Loading...
HomeMy WebLinkAboutBuilding Permit #606-13 - 66 SETTLERS RIDGE ROAD 6/16/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO ^N Permit NO — l Date Received 2 ` Date Issued:/,11. IMPORTANT: LOCAT PROPERTY OWNER -- O 1 MAP NO: C& / PARCEL: //0 pplicant must i all items on this rICyr( e (-6&0 0 Print 100 Year Old Structure ZONING DISTRICT: Historic District Machine Shoo Villa yes no yes no ves, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ;MC$epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PEREOFED' )OUc La V( Awe //6 FQ, �. \A Ck Idntificati n Please TyiAe or Print Clearly) OWNER: Name: l R U Phone: Address:e l CONTRACTOR Name: r -IM Phone: Address: Supervisor's Construction License: `, Exp. Date: �&Lod Home Improvement License: Exp. Date: t3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BA ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tp thein' ganty f, n� 'Signature of Agent/Owner Plans Submitted ❑ Plans Waived ❑ Signature of contractorG' Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE 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 DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comm Comme Water & Sewer Connection/signature & Date Driveway Permit tbPW To wa Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes Located at'124 Mair. Street Fire Departinent-signatureldate y: COMMENTS no 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 use El Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The foliawing 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 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/Crossection/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 Construction (Single and Two Family) ❑ Building Permit Application ❑ 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 ❑ 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 submsted with the building application Doc: Doc.Bui!ding Permit Revised 2012 Location,k, (gA 4q No. 4:W60 Date Check #xr—+ C;P TOWN OF NORTH ANDOVER Certificate of Occupancy $ — Building/Frame Permit Fee s4f el - Foundation Permit Fee $--.. Other Permit Fee $— TOTAL $ A-qop Building Inspector MI E19 * ua, � O 0 O CO t U Y "O O LL v +' In u +-' a). N 0 a Z Z m c O N '6 c 3 LL t txoto O_' a1 c E U co c LL O U a Z Z d t j O0 O_' c0 C LL 0 H N Z U W W t O_' u U � V) m c LL OC Wa Z N U)w 7 CC f0 c LL H Z w Q p a LL L a) i O m z aJ Ul al y O V) C 3 (a J m C C O 41*70 0 c• v •a N d1 m o VI:oz : o_ N c 0 c > H L + V0 .0 i :d N ® : i of 1 o c c a L •Lm seaso v� 4) Co W_ O O LU*- -W LL 'N tl1 ~ N '7 w 'L- C> (D V m 0-00. U N M Z O OL C O F— t - O_ o 0 Z O m z Cl) G.. W H W IL O LUa U) Z - o Co Cl) r O U Z U co LUJ m v v C) 0 . BUSHNELL CONSTRUCTION 89 Meadowbrook Rd N. Chelmsford, MA 01824 Fed ID # 04 385762 (978) 256-4388 Registration # 108952 3/11/13 PROPOSAL SUBMITTED TO WORK PERFORMED AT Paul Montecalvo same 66 Settlers Ridge Rd N. Andover, MA I propose to furnish labor and materials to repair water damage Scope of work 1.Permit A. Apply for and supply building permit 2. Remove and replace all damaged wallboard and insulation in great room,kitchen,sunroom,basement,garage Total Estimate $12,000.00 10% deposit $1200.00 25% completion wallboard $4000.00 Balance upon completion $5800.00 Work will commence week of March 10 2013 and will be at substantial completion April 12013 All contractors shall be registered with the State of Massachusetts any inquiries shall be forwarded to Office of Consumer Affairs Ten Park Plaza, Suite 02116 . Boston, MA 02116 (617)973-8700 All warranties on the owners rights under the provisions of