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HomeMy WebLinkAboutBuilding Permit #1331-2016 - 80 SETTLERS RIDGE ROAD 6/27/2016 BUILDING PERMIT{ NORTH �j LED 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION C2, �J , r,, ii _ y Permit No#: '/���" Date Received I � " �9 DRAraD�Pp`4 5 i SSACHUS� Date Issued: Z 1 1 IMPORTANT: Applicant must comple e all items on this page LOCATION Q C int PROPERTY OWNER 'r Print 100 Year Structure yes o MAP 6 I*D/ PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res! ntial Non- Residential ❑ New Building 60ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: D Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ��fi 5 I Identifica i n- Ple se Type or Print Clearly OWNER: Name: Phone: Address: . tculf Contra, for Name: �; G(�Phone: (� Email: 00 Address: I OD IILO (I 10`- i l d Supervisor's Construction License:N--0-7 (0 Exp. Date: Home Improvement License: ai q 13 Exp. Date: ARCHITECT/ENGINEER ,A- Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ I ., � FEE: $ LN Check No.: Receipt No.: NOTE: Persons contractink with unregister d contractors do not have ac ess o the guaranty fun Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dempster 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 Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes C, Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street O Fuk t DEPARTMENT - TempiDumpster onsite ,yes Located;at 12.4�Mbin:Street Fire,Departrrient signature date COMMLNTS 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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Pennit 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 0 .� Building Permit Application Workers Comp Affidavit .rK Photo Copy Of H.I.C. And/Or C.S.L. Licenses � Copy of Contract 4� Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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) n Mass check Energy Compliance Report (If Applicable) ` J 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 � 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 OTE: 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 recordinE must be submitted with the building application ! 1 Doc:Building Permit Revised 2014 Location _ . C.J No. �3� ��— G��1�+ DateI f� 1 ' t • - TOWN OF NORTH ANDOVER f r- ' Certificate of Occupancy $ Building/Frame Permit Fee $L42-`r Foundation Permit Fee $ Other Permit Fee $� TOTAL $ Check#5j4 Building Inspector "' NORTH own of �� : ndover to No. �) * t 1 I Z oh , ver, Mass, ��Q o K. 1. COCHICK!WICK A°RA r e D P`PP`,��(y S U BOARD OF HEALTH Food/Kitchen PERM [T T D Septic System THIS CERTIFIES THAT ........ Jfroel..... ..... ........ . .............f ...... ...... ...... BUILDING INSPECTOR ... Foundation has permission to erect ......... ................ buildings on ... ....... • ..� Rough tobe occupied as ........... .. ........�....lre ro .............................................I................... Chimney provided that the person accepting t 's 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 CONST TION Rough Service . .. ....... . ......... tECT .. . Final BUILDINGIN GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. PROPOSAL L.E. Morgan Construction Company wnaxxpt' 86 Billerica Avenue,Unit#1 �S N.Billcricn,MA 01862 omova Office:(978)670147471 IF..:(978)670-6477 J ,® one n e... 1.' c r, O I s coc.nw f q 0 1 . n.. S 'p d n to the wood deck,�layers of shingles,dispose of debris to a licensed recycling facility: Insta 6' be and water shield at the gutters 3 feet of ice and water shield in valleys. Install synthetic underlsyment on the remainder of the wood decking. Install 8°aluminum drip edge on all perimeters,color choices:O White,0 Mill,:1 Brown,U Copper. Install�yearl�ceNdn...�iCkir. xG� architectural asphalt shingles,and hurricane nail. Install ridge vent manufactured by G0&-- to all ridges and dormers. Install Pl1 new skylight flashing kits manufactured by 101A Flash all cheek walls,pipes,skylights,and penetrations to manufactures specifications. Remove existing lead flashing /avr7 N'W� chimneys and install new lead flashing. Install matching cap shingles to all ridges,hips and dormers. WE PROPOSE `reby mfu hmaterial and l.bor mmv1. rcord.nce with show speci5c.cinn.,for thesum of: �itr'T v 7A<+..-.c...✓ �n..9�i dou.. d 11,840 u.n.,w�.a.mteea m tic m.ct.a un»on n oe ca,axea r.wwareo�to n.tnei.ttvdr,gbsdMutl peakex Any.tlaefmader40an d.,n Nwe Authorised SiBnatuse' sNMiuliwe YnoMp.,tmmab MI M.me.tlonr.+o...nenwEew er,p WI nemn,e nn enn tlw9emmand eboean enm.a.arwaters me h�rrowmt Nae:Thispropesal may ho withdrawn y w.b�,.roc..P.,�uu,oaw.,,..ttrcn u,,.,ma. i 1/ by ua iCnot.caPted within � days. ACCEPTED AS A CONTRACT-The above prices, y Ono m.capmu: t specifications and conditions are satisfactory and are A.."= .uo" sie.emm: G hereby accepted.You arc outhoriacd to do the work ve Specified.Payment will be made na-d tlined above. A°,so,ma S,e..wre: Additional Remarks, = G o —+j J?QPK%v 1.3 f(ftt THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION I The Commonwealth of Massachusetts u Department of.l'ndlustria Aceidents i n _ r d 1 Congress Street,Suite 100 Boston,MM 02114-2 017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE JELLED WITH THE PERN.CITTING AUTHORIT'Y'. A licant Information Please Print Le 'b1 Name(Business/Organization&idividual): 1 .Address:_Am, N-Con � 7cif City/State/Zip: 1, �� K44me#: U ir ( "7 V? Are y an employer?Check 'e liropriate box: Type of project(required): I am a employer with employees(M and/or part time).* 7, ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me.in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp..insurance required.]t 9. ❑Demolition 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole I L[l Electrical repairs or additions proprietors with no employees. 12..[]Plumbing repairs or additions 5.E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof re i These siib-contractors have employees and have workers'comp,iusirance.t ❑ 6.C]We are a corporation and its officers have exercised their tight of exemption per MGL C. 14.4j`6ther 152,§1(4),and we have nca employees.