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HomeMy WebLinkAboutBuilding Permit #658-2017 - 458 JOHNSON STREET 12/20/2016BUILDING PERMIT ( TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: COSF '—� 1 Date Issued: (7 1 N 1 &110 IMPORTANT: Applicant must LOCATION cl51 t-Pln500 '57 - PROPERTY i PROP T OWNER_ MAP PARCEL: z -a CA r FY rnTr r Date Received all items on this r 10RTy\ 0 1 Print 100 Year Structure yes no ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition 0 Two or more family [I Industrial 0 Alteration No. of units: [I Commercial ❑ Repair, replacement ❑ Assessory Bldg or Others: w,-4 —r t'e�' 104 &- ❑ Demolition [IOther ❑ Septic ❑ Well 0 Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer DESGKIF I IUN UI- VVL)MM 1 U aC rcr<rvmnw. T'T�C Sia�`Pwtll C',-//r//es���?t��('i0P w9t/5 C1'080"R�'�5 Identification - Please Type or Print Clearly OWNER: Name: mo., ra e'C� r Pr A i rel- Phone: "1�1- ��o" 9��'-• Address: (-/S-k 701.n51 V, 5i /I of i t, /andovtr Pete- LeWaitc Contractor Name:Esixi S& Phone: Email: Pla- M 615 Address: • Supervisor's Construction License: /0G n t Exp. Date:---LF/--/,-F y� Home Improvement License: /0 ARCHITECT/ENGINEE Date: )_ d �� 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: $ X15 0 0 D FEE: $ Check No.: � ! Receipt No.: - (DLI NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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: Located 384 Osgood Street FIREDEPAR=TMENT - TempDumpster;onsite ;yes +no _ �.� - hocated;at'.12, Main.Sti'eet FirelDepartment 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine 2 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 TE: 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 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 2012 I ECC Energy code 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 Location d 3 : Z, P s w I C i", �"F - No. � SD - 2 01-7 Check # 0 I %J Date 12- - ?-'Q - � 0 /& TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Building ln�pector V r L V, rA O J U. O d' Q m tm Y Y \6 O LLO a N ;N Q Ln O U Z Z > O ° N C L00 7 LL O �' N CC C U LL OO W Z Z m C C > d t O LL d Z a V L.7 W W Lto OC 4J v i (n = LL O a Z H Q Lon 7 1' — LL Z W a W W LU LL N i m O Z v N (% v Y O {n G o W IL co Z C9 Z m U) C o� G co z V w ■ CL Cl) w0 U �c W a z • Ai ti E O z CL O (A 0 � CU Co �o� U- E ca i W 0- 0 CD ' O cc c Q CL Q �Q O � � M Co A-) J -0 .CL O rzC O CL V U) CL U_ 0 ' RISE Engineering Contractor Regist atlon No No CT Registration No MSE A division ofThidseb Engineeft CT �°n°�`°r °" ENGINEERING 60 Shawmut Unit #2, Canton, MA CONTRACT (401) 7843700 FAX (401) 784-3710 Page T PROGRAM CMA-HES A u�xaro saMweinmacAa OaSCat6�BELOW CUSTOM ---- — DOTE sums v�oaxortoEn Monica Carpenter o (781)710-9063 01202016 428113 00003 458 Johnson Street anc 458 Johnson Street SERVE QTY. aTATE,LP .. _ - aaLa4 arf. STATE. EP— North Andover, MA 01845 "21 North Andover, MA 01845 B DESCRIPTION PHASE TWO - Proposal for next years weatherhatian project. Prices and program incentives not guaranteed. 50.00 ATTIC ACCESS: Provide labor and materials to insulate the back of the attic door with 2" rigid Thermax board and seal the door's edge with weatherstripping to restrict air leakage. S73.91 STAIRWELL: Provide labor and materials to install Class I Cellulose insulation to the sheetrock or plaster ceding wWor wails of a stairwell which are common to heated space, through a surface dell and plug method. The holes are plugged with styrofoam plugs. and spacided to a rough finish. Any sanding and painting required are the customds responsibility. S175.00 WALLS: Provide labor and materials to install blown in Class I Cdhdose to (30)square feet of exterior wails through an interior surface drip and plug method. Plugs will be spackled end tett with a rough finish. Finish sanding and touch-up priming/paiming will be the customers responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead -Safe information guide explaining the potential risk: of the lead hazard exposure from the weatherization wok to be performed. Your signature is your admowedgenient of receipt and agnomen to proceed. 