HomeMy WebLinkAboutBuilding Permit #820-2017 - 51 BRIGHTWOOD AVENUE 3/2/2017Permit No#:
Date Issued: 7/
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PROPERffY ®W
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BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
11 Date Received
IWORTANT: Applicant must c
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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
I] Assessory Bldg
IR Others:
❑ Demolition
❑ Other
Se'':tie: 1Ne(1
S*id,
q Floodplain V1/et( nds
1Naters}ied ®st�ici ..
_
aWater/Sewer.
1L)Lb(;K1Y 11L)N LA- N4lUMM t U 01= r
l ^Skj IC•T1,8N 70
Identification - Please Type or Print Clearly
OWNER: Name: je a tnN e o h oy 4 H Phone: to
Address: S/ r�l % �c✓ocd a vC
: Peter Leblanc r.
Cont'racor Name::. - - Z�+,�_ i•;:;.�
tra - - -
�: � one;: ,.
7.
` mato X1 : .$ 5: --
Address: -: -
s
e, _
Exs Dates _�i
on`Licen �..__.. -__
uctl P=
., Supervisor -s Constr _ -
�D
ARCH ITECTIENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $92.00 PER $1000-00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PFR S.F.
'-___,Total Project` Cost: FEE: $ _
Check No.: (� Receipt No,, 'J 1�
DOTE: Persons contracting witli uizregisterecd contractors do not ve: ccess to the g z arcanty fund
Location
No. ifsc i� t DateZ
Check # f 11
l.!
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $4..5
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
�` Building Inspector
Plans Submitted ❑
Plans Waived [I Certified Plot Plan ❑ Stamped Plans ❑
'r- Pp 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
COMMENTS
Reviewed On Signature.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on _ Signature
COMMENTS
Zoning Board of Appeals: Variance10. , Petition No: Zoning Decision/receipt submitted yes
a Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town. Engineer: Signature:
FIRE DEPARTMENT' -.Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signature/date
��K nn nt--nlT�
Located 384 Osqood Street
no
-Nmension
Number of Stories: Total square feet of floor area, based on Exterior dimensions,
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter IOGation, mast or service dropr--equires; approval p vat of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A—F and G min -$100-$1000 fine
Doc.Building Permit Revised 2014
Building Department
The following is a list of the required forms to be fitted 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/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
14OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
n 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
act
❑ Mass check Energy Compliance Report
n 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 ti
Doe: Building Permit Revised 2014
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Federal ID # 054405629
,. M Contractor Registration No 8186
1AA ContractorRe&Watlon No 120979
RISEA
division of Thieiseh Engineering CT Contractor Registration No 620120
ENGINEERING
60 Shawmut, Canton, MA 02021 CONTRACT
�i
339- FAX 339-502-6345
Rage t
PROGRAM
THIS COKMACT 15 ENTUM INTO BETWEEN FM
CMA-HES ENOINEERM AND THE CUSTOMER PO1t YDRKAS
oESCRISEOaE M
CUSTOMER PHONE DATE CJEINTI YORK
ORDER
Jeanne Donovan (617)240-2086 11/20/2015 405510
00004
SERVICESTREET MIXING STREET
51 Brightwood Avenue 51 Brightwood Avenue
SERVICE CITY, STATE, ZIP BKitNO CITY, STATE, ZIP
North Andover, MA 01845 North Andover, MA 01845
JOB DESCRIMON
AIR SEALING: Provide labor and materials to seal areas of}roar home against wasteful, excess air leakage. This work will be performed in
concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor
air quality. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage
to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) This will require (8) working hours.
A reduction in cubic Feet per minute (efnt) of air infiltration will occur, but the actual number of cfm is not guaranteed.
At the completion of the weatherization work, and at no additional cost to the homeowner, a final blower door and/or combustion safety
analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality.
$680.00
ATTIC FLAT: Provide labor and materials to install a 12" layer of R42 Class I Cellulose added to (672) square feet of open attic space.
$1,075.20
ATTIC ACCESS: Provide labor and materials to insulate the back of (1) attic hatch with 2" rigid Themmax board. Weatherstrip the perimeter.
S60.00
VENTILATION: Provide labor and materials to install (1) insulated exhaust hose with roof mounted napper vent to exhaust existing
bathroom fan(s).
$118.75
VENTILATION: Provide labor and materials to install ventilation chutes in (78) rafter bays to maintain air flow.
$156.00
BASEMENT CEILING: Provide labor and materials to install (104) linear feet of R-19 unlaced fiberglass insulation to the perimeter of
basement ceiling at the house sill.
$182.00
OVERHANG: Provide labor and materials to install (160) square feet of 3.5" R-13 kraft faced fiberglass plus V rigid polyisocyanunde board
insulation to an exterior overhanging floor. All seams will be scaled.
$526.40
RISE: Engineering will apply all applicable, eligible incentives to this contract You will only be billed the Net amount. Currently, for eligible
measures, Columbia Gas offers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 1001/6 for the Air Scaling measures
up to the first $680 and an additional $340 if savings are justified by the auditor.
