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HomeMy WebLinkAboutBuilding Permit #1132-2016 - 92 BUCKINGHAM ROAD 4/27/2016 (��'�^'l 1 v ✓ f �ry 1 r NORrh q BUILDING PERMIT 3? TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit N0: 1 � "— Date Received �C, lea* �•4 o�g4TE0�PP�•(y Date Issued: 71 t SSACHU`�� IMPORTANT:Applicant-must com lete all items on this page z LOCATION__ i r.rg; °L``t � Print a PROPERTY OWNERS r w - rint _ . MAP NO © PARCEL ONING DISTRICT: Historic District yes Machine Shop V illage yes no TYPE OF IMPROVEMENT PROPOSED USE Resi tial Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Q.Septic ❑'Well ❑.Floodplain D,Wetlands . ❑ >1Naterstied District ❑-Water/Sewer s, Identification Please Type or Print Clearly) OWNER: Name: . A i e Ii Phone: Address: AUCLIV)AhM ^ and1 r N R N am -, a` PF one: P.m _ Address 01 w e, Supervisor s Construction License j Exp Date: Home.Improvemer tlicense Ex Date: p `-i q ARCHITECT/ENGINEER APhone: 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: $ U N FEE: $ 144— Check No.: J�2,'�l Receipt No.: . NOTE: Persons contracting with unregistered contractors do not have acc s o the guaranty fund ignature of Agent/Owner ¢� Signature of cont.., rl ' 7 L t BUILDING PERMIT of "oRTH TOWN OF NORTH ANDOVER �,? y�'``' .; =6 0 10 ' .>^ - A APPLICATION FOR PLAN EXAMINATION * .T H �' (`O •ww O Permit No#: Date ReceivedTop ��SSgCHU`����9 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION PH t in PROPERTY 6W' NER r 3 r _t ,__,;;� Print J.100 Year Structure a yes no, MAP PARCEL ZONING DISTRICT Historic District yes no 7"77777"7777777:7-777- Machine Slop village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family - ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _❑ Other iC1hS`ep ic �Wel`I � � flFlop odplan Wet`l'ands _ ire U1laters ed ,istnct _ < DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: _ s - Contractor Name -Phone Address: �. Supervis.or's Construction License =: { .;;_ :..Exp ` Date 4 ti Home Improvement License. ARCHITECT/ENGINEER Phone: ` Address: Reg. No. .. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to thZ g-yeranty fund --- - € vim A n e 'mak'+ Location [DatoA-77 �, No. TOWN OF NORTH ANDOVER Certificate of Occupancy 's ' uilding/Frame Permit Fee $ �L B Foundation Permit Fee $ Other Permit Fee $—'= TOTAL f3 7-4\ 7 Che ck Building Inspector 0 3 0 4 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 ori Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted- yes flanning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street t d at �� reet �` mp Dum�pster�on sit �yes -��� � no p .- Lova e 124 Main S Fire DepartmAt n turWK a/dat '� may, .rm 2•+>,=,�,,...,�ate. 'i.'.-•,s.. ..-s.ma.:li..e.:.,i..�6+2,t1�-s. t ....b-.�+{r?E4.a..- " # '*s Qa,' 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.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 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 OTE: 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 --- 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 recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH own of O to N®. Z �l o h ver, Mas 1 coc Nlc Ml WlcK LAK y1. �.9s RATE0 U BOARD OF HEALTH Food/Kitchen PERMIT rSeptic System •�► +a BUILDING INSPECTOR THIS CERTIFIES THAT ................. 01............................................................. ................................ Foundation has permission to erect . ... buildings on .C.U. Rough to be occupied as .. ... . .. ..�. ....... ... . .. ............................................................................ Chimney provided that the person accept g this permit shall in every respect copform 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 CONSTRUCTION STARTS Rough Service ..... ........ .. ............... ........... ............ Final BUILDING INSPECTOR GAS INSPECTOR ` Occupancy Permit Required 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. PROPOSAL L.E Morgan Construction Company We Accept: 86 Billerica Avenue,Unit#1 ( /1SA ° on i IRNNW N. Billerica,:MA 01862 Office: (978)670-47471 Fax: (978)676-6477 r P OPOSAt UBMITT- - ' PHONE .STREET. t.: J61 E r CITY,STATE AND ZIP CODE 1yy) o NTACT � JOB PHONE < 1 rA �Q Strip down to the wood deck; -!k— layers of shingles, dispose of debris to A licensed recycling facility: Install ice and water shield at the gutters feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the wood decking. Install 8" aluminum drip,edge on°all perimeters; color choices:74 White, ❑ Mill, U.Brown, Uopper. Install TO ear ka tis dh �, Ce,�-7tgr.�'fio o cf y._ architectural asphalt shingles, and hurricane nail.. Install ridge vent manufactured by Car k to all ridges and dormers. Install N� new skylight flashingkits manufactured by _ NIA Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing loo re chimneys and install new lead flashing. Install matching cap.<shingles to all ridges, hips and dormers. WE PROPOSEr hereby to furnish material and labor-complete in accordan'e with above specifications,for the sum of: �:...Gwr / Av'+-les✓�A>7 -►• wwreLy.vC' -�-c ll[ Ti D4 . am b dollars($ All material is guaranteed to be as specified.All work to be completed ina workmanlike manner according to standard practices.Any alteration or deviation from above Authorized Sign . specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.Our workers are fully covered Note:This proposal may be withdrawn by Workmen's Compensation Insurance and Liability Insurance. by us if not accepted within days. ACCEPTED AS A CONTRACT-The above prices, ate of acceptance: 'i specifications and conditions are satisfactory and are thorized Signature:hereby accepted.You are authorized to do the work as — specified.Payment;will be made as outlined above. Authorized Signature: Additional Remarks: S E OLOR vm THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Massachusetts UVDepartment of IndustrialAceidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avrilicant Information Please Print Le ibl Name(Business/Organization/Individual): 1_ Address: 1 {�Rt f G9 k-,Aj City/State/Zip:,�►' - ` ' 1 C 0 Y110 Q hone#: q Y) 10 4-7 Are yo employer?Check propriate box: Type of project(required): I am a employer with employees(full and/or part-time).