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HomeMy WebLinkAboutBuilding Permit #674-2016 - 84 BRENTWOOD CIRCLE 12/1/2015SG'f1n,,C-0 l, �-7-1-'� (A. BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION G tt Date Received . M <ocwic ewrtK 1' m O • e-� ya, �RgTGD TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial XAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other •'i_4 X 'k"'-•.� c ®1® [jWater/Sewer� Flood Iain ®UVetland5� �Ta, a wli ❑Watersheds®istnct' a*� c DFSCRIPTION OF WORK TO BE PERFORMED: r Identification - Please Type or Print Clearly OWNER: Name: �kSu,� Vit.. �a ��rr.s... Phone: -70S �i�c� 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. Total Project Coit: $,.Z ox 00 FEE: $ Check No.:� Receipt No.: Z9 165� NOTE: Persons contracting w14 unregistered contractors do not have access to the guaranlyfi T '%Ska-n— u°re'i b v' - r* VA a. U LO CV .. '`3 Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/Massage/Body Ari ❑ 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 e U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i s Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments D 6onservation Decision: Comments 4 Water & Sewer Connect[on/Siq�nature &Date Driveway Permit -DPW Town Engineer: Signature: 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 N® MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA -- (For de0artment use) ® Notified for pickup Call Email I Date Time Contact Name Doc.Building Permit Revised 2014 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 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) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products DTE: 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 :)TE: 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 FermitRevised 2014 C � U) 0 -0 0 CD CD 0 mo C F)• o =• y > `m -0 0 vCD � �_ Cr CD CD 0 CD aWGo CD CL m 0 N CO CD ' 5 v CO) 0 Z 0 70 CD 0 CD 1' V Z m 0 CO) ® 0 -0 O = i o Vo v<rr a e/) --I CCD n C7 � m CD 0 .n-r��CL0 y ;moi Z® 5-a N O CD' ,7 •'' O_ O rt Q O m CD y rt co) N C. 'am CD 2 0-% O @ D O O —� N CL O n L(9 cD CD C CD m =' < 0 —� c o, Cr > co N C Q 0 O N Q < N �• - CCD l) N CD V+ O CD N gym! W C Z CD cnO a N r0irt 0 cD 0 Z =~ O U3 '/+ OA 0 �_ CO CSD 3' C CD U)CD _� `.) C1 N U) 0 h — =r N CD `a n' O O rt O O Q O • N 3 O Ln m oz ou c 3 T 5. °—' 7pT O o=o °—' N O ;v O ago T °—' :O O m -n °—' (� _3 m C � O QQ T O m d rr Ln N0 L C T a + 7o D m D G7 N z H r m a r m n 0 V C W Z Gl V D 0 W C v z m 0 3 S rD ' O v O r4 _ O ft v s O �h �I Inland Quality Builders 28 meadow Lu Wesd'ord, MA 01886 Phone # 617-839-26.59 Proposal For: I Name / Address I Jason & Jcn Eastman 84 Brentwood circle North Andover, MA • 0 GENERAL CONTRACTOR NUV CONStxuu ION 1 tzar.+Ooet. W, a7tw.lnlanil(ivali1%•Ruildcr .ccom Description IQB proposes the following scope of work listed below: IQB will strip and rc-roof the existing house and garage: - IQB will strip existing shingles to existing plywood - IQB will then apply grace ice and water 6 up the roof and around all skylights and valley's - IQB will apply all drip edge Ahich will be white - IQB will use synthetic roofing paper for the remainder of the roof. - IQB will install new ridge vent in main house and garage - IQB will supply and install new 30 yr architectural GAF shingles per manufacture installation guide. - IQB will supply 20 yd dumpster Payment: Deposit 5 3600.00 Final payment upon completion 5 3600.00 Date Estimate # 11/30/2015 648 Dan@l iil,u tc l Qualiq•Bui ldcts.Com Project Roof IThank you for giving IQB the opportunity to provide this quote for you! I Total $7,200.00 I This proposal expires one month from the date written All work is warranted for materials and labor for a minimum of one year. This proposal is valid for one month from the date above. The total listed above is the total cost of your project as outlined above. Change Orders will be written for all changes in the scope of the work. Each change order must be approved by you before work begins. Payment for all change orders is expected at the time they are signed.1 f this proposal is accepted please sign one copy and return it to Inland Quality Builders. We also understand that Inland Quality Builders reserves the right to delay completion of the work for nonpayment of any invoices. Signature below acknowledges receipt of two Rights of Rescission forms included below. Signature /,, L01 Date R 13" /2015 Customer Signature Date / /2015 Inland Quality Builders Representative The Commonwealth of Massachusetts Department ofInndustrial.Accidents N 1 Congress Street, Suite 100 �f d Boston, MA. 02114-2017 OR www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: Z City/State/Zip: C Phone #: G 11' �33`� Z b Srlk Are you an employer? Check the appropriate box: 1.91 am.a employer with •�.: employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3_Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ 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. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors hale employees and have workers' comp. insurance. 