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HomeMy WebLinkAboutBuilding Permit #1035-15 - 55 LINDEN AVENUE 6/10/2015 A4" -itVI NORTH 1 BUILDING PERMIT o� TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION * Permit No#: UV���`� Date Received gSSACHUS Date Issued: )to , IMPORTANT: Applicant must complete all items on this page LOCATION ` �� Print �PRbPERTY OWNER__�(l Y t1 b U ]Gt Y`& _ Print 100 Year Structure yes o MAP OZZ PA R C E L_ __. ZONING DISTRICT: _ Historic District yes tnoz s..� Machine Shop Village yes o , .� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Well' o Floodplain 0 Wetlands D Watershed:District 0 Water/Sewer„ DESCRIPTION OF WORK TO BE PERFORMED: v� i wj 'Dr "yob , & r cyfrJ 1btrgl k-S S i N line-CW Ct 1 Identification- Please Type or Print Clearly OWNER: Name: Ca i r 6(ha rA ,S Phone: 1��3 �i�i�• ��u g Address: SS -Ina-"r) S� Contractor Name. Y.A,Y ta,.� '1rrPhone: 1LL� 3 Seo •.3 til , -_ . Address:. . A 3LIN twt._U'1fi1:1 D�� ,9 Supervisor's Construction License .. .��' °2' Exp. Date:_ 5 Z S 1 r� .. .�.._ m� ,t Home Improvement L-icense J. 3 Exp. iNte;_ 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: $ Z � �to • S FEE: $ 3 l Check No.: ? � I Z Receipt No.: p q b -- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of Agerit/Owner e-C _ ___: Signature of contractor 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses Q 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 o Building Permit Application i ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � g ❑ Building Permit Application ❑ Certified Proposed Plot Plan D Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydra.;ulic Calculations (If Applicable) o 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:Building Permit Revised 2014 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ r 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 a 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 FIRE DEPARTMENT .-Temp Oumpster on site yes___ _ - no Locateat 124,Main Street _ { d a-= - . -- Fire Department signature/date __ z 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 I NOTES and DATA— (For department use) t i I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location No. :'/�!w � Date • - TOWN OF NORTH ANDOVER F ♦ � Certificate of Occupancy $_ Building/Frame Permit Fee Foundation Permit Fee $ ° Other Permit Fee $ r TOTAL $ i. Check#-- T�t t L•�' 4 Building Inspector NORT1i Town of E ,, ndover 0 0%T h ver, Mass, JID coc MIc"twic. y1• A04ATED S U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT .......... � .o - BUILDING INSPECTOR :.r . . .................. . :.,.!' l ,,.,.,, ........................................... c Foundation has permission to erect .......................... buildings on ..�5........!�J.Alll ........., ............ Rough to be occupied as ...............h: J.. , !V l.......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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOS TS Rough Service ................... ........... ............................................ Final BUILDING 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. to CPI r� Federal ID d RISE Engineering RI contractor Registration No MA contractor Registration No A division of nkgscb Engineering CT Contractor Registration No 60 Sbawmnt Unit A Cantom,MA 02021 CONTRACT 339.502-6335 FAX 3"-502-C348 Page 1 PROGRAM THIS CONTRACT IS ENTERED On BETWEEN RIS ®�CUSTOMER a"-Us DESC 0 Carrie Richards (978)886-4448 04/16/2015 404668 00003 mmia Maw RMLING STREET 55 Linden Avenue 55 Linden Avenue North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Am SEALING:Provide labor mid materials to seal areas of your 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,weatherstripping and other products. Primary area for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.)