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HomeMy WebLinkAboutBuilding Permit #571-2017 - 61 BRENTWOOD CIRCLE 11/28/2016 V. t%ORTy BUILDING PERMIT OF�itso ,6q+ TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION Permit No#: 5 7 ( 7 Date Received ao /ITEn SSgcHUS�� Date Issued: �C) f �° LVOORTANT:Applicant must complete all items on this page LA ct N. A. `a is., +.. A Print y # -x ROPERTY 3WNERt2� � �Qlv.� .. a �..._ :,.�._ tr. r + ' _ Print ` 1 DD fear Structurek���• yes no MAPPARCELZONING DISTRICT: Historic ®istnct yes no �--., _».mss. .a ti�`z P` _*�.. �4- .r:°Y'-•; '"��,� w�-fu.' .. ' '_? t 1 ` ` Mach ineShopV�llage {,:yes TYPE OF IMPROVEMENT PROPOSED USE Res!2§ntial Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alt ation No. of units: ❑ Commercial Vl�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic 'i,Well i 0 Floodplain - ❑Wetlands ❑ Watershed Distract ❑Water/Sewer DE�CRIPTION OF WORK TO BE PERFORMED: - r . P Identification- PIease Type or Print Clearly' OWNER: Name: �rah k Te rr-C1h oVC., Phone: q 7,9-69d--3S3A Address: / t`2 I.,l�ec� /�. c�o ¢,,r. vn/� 0 t g_ Contractor.Name ,5, � �t :k Phon.e:: °Addr`essa� r , `i' �r'' .�6'h/� d i8tr` Supervisor'sCon ructi nLicense# �S 1 ©�:C�:6 Exp' Date +[/ %' �'7' a " M er , _ - H�orn'e Improver ie cense ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. __,l"otal Project Coit: $ O , C`-z%'C7 FEE: $ . Check No.: W3 Receipt No.. 3 i �i­ C) NOTE: , soil, ntXcrcting with unregistenz r- caors do not have:access to the guaranty fund Sig_ature_of.AgeriJ contractor' I { Location (0 6 r Pro- t p No. l ~ go Date /I- TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ If TOTAL Check# Building Inspector �F i Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ '13-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/MassageBody 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 i HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plar ,g Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature� Date Driveway Permit DPW Town)Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -' Temp Dumpster on site_ yes no Located at 124.Main Street Fire.Department signature/date COMMENTS F77' limension 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 droprequires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10o-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email ate Time Contact Name --------------- Doc.Building Permit Revised 2014 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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 Hydraulic Calculations (If Applicable) El Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 t%O R TIy own of ) ndover No. 1a D. 6 h ver, Mass, COCMICNC WICK �,9s gAreo Jkf' U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT . T.. �i�.�.....I........r� ..,��.....,,,,,,,� BUILDING INSPECTOR . ................. . ..... has permission to erect .......................... buildings on .....(*..!........ .r ! .d. ........... Foundation 9,6 1PRough tobe occupied as .................. '.`. ......... .......................... ................................................................ 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 CONSTRUCTIO . S AR7k. Rough Service .............. .. .. ......... .... ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. WAI rrHT R00FIN dr O Massachusetts Home Improvement Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MOL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should fust obtain'a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283.3757 or on our website. Homeowner Information Contractor Information Name `., Company Name F�avi Street Address(do not use a Post office Box address) Contractor/Salespe n/OmerName 61 B rp-rl-�coo0CL Cir S Co it W4-4 3 1\t' Cityflown State Zip Code Business Address(must include a stfeet address) N. A ndov awr roil Mqs- 350 6tz,rr S4- DaytimePhone Evening Phone Cityfrowa IState Zip Code 8- 8-&353La Same Al. tqn AvLr Mol 018'157 IofailingAddress(It different fromabove) jBusinessPhaneQ7$-6 eUV71 Federal EmployerMorS.S.NumberW 35q5qjg Home CoeiacterR!7,Namber Expr-atlaa Este ran mquira stat most bone f impro relist rentn..br rare / 39,569 avagd registration number (/ 7 The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,u e additional e , 3}y,) o tf S�-i r6 Cup l�cl l-F ST„n� v �- q GL c.,,`_ptShtkg-�. P(eas� 5�e cQe at'le_a4 Q �ro�as , Required Permits-The following bi ldingpennits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circtunstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fuad provisions of l aZ I6 Date when contractor will begin contracted work MGL chapter 142k) h/ Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule //// Tito Contractor agrees to perform the work,Sunish the material and labor specified above for the total sum of l0.OD,9a 00 (*) Payments will be made according to the following schedule: S 333 00 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ o�0 by ( /_or upon completion of t! ? a 7' r 0 l i S o21f0oo,D0 by—I—/—or upon completion of ,;kl3 Of S � b 67 upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) the following material/equipmentmust be special S 'd for ordered before the contracted work begins in order tomeetthecompletion schedule.('•") S_ tobepnidfor NOTES:(4)Including all finance charges(")Law requires that any depositor dowa-payment required by the contractor before work begins may not exceed the greater of(a)one hind of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Exnress Warranty-Is an express warranty being Provided by the contractor? Yo El Yes(all terms of theNvarranty most be attached to the contrnet) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor farther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,site contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefiolly before signing this contract • Don't be pressured into sigaing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make store the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can con Snn coverage,or ask to . see a copy of a"proof of insurance"document. • Know your rights and responsibilities, Read the Important Information on the reverse side of Us form and get a copy of the Consumer Cndde to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at aplace other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the thud business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right, DO SIGN THIS CONTRACT IF THERE ARE.ANY BLANK SPACES" Ttvo d czlcopiescftLecontrectmnstbecompleted aid sigzed.Oascopy sHc.ildgotodte6omeasmer.T7 de"opysi:c•:ildba4epthyLwcc.