560.00 WAILS: Furnish and install blown in Class I Cellulose to (465) square feet of shingle andlor clapboard exterior walls. The bun of the upper course of your wood siding is cut to drill holes into the wall sheathing behind. The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails. Touch-up painting, irneeded, will be the cuustomees responsibility. Invoicing will occur upon eenplWon of installation. Homeowner has received a copy ofthe EPA's Renovate Right Lead -Safe information guide explaining the potential risl- of the lead hazard exposure from the weetherization work to be performed. Your signature is your acknowedgement of receipt and agreement to proaxd. 5860.25 RISE Engineering will apply all applicable, digible incentives to this contract. You will only be billed the Net amount. Currently for eligible measures, Columbia Gas offers 75% incentive, not to exceed 52,000 per calendar year, and an incentive of 10096 fm the Air Sealing measures up to the fust 5680 and an additional S340 if savings are justified by the auditor. For the safety and health of your homes indoor air quality, we will be conducting a blower door diagnostic of the available Our flow in your home both before the work is begun, and after the weatherization work is complete. We will also conduct a full assessment of the combustion safety of your heating system and water beater. This has a value of 590 and is at no cost to you. Taal allowable weatheriTation incentive is 53.110. $90.00 = E 0 D1 :IF JUN 2 4 2016 n F 0 # RISE Engineering FU Coe&wW ft=Wr RqbWdftft NO F;h MACanbactor Regisftw 0No ISE A d1vWon of Thitbcb Eoffineedog CT Cwftctw ReffisMw No ENGINEERING 60 SIm mut Unit #2, Cum, MA (401)790700 FAX(401)794-3710 CONTRACT Page 2 PROGRAM T"Counvors 0 rewfoarromme CMA -HES 090MOMAM CUSTOURNRYOMAS CESCRmenflam LtimTowsR PH= OATS Monica Carpenter (781)710-9063 0120/2016 428113 00003 iE� i:iiiliF SUM FIRM 458 Johnson Street 459 Johnson Street North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION Total: $1,269.16 Program Incentive: .$966.87 Customer Total: $292.29 WE ACRE MMOW TO FURMSH SOW= - COMM IN AtxORW= WITH ABOVE St MW=TWft FOR THE SUM OF ***Two Hundred Ninety Two & 291100 Dollars $292.29 tOMFWAL =PWYMAMAMMALMMENOMMUM CUSTMMA=MTORMffAMMOMORPULLOITMWCWi%VftLBEMARMUMMYMAW UiPAM MLMMAFTM30UMqURM=F=0w=T X WffMt =ON 0MRNIMM MOMOF ROOM 30=WW- AWCOMMM Reat"Umm DO NOT SIGN THIS CONTRACT IF INEIM ARE AM MAW SPACES C Nathan Weiss r& IL F EXECUTO DATE tW(0WF C=MRWIT - IrM AWN MCM M� I .1p DAYS. �ITOUSAMMMKMWACCBnMVWMMMMWMMMDODMW= Ad 00 1'j G// il « RISE60 Shawmut Road, Unit 21 Canton, MA 020211339-502-M ENGINEERING www.RISEengineering.com I OWNER AUTHORIZATION FORM r Name) owner of the property located at: (Property Address) d� I "[ftrM4 Digs (Property Address) hereby authorize L0 ( C, I- I j t A Jr- .L ✓15 1c, (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Y Owner's nature aLCIL Date The Commonwealth ofMassachusetts - - -Deparhnent Q.fIndustrialAccidev& IV , Office oflnvenVations ke Ji 1 Congress Street, Suite 100 Boston, I'M 02114--2017 www.massgov/dia Workers' Compensation Insurance Affidavit., Builders/Contractors/Electricians/Plumbers ucant Ynformatian -� .mac i i aus J.r D1Y Name (Business/Organization/Individual): pR c p 1Ng1 11 ATIM Address: PO BOX 958 A VER {IAA 01810 r Phone#: e yon an zmproyer? Check the appropriate box: 1.9 I am a employer with 4. (] I am _ a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet I ship and have no employees These sub -con -.actor.