(15)working hours. At the completion of the weatherization worn,and at no additional cost to the homeowner,a fmal blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $1,125.00 $0.00 KNEEWALL SLOPE:Provide labor and materials to install 2•FSK faced semi-rigid fiberglass board insulation to(456)square feet of kneewall rafter area. $1,509.36 ATTIC ACCESS:Provide labor and materials to make(2)temporary access to an attic area The opening will be closed with materials similar to those existing. Finish sanding and painting is not included. $170.00 BASEMENT DOOR Provide lab to insulate the back of the basement door leading to the bulkhead with 2°rigid board that m �eee 3 requirements of building code. Seal all edges and seams with FSK tape. $72.22 ? 215 Total: $2,876.58 APS 2 Program Incentive: $2,307.43 Customer Total: $669.14 TO FURNISH SERVICES-COMPLETE W ACCORDANCE WITH ABOVE SPEWMAM+IS.FOR THE SUM OF .Five Hundred Sixty-Nine&141100 Dollars $569.14 UPON FINAL DAR•ECnOTI AMDAPPROVAL BY MEENOWEEWNO.CUSTOMER AGREED TO REAR AMOUNT DUE W FUU.WfEREST OF IS WILL BE CHARGED MONMYONANY UNPAID BAWICE AFTEN m DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,MGM OF REOIB M SCHEDWNa AND CONTRACTOR RE6BTRATION. DO NOTSIGN TMS CONJW PT ICTUC=AOCAMV=1AWVODA PCC Ca to/e l Signature: C"x' R• 4 'es /C�o(S Cwde Rkhards(Apr 17.2015) CeR10 ft rde n sot Email: canie.a.dchards@gmaii.com NOTE:TMCONTRAOTMAYBEWITHDRAWNBYUBWNOT WM DATECFACCEPTANCE ACCEPTANCH OF CONTRACT-THE ABOVE PWCES.SPECWiCATIONSAND CONOOWNS ARE SATMACTORY TO US AM ARE HERESY ACCEPTED.YOU AN 30 DAYS. AS SPBCWM PAYMENT WILL BE MADE AS OUTLINED ABOVE AUiHOR®TOOOTNE WORN • i ••• °. - • •• . 1 �It d raw SIVAPROVER." "a It .., MIT _ MIENSIP noun Mamma 0 rA ENO NESSE! OPP m OM wim !/m■■■ 1mr%®R'�iki ■ Mt!■■ilO mrdmmm■�MENWA �.� ■ US sown ROOM NOR a �� ■ !■> SFA am MINE FOR W" toss ■ROill a Sr.[lCl � !!`d. !t�9M ■� '.fii' (! IN MEN MEN mm��mmoom Nis BEAK MISS mons a- as iiia■■l l l�l wm■ ,Au� N a mi ■� .Vii!Jam! ■/3!!■ �!l� �■���t■!�;l1 INS N Rs EE mrmml FEE a Al'sl�:its■t1!■w,sem■1 51 ■I��ilrwr ! au.aw%?'s�r WX=rte t�s�le�#1t��! �1��1®5t'4.➢7�E�' ME rMA +s ���`.+�il������,,Ow-SltmiilltEr:/fi�//����iS1Rl�t��Ua�MWJse= ■` OWNER AUTHORIZATION FORM (owner's ) owner of the womW loafed at ss LiK (Property Address) Moir w ulFJo . G g R' v`�✓. Yr�La t ( ►Adm) I hereby authorize (Suboonbador) an authorized sub=ftftrfor RISE Englneering,do ad on my behalf to obtain a buffng pemdt and to perform work on my property• C#%a ft(Apr 27,2015 O%gWs [EGEO v Ems_ V APR 282015 lie Ment j'ldta h-ialAccl€lcrus ice of Invesfigations A Congress Street,Suite 100 Boston,MA 02114-2017 WWW.Mass.gorldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aalicantlnformafion , Please Print Lmibly Name Address. t Are you an ernployt4r. Check the appropriate lsna: 1, TYpe of Project(required).-- 1 wn o employer with 5 4, 1 am a gmeral contractor and 1 employees(full an& r part-tinx)..