtcmmt may be forwarded to the Office of ave ligations of the.DIA for insurance coverage verffimtiom ------------------ 'do hereby ce e e ins and penalties OfPeliury th&the&fQrMad0RprW&d above is trice and correct. rumaaTe: 0 Date: Official use a*. Do not write In this area,to be comp[Md by city or town g City or Tovm, PermJVUcwe# 13SWng Authority(circle one): S,Board of Health Z.B1111ding Department 3.City/Town Clerk 4.Electrical Inspector 5Plumbing Inspector Mer Contact Person: Phone N. WINDO-2 OP ID:HI A`COR,D CERTIFICATE OF LIABILITY INSURANCE FD 0TE 7(MM/DO 07/18!201616 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 NAME: C Timothy Ward,CPCU,CIC Senn Dunn-GSO Y 3625 N.Elm St. PHONE/ Ext):336-272-7161 FAX No).336-346-1397 Greensboro,Ward, ,CPC ADOR1Ess:tward@senndunn.com C.Timothy Ward,CPCU,CIC INSURERS AFFORDING COVERAGE NAIC# INSURER A:Citizens ins Co of America 31534 INSURED Window World of Boston,LLC INSURER a:Allmerica Financial Benefit I 18 Shaver Street North Wilkesboro, NC 28659 INSURER C:Hartford Fire Insurance Co. 19682 No INSURER D: INSURER E: 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 I ADD L SUB LTR TYPE OF INSURANCE 1 S D POLICY NUMBER MM/DD ELICYFF MNYYYI WDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 CLAIMS41ADE ®OCCUR OB6790252707 04/01/2016 04/01/2017 DAMAGET RENT -D— S 500,00 Business Owners MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG S 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINEDccident SINGLE LIMIT S 1,000,00 B X Ea a ANY AUTO AW68757615 06/16/2016 06/16/2017 BODILY INJURY(Per person) S ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOSNON-OWNED PROPERTY DAMAGE AUTOS Per accident S S X UMBRELLA UAB X OCCUR EACH OCCURRENCE S 1,000,00 A EXCESS LIARcLAIMs MADE OB6790252707 04/0112016 04/01/2017 AGGREGATE S DED RETENTION S S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X S ANTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 22WECU2635 01/27/2016 01/27/2017 ELEACHACCIDENT S 50000 OFFICER/MEMBEREXCLUDED? ❑ MIA + Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE S 50D,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,00 •r DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 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. 1600 Osgood St.Ste 2043 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ���� �+ DATE(MMIDDIY r/1 C" CERTIFICATE OF LIABILITY INSURANCE 4/29/2016 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 policy(iss) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certairt policies may require an endorsement. A statement on this certificate does not confer rights to the l certificata holder in lieu of such endorsement(s). PRODUCER CONTACT NAME Melissa Pflug Nfa.ckintire Insurance Agency Inc A/CrN E (508)366-6151 FAC No `508)366-5202 L1 west Main Street AD�ss:melissap@mackintire.com INSURER(S)AFFORDING COVERAGE NAIC Westborough MA 01581-1931 INSURERA.Netherlands ;24171 INSURED INsuRERB:Libert Mutual/Peerless '.24195 Newpro Operating LLC INsuRERcAcadia Insurance Co. 26 Cedar St. INSURER D: ! INSURER E: Woburn MA 0180E 1 INSURERF: COVERAGES CERTIFICATE NUMBER-Master 15-16 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 OROTHERDOCUMENT WITH RESPECT To AHICH 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 MAYHAVE BEEN.REDUCED BY PAID CLAIMS. ILTR; TYPE OF INSURANCE POLICY NUMBER MOL'C EFF I MM/� EXP I LIMITS LTR i X COMMERCIALGENERAL LIABIL(TY ( 1,000,000 Cli J� El 6 100 00.0 A I LAi+.IS YI3CE I� REMISES E3 ircuRar.C3i 3 ! ^-SP8589577 .12/31/2015 12/31/2015 :. 5,000 dED P Ang Ire oer;or, s. j I PERSONAL 3.sDy N uP'I 1 ; 1,000,000 _.MI`s cL,E3==G NE=-LAGGPE A:7 3 2,000,000 ii j i I Dgr)DUCT3 --()MP/1;,P aGG 15 2,000,00.0 --JEe i AUTOMOBILE LIABILITY 1 i EGM IPI F7'SIH�,LE_MF 13 1,000,000 3ccdan[` i - , 3G.CIL I FL,UR(.Per aer,on i ' S A �rJ ,G ! L aL ;•raNED ; X I „JF—UL=D : BA 8584179 '12131/2015.12/3112016;300IL! tJ UR''.Per3xidertj —{ aL? ' i I �RVPERI r DAMAGE g I A X I,JVN-•Jb+TIED I � I �a -iIREr:aUT jd AUTOS r 3radert' �Jnnsured motonst91 a Iitlim,t S 250,000 X UMBRELLA LIAB X .),,CUR- SA.CH OCCURP,EPJ� 6 5,000,000 EXCESS UAB ,LgIMS-MAGE; I (AG3R.E>RTE 3 5,000,000 DEG TXRETENTIONS 10 000 ICO 8592578 12131/2015j12/31/2016I S `WORKERS COMPENSATION I I i PER OTH- AND EMPLOYERS'LIABILITY x 3T.4TUTE cR ANY PROPRIETORtPARTPIEPF-,<EJJTIIIE Y!N E�.FACH ACCIDENT C 500,000 OFFICERIM&OSER EXCLDED? I� N l A; C (Mandatory in NH) 9C-20-20-003506-02 5/1/2016 i 5/1/2017 __.-'ISEASE-EA EMPL="Ed 6 500 0.00 Ifyes,J9scnbe under i i f D oCRIPT!ONOFOPERA.T'GNSoalow ! i DISEaZE-POL!CY-.MIT $ 500,000 I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TO Whom it May Coacern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE T illoyr agh/DOPal"E O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 n0Ie01I r -Massachusetts Department of PuWlc.Safety . Board of Building Regulations arra Standards License: CS-029090 THOMAS PAUL FOXON 230-WALNi1T ST REAWNG MA 01867 l �` `� ✓� -Xplratjon: ' t,amrnissuoner iiM912017 A .011 - eeo � guSiess Reg lalx 1- pukyl_ua-Suite51? - - - — - � sty a:rb�uset s di 16 Home Improv p��°r Re m©z1 �.._1 Ra9lsUatton: 148689 Type: Sappl Md card — m Exptrattan: 5(5l2Q1T E p to OPERATING, LLC. T HOMAS �rOX41 26 CEDAR ST. i WOBURN, MA 01801 4 � �� �� aad n3turn��g reaaoa far ch$a;� e II �t„AddYe�s, O 0 xi Q I&glo C]Last card c�,&a monoaudfbrb* t 4_�°siY a� 1,G:ansa or regadr � rebs riicearCan9umea' BaBestne�cAegala- beforath004Wt�tiondatL iffottnd - wit E nPR CpNTpA=R Ofce of lcoaso mum ad Bye Rogutatian �` Type: 10 ParkJAM-Su[n0S1" [strali Suppwment C= Boston,KA o2ai6 PI NEUUPP.O OPERK-1 L- THOMAS Foxo? 26 CEDAR Not velfd withani sit 1103URN,MA 0801 tlad�s eeret9ri