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Home My WebLink AboutBuilding Permit #985-2016 - 59 SALEM STREET 8/21/2016BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 0 7;4 V//-, 44 _0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building El One family 0 Addition [I Two or more family 0 Industrial 0 Alteration No. of units: [I Commercial X,Repair, replacement El Assessory Bid El Others: El Demolition El Other —N�t Qpfic D,VVell, nflo.a,dplaln ff Wetil �n� atorshod�. ii6t EJ n�Q('PIPTWW t)F WnRK TO RE PERFORMED: Identification - Please Ty e or Print Clearly OWNER: Name: 0,47��t J 0/r/ 1tTC2A1 Phone: CI�V-O'S-7—ZcWl ARCH ITECT/ENGI NEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT. $1Z00 PER $1000.00 OF THE TOTAL ESTIMATED COST BA N $125.00 PER S.F. Total Project Cost: $ 9, 000 FEE: $— 16sr— Check No.:- /I z �),- q1 - Receipt No.: NOTE: Persons contracting with unregistered coptr3rctors do not have access to 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 DTE: 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) ,4, Building Permit Application 4 Certified Proposed Plot Plan 4. 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 IECC Energy code Engineering Affidavits for Engineered products 10TE: 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 Doe: Building Permit Revised 2014 J Plans Submitted-[] Plans Waived Certified Plot Plan Stamped Plans F1 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning(Massage/Body Art F1 WeR Tobacco Sales 11 Private (septic tank, etc. El Permanent Dumpster on Site El Swimming Pools El Food Packaging/Sales F1 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/SLqnature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street -A M.— WE, ME ta lull �es a e', a 'P 7 77 115 ..... ..... ..... le;a I - n 3 A i-- L 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.$100-$l 000 fine NL) i tb ana UA I A — wor ciepartment use LJ Notified for pickup Call Emai Date Time Contact Name' Doc.Building Pennit Revised 2014 Location .52 N o. Date Check# 30139 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $ O� Other Permit Fee $- TOTAL $ 136ilding� Inspector CO) a (D 0 z r.q. 0 CD CL r- 2) > to 0 0 cr CD 0 CD CL 0 S' = cc CD 0 r-v� 0 7 LW.A U) 0 0 0 U) 0 a U) 0 CD 0 CD CD CD 0 z 0 CD a 0 CD a z r - m U) cn 0 0 z cn 7Z z cn 03 G): Z Cn m 0 -4 0 ;v -u m m X a 55 m Ci) z 0 M --I :�:l 0 0 0 CD N 0 0 co X CD co c 0 CD 00-0 — L =r —j 0 " 0 0 r r U) CD C—D _0 0 CD 0 CD C-) m 0- 0 0 =r CO. =A CD 0 0 0 CL m F ID CD V 0 CD -0 CD CD A) % -1 U) CD to CL =r CD CD =r _0 CD -0 0 to U) 0 h U) M CD 0 0 " : rr CD U) CL > = O= CLO to 0 0. U) < CD 0 CD U) a) C<D = CD CL CD U) -0 CD C.) CD 00 CD (D CD CD U) 5,0 =r > CD = 03 CD "0 2) 0 C3 �—jo df� *q 0 44� fD 01 Ln ig (D — z 0 co c , :3 fD m m M > m z -n ;o 0 c . aQ =r > fA M m 0 -n 3. cu Ln !� < Fi rD :;a 0 aq =r m rl m M m 0 -n S. cu ;:0 0 c C) M m 0 -n n m- rD :;p 0 aq -n 0 D CL a) 0 =3 w C: F 2 z C) m 0 Ln fD _0 r) Ln < rD 3 -n 0 0 rD :3 0 0 m 0 44� fD 01 Dempsey Roofing LLC P.O.BOX 383 Billerica, MA, 01821 Radek Cell: 978-808-6678 www.dempsey-roofing.com Fax: 978-362-3102 3/16/16 Proposal Name: Cathy Johnson Address: 5f Salem St. City: North Andover State: MA Zip: 01845 Phone: 978-857-2001 Description: • install tarp from roof to ground to protect siding & landscape • Strip existing 1 and 2 layers down to roof deck. Inspect & re -nail where necessary. Replace three plywood's with mold. Any additional replacement will be at an additional cost of time and material; $65/sheet • Install 6' of ice and water shield underlayment along all eves • Install 151b paper on remainder • Install white Pro Flow vented drip edge along all eves • Install 8"' white aluminum drip edge on all gables • Install LTD Lifetime GAF Timberline or CertainTeed Landmark architect roofing shingles (color & manufacture chosen by homeowner) • Eliminate 3" pipe and pipe flange. Board in • Install one new Ypipe flange Will use current step flashing Cut in and install cap shingles over ridge vent to ensure proper ventilation Cover gable vents from inside Counter flash and caulk chimney. If there appears to be inadequate lead flashing, there will be a need to grind in new lead flashing at an additional cost of $450 Clean all gutters Remove all roofing debris 0 Material, labor, permit and dump fee included Porch roof: material is included; labor will be done by others Total: $9000 $3000 down for materials, remainder due upon completion Ten year warrantee on all workmanship Proposal valid for 30 days Signature of acceptancelt 7//6 The Commonwealth of Massa. chusetts Department of IndustrialAceidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plu.mbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Nalne (13usiness/Organization/Individu' eel�9��ItI6 Z -Z -(f Address: /,C,> 0, Z�ali_ '5 City/State/Zip:S�ZZ��/Oe'5�,";'�aP/&Z/ Phone#: '_1 6a, Are you an employer? Check &e appropriate box: crop I. I amaemployerwith I loyees (full and/or part-time).