Loading...
HomeMy WebLinkAboutBuilding Permit # 4/21/2015 0oRry BUILDING PERMIT ®�<-`eD 16��0 °° o� TOWN F NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �Ssgcaaus�� Date Issued: IMPORTANT: Applicant must complete all items on this page ( , r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑Komsmercial al ❑Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other , IlrA�a':.