* have bM the sub-contractors, New construction ti�tt 2.0 I Oro a sole proprietor or paler- listed on the attached shect. T Remodeling ship and have no `lt h es cto ha _ Demolition working for to as any capacity, employces and havre worketrs' comp, insurance." ltt:ilclira addition ti€ [No workers* comp-imsurance required,j 5. We are a corporation and its 10, 1»Joctrical repaim or additions .to 1 am a to user doing at u rl 01Meets have exercised their 11, Plumbing repairs or additions myself: [Nu v ' comp. right of exemption per MOL l�r lttacaf repairs insure required.]+ e. 152,§1(4),and we have no employees. [ o ur e s' 11C]Other ..... co :insurance reuir, *Any aMliwu that 6&ks b ax#t muggiso feta out lbe Noction below 4wwirg � Policy apatsaat� :aaraza�n jiCnne0A&=M;;fto Submit tt a ddaxrt rods"t ragthe;,are doul au wMk 2ndthcn hire ctt-tsacte cootr&,:tem MwarAtbmit A now affidaviondicaoN such: 9C a ate ctctrs haat cbeck tka?iq box mw amcWan audional s w Maas of,the gub-amtractors xW stag w hother or not those entities 1mve c4up3ryt _ If'the a to to twat a ,they mio,,T prttwidc tt t Ni s`cam,poti saumber,. I agar air a mpk er thatproWd'l��r ts*ez� �irrn rarnrr fir }�e�xPiaeesk .,�edr� 6thr ftp aid�ml�site ' i�,f�rr�m�tirrn<. Insurance Cbtrtpany Nam. — Policy Policy ur Sclf--ie . tol Lou 1:xpiration late. Lt3j 7r) 1uh SiteAddress: Attach a copy of the*arkers'ca a€ sation policy declaration page(showing the policy ar tuber and expiration date. Failure to sure coverage as required under Section 2 .r of MGL c. 152 can lead to the impositi can tr i�ninal penalties of fmc up to$1.500.00 aa&er one- CQr imprisonment,as ll as civil penalties in the form of.a STOP N ` 3RK ORDER and a firec o . f up to 2 .00 a day against the violator, Be advised that a copy oftlus statement be forty rd to the Office of II l v-°estti aurins of the 01A for insurance coven.ge verification, I do hereby renify ander thepains andpenahies of PediO dw the t,fwwtahon r; d eve is tare and correct.: Si t �j Ih That '`�5..... Oftleial w Dribs. Do not wrim in this area,to be completed y city or tovw official, City or Tn: I r dtM Iming Authority(circle Otte):, 1.BeaM of Health 2.SuMug Department crit 3.City/Tow-n Clerk 4.Mectrical Inspector S.l wing Inspector f.Other Contact Pl ane ACC)RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `,,,� 10/29/2014 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 Nancy Usher Martin J Clayton Insurance Agency, Inc. P"o AIC"E (413)536-0804 FAX Not.(413)534-7874 1649 Northampton Street E-MAIL AnnRFqq- P. 0. Box 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURERC: 44 Essex Road INSURER D: INSURER E: Ipswich MA 01938 INSURER F: COVERAGES CERTIFICATE NUMBER:CL148800843 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY Up LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE ❑X OCCUR L43487F /6/2014 MED EXP(Any one person $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB OCCUR E020792125 0/18/14 0/18/15 EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ WORKERS COMPENSATIONWC RYSTATU- OTH- AND EMPLOYERS'LIABILITY Y I N LIMITS ANY PROPRIETORIPARTNEWEXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,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 GAUTHIER INSULATION ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel Sullivan/SARAHACORD 25 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. MPIMM62d with pdfFactory trial'96 si8fi oay4w stiff t,Rrny dzSPlr� """�" i� �,•� . Hn 12/10/2014 1 :21 :37 PM PAGE 2/002 Fax Server I CERTIFICATE OF LIABILITY INSURANCE DAZE "'MAI YY-, �`'"" 12i1D12014 THIS CERTIFICATE IS ISSiJEO AS A MATTER OF INFORMATION ONLY AND COtlFERS IJ6 It3GHTS!JPON 7HE CERTIfiI'ATE HOLDER: THIS I CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE I'OLICIES FIELOW. TH1S CERTIFICATE OF INSURANCE DOES NOT COIISTITUTE A C014TRAL-T BETWEEN THE ISSUING INSURE-R(S), AUTHORIZED ! IIEPRESEIITATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holderif.an AI)f)IIJOiIAL INSURED,the poficyties)must be endorrr_d, If S1.1I3i?OCATlO61 IS WAIVED,subject,to the terms and conditions of the polury, certain policies may require an endorl.emenl.. A sLal.ement on this certificate does not.confer'rights to Lhe ( certificaiw holder in lieu of such nndomements), --- ----._..._.._.. .............,_...