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HomeMy WebLinkAboutBuilding Permit #619-2017 - 79 KARA DRIVE 12/8/2016�c�✓ I�i� �� ` BUILDING PERMIT oNo oT" qti TOWN OF NORTH ANDOVER 3� APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �faA°RwrEo pP.45/ Date Issued: ` IMPORTANT: Applicant must complete all items on this pane LOCATION 1 � )t q'n- Y -\,Y-. -Print PROPERTY OWNER 'Lhn;f-ee` 6Gif5-5 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residen ' I Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial C�teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑Watershed District 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ��1 C��`tti `yze ✓c f2'LJ9 !O �� ire G Ce � _5 4- dx 1� Identification - Please Type or Print Clearly OWNER: Name: �eii "14-- Ga.5-.S Phone: Address: 7q )U-rr, Contractor Name:.& -.G Ah-,, Phone: q� �• 7 �1�1 c�l r7 Address: 3 t 5711, Su,l-�i-�-, Supervisor's Construction License:.. S'% � 7-7 Exp. Date: LIIZ3119- Home Improvement License: t _ _ - Exp. Date: 312-fL 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: $ 36r - f FEE: $ --- Check No.:Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access the guaYan .and A _ _ _ _ - - Signature of Agent/Owner Signature of contractor 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 PLANNING & DEVELOPMENT Reviewed On Signature, COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS V Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: • Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS ood Street Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 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 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 submitted with the building application Doc: Building Permit Revised 2014 Location AY? A Av k - No. ( �� Date TOWN OF NORTH ANDOVER I Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # Bui ding Inspector idpp-� rA rA Q w LL D O 0 m N t U \U O LL N Q a) VI OO W a Z OZ Z "' m C O 'O 7 O LL t40 O d' E C t U LL W Z J d t O [C f0 C LL F- W a ? Q U F-� J a+ W L j O 2' U N V) f9 O LL cc O a Z t . j p W N C LL Z W w W OC LL N i 1 CO z 41 L V) 4-; a (3)O p V) vE y ON <u W u Or r� u O Q 046 SNL O Cc AWE N C E Q L N � � C CD ai E O = d*NC (� L w JAW J �m a Mrow y ; O i O O N > :a I'= OQ C O '=Vo o CL O = O O A 3 tm C,'> O c c L H- CL Q' t -200) +-• m m 0cnO car O N 2 m O N W = -o:E O O � LL y 9 w C O ml M t O aM u E _ O W 42) 0-0O' CL L Q N a) '> = c ...I N .n O O H t CL O U > CO 2 Z X. CDZ Cl) w CL W W a. 0 •m Z O CO J IIty WS tract �gttage m�bb�"req"'ten"'msoftbeslasxQme °tegaladviceif°�ait�ittratxoriaiv Oce f C r GWdvtDH0m*h gnUVa���g��' AuypaMPlmmiRgh�. entsshmdddoeROHmIIdestandwd onstrmerAffarssaadBusmessRegp}ati,,O"' agan�i -i-gt myworkenyaQrr fm Yaa flab olacogyaf A l�[OrileOtr}aer orTWMa0tiiaeat-617-973,8787ar1-888 7 fre�bYcaUrogthe rraation tame Curttraetorinfone�ation mbsk -eh%7f c ComFaoyrlVante Eras �cictroaesar faea .a... stC°=M:t�ft lftbc_. _._... . .. c�ieatc �J the Collin dgt it ogre`s to lathe faaaitrmg iaarkfor (Describe irtdatai}thexodttorompt gthe �elaamearnm n'pe.laaaRa,etragadeaf�tsiatstabettsed, se,ddi8an.,tsh Required Perm is _?'RafoU �q•Y4 Q� - d /� and viibesecuredbythecontra t btnldmgFermTtsaterequired propStartaad •�J (OwIlers Who s ctora3thehameawng'sa °mPieganSt3terhrfe_�e� e LcietB €sora aettse g6eir oats pea�nif3edt be adhered to Rn}ess cu og sr3[ethtie will es t ' the Gut.n WM be bid the contrsctoi's control