* 2. i am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers7 comp. insurance required.] 3.FJ I am a homeowner doing all work myself [No workers' comp. -insurance required.] t 4.F] 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 proprietors with no employees. 5. n I am a general contractor and I have hired the sub -contractors listed on the attached sheet. Thes6 sub -contractor's liav� employees and have workers' comp. insuranceJ 6.FJ we are a corporatio, n and its officers ' have exercised their right of 'exemption per MGL c. 152, §1(4), and -,ye have nQ.e loyegs. fNo workers' comp. insurance required.] Type of project (T�quir�d): 7. New construction 8. Remodeling F1 Demolition 10 E] Building addition 11. n Electrical repairs or additions 12. Plumbing repairs or additions 1�.D<koof repairs 14.F] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who subinif Us affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-co'61iractors have employees,, �hey, must provide their workers' comp. policy number. lam an employer that isproviding workers' compensation insurancefor my employees.' Below is thepolicy andjob site information. Insurance Company Name:_,,_N/7 C017)P4,411, -7 Policy # or Self -ins. Lic. 4?WC -4 �90 � 70 �--2,0-94_Expiration Date: // Job Site Address: 6-111, S 77 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 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 violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby 751��r t ofperjury that the information provided above is true and correct. Sianature: Date: Phone#: qe�roo_ Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitfLicense # Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Gerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contrdbt of hire, expres's or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal rep I resentatives of a deceased employer, or the receiver or ft-ustde of an individual, partnership, association or other legal entity, employing empl6yees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment bd deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill- out the workers' compensation affidavit completely, by checking - the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department- of Industrial Accidents fok confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city.or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are ri equ4red to obtain a Workers' compensatio.d'policy, please call the Department, at the number listed below. Self-iiisur6d companies sh,ould'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "fob Site Address" the applicant should write "all locations in _(city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia 0311812016 15:01 Prescott & Son Insurance Agency TAX)7813333278 P.00 11002 CC>,RbP CERTIFICATE OF LIABILITY INSURANCE �Hl DATE IMWDDNYYY) 3/18/2016 CE S 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(les) must be andonsed. 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 confor rights to the certificate holder In lieu of such endorsoment(s). PRODUCER CONTA Tc -NAME: ammercial Linaa kreacott and Son Insurance Agenay,lna. PHONE .5.tj. (781)322-2350 FAX lAtc, No IAJC, Nol; J 963 Eastern Avenue E! -MAIL AOOR�85@ Malden MA 02148 INSURER(SI AFFORDING COVERAGE NAIC # INSURER A.Enduranca Amer±oan Inm Co INSURED INSURER B Darripsay Roofing LLC INSURER C: 7 RICHARDSON ST INSURER 0: INSURER E: -Billorica MA 01821 INSUAwl i;; COVERAUES CERTIFICATE NUMBER:CL1631622656 REVISION MHMRFR- 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 SU13JECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOLSUHR __p_0L_JaTg�7F__ POLICY NUMDeR PDLICYEXP MMIDONYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FiJOCCUR EACH OCCURRGNCE S 1,000,000 DAMAGE TO RENTED PREMISL,$ (Ea occu"grics) IN 100,000 CEC2DO0005D401 9/3/2DIS 9/3/2016 U.0 EXP (Any one