HomeMy WebLinkAboutBuilding Permit #489-2017 - 97 SAW MILL ROAD 11/9/2016Contact: Phil Morris 978-880-7088OORrN
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phil air-tightweatherization.com BUILDING PERMIT LL 3� ;�`�.``° 6�°0
TOWN OF NORTH ANDOVER
` ��1�7 APPLICATION FOR PLAN EXAMINATION
' - -
Penn�O:/ / Date Received
�9S AU
Date Issued: %/ - _ a a� s CHs
IMPORTANT: Applicant must complete all items on this page
LOCATION 97 Sawmill Road
PROPERTY O NE#`t Mary Honan
Pnrtt
MAP NC)IAtCEI.:%
ZONING EHisloric Districts no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
Pq One family
❑ Addition
❑ Two or more family
11 Industrial
El Alteration Insulation
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain- ❑ Wetlands
❑Watershed District
WatedSewet
Air sealing, blown in cellulose to attic floor, install door sweeps and weather stripping.
Install bath fan roof flaspper
a
Identification Please Type or Print Clearly) d
OWNER: Name: Mary Honan Phone: (978) 794-3052
Address: 97 Sawmill Rd, North Andover, MA 01845
CONTRACTOR Name: James Fortin Phone: 978-998-0690
Address: 50 Rundlett Way, Middleton, MA 01949
Supervisor's Construction License: CS -052576 Exp. Date.
Hon* InWovement License: 1656413IExp. Date: 3/15/2018
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: $ 3,158.18 FEE: $ 3 -?
Check No.: (3 10!2 Receipt No.: 3 it S -5 --
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
gnature of Agent/Ownermary an(Nov 7.2016) Signature of contractor
r L
s
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR. PLAN EXAMINATION
Permit No#: Date Received
Date Issued:
TYPE OF IMPROVEMENT
MORTANT: Applicant must complete all items on this page
Residential
Non- Residential
0 New Building
0 One family
0 Addition
El Two or more family
0 Industrial
0 Alteration
No. of units:
11 Commercial
11 Repair, replacement
11 Assessory Bldg
0 Others:
El Demolition
`PROR; 9 -PT * iY`, 0 W__ N. E
Y 81 r yps no
0 Floodplain h EWetan-s
Watershed
-Z IN — i I _1 "
01 YN—PI.S. C,
L� a7i��.:
"T
no
Machineage.
yeses n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
0 Addition
El Two or more family
0 Industrial
0 Alteration
No. of units:
11 Commercial
11 Repair, replacement
11 Assessory Bldg
0 Others:
El Demolition
0 Other
E'Lptie' e
0 Floodplain h EWetan-s
Watershed
1 -.0 Water/Sewer
lJt:bL;KIF I JUN Of- YVUKK TO ISE PERFORMED:
Identification - Please Type or Print Clearly
OWNER: Name: Phone:
Address:
ARCHITECT/ENGINEE
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.
Irotal Project Cost: $ FEE: $
Check No.: Receipt No',
NOTE: Persons contracting witli unregistered contractors do not have: access to the guaranty fund
Signature of ent/C", - '�o
Sidnatun bf cofftr�a�to"_,.
F
i
Plans Submitted ❑
r -
Plans Waived Ell Certified Plot Plan ❑ Stamped Plans ❑
I YPE bF SEWERAGE DISPOSAL
Public Sewer ❑
Tann ing/MassageBody Art ❑
Swhnming 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
COMMENTS
Signature,
CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH
COMMENTS
Reviewed on Siqnature
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Comments
Zoning Decision/receipt submitted yes
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
t_ocatea ;id4 usgooa street
FIRE DEPARTMENT'- Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS r'
limension
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_rrequires approval of
Electrical Inspector Yes No
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
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
40TE: 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
i�
Doc: Building Permit Revised 2014
Location Cj -) 5 rlyi v" r C 1)
`a
No. 017 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ �-
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# 1365
/1 r
Building Inspector
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50 Washington St, Suite 3000
Westborough, MA 01581
CONTRACTOR WORK ORDER
Printed: 10/24/2016
Work Order Id: S24789P57547C271
Contractor Information
Customer/Site Details
Air -Tight Weatherization
Mary Honan
Email: mhonan@formarketingmatters.co
50 Rundlett Way
97 Sawmill Rd
Phone (Eve): 978-7943052
Middleton, MA 01949
North Andover, MA 01845-1435
Phone (Day): 978-7943052
Site ID: S00050224789
Incentive Payments
Customer Share
Weatherization Incentive
Air Sealing Incentive
Total Incentive Payments
Total Customer Share
Less Deposit Of
Customer Share Balance (Due Contractor)
Air -Tight Weatherization
50 Rundlett Way
Middleton, MA 01949
978.998.4684
$1,748.48
$826.87
$2,575.35
$582.83
$194.00
$388.83
CONTRACT AGREEMENT / OWNER AUTHORIZATION FOR CONTRACTOR TO PERFORM WORK
1 as owner/authorized agent of the subject property, hereby authorize James Fortin to act on my behalf, in all matters
relative to work authorized by the building permit.