- have working for me in any capacity. [No workers' comp. insurance employees and have workers' required. j 3. ❑ I comp. insuranee.t 5. [] Rre are, a corporation and its am a homeowner doing all wot33xt officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] i C. 152, § 1(4), and we have no employees. [Ivo workers' COMA insurance required ) Type of project (required): 6. Q New construction f. ❑ Remodeiing 8. E] Demolition 9- (] Building addition 10.0 Electrical mgairs or additions ..1.0 Plumbing repairs or addifions 12.❑ Roofrepairs 13.0 Other *may applicant that :.heclabox -1 must also fill out the section below showing their workers' compensation policy in%nnahon. Homeowners who submit this affidavit indicating they are do aloutsidel _ new tCnnhmctors that ch?cl; the box const at ached zn 8Mtional shed sh wwiona the rine a to sub -c acontractors =daft ustm . teethe: urnbmk tho- mecatingsucb �,y game empioyees. If the sub-connactors Have employees, they must provide their workers' comp. policy aumbec F,. ,•• -u= w••pE=�j'er EnT 4S pTOv'Mg workers Co;:u�enssti9Yc �7si[r�ilr�e jCP iivpinyeys. �edo::� i8 tl:o 1 information. policy and ob sit° Insurance Company V ('4 h re Y Fol, ; # or Sclf-ins. ,r ic. #: ?Oyl C i,� - Expiration Date: VIA ��_ p 1 � Jot; S,tc Adds-ess:�,�� �V {� r so n S i �• • s �ttyl�tat�iZip: GI . r9r.� ✓!�� 'k titch a copy of the workers' compensation policy declarationh sowir, s as re page (showing Me Policy number and expiration date). Failure to secure cove ge quired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Erne up to $ i,500.t)0 and/or One-year irtpr'sonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violaror. Be advised that a copy of this statement miry be forwarded to ttie Office of Lrrve-stigations of the DIA for insurance coverage verfficaiion. do hereby cerci u tdeF the Pa4fts anti ena&ie-r of er'ury brat Elie ut orination Provided above is fry p .�e and correct. Si azure: t�- 'Date. Phone #• Cj i,F- N o) - 7 G -?.4 Jcial use only. Do not write in this area to be completed by city or town official City or Town: Permib icense # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical ins 6. Other pector 5. Plumbing Inspector Contact Person • Phone#: A VRU CERTIFICATE OF LIABILITY INSURANCE DATE(MWMNYYY) TYPE OF INSURANCE 6/10/2016 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 ADD17IONAL INSURED, the policy(ise) must be endorsed. 9 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 endorsemen s . PRODUCER Insurance Solutions Corporation COANTACT Linda Bogdanowicz PHONE(603)382-4600 FAX No:(603)382-2034 60 Westville Rd ADDRESS: lindab@isc-insurance. cam ADDRESS. INSURER AFFORDING COVERAGE NAIC # Plaistow NH 03865 INSURER A 'Western World INSURED INSURER B Nautilus Insurance Group Polar Bear Insulation Company Inc PO Box 958 INSURER C: INSURER D: INSURER E: Andover MA 01810 INSURER F: wVr_MAwts CERTIFICATE NUMBERCL1632326134 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. ILTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF M YYI POLICY EXP IMWDD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CMMS-MADE $ OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 NPP8274967 3/24/2016 3/24/2017 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: R POLICY ❑ JEcT F]LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPlOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL AUTOS ED AUTOS ED BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Paraccide $ $ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1 000 000 B EXCESS LIAR CLAIMS -MADE AGGREGATE $ 1,000,000 DEO I I RETENTION S $ M026107 3/24/2016 3/24/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? NSA