-..............._._....__ __...� -I _ .._.. --- _._...,._---.---- _._. ._..._._,..._---- __-..._....--_. I•iiCUa c:_.w j .;gMIA`I Clayton Martin J Ins Agency Inc gerkle Assigned Risk Setvims - ._. 1649 Northampton St ;4 E., E30D 1i34.45R9 n'_ No; A66 215-N118 PO Box 989 nLx�RFss. Pr,IicyServieesCherkleyrisk.a)m 1 Hof Oke MA 111041 ikS;W6R5 A!TUWANGCUVN4AG6 N.vca 'kS:/RE Ci IN ER A Gauthier Insulation Inc KS A7.R R. PO Box 344 NsURCRc ry fpswich, MA 01938 N"IR ERINsu,cRE INS V4ER r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS Tt);;ERCIFY THAT THE POLICIES OF ithGURANCE LISTED BELOW HAVE BECN ISSCED TO THE "SURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITHST'ANOING ANY REOVIIlEM1ENr,TERMS Oil CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHK;H THIS CERTIFICATE MAY BE ISSUED OR f,4AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS, EXCL=ONSAND O)NDITIONS OF SU(;HPOLIC:IES.LRAITS SHOWN MAY HAVE BEENREDUCED BY PAR)CLAIMS. +,lir IN r.7(:;N$i I R A Nt:P ' L7t3 IN$R WVLi POM C,Y NUMRFR 'Ad AilCtU/If4, NYrY) 61ASQ1nlYYYY', LI k'!TS OENERAL OARILITY AUTOMOME LIARILITY WORKERS CONPEWATIONUTN- ANDEHPLOYEAVLIASILITY Y•'N ANv I R01nRIF7 ORIPAR1 NC RJFXE.:t,TIvr — n orrn;t::x4;:r11=.€[r4r;xit_ucrrn ©I L4 WC•20-20-001661-0G 10/3012014 110/30/201,5 Et EAC ItPd,CI E N 1 $500000 (Wold nrorY f o N14) I �IISEASEXA EMPLOM 5 .5D0.CHTD i,f gr,R;PT Y:N OI' DPE14.l'lIL`NS i!C:Sc:f:!r7r:N::xZ^. n3!D:tlS 7!,(:fA'IUN�'/S',.Illt:Ec 3 A .,a+•r,.a:A+.nrzn+al.A.Ce:ra:,l n>:::,rr,SALnd•,r,r::,,,..,P,n.:,.rewr,ar Coverage Election Category EieLt.Status Name State(')_ All EntitieVLocations Officer Exclude Kurt Gauthier MA Gauthier Insulation Inc Officer include Brittnie Aiello 44 Essex Road Ipswich, MA 01938 HOLDER CANCELl ION SHOULD ANYOF THE ABOVE DESCRIBED POLIOES BE CAWELLED BEFORE THE EXPINA'TION DATE THEREOF,NOTICE WILL BE DELIVERED IN Mass Save Program/Conservation Services Group,Inc AtS,0C4DAtX•E yVITH'THE PULIC,Y P17t)VISI;r NS. 50 Washington Street West BOraugh,MA 01581 - t.. ignature: �`.... _. ACORD 25(2010(05) BRAC 3139 1 ti Office of Consumer Affairs and Business Regulation 10 Park.-Plaza - Suite 5170 r Boston, IvMassac4usetts,02116 Home Improvement C* tor Registration Registration: 173410 Type: Individual _ Expiration: 10/112016 Tr# 257612 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 IPSWICH, A 01938 � � � � � � " __...___�_ _.e . _._� _..___ _ ...�. Update Address and return card.Mark reason for change. AddressRenewal ] Employment Lost Gare SCA 1 c'k 20M-05111 � office of Consumer Affairs&Business;Regulation License or registration valid for Wividul use only rs� i HOME IMPROVEMENTONTRACTOR before the expiration date. It found return to.- 'RType: ofce of Consumer Affairs and Business Regulation egistration X7341{} Vxpiratlon:&�-1t?/1�2016 Individual j 10 Park(laza-Suite 5170 ` Boston,MA 02116 KURT GAUTHIER ' KURT GAUTHIER 44 ESSEX RU IPSWICH,MA 019384ot undersecretary valid wi out signature D"Or"Ont Of Public � A U1114ft .P.(Box es xireo