arise GL chgpter I4 A,) ty pond P, -.OV ;ons of -- "Datewhen cant> cwwilt bogin contracted wpr}r, Tow con traC'I'dceandPa Ymeat S^ ��� uQilt will be substzntiaUY Completed. IhcContraaoragtesto .ltetiale PCriaimtbeIvadS fumis°rbe�alaad? PaMOBts Will be made r ed abmT&-tbetota} smu of J �� • aa6 ��thefoilov,iogschednie. (°) 'r--_____ uoaas%BRingeaa�{aorto ' exceed I/3 ufthe total Contr2et Price the Cost of S--- -----_ b1' /— _ / Qr nQQa Completion of SPeCW mderitem� Webevaris�tcr) �----_ by I /T4 Dragon ixtmatetioa of ------ upon completion oftbecall ire �vfarltidsdetaaa Ta°�dbefar,a * �Pmentmratbepeciaf 5 fuItPa3�eRtua cant*actis Pleiedtobotitgattys ciion tom- the comp}0iO t�iu }� m o. -der m d f ) N41" E S. n Incluang.jt !— be � ftaaneceitarg� ("} LAW � altar arty deposit ar daua•paymcu not exceed , of a xitir munbe {)tee hirdaftheiatnJ m+itatrd pxiat otderad iu advarcc to m=tbbe eoommFtedc",hedaleackw �t aFany� the b� �be&ns may ;.bcosisl� _a = a[uiFmmtar mademazetiat u�ubcontrnrtors-7'beCantta�r nto videdtr tbecnntrcetaf? t-tN.o paztYisuhsontractarrtr}imd asiestctor l r � es aliftstt aTlhca t ntvmtrthe iin�tetltathemnhs aterials by theconL-actat i'nc Ponstb.eforcamcletianoftheuV �7ndfabartmdert6isavaeem t taIwIhera be solei � "dfe a oftheaetioasofaaythirsi Conttuct Ace- Upon Sf Y respon oleibraB PM=ts a all SUo can tract shall notlmply tbat imylt�ea�oro�thera�mem becomes abl bcantracton; for Catefitlly before signing this Contract security ere' bas beep g aced on erlaw Unless othervrise noted Placed QR themm,dence. Revievitfiefollowin r>R25m lhfsdacnmetrt; the ° Don'tbe gcautionsandnedees Ft` -`noel into si ° ff,2 a sure the Contractor gig led Ham T -i time to tt ad and full and subcaah-.ttomtoberegisteredmithtire - tCanttzctor.y''te to the ga�tionsifsQmethingisnacfear S 91SURUIMbyiytitin DirectorofHome iml tnQsthome' ° Does the cants g to the Director at 10 ant Contractor impmemeot contractors and Contractor have �%PI-� Ram St70, $oston, lb1A D2I16oa You may inquire about contractor see . Copy ofa`Proofofins cerdo��ent. ,Qs bS`raflmg63T-973-8787or8882S3-3757. Kmatti,yourrighfs aad arcuation so that Guide to 2hcHQtReiraonsrlalrtres. Readtheitaptaiionoaihese y°ni�+iCQnfamcoveraggoraskto ptovemertC0wmcsori,av< vetsesdeofthisform You mr nudger a copy aftlneConsomer May Cancel this agretentifithasbe contractorinwritiRgathis/hermain Mae stgu=ap:S�th wird business au the con YfQUouingtftesigrssngoftjim�mytaatlposte$ bytele ufbnsiaess�Providedyounci the �G NOT SIU'I4T wtachedn6dee of l �� sent or by not IalerOno midnight ofthe ��� �� r �n an CNOTanation of thiANys ri - TRD 1Q�nr1�¢G CFtCL• e-�- C1Ci D,C�. y,,• "" TftRE nRr Oxmpqus2 tdtsc.�yamis LLJ �� SPACE'S!H i):e°t�Ctppy.,, bet¢ps Rom ..Q.w . rte -=r a arpat�af! CanIIac a: s Signalmu Daze ------------ �� 'lie Commonwealth ofTdassachuseft,s Deparinnent ©f ndustr ial Accidents ®]lue of bivestigations 600 Washington ,street Boston, MA 02117 Workers' Compensation insurance Afdavit: Bullaers/{Con"L-raetorsfEleetricians/Flumbers ADD11cant infor nat on Please Print Legibi� Name (BusinesslOreanization/Individual): Address: F�p,c1 \h' `t i obi; City/State/Zip: Phone #: ` Are you,,1fi' employer? Check the appropriate box: 1. [,I' am a employer with� 4. ❑ I am a general contractor and I employees (full and/or part-time)."have hired tie sub -contractors 2. r7 1 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. employees and have worker' [No workers' comp. insurance comp. insurance .'