^,A-xcbr. x '/" , omtAwner'a Signature ontract is ignature /,,2 Ll Date Date T— --" b %4 4 Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter,'42A. Homeowner's Signature tontra4ofs Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in anyway,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisionsof the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree maybe added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until bothparties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABRwebsite at littp://www.mass.Roy/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http://mvw.mass.sov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: b�ap://db.state.ma.us/homeimprovement/licenseelistgM For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 version 2.1-11=010 The Commonwealth of Massachuseas Department ofIndustrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ' www.massgov/dia Rrorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. , Applicant Information ( f . lPleaseP1rint Leeibly Name(Business/Organization/Individual)' IA2,r t q k� O ( /ZGi CJ �' VVJ`t®�J� Address: 3S-O B e r r e. Sf- City/State/Zip: Af 1 KAygg✓ lT,9 01M- Phone m q W- 6 9?d,,��7 ',re you an employer?Check the appropriate box: Type Of project(required): i.a employer with�_carplay full dlor part-time).- 7. 0 New construction .01 am a sole proprietor or paru=sbip and have no employees working for me in 8. E]Remodeling any capacity-[No workers'comp.insurance required.] 9. El DemOlitiOD 1 am a homeowner doing all work myself-[No workers'comp.insurance required.]t .0 10E]Building addition .❑1 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 sok I LE]Electrical repairs or additions proprietors with no employees. . 12-E]Plumbing repairs or additions 0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 71cse sub-contactors have employees and have workers comp.iacmance.t 13.Q f rep aiis t We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[Z Chet sl �rZ re roO 152,§1(4),and we have no employees.[No workers'comp.insurance required.] ry applicant that checks box#I must also fill out the section below showing tick workers'compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. nuactors that check this box must attached an additional shed showing the name of the sub-contractors•and state whether or not those entities have )loyccs. If the sub-contractors have employees,they must provide their workers'comp.policy number. m an employer that is providing workers'corapensadon insurance for my employees. Below is the policy and job site �rma6on. urance Company Name: c & 0—o u icy#or Self-ins.Lic.M 3 87 18 7- ©/6 Expiration Date 30 61017 Site Address: 6/ A Yet 1 Ll DO d— lit Y. city/State/Zip:_ A/, /4r A✓W MA ©/Y yS II!, ach a copy of the workers'compensationpolicy declaration page(showing the policy number expiration date). lure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 /or-one-year imprisonment,as well as civil penalties in the form of a STOP WORICORDER and a fine of up to$250.00 a against the violator_A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance erage verification. hereby certify der the pains and penalties of pe fg�lh6t�ie information provided above is true and correct nature: Date: l 6 dial use only. Do not write in this area,to be completed by city or town q,�cia1 'ity or Town: Permit/License# :suing Authority(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector Other ontact Person: Phone It: AC�® DATE(MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 11/28/2016 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(les)must have ADDITIONAL INSURED provisions or 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 T A SULLIVAN INSURANCE AGENCY INC NAME:CONTACT 135 MERRIMACK ST PHONE FAX METHUEN, MA 01844 a C.No. Xt: A/C N°: MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED SCOTT WRIGHT INSURER B: DBA WRIGHT GUTTERS INSURER C: 350 BERRY ST INSURER D: NORTH ANDOVER MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 32972503 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 POLICY EXP LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDPOLICY EFF (MM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FIOCCUR DAMAGE T RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 1 PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED tid P BODILY INJURY(Per accident)AUTOS ONLY AUTOS ( ) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC5-31S-387187-016 9/30/2016 9/30/2017 ORH AND EMPLOYERS'LIABILITY Y I N -/ STATUTE E ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100000 OFFICERIMEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SCOTT WRIGHT. This certificate cancels,and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION PAUL HUTCH INS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING INSPECTOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 120 MAIN STREET NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE ,� )46,t�L�Sd­,uLcO�(- LM Insurance Corporation ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 32972503 1 1-387187 1 16-17 WC 1 n0270256 1 11/28/2016 8:05:27 AM (PDT) I Page 1 of 1 Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain License or registration valid for individal use only less than 35,000 cubic feet(991 cubic meters)of enclosed before the expiration date. 1f found return!`tos space. Office of Consumer Affairs and Business regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts _ State Building Code is cause for revocation of this license. Not valid without Agnature DPS Licensing information visit:WWW MAS5 GOV/DPs ,,...o� �--�60Z•iBL/8 tt�tuoO,�...W. ....-..�:../" �e�aaaas�apan .uotleaidx3 5;V%0 V1N'H3A00NV•ON .LS AN838 05£ 07 ;!tea r 11191UM 1100S SV81;0 YW UBA0ANV HISON c, ' d ` 1S AIJH38 05£ S21311f1J 1HJRiM ? 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