PER 0TH_ STATUTE ER E.L. EACH ACCIDENT $ EL. DISEASE- EA EMPLOYEE$ (Mandatory In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached tt more space Is required) Town of North Andover 1600 Osgood St, Ste 2032 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 th Maglia/SJA� ©1988-2014 ACORD CORPORATION. All riahts reserved_ ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025tmimii 6/10/2016 Preview: Certificates of Insurance CERTIFICATE OF LIABILITY INSURANCE DATE 11tNUDDnYYY) 06110/2016 THIS CERTIFICATE 1S 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 the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does IS WANED, subject to not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER N= Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevardae NoRoseland, NJ 07068 INSURED POLAR BEAR INSULATION CO INC PO BOX 958 Andover, MA 01810 NorGUARD Itlstoancc C=,, a COVERAGES INSURER F: CERTIFlCATE NUMBER: 503587 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 1NSUREDEN NAMED ABOVN 11 11, 11E 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. .TR TYPE OF INSURANCE INSV WVD POLICY NUMBER 1111101: 1,111 GENERAL LIABILITY MWDDIYYYY MIDDIYYYY) LIMITS CLARAS•L1ADE � OCCUR EACH OCCURRENCE S ri SHOULD BEFORE THEEXPIRATION DATE �T EREOF,ENOTT CEIEWIBLL BE DELIVERED N ToWn of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood st 1 suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25 2014101 AU 1988-2014 AC ) The ACORD name and logo are registered marks of ACORD MED EXP (Any ono Wwnl 5 GREGATE LIMIT APPLIES PER: PERSONAL B ACV INJURY S CY [:] JEC ❑LOC GENERAL AGGREGATE S OTHER-. PRODUCTS. CCM"P AGG S ILE LIABILITY S UTO Ilia acadm1l S :+'NED SGlEOULED t7—R S BODILY INJURY (Pts Pelson) S AUTOS AUTOS O00VT1ED BODILY INJURY(Pts accident) S Wer Mcide10 S ELL.ALIAB OCCUR S SS UAB CLAIMS-LUU)ERETENTIONS EACH OCCURRENCE S AGGREGATE S COMPENSATION AND EMPLOYERS' LIABILITY YIN S X Y PRCPRIETCR'PARTNEREXECUTIVE STATUTE ER landatory FICER,REMBER EXCLUDED? Y in NH) N I A N POWC772258 01/01/2016 01/0112017 EL EACH ACGDENT S cs. describe tndtt SCRIPTION OF OPERATIONS bdow E.L. DISEASE - EA EMPLOYE S EL. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATK)NS I LOCATIONS / VENCLES (ACRD 101, Add=Rcmarksdi 1 Schodde, may be attached N more swm is requ4dd) SHOULD BEFORE THEEXPIRATION DATE �T EREOF,ENOTT CEIEWIBLL BE DELIVERED N ToWn of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood st 1 suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25 2014101 AU 1988-2014 AC ) The ACORD name and logo are registered marks of ACORD .tk '-, Wo /i 99920 aft 0 Office of Consumer Affairs and Msiness Regulation IF rark Plaza 10 Boston, Massac.busetts Home Improvement Contractor Registration Registration: 132726 - - Type: DBA Expiration: 7/2/2098 Trd 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOY. 958 ANDOVER, MA 01890 - - SCA 1 0 20 4XV11 G51 -1.c `6»rn,nnroer f/lr of c%j�nera�rrle!!t *1OtIIce of ConsumerAffdo & Business Itegularion HOME IMPROVEMENTCONTRACTOR Registration: 102M Type: .a; Expiration: ' 71212018 DBA POLAR BEAR INSULATION CO. . Vincent LeBlanc 51 SO. CANAL ST. 45A LAWRENCE, MA 01841 Undersecretary Update Address and return card. Mark reason for changer. Address []Renewal [] Employment Q Lost Card Licem or registration valid for individual we only before the expiration date. If found return to: Office of Cousmner Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, MA 02115 � 4AM-11 - I IV NotvaTid without signature ? Massachusetts -7-01epartment of Public Safety Board of Building Regulations and Standards C„tlstrttCtipli S�trc; +iS+er SpcciaiIt,. CtSM-106017 • r PETER A LEBLANC 2 EAST PINE STREET r _ Plaistow NH 03865 ►� Expiratior, Ca nl llss,onec 04/2812018