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no. employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. [1 Remodeling 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or additions 12. Q Plumbing repairs or additions 13. [] Roof repairs 14. n Other *Any applicant that checks box 4l must also fill out the section below showing their workers' compensation policy information. i Homeowners 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 the 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. Yam an employer that is providing workers' compensation insurance for• my employees. • Below is the policy and job site information. Insurance Company Name: Policy # or Self ins. Lic. #: F� b Z�3 d Expiration Date: �i Job Site Address:y`'l ���,A.ay` e -;(c L(i- 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 DTA for insurance coverage verification. I do hereby certify r e pains/and p of per ' ry that the information provided above is true and correct. Official use only. Do not write in this area, to be completed 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 Phone 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 bf liire, 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 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 -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 fox 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 buzn 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-MA.SSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia INLAQUA-01 SWHITEHURST ,R�n CERTIFICATE OF LIABILITY INSURANCE FD 111.TE IDDlYYYY) 11/1912015 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 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 Knapp, Schenck 8: Company Insurance Agency, Inc. One India Street Suite 204 CONTACT NAME: PHONE 1617 742-3366 jglc No : 617 742-2832 LAIC. No. Ext/: ( ) E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Boston, MA 02109 INSURER A. Arch Specialty insurance Company 21199 i _ INSURED INSURER B: Safety Insurance Company GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PRO- - D LOC INSURER C'. PRODUCTS - COMPIOP AGG $ 2'000,000 Inland Quality Builders, LLC _ OTHER AUTOMOBILE LIABILITY 4 ANY AUTO 28 Meadow Lane INSURER D : 16220426 INSURER E: 10/24/2016 Westford, MA 01886 INSURER F : BODILY INJURY (Per accident) I s 300,00 r C orlell%ATG til RACCD• KFVINIUN imunrimr-K: li V Y Gr\/1 V GJ 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. IN RI LTR A TYPE OF INSURANCE IINSD X I COMMERCIAL GENERAL LIABILITY I CLAIMS -MADE N OCCUR �i THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN UB WVD �BAG`1024398 ' POLICY NUMBER POLICY EFF MMIDDAYYY 09101/2015 POLICY EXP MMIDD/YYYY) 09/0112016 LIMITS EACH OCCURRENCE $ 1,000,000 PREMISES (OEs oNcTwnence) I S 100,00 MED EXP (Any one person) i $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 I i GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PRO- - D LOC GENERAL $ 2,000,00 PRODUCTS - COMPIOP AGG $ 2'000,000 $ B OTHER AUTOMOBILE LIABILITY 4 ANY AUTO I 1 16220426 10/2412015 10/24/2016 COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ 100,000 BODILY INJURY (Per accident) I s 300,00 — ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NOTOSWNED —, I '(Per PROPERTY DAMAGE aoddent) $ 100,00 is UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ AGGREGATE is EXCESS LtAB CLAIMS -MADE DEC) 1 1.RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIMBERIPXCLUDE/D,(ECUTIVE ❑I (MandaRryInN R EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A I I i ' I 1 $ ATUTE I ERH i I I STO I E.L.. EACH ACCIDENT Is E. L. DISEASE - EA EMPLOYEE, $ E.L. DISEASE - POLICY LIMIT 1$ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Compensation coverage is active and in good standing. A Certificate of Insurance will come directly from the carrier. /x.11 - - rANr r -I I ATinti - 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 O1988-ZU14 AUUKU L;VKt'UKA I IUI I. An rlgnTs reserveo. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE ll._� DATE(MM/DDIYYYY) 1 11/19/2015 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:Helen O'Neill KNAPP SCHENCK AND COMPANY INSURANCE AGENCY INC. a/c°"x Ext): (617) 619-0204 JC No: ADDRESS: swhitehurst@kscins.com INSURERS AFFORDING COVERAGE NAIC # One India Street INSURER A: ACE AMERICAN INSURANCE CO 22667 BOSTON MA 02109 INSURED INSURERS: INLAND QUALITY BUILDERS LLC INSURERC: INSURER D: INSURER E: 33 MASSAPOAG WAY INSURER F: DUNSTABLE MA 01827 COVERAGES CERTIFICATE NUMBER: 13583 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM D LIMITS C. MA 01886 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE r_1OCCUR DAMAGE T( PREMISES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ NIA GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per axi t UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE N/A DEC) RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBEREXCLUDED?NIA NIA NIA 6S62UB0G31060915 09/17/2015 09/17/2016 X I STATUTE ETH E.L. EACH ACCIDENT $ 500,000 -- E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is 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 employees 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.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER rANrF1 1 ATInN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN T ACCORDANCE WITH THE POLICY PROVISIONS. 2/ AUTHORIZED REPRESENTATIVE C. MA 01886 �. Daniel M. Cr . a. y, CPCU, Vice President — Residual Market — WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD /re �r���r.rrr,a�tcoecc�t� a��lic;rccr.�u�cC�� Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR --registration: 167038 Type: xpiration 8/2/2016 DBA INLAND QUALITY BUILDERS DANIEL MCGONIGLE, 69 ARNOLD AVE. LOWELL, MA 01852 - Undersecretary MassachusettsDepartment of Public Safety Board of Building Regulations and Standards License: CS -094579aµ: - Construction Supervisor,, DANIEL J MCGONIGLE ' 33 MASSAPOAG WAl( DUNSTABLE MA 01;; W nn ,,+ 1 111 1• Expiration: Commissioner 10/23/2017