For the safety and health of your home's indoor air quality, we will be conducting a blower door diagnostic of the available air 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 systema and water heater. This has a value of $90 and is at no cost to you. Total allowable weathcriration
incentive is $3,110-
$90.00
f y RISE Engineering ' . RI Contracttorr 05-W5629
eg mon No 8166
INA Contractor Registration No 120978
R1 EA division of Thieisch Engineering CT Contractor Registration No 620120
ENGINEERING
60 Shawmut, Canton, MA 02021 CONTRACT
339-502-5177 FAX 339-502-6345 CONTRACT
Page 2
PROGRAM
THIS CONTRACT IS ENTERED INTO BETWEEN. RISE
CMA-HES ENGVAMRWGAND THE CUSTOMER FOR WORK.AS
DESCRIBED BELOW
CUSTOMER PHONE DATE CLA NT S WORK ORDER
Jeanne Donovan (617)240-2086 11/20/2015 405510 00004
SERVICE STREET DaLING STREET
51 Brightwood Avenue 51 Brightwood Avenue
SERVICE CITY, STATE, ZIP BR.LING CTTY.STATE-ZW
North Andover, MA 01845 North Andover, MA 01845
JOB DESCRIPTION
Total: $2,888.35
Program Incentive: $2,358.76
Customer Total: $529.59
WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF
*Five Hundred Twenty-Nine & 59/100 Dollars $529.59
UPON - AND APPROVAL BY RISE EN6INEERRiG. CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL NREREST OF 1% WILL BE CHARGED MONTHLY ON ANY
UNPAID AFTER IGGAYS.SEEREVBMFOR.WORTARTWOR"TIMON GUARANTEES, R1aHTSOF RECWWW.SgtEDRJNQ. AND CONTRACTOR REGt9TRAT10N.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
_--�n ev
AUTHNA - -RISE EIpNIsarllq CUS A
NOTE: THIS CONTRACT MAY BE WITHDRAWN BY u3 IF NOT E%ECUTW WnHVI DATE OF ACCEPTANCE
ACCEPTANCE OF CONTRACT - THE ABOVE PRICES. SPECIFICATIONS AND CONOMONS ARE
30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTIWRMW TO DO THE WORK
AS SPECIFIED. PAYMENT WILL DE MADE AS OU L94W ABOVE
W
OWNER AUTHORIZATION FORM
Jeanne Donovan
1,
(Owner's Name)
owner of the property located at
51 Brghtwood Ave, North Andover, MA 01845
(Property Address)
51 Brightwood Ave, North Andover, MA 01845
(Property Address)
hereby authorize -/Fl � C, t-
►- �rfy 1 kTi
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property.
�- (:a �
Owner's
Hate
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
POLAR BEAR N
Name (Business/Organization/Individual): PO BOX 958
ANDOVER, MA 01810
Address:
City/State/Zip:
Phone #: J? ?- C T b -
Are you an employer? Check the appropriate box:
Type of project (required):
1. E I am a employer with (!�7
4. ❑ I am a general contractor and I
6. New construction
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
7. ❑ Remodeling
ship and have no employees
These sub -contractors have
g, ❑ Demolition
working for me in any capacity.
employees and have workers'
9. n Building addition
[No workers' comp. insurance
required.]
comp. insurance.#
5. ❑ We are a corporation and its
10.❑ Electrical repairs or additions
3. ❑ I am a homeowner doing all work
officers have exercised their
11. ❑ Plumbing repairs or additions
myself. [No workers' comp.
right of exemption per MGL
12.❑ Roof repairs
insurance required.] t
c. 152, § 1(4), and we have no
13.❑ Other
employees. [No workers'
coma. insurance required.]
*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.
$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 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. h
Insurance Company Name:g� r (7 �l 19 t j. � S v f A W � �b b►\ P4 V1 11
Policy # or Self -ins. Lic. #: powe k\f 0 � & f Expiration Date: at /01/2"?
Job Site Address: City/State/Zip: 9/1
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 up 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.
I do hereby certify under th"ains, and penalties of perjury that the information provided above is true and correct:J.