* 7. []New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10[J Building addition 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 11.EJ Electrical repairs or additions proprietors with no employees. 12.Q PI bing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t p. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Othei 152,§1(4),and we have no employees.[No workers'comp.insurance required.] ' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. I I am an employer that is provi g workers'compensation insurance for my employ s. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#; ? 6' Expiration Date: Job Site Address: j '1 ti 1�. City/State/Zip: , t I 0 � Attach a copy of the workers'compens tion 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 iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ve tc ion. Ido l:er°b cer rfy under t/re pains d pe a ies of peijui that the infmntation provided.above is true and correct. .Simi hone W. 9-?k- use 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• ,et►C 0" LEMORGA-01 BBOYER �.- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF 14/2016 INFORMATION ONLY AND ORO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.HIS 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 Welsh&Parker Insurance Agency,Inc./Hudson Office NAME: 131 Coolidge Street,Suite 100 PHONE 978 562-5652 FAx Hudson,MA 01749 (AIC, (AIC No):(978)562-7120 E-MAILL EM):( ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Western World Insurance Company INSURER B:SAFETY IND INS CO 33618 LE Morgan Construction Inc INSURER C:Scottsdale Insurance PO Box 75 Billerica,MA 01821 INSURER D: INSURER E: COVERAGESINSURER F: 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 A DLSUB LTR TYPE OF INSURANCE (INSD WVD POLICY NUMBER POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY MWDDNYYYMM/DDNYYY LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR NPP8381520 04/13/2016 04/13/2017 DAMAGETORE TED PREMISES(Ea occurrence) S 100,000 M ED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JE O- I I LOG GENERAL AGGREGATE S 2,000,000 OTHER: PRODUCTS-COMP/OPAGG S 2,000,000 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT B ANY AUTO 6230688 (Ea accident) S 1,000,000 ALL OWNED X SCHEDULED 10/13/2015 10/13/2016 BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY Per accident S HIRED AUTOS X NON-OWNED ( } AUTOS PROPERTY DAMAGE $ —(Per accident UMBRELLA LIAB X $ OCCUR C X EXCESS LIAB CLAIMS-MADE XLS0099346 EACH OCCURRENCE S 5,000,000 04/13/2016 04/13/2017 AGGREGATE S 5,000,000 DED RETENTION S WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY PER OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE ER OFFICERIMEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ (Mandatory In NH) It yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DfSEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached ifmore 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 ACORD 25(2014101) 1988-2014 The ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserved. of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM//2015 ) TII{) 4ERTIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BALDWIN\WELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE#100 (A/C,No,Ext): (A/C,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: INSURER D: PO BOX 75 INSURER E: NORTH BILLERICA,MA 01862 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY a PROJECT F]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 LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-15 12/14/2015 12/14/2016 LIMITS ANY PROCER EMB R/PARTNDED? CUTIVE Q N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (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/LOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE 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 -NORTH ANDOVER,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 veru�o- B iliu£-ig Regulations and Stai.aarv-$- ✓f/ioo Ce ni- meL9r7 IrdLi4r"s _ I1S1DC5S egu aC[6n HOME IMPROVEMENT CONTRACTOR :c`v License: CS-079476 _=�; ,,, Registration: 137913 T ype: Expiration: 1/27/2017 Individual LAWRENCE E 1 A1ibRENCE E.MORGAN:IR. 86 BILLERICA AVE ; N BU LERYCA MA 60- ,J) LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 _ Expiration N.BILLERICA,MA 01862 Commissioner 06/03/2017 Undersecretary 5arellFafAF1Ba1ifi _-' _ - i OSHA fR ���- JJ Zam7a7c�aYon _ E . I N��,� This card acknowledges that the recipient has successfully completed a �'S.Dep artr.:e^t of t c 11( 30-hour Ocbupational Safety and Health Training Course in 0--ccra:ona£Safety and'reafft :,.,;,n: ,f=a£ Construction.Barely and Health � L A R R Y MO R&A r r —Je has successfully completed a"G-`cur p,; upatien_f Safetyand Heal?h i Training Course in _ Constructio-n Safeij Health 4 IF . - ;_)CAL � E LOyt S Rot-! ! ®.S � . ( :A ` Gather name—print or type) -- (Course end date) 3 (Trainer) (Cate) - - - J I ROOF TOP RECYCLING SEAN ANESTIS PRESIDENT&CEO 369 CODMAN HILI.ROAD TEL 978-263-1899 BOXBOROUGH,MA FAX- 978-263-1879 EMAIL:R00FT0P1@VERIZ0NNET CELL 508-726-5341