MGL c. 142A Owner has the right of 3 day rescission on this contract Any alteration or deviations from above specifications involving additional costs will be executed only upon written work orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tornado and all other necessary insurance upon above work. Workmen compensation and public liability insurance on above work to be carried by Bushnell Construction. Do not sign this contract if there are blank spaces ers Acceptance Respectf ly Submitte 3/15/2013 10:28 AM FROM: E. Connolly Ins Agcy Edward M. Connolly Insurance Agency, Inc. PAGE: 002 OF 002 AC"M? CERTIFICATE OF LIABILITY INSURANCE �••� DD/YWY) DA73/15/13 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 erldorsement(s). PRODUCER Edward M. Connolly Ins. Agency 7 Lincoln Street PO Box 408 CONNAME: Luci Fitzpatrick PHONE 978 692-6871 FAX NO: t978l 692-7834 E-MAIL ADDRESS: 3000 Westford, MA 01886 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: WESTERN WORLD INS. CO INSURER B: TECHNOLOGY INSURANCE CO. MICHAEL BUSHNELL DBA INSURERC:CaHHERCE INS. COMPANY BUSHNELL CONSTRUCTION INSURER D: 89 14EADOWBROOK ROAD INSURER E: N. CHELMSFORD, MA 01863 INSURER F: NPP1331914 \_VVCKWbCJ L t:KIiI-ICAIt NUIVItlt K' RF1/IRIfIN NIIIIIIRFR• 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 LTR TYPE ADDLSUBR POUCYNUMBER POLICY EFF M/DDNYW POUCYEXP MM/DDYYYY LIMTS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY NPP1331914 4/26/12 4/26/13 D1M41ET1RENTED SSE ccurrence $ 50,000 MED EXP (Anyone person) $ 1,000 CLAIMS -MADE � OCCUR PERSONAL&ADV INJURY $ 1,000,000 GENERAL AG GREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER : PRODUCES-COMP/OPAGG $ 1,000,000 X POLICY FRO LOC $ CANYAUTO AUTOMOBILE LIABILITY PLL EDAUTOS P59831 9/13/12 9/13/13 COMBINED SINGLELIMIT $ (Eeaccidert) BODILY IN URY (Per person) $ 100,000 BODILY INJJRY (Per accident) $ 300,000 X SCHEDUHEDULEDAUiOS HIREDAUTOS (PROaccide DAMAGE $ 100,000 NON40WNED AUTOS $ UMBRELLA LIAS OCCUR FFACHOCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEDUCTIBLE $ RETENTION $ B VIORKERSCOMPENSATION AND EMPLOYERS' LIABILITY Y / NI ANY PROPPIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? y N/A TWC3323879 6/25/12 6/25/13 WCSTATU- X OTH- FR E.L. EACH ACCI DE NIT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory In NH) Ifyes, describe under E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) JOBSITE: 66 SETTLERS RIDGE ROAD, NORTH ANDOVER, MA 1,.CK IIri--,Kir-11VLUrK GANGELLATION 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. 1600 OSGOOD STREET BUILDING 20 AUTHORIZED REPRESENTATIVE SUITE 2035 NORTH ANDOVER, MA EDWARD M. CONNOLLY JR. © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) IFAS CERi1FfCATE5/2/12 IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMAT1VEt,Y 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must he endOrsmd. If SUBROGATION IS WAIVED, sub)ect.to the terrrla and conditions ofthe policy, certain policies May require an endorsement. A statement on this certificate does not confer rights to the certificat,a holder In lieu of such endorsamantfsl. PRODUCER EdwardNNW. Connolly Iles. Agency T Edward M, Connol,l JRR. PNONE FAX 978 692_6871 ; (978) 692-7914 7 Lincoln Street PO Sox 408 9FRCRMFR - 5000 Tlias�ord, MA 01$$6 IMIS INSURED -_wsu. 1a;W81 AFFORDING COVERAGE NAIL INSURERA:WESTERN WORLD INS. Co MICHAEL SUSHNET�Z ASA INSURER 13: T>;CHNOLOGY INSYTTi.ANCE CO. SUSiINEi.i, CONSTRUCTION INW11TR-c: COZWRCE._ _INS. 89 MEADOMROOK ROAD NBURERD: - N. CHELMSFORD, MAS 0 ,863 1MMIRPOP. --wvCr%AU=5 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 8Y 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. TAX TYPEQFINBWRANCE ADDL . - MANE LYYYYY LIMITS -INSRPo UMBER ERAL LIABILITY EACH OCCURRENCE $ ] goo boo COMMSRCIALGENEMLLIASILITY NPP1265666 4/26/12 4/26/13 DANAGETORF TED CLAIMB�AADE I_X I OCCUR EmISE51Eq p 1 }� �.. 