Loading...
HomeMy WebLinkAboutBuilding Permit #1324-2016 - 50 WEST BRADSTREET ROAD 6/22/2016 �V/ , "!11`VVV1�4`'l"` ' ` ✓' BUILDING PERMIT f TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7 H Permit NO: �L 2 Date Received n4 '` O �.9 �RwifO 4PP�� Date Issued: L-d/ I SSgcHu5 I PORTANT:Applicant must complete all items on this page LOCATION .,= to �° PROPERTY 0WNF7t-�c I < - °" Print MAP NO. .Et: ZONING DISTRICT. "Historic District ; ryes no �°. Machine Shop`Village ,yes `no k' TYPE OF IMPROVEMENT PROPOSED USE Resig@ntial Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Cl Se tic o We11 ❑ Flood lain` Wetlands ❑ Watershed Distract p p .:. 0 Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: ,� , rD n Phone: ' Address: CONTRACTOR Name ��. C11, Rhone; k Address . ff r00- 4 � Ire 4 Supervisor's Cons#ruction License JklExp Date . Home Improvement License x Exp Date .. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATEDOST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ �l O Check No.: SiZ�l Receipt No.: -mob S-�, 3 NOTE: Persons contracting with unregistered contractors do not have acce o the guaranty fund Signature c Agent%Owner s T of contraZI r BUILDING PERMIT o %AO oT" ao TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION `" p �A o ^mn Permit No#: Date Received 74QDRRTED�epy(y CHU`+�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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 0 Well ❑ Floodplain., 0 Wetlands 0 WatershedDistrict, []WaterlSewe'r_ x DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: P. Home Improvement License: 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: $ FEE.- $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Aa6ht/Owner.. - Signature�of.contractor �� �I Cr R Plans Submitted ❑ Plans Waived ❑ Certified Plot Flan ❑ Stamped flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swhnm'ng Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORINT PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature i 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 Con nec ion/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street � - - �"""`^ - --rr— �.-"-Y "e«7<r^"'." "".k. '•�.r,.`!�;3"ti^ -, ar .��- MIRE DaYP�R�T�ENT .-'T'empyDurnp is er on sife=, yes A ���no � • -� g" .0 dt..3."`�,�.:�... Ansi r Fop�ffieda-�Ns.',!24 Main Streets eartrnentsigna$u�e/date, &' .� � �` t�,e=r�'ri*.. -:i. r..o.'..q.,r a-'::-_.>. A r..t-mow po-;�...-.•.��_.«�i9...«+'.w.,ww==g+iS,:y.�.yy„p�r=.��c,,.��-�.�. �-�4�i',.,�.�, ♦_ `-F� 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 apse) i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department artment 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 OTE: 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) i6 Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses 4, 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 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 No. / ��2L ��„ Date t v e Z17 r , • - TOWN OF NORTH ANDOVER .`� ter„ • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Check# 244 3 C1 5 3 � Building Inspector NORTH Town of f Andover O 0 No. oh ver, Mass, COC NICNIwIC,c y1' 0A TE D U BOARD OF HEALTH VERMIT T L Food/Kitchen Septic System ✓lj THIS CERTIFIES THAT ........ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. 41... Rough Air to be occupied as ......... ......4 .... .. .. .. .................................................................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TIO Rough Service .. .. . . . ... . .... . ...... ....... ......... Fina BUILD INSPECTOR 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. PROPOSAL L.E. Morgan Construction Company We Accept: 86 Billerica Avenue,Unit#1 W14 N. Billerica,MA 01862 Office: (978)6704747/Fax: (978)670-6477 ; TMOsu D TO ,wry V / 1 I E V t JOB NAME T,ST fl/p�jF Z CODE ^ L JOB LOCATION TACT _P S(` liiE CELL PHONE OTHER JOB PHONE Strip d n to the wood deck, -QL layers of shingles, dispose of debris to a licensed recycling facility: Install ice and water shield at the gutters feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the wood decking. Install 8" aluminum drip/ edge on'all perimeters, color choices: 0 White, ❑ Mill, ❑ Brown, C3 Copper. Installer� year��d vlarchitectural asphalt shingles, and hurricane nail. Install rird`g/e`vent manufactured by 4-L to all ridges and dormers. Install new skylight flashing kits manufactured by Flash all cheek walls, pipes, skylights, /and penetrations to manufactures specifications. Remove existing lead flashing ` L> chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WE PROPOSE hereby furnish material and labor complete in accordance with above specifications,for the sum of- 4e f4e awC� A,-,00 C:6— ollars($ 4pe All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above Authorized Signature: specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.Our workers are fully covered Note:This proposal maybe withdrawn by Workmen's Compensation Insurance and Liability Insurance. by us if not accepted within days. ACCEPTED AS A CONTRACT-The above prices, Date of acceptance: Za specifications and conditions are satisfactory and are Authorized signature: dr/ hereby accepted.You are authorized to do the work as specified.Payment will e a O Authorized Signature: Additional Rema s: SHINGLE COLOR-----' z- l el THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Massachusetts Department of IndustrialAceidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aipplicaut Information Please Print Legibly Name(Business/Organization/Individual): 1 10 Cul i Address: i rpn 1h nsL �>n r City/State/Zip: i I C e#: V-7 V-7 Are yo employer?Che appropriate box: Type of project(required): l.?l am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. FJ Remodeling any capacity.