[No workers'comp,insurance required.] ' z Any applicant that checks box#1 must also fill out the section below showinIL g their workers'compensation policy information. Homeowners wfio submit#his affidavit indicating they are doing all work and then hire outside contractors just submit a new affidavit indicating such. Contractors that check th 5s box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-conuacfors fiave'employees;,tliey must provide their workers'comp.policy numbe}. X am an employer t1zat is pr i iizg woNkers'compensation insurance or my employees.'Below is the policy and j'ob site information. Insurance Company Name Policy#or Self--ins Lic.#: Expiration Date:� Job Site Address: r City/State/Zip: �, I t kt Attach a copy of the workers'compensation policy deet ration 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 verifeel4ion. X do here e i y under the paine s o jy that the info anon provided abov is true nd correct. Si afar Date: Pho #- Of ial use only. Do not write in this area,to be completed by city or town official.. ity or Town: Permit/License# Issuing Authority(circle one): 1.Boar of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: Information and Instructs®ns Massachusetts General Laws cy x 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 o£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 representatives of a deceased employer,or the receiver or trustee of ars individual,partnership,association or other legal entity,employing employees. HovUever the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe 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=contractoz(s)name(s),address(es)and-phone nuinber(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 fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retuned 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 w.Orkers' `J compensation.policy,please call the Department•at the number listed below. Self-insured companies sb ould'entex'their self-insurance 1 Nene 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE ! ` Fax#617-727-7749 Jl Revised 02-23-15 www.mass.gov/dia LEMORGA-01 BBOYER CERTIFICATE OF LIABILITY INSURANCE DAT14/2DIYYYY) 4/114/2016 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 CONTACT NAME: Welsh&Parker Insurance Agency,Inc./Hudson Office PHONE 56 131 Coolidge Street,Suite 100 (AIC,No,Ext):{978} 2-5652 (FAX N.Y.(978)562-7120 Hudson,MA 01749 E-MAIL AIC ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Western World Insurance Company INSURERS:SAFETY IND INS CO 33618 LE Morgan Construction Inc INSURER C:Scottsdale Insurance PO Box 75 INSURER D: Billerica,MA 01821 INSURER E: INSURER F: COVERAGES 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 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 ADDL SUBR LTR TYPE OF INSURANCE M INSD WVD POLICY NUMBER PMIDDNYYYMMIDDIYYYY LIMITS EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY n EACAGH OCCURRENCE $ 1,000,000 OCCUR NPP8381520 04/13/2016 04/1312017 DAM CLAIMS MADE O RENTED PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY JEn LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B (Ea accident) $ 1,000,000 ANY AUTO 6230688 10/13/2015 10/13/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS $ Per accident) S UMBRELLALIAB X OCCUR C JC EXCESS LIAB EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 AGGREGATE $ 5,000,000 DED RETENTION S WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE $ OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WORKERS COMPENSATION CERTFICATE OF LIABILITY WILL BE SENT DIRECTLY BY THE CARRIER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street,Bldg 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE TDDIYYYY) TWYS.GERTIFICATE 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 PRODUCER,AND THE CERTIFICATE HOLDER. PORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to Ttthe terns and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to e certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BALDWINIWELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE#100 (A/C,No,Ext): (AIC,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: PO BOX 75 INSURER D: NORTH BILLERICA,MA 01862 INSURER E:INSURER F: II COVERAGES 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LI PAID CLAIMS. MITS SHOWN MAY HAVE BEEN REDUCED BY INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ POLICY PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO 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 LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-58738312-15 12/14/2015 12/14/2016 LIMITS ANY PROPERITOR/PARTNDED? CUTIVE OFFICER/MEMBER EXCLUDED? rN N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESHRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. "ERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET,BLDG 20,SUITE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR! TA ( j NORTH ANDOVER,MA 01845 " ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD//CORPORATION. All rights reserved. — _ Massachusetts Department of Public Safety ---- Board of Building Regulations and Standards &2/ e cvr�urnoraiaeal�c�U[�GccasacluJel License: CS-079476 �. Office of Consumer Affairs&Business Regulation Construction Supervisorr -- HOME IMPROVEMENT CONTRACTOR Registration: 137913 Type: LAWRENCE E MORGAN,JR ;; Expiratiom. .-4#27,12017 Individual 100 IRON HORSE PARK LAWRENCE E"MORGAN- R Y NORTH BILLERICA MA 01862 LAWRENCE MORGAiN ;;> r?' 100 IRON HORSE PARK Expiration: BILLERICA,MA 01862 Undersecretary ' Commissioner 06/0312017 Occcpatiapn4 This card acknowfeifges ttrat#be racip'tetit has stfc6essfufly ccrrpfEted a - `4 30-flour 066u0ationaf Safetyand Health Trainirtg Course in O.r:paticnaYSRfe, ariC eater, :n ;rzGt Gorisruction Safety and Health } LA has SUCCessfuth*Com Y ted r ,r t P E Fir -� c:,UpafrOrlglS2(Eit•and Health Tr27.^ging burse!n - - ` ( S { construction Safety 8 HeaEtta . 5 1 ti. (Trainer name_.printnr.bpej'� �"�' ---�------ L�.4�t�� ���� . • {Course enddatej 0SAU& (Trainer) Bate) - i