Owner/Authorized Agent (Print): Mary Honan
Owner/Authorized Agent Signature: Mary nd an(Nov 7, 2016)
Contractor Signature:
Contractor: James Fortin
Construction Supervisor License: CS -052576 Exp: 10/03/2017
Date: Nov 7, 2016
Total Installed Measures
Location
Description
Quantity
Unit $
Total $
Living Space
Perform Air Sealing at Estimated 62.5 CFM50
8
$84.32
$674.56
Door Sweep
3
$23.18
$69.54
Exterior Door Weather Stripping
3
$27.59
$82.77
Living Space
Hatch: Thermal Barrier Polyiso 2 inch (Attic)
1
$41.71
$41.71
Living Space
Attic Floor Open Blow Cellulose 7"
952
$1.53
$1,456.56
Attic
Propavent 2' or 4'
102
$3.83
$390.66
Damming
84
$2.19
$183.96
Attic
Vent bath fan to roof flapper
2
$129.21
$258.42
Installed Measures Total
$3,158.18
Payments
Incentive Payments
Customer Share
Weatherization Incentive
Air Sealing Incentive
Total Incentive Payments
Total Customer Share
Less Deposit Of
Customer Share Balance (Due Contractor)
Air -Tight Weatherization
50 Rundlett Way
Middleton, MA 01949
978.998.4684
$1,748.48
$826.87
$2,575.35
$582.83
$194.00
$388.83
CONTRACT AGREEMENT / OWNER AUTHORIZATION FOR CONTRACTOR TO PERFORM WORK
1 as owner/authorized agent of the subject property, hereby authorize James Fortin to act on my behalf, in all matters
relative to work authorized by the building permit.
Owner/Authorized Agent (Print): Mary Honan
Owner/Authorized Agent Signature: Mary nd an(Nov 7, 2016)
Contractor Signature:
Contractor: James Fortin
Construction Supervisor License: CS -052576 Exp: 10/03/2017
Date: Nov 7, 2016
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
`'Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Avvlicant Information Please Print Legibly
Name (Business/Organization/Individual): Air -Tight Weatherization, LLC
Address: 50 Rundlett Way
City/State/Zip: Middleton, MA 01949
Are you an employer? Check the appropriate box:
Phone #: 978-998-4684
1.[Z] I am a employer with 20 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.❑ 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 have employees and have workers' comp. insurance.* -
6.❑ 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. ❑ Remodeling
9. ❑ Demolition
10 ❑ Building addition
11.❑ Electrical repairs or additions
12. ❑ Plumbing repairs or additions
13.[—]Roof repairs
14. ❑✓ Other Insulation
*Any applicant that checks box #I 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.
: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.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Guard Insurance Companies
Policy # or Self -ins. Lie. #: AIWC781370
Expiration Date: 7/11/2017
Job Site Address: 97 Sawmill Rd City/State/Zip: North Andover, Ma OIT45
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 $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
V Date: 10/31/16
Phone #: 978-998-4684 y
Oficial use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
2016-11-09 09:11 air 19789692161 >> P 2/2
CERTIFICATE OF LIABILITY INSURANCE DATE(M08!19//22016016Y)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(Ias) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, Subject to the terms and Conditions of the policy, certain policies may require an endorsement A statement on
this certificate does not confer rights to the certificate holder in lieu of such ondorsement(s).