person) $ 5,000 LERSONAL & ADV INJIJRY $ 1,000,000 Gr=N*L AGGREGATE LIMIT APPLIES PER: POLICY [:] JPE'C'T' F__] LOC GENERAL AGGRFGATg 5 2,000,000 PRODUCTS - COMPIOP AGG $ 1,000,000 $ OTHER' AUTOMOBILE LIABILITY COMBINED SINGLELIMIT JF .. Ift"I BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per aceldant) $ -P7ROPFRTY HIRED AUTOS NON -OWNED AUTOS DA X43E IP@r accloent) $ UMBRELLA LIAM OCCUR EACH OCCURRENCr EXCES3 LIAO CLAIMS -MADE AGGREGATr DED I I RMNTJON S WORKER$ COMPENSATION T11 - PSTERITUTE AND EMPLOYERS` LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVr= OFFICERIMEMBER EXCLUDED? NIA E 17ER E.L. EACH ACCIDENT F_L_ DISEASE - EA EMPLOYEE $ I(M.nd.t.ry In NMI If lea. dascrlb6 uAder 0 SCRIPTION OF OPERATIONS below &L. DISEASE - POLICY LIMIT III -L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarke Schedule. may be attached If more space is required) RE'.. 59 Salem Road, Worth Andover, Ma 01845 CANCIELLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 81ii.FORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood streat ACCORDANCE WITH THE POLICY PROVISIONS, Building 20 Suite 2035 AUTHORIZED RIPRES12NTATIVE North Andover, HA 01845 1 S Sch . olnick/PJR 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) 0311812016 15:02 Prescott & Son Insurance Agency (FAX)7813333278 P.0021002 AC40)?H CERTIFICATE OF LIABILITY INSURANCE DATE IMMIODNYYY) I . 03/18/2016 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 poilcy(ies) must be endorsed. If $UBROGATION 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 andorsamant(s). PRODUCER ONTA NAMP, Paul Rackl PRESCOTT & SON INS. AGENCY INC. __TMAIC, PHANP. .2350 IAIQ Po E.11: (781) 322 Not: F -MAIL ADDEF11: paul@prescollandson.com 953 EASTERN AVF:NUE I NBURER(q) AFFORDING COVERAGE NAIC 0 INSURER A: AIM MUTUAL INS CO 33768 MALDEN MA 02148 INSURED INSURER a: DEMPSEY ROOFING LLC INSURER 0: INSURER D; 114SURrRe: P 0 BOX 3a3 INSURER F: BILLERICA MA 01821 COVERAGES CERTIFICATE NUMBER: 38354 RFVISInN KILIMRFR- 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I -TR I TYPE OF INSURANCF ADOL3USR POUC114UMBER _PbUQY FXP (MMIDWYYVI LINQT6 HCO, COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR EACH OCCURRENCE 9 D PREMISES i9j_p66V_rrQnC91I $ M(P (Any one person) 3 — .MED PERSONAL & ADV INJURY 3 NIA GEN'L AGGREGATE LIMIT APPLIES PER: POLICY M PRO' F JECT _] LOC R Ga RALAGGREGATE 3 .2�LNR_ PRODUCTS - COMPtOP A13G S S OTHER: AUTOMQBILF. LIABILITY MOIN99 INGLELFM—IT S 29. accIdont? ANY AUTO BODILY INJURY (Per person) 9 ALL OWNED SCHEDUL&D AUTOS AUTOS NON -OWNED HIRED AUT03 AUTOS N/A BODILY INJURY (Per viccIdont) $ AMAOE $ UMURELLA LIAIS OCCUR EACH )CCURRENCE EXCESS LIA& CLAIMS -MADE N/A AGGREGATE DED I I RPTENTIONS 8 A WORKERS COMPENSATION AND EMPLOYFRVILIABILITY YIN ANYPROPrilPYOR/PARTNERIEXECUTIVE OFFICEWMEMARA EXCLUDED? I N/Al (Mandatory In NW) If g, describe undar D SCRIPTION OF OPERATIONS below N/A N/A AWC40070274872015A 07/01/2015 07/01/2016 FITUT, EORTH, X I RA E.L. EACH ACCIDr:NT s 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 r -L, DISEASE - POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORO 101, Additional Remarks gGhpdule. may be attached ir more epa� In required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization Is given to pay claims for benefits to employaos in states other than Massachusetts If the insured hires, or has hired those employees outside of Massachusetts, This certificate of Insurance shows the policy In force on the date that this certificate was Issued (unless the expiration date on the above policy precedes the Issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification Search tool at www.rness.govAwd/workers-compensationAnvesUgationst. Town of North Andover 1600 Osgood St Uldg2l) Suite 2035 North Andover SHOULD ANY OF THE ABOVE D53CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MA 01845 I Daniel lvl6cay, CPCU. VIce President —Residual Market— WCRIBMA @ 11988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORID name and logo are registered marks of ACORD Massachusetts - Department of'Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-099681 ERIC DEWSEV. - 7 RICHARDSONS if BILLERICA KA;018 J. will Expiration Commissioner 05123/2016 Office o Consu er Affairs & Business Regulation 0M IMP NT NT ,Registration: ��-'178026 Type: Expiratlon-.7�-A -8�� LLC "ION, N DEMP ROOFI ERIC DEMPSEY 13'� 7 RICHARD ST q BILLERICA, MA 01821 Undersecretary 4