+ required.] 5. ❑ We are a corporation and its 3 ❑ I am a homeowner doing all work officers have exercised their myself. [No workerscomp. right of exemption per MGL insurance required .1 c. 152, § 1(4). and we have no employees. [No workers' come. insurance reouired.] 70 ' 7GfV- ol /q Type of project (required): 6. ❑ New construction 7. Q Remodeling 3. F] Demolition 9. Q Building addition 10. F-1 Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑�tther pairs i3. Sv/�� 'Any applicant that checks box rl must also fill out the section below shoivin.-their workers' compensation policy information. ' Flonieowners 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 tiie 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. 1• am an ernployer that is providing workers' compensation insirrance for mj? employees. Below is the policy andjob site irr j orinatlon. Insurance Company Name: iGl Yr G Policy - or Self -ins. Lie. ;-: j627 0 12- Expiration Date: . 31Za�) -7 Job Site Address: 7 q kap -Dr-City/State/Zip: Al. A�a6n�� Attach a copy of the workers' compensation- policy declar atiosa page (showing the policy number an'=t's expiration date). Fai ILire 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 S 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. 1 do hereby cerdfv under the pains and penia{ties of peiju.;y that the rzforrnation provided above is true and correct. Phone f: 7tw- d/ LI Official use only. Do not write in azis area, to be completed by city or tonna of City or Tovi-a- Fermit/License # Issuing Authority (circle one): ±. Board of Health 2. Building Department 3. Cityl T octan Clerk 4. Electrical Inspector- S. Plumbing inspector 5.Other Contact Person- Phone #: •"" �� 1 Nyi aur c.vJ.0 a . az . LY rivi t1t1VL, G/ VVG raA Durvur CERTIFICATE OF LIABILITY INSURANCEI DATE(MM/DD/YYYY) n7/231901L. TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS rRTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE PRODUCER. D 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endo; rsemen s . PRODUCER CONTACT I NAME: PHONE (A/C, No, Ext): FAX (AIC, No): EASTERN INS GROUP LLC 233 W CENTRAL STREET EMAIL ADDRESS: NATICK, MA 01760 22MLW INSURER(S) AFFORDING COVERAGE NAIC # INSURED ATLANTIC WEATHERIZATION LLC INSURER A: AMERICAN ZURICH INSURANCE COMPANY INSURER B: INSURER C: 61 REAR JEFFERSON AVE INSURER D: INSURER E: SALEM. MA 01470 INSURER F. j COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANYCONTRACT 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 PAD CLAIMS. INSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE IMIADDIYYYY) POLICY EXP DATE IN MDD%YYYY) LIMITS GENERAL LIABILITYEACH COMMERCIAL GENERAL LIABILITY i OCCURRENCE $ DAMAGE TO RENTED REMISES (Ea occurrence) CLAIMS MADE f__1 OCCUR.I MED EXP (Anyone person) $ ERSONAL & ADV INJURY $ GEN'L AGGREGATE UMfi APPLIES PER: ENERAL AGGREGATE S POLICY [—]PROJECT ❑LOC RODUCTS - COMPIOP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA UABOCCUR H EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE g DEDUCTIBLE $ RETENTION $ ; g A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY Y/N UB -5B270121-16 03202016 03120/2017 X wC S'TATUrORY LIMITS OTHER ANY PROFERITORIPARTNER/EXECUTIVESOO, OFFICER/MEMBER EXCLUDED? a N/A E. L EACH ACCIDENT $ 000 (MandatoryIn NH) I If yes, desalbe under E.L. DISEASE - EA EMPLOYEE S 500,000 - POLICY LIMIT $ 500,000 DESCRIPTION DF oPERAnays belowE.L.DISEASE DESCRIPTION OF OPERATIONSILOCATIONSNENICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERMCA17E HOLDER AFFECTING WORKERS COMP COVERAGE. 's CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIB ED POLICIES BE CANCELLED 1600 OSGOOD ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED C IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR}- N. ANDOVER, MA 01845 A^^On AL /Mwninr. registered marks o 2010 ACORD CORPORATION. All rights reserved. ACC>R nQ0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMfODfYYYY) 3/9/2016 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(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 Eastern Insurance Group LLC- 233 West Central St j Natick MA 01760 NAME: CT Construction PHONE (800) 333-7234 FAX No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER AArbella Protection Ins. Co. 41360 INSURED Atlantic Weatherization i 61 Rear Jefferson Avenue Salem NA 01970 INSURERS -Nautilus Insurance CO INSURERC: INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBERNaster 2016 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. !LTR TYPE OF INSURANCE D POLICY NUMBER MMIDD EFF MMIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 8500042816 /20/2016 /20/2017 DAMAGE TO RENTEU PREMISES (E occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY S 1,000,000 X CONTRACTUAL LIABILITY X CG0001 10/01 FORM GENERAL AGGREGATE S 2,000,000 GENLAGGREGATE LIMIT APPLIESPER: PRODUCTS -COMPIOPAGG $ 2,000,000 POLICY X JErTPRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 BODILY INJURY (Per person) S A ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS 1020015871 /20/2016 /20/2017 BODILY INJURY (Per accident) S X HIRED AUTOS X NON OWNED AUTOS 1 PROPERTY DAMAGE Per accident $ PIP -Basic $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DED RETENTIONS 10,000 S 1 600058654 /20/2016 /20/2017 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITYY! N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? � E N f A E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE4 S (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS below B POLLUTION PL200378614 0/1/2015 0/1/2016 EA POLLUTION CONDITION $1,000,000 GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) TOWN OF NORTH ANDOVER 1600 OSGOOD STREET NORTH ANDOVER, NA 01846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/SME— ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnn5a ni Tha at -.1 n2ma onrl Innn ara ranicfarar1 mnr4a of .&CtnP ) Massachusetts Department of Public Safety I�. Board of Building Regulations and Standards License: CS -087977 Construction Supervisor ERIC W PALM 3 HILTON ST SALEM MA 01970 NIZOK CA— Expiration: Commissioner 0412312018 r J>i�.i�ta)wlllBlrttrrtl�f a�+_ f£rrl�rn�rr,.F��' Office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR deglstration. 142089 Type: s lr pira6on: W12I201& Ltd Liabitily Corpor ATI.AN71C WEATHERIZAnWLL.C. ERIC PALM 61R JEFFERSON AVE {ice SALEM, MA 01970 Undersecretary Construction Supervisor Restricted to_ Unrestrid ed - Buildings of any use group which colttain less than 35,000 cubic feet (991 cubic meters) of . enclosed space. Failure to possess a'curent edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit- W W W.MASS.GOVIDPS License or registration valid for ind'evidul use only before the expiration date. If found return to: - Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 L� zP� Not valid without signature