[No workers'comp.insurance required.] In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.[:]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof r4pQrs These sub-contractors have employees and have workers'comp.insurance.= 6.O We are a corporation and its officers have exercised their right of'exemption per MGL c. 14 Other r 152,§1(4),and we have no employees.[No workers'comp.insurance required.] r l *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 now affidavit indicating such. #Contractors 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 I am an employer that is prov' ng workers'compensation itisuratice for my employees. Below is the policy and job site lnfor ination. i Insurance Company Name: Policy#or Self-ins.Lic.#: ► ?. � Expiration Dater _ a i Job Site Address: r n City/State/Zip: 4 i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 up to$250.00 a day against the yAplator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver' c ion. I do here r•tify tender thepains and pwtallies o y that the informqV911provided above is bre and correct. Si il. bate: one /�M 14 �7 C1 V;?(0- ig Official use only. Do not sprite in this area,to be completed b city or town official Y p Y h' .ff 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#: DATE(MM/DD/YYYYI CERTIFICATE OF LIABILITY INSURANCE TN134E tTIFICATE 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 `R PRODUCER. D THE CERTIFICATE HOLDER. PORTANT: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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BALDWIMWELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE#100 (AIC,No,Ext): (AIC,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: INSURER D: PO BOX 75 INSURER E: NORTH BILLERICA,MA 01862 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MM\DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE 0 OCCUR. DAMAGEREMISES S( RENTED $ (Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [—]PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-15 12/14/2015 12/14/2016 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVEa NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICMONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. "ERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET,BLDG 20,SUITE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TAS-- fa l+i NORTH ANDOVER,MA 01845 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER f-f c®RO" DATE(MMIDDIYYW) CERTIFICATE OF LIABILITY INSURANCE 4/14/2016 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(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 CONTACT NAME: Welsh&Parker Insurance Agency,Inc./Hudson Office PHONE 978 562-5652 FAX 978 562-7120 131 Coolidge Street,Suite 100 (A1C,No,Ext):( ) FAX No): Hudson,MA 01749 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Company INSURED INSURER B:SAFETY IND INS CO 33618 LE Morgan Construction Inc INSURER -.Scottsdale Insurance PO Box 75 INSURER D: Billerica,MA 01821 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. (NSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR INSD WVD POLICYNUMBER MMIDD/YYYY MM/DDNYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE n OCCUR NPP8381520 04/13!2016 04!13/2017 ED PREM AMAGE SES(Ea ocTO currence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL'&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE IS 2,400,000 POLICY JEn LOC PRODUCTS-COMP/OPAGG 5 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) B ANYAUTO 6230688 10/13/2015 10/13/2016 BODILY INJURY(Per person) S ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE S HIREDAUTOS AUTOS Per accident S UMBRELLA LIAB X OCCUR EACH OCCURRENCE IS 5,000,000 (, X EXCESS LIAB CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 AGGREGATE S 5,000,000 DED RETENTION 5 is WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S IF yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) WORKERS COMPENSATION CERTFICATE OF LIABILITY WILL BE SENT DIRECTLY BY THE CARRIER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street,Bldg 20,Suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety ° = Board of Building Regulations and Standards aQ tra��eareoniaeattl aC/l�ccasac�tate/1 . of Consumer Affairs&Business Regulation Office O License: CS-079476 ' HOME IMPROVEMENT CONTRACTOR Construction Supervisor z � Registration:,_ 13.7913 Type a k; Expiratiom-:=Ji2 . 1-7 Individual LAWRENCE E MORGAN,JR .. E` _ 100 IRON HORSE PARK LAWRENCE E.MOFtGFch€ R –`" NORTH BILLERICA MA 01862_;= , LAWRENCE MORGA'J' ;Ji;- 100 IRON HORSE PARK BILLERICA,MA 01862 ^M lJl� Expiration: 1[Jndersecretary Commissioner 06/03/2017 a salon'ai4twiah f Th-s i and acknow€edges"that#he'recip� it has;sUcoessfuify compo ted a 30 hour OctupationaT Safeijrand lieaitfiTra3ningCourse inancn2r'Satetf a7G teat: �,._, :,••:t;auan Construction Safety and Health 1 i LY MOR has successfU117 ccmplcted a ICLF-i aur ry.� upaZrori3i Safew and Health t Tr2rrorng Course s Conslmctioj Safety&Ftea€tij Iralnername - 5 Rt'� pr€ntor#s�pej ��ita �SA> LGourse end.date) Date) --. - f O