4.1kDate:/okA
Phone #• q%s-- y off" %O io
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 #:
ACORO-0
`40 CERTIFICATE OF LIABILITY INSURANCE
DATTE (MMIDWYYYY)
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 INSURERft AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condIdons of the policy, min 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
60 Westville Rd
Plaistow NH 03865
CUO CT Linda $ogdaaowiQZ
PHONE (603)382-4600 FAX NO: (603) 382-2034
:Iindab@isc-insurance.com
INSURER AFFORDING COVERAGE NAIC 4
INSURER A: Western World
INSURED
Polar Bear Insulation Company Inc
PO Box 958
Andover MA 01810
INSURER B Mautilus Insurance :iron
INSURER C:
INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:CL1632326134 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRLIMITS
ILTR
TYPE OF INSURANCE
D
B
POLICY NUMBER
POLICY EFF
EXP
AUTHORIZED REPRESENTATIVE
A
8 COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑$ OCCUR
,A A
Reith Maglia/SSA��'��=---
NPP8274967
3/24/2016
3/24/2017
EACH OCCURRENCE S 1,000,000
RENTED
REMISES DAMAGE ToEa occurrence S 100,000
MED EXP Any one person 5 5,000
PERSONAL &ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMITAPPLIES PER:
B JET LOC
POLICY ❑
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - C.OMProP AGG 5 2.000, 000
S
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREDAUTOS AUTOS
COMBINED SINGLE LIMIT $
Ea accident)
_
BODILY INJURY (Per person) S
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Peraccitle
$
B
X
4
UMBRELLA LIAR
EXCESS UAB
OCCUR
CLAIMS MADE
m026107
3/24/2016
3/24/2017
EACH OCCURRENCE S 1,000,000
AGGREGATE S 1,000,000
DED I I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVEElN/A
OFFICEWMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
P!B? OTH'
STATUTE ER
EL. EACH ACCIDENT $
E.L. DISEASE- EA EMPLOY $
EL. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101. Additional Remarl® Schedule, maybe attached R more space to required)
CFRTIFI(`ATF HAI nFR CANCELLATION
ACORD 25 (201"1)
INS02517014011
@ 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1600 Osgood St, Ste 2032
ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover, MA 01845
AUTHORIZED REPRESENTATIVE
,A A
Reith Maglia/SSA��'��=---
ACORD 25 (201"1)
INS02517014011
@ 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
1/3/2017
Insurance Services
RCERTIFICATE OF LIABILITY INSURANCE
llie�THIS
DATE 'AC
o1/03/20117
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:
Pn cONE • Ext): INC, ft
Automatic Data Processing Insurance Agency, Inc.
ADDRESS:
1 Adp Boulevard
INSURER(S) AFFORDING COVERAGE NAIC fd
Roseland, NJ 07068
INSURERA: NorGUARD Insurance Company 31470
MED EXP (Anyone person) S
INSURED
INSURER B:
POLAR BEAR INSULATION CO INC
PO BOX 956
INSURER C:
$
Andover, MA 01810
1NSURERD:
INSURER E:
INSURER F:
CnVPRAt;ES CERTIFICATE NUMBER: 5VUJ/U HIEVISION NUMt3ER:
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_
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDDIYYYY
MIDOVYYYY
LIMITS
North Andover, MA 01845
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE M OCCUR
ti
EACH OCCURRENCE S
PREMISES Ea occurrence $
MED EXP (Anyone person) S
PERSONAL & ADV INJURY S
GENL AGGREGATE LIMIT APPLIES PER:
POLICY F-1 PERO- F—]]LOC
JCT
OTHER:
GENERAL AGGREGATE S
PRODUCTS - COMPiOP AGG 5
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
Ea accident) S
BODILY INJURY (Per person) S
BODILY INJURY (Per accident) S
PROPERI Y DAMAGES
(Par accident
S
UM13RELLALMOCCUR
EXCESS LIAR
CLAIMS -MADE
EACH OCCURRENCE S
AGGREGATE S
DED I I RETENTIONS
S
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYY / N
ANYPROPRIETORIPARTNER[EXECUTIVE
OFFICERIMEMBER EXCLUDED? Y❑
(Mandatory In NH)
Ifyes, describe nd�
DESCRIPTION OF OPERATIONS below
NIA
N
POWC840361
0110112017
0110112018
X STATUTE ER
_
E.L. EACH ACCIDENT $ 11000,000
EL.DISEASE-EAEMPLOYEE S 1,000,000
E.L. DISEASE -POUCY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if morespace is required)
Contractor License: CSL 106017 HIC 102726
lrCOTICINATC Ural nro CANCELI.A nnN
AV 1VGG-LV74 ALVKLF LVKrVKA I IVP[. All rigntu reuerveu.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
https:lladpia.adp.com/ISE,xtemal/applindex.html?clientid=2037315&requestFrom=run#lhome 1/1
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.
120 Main st
AUTHORIZED REPRESENTATIVE
North Andover, MA 01845
ti
AV 1VGG-LV74 ALVKLF LVKrVKA I IVP[. All rigntu reuerveu.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
https:lladpia.adp.com/ISE,xtemal/applindex.html?clientid=2037315&requestFrom=run#lhome 1/1
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Dome Improvement Contractor R.eestradon
Registration_ 102726
:. Type: DBA
Expiration_ 7/2/2018
POLAR BEAR INSULATION CO.
Vincent LeBlanc
P.O. BOX 958
ANDOVER, MA 01810
SCA 1 a 206,-05/tl
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Guice of ConsumerAffairs & Business RMWation
HOME IMPROVEMENT CONTRACTOR
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Re
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Expiration: 7/212018 BBA
POLAR BEAR INSULATION CO.
Vincent LeBlanc
n# 419291
Update Address and return card. Mark reason for change,
Address F1 Renewal ❑ Employment ❑ Lost Card
License or registration valid for individual use only
before the expiration date. If found refvra to:
Office of Consumer Aiiairs and Business Reeub ion
10 Park Plaza Suite 5170
Boston, lViA 02136
51 SO. CANAL ST. a5A
LAWRENCE, MA 018441
Undersecretary Tak valid without signature
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z="sS: CSSL406017
PETER A LEBLANC
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2 EASTPH4E STREET
Plaistow NH 0388
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