50 , 000 MED IOW (Ary one persen) S 7 _ nnn LIMIT AUTOMOBILE LIABILITY I jNi'AUI'"Si 'u I.OWNEDAUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLALIAB OCCUR EXCESSLIAS CLAIMS -MAD DEDUCT181k RETENTION S B VJORKERS COMPENSATION AND EMPLOYERS' LIAe0.1TY OFFtPCEROAPMEre6 Rr?fCLNUDEoCUTIVE !NI NI f&)andabm In NNI PERSOKA!t&ADV INJURY $ 1,100 �OO( GENERALAGGREC,ATE OOO•QO( PRODUCrS-COMPIOPAGG S y 0001Ont $ COLSINED SINGLE UMIT S F59831 9/13/11 S/13/x2 (E1kac0wrt} BODILY INJURY (Per peBon) $ 100,000 BODILY INJURY (Per eecldent) S 500 000 PROPERTY DAwgi; (Poraccldent) $ 100,000 S EACH OCCURRENCE AOGREGAT TWC52$0352 6/25/ A 6/25/1 J wcKATu- OTrI, TO.RXU FL, E.L.EAGMACaDEW S 5001000 E,L,DISEASE.EAEMPLOY $ 500000 E,L.DISEASE-POLICYLIMIT S 500.000 DESCRIPTION OP OPERAMONS 1 LOCAnDNS I VEHI CLES (Attaeh ACORD 101, Adtl 061101 Rerrerke SelikkiM, If more epees Ie mgrAmd) JOS SITE: 3 LORDEN ROAD WESTFORD, MA, SHOULD ANY OF THE ABOVE DESCRIEED POLICIES K CANCELLED SEPORE TOWN OP WESTFORD, MA THE EXPIRATION DATE THEREOF, NOTICE WILL 8E DELIVERED IN BUILDING DEPT, ACCORDANCE WITH THE POLICY PROVISIONS. 55 MAIN STREET AUTHORIZED REPRESENTATIVE WESTFORD, MA 01886 NANCY A. RIVET 1188,2009 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORU The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ,Y www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: I' -�- - , i ✓� /II Mr you an employer? Check tie appropriate box: EI am a employer with ( 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other .ny applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. im an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. surance Company Name: dicy # or Self -ins. Lid. #: b Site Address :tach a copy of the workers' compensation policy d Expiration Date; City/State/Zip: page (showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Le 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ✓estigations of the DIA for insurance coverage verification. !o hereby 4Atify upper (71ek h1nsa1ftpyha4Vs ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completer) 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 #: 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 contract of hire, express 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 representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 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 be 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) 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 for 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 required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should 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 "Job 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-NMSSAFE eked 5-76_n5 Fax # 617-727-7749 v�e oaz2��2�tcuea >i-19% aJdac>l,M 't Office of Consumer Affairs & Business Regulation VOMEIMPROVEMENT CONTRACTOR egistrati on: 108952 Type:xpiratio: 8/27/2014 DBA BUSHNELL CONSTRUCTION %_ Mlchael Bushnell i 89 MEADOWBROOK RD. gr Chelmsford, MA 01863 Undersecretary � Massachusetts - Department of Public Safety Board of Building Regulations and Standards I. Construction Supen i.sor License: CS -058872 MICHAEL E III SHNEL�L 89MEADONM-'ROOK RD~r� r- N CHELMSFORD MA 01863 o> t 5' Expiration Commissioper 03/31/2014