PRODUCER
MassPay Insurance Services, LLC
27 Garden Street, Unit 16
Danvers, MA 01923
1 WI= Air -Tight Weatherizatlon, LLC
50 Rundle" Way
Middleton, MA 01949
INSURER B
INSURER C
Jacqueline Marie Montes
,,. (978) 774-4338 x105
_ INSURER($)AFFORDIN13COVERAGE
AMGUARD Insurance Company
774-1318
NAIC N
42390
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 3UBR POLICY EFF POLIO Exp
LTR TYPE OF INSURANCE POLICY NUMBER MWb0 p LIMITS
H7C
ERCIAL GENERAL LIABILITYEACHocCURRENCELAIMS-MADE E-1OCGVR DAMAGE TO ^ -M
noeu,ee. ie
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PHO � LOC
JECT
OTHER:
AUTOM0131LE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AU7
06
HIRED NDN -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAR OCCUR
EXCESS LIAR H—.—
A WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIEl'ORIPARTNERIEXECUTIVE
OF
uu-..FICER/MEMBER EXCLUDED? N / A
a-...... i...,..,
5282 107/01/2016 07/01/2017
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Sehedule, May be attached IF mole Space IS requl/ed)
3roof of Workers Compensation
Town of North Andover
120 Main Street
North Andover ,MA 01845
ACORD 25 (2016/03)
MED EXP (Any one persoti) $
PERSONAL d ADV INJURY $
GENERALAGGRF-GATE $
PRODUCTS-COMP/OPAGG I$
EACH OCCUF
AGGREGATE
E.L. EACH ACCIDENT - $ 1,000,000
E.L. DISEASE - EA EMPLOYEE S 11000,000
E.L. DISUSE -POLICY LIMIT 5 1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TME POLICY PROVISIONS_
AUTHORIZED REPRESENTATIVE _
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are reglstered marks of ACORD
5
COMBciINED SNGLE L
$
(F.' acda,I
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
S
PROp! ht r DAMAGE
$
Ow eccldenl
fC
S
EACH OCCUF
AGGREGATE
E.L. EACH ACCIDENT - $ 1,000,000
E.L. DISEASE - EA EMPLOYEE S 11000,000
E.L. DISUSE -POLICY LIMIT 5 1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TME POLICY PROVISIONS_
AUTHORIZED REPRESENTATIVE _
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are reglstered marks of ACORD
ACORV CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
OF INSURANCE
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(les) must have ADDITIONAL INSURED provisions or 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 TGA Cross Insurance, Inc.
401 Edgewater Place, Suite 220
Wakefield, MA 01880
CONTACT
NAME: TGA Cross Insurance Inc.
P"SNE 781-914-1000 (AICFAX No): 781-246-2601
E-MAIL
ADDRESS: switchboard@tqacross.com
INSURERS AFFORDING COVERAGE NAIC #
EACH OCCURRENCE $ 1,000,000
INSURER A : Arbella Protection 41360
www.tgacross.com
INSURED
Air -Tight Weatherization, LLC
50 Rundlett Way
INSURERS:
INSURERC:
INSURER D:
Middleton MA 01949
INSURER E :
A
INSURER F:
LIABILITY
ANY AUTO
OWNED SCHEDULED
✓
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY I/AUTOS ONLY
COVERAGES CERTIFICATE NIIMRFR- oanonmmn RFVISIAN NIIMRFR-
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.
I TR TYPE
OF INSURANCE
ADDL
SUBR
POLICY NUMBER
MM/DDY EFF
POLICY
O DDIIYYYY
LIMITS
A
✓ COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ✓ OCCUR
8500046432
3/5/2016
3/5/2017
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
ccurrence $ 100,000
PREMISES Ea occurrence)
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO- LOC
POLICY ✓❑
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
$
A
AUTOMOBILE
✓
LIABILITY
ANY AUTO
OWNED SCHEDULED
✓
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY I/AUTOS ONLY
1020015286
3/8/2016
3/8/2017
Ea aBccl aEeDtSINGLE LIMIT $ 1,000,00
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
$
B
�/
UMBRELLA LIAB
EXCESS LIAB
✓
OCCUR
CLAIMS -MADE
4600052930
3/5/2016
3/5/2017
EACH OCCURRENCE $ 4,000,00
AGGREGATE $ 4,000,000
DED ✓ RETENTION $10,000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
PER OTH.
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT 1 $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Town of North Andover
1600 Osgood Street
Building 20, Suite 2035
North Andover MA 01845
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
Thomas I Gregory
U 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
28899058 1 223720 1 16-17 GL, AUTO, UMB I Jill DeHetre 1 3/9/2016 8:32:51 AM (EST) I Page 1 of 1
Office of Consumer Affairs and Business Regulation
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10 Park Plaza - Suite 51.70
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Reqistration: 165640
H-.-- - Type: LLC
Expiration: 3/15/2018 Tr# 419291
AIR TIGHT WEATHERIZATION, LLC -
JAMES FORTIN
50 RUNDLETT WAY _ - — - - -- - -- — -- - ------
MIDDLETON, MA 01949 = -------- - - - -- - - - —
Update Address and return card. Mark reason for change.
Lj Address F 1 Renewal ❑ Employment Lost Card
SCA 1 is 20M-05,11
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Office of Consumer Affairs & Business Regulation
P1r OME IMPROVEMENT CONTRACTOR
.71 in Registration: j65640 Type:
Expiration. 3115(1018 LLC
AIR TIGHT WEATHERIZATION, LLC
JAMES FORTIN
50 RUNDLETT WAY—
MIDDLETON, MA 01949 Undersecretary
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS -052576
Construction Supervisor
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JAMES E FORTINE N� rr,
50 RUNDLETT WAYq o
MIDDLETONMA-01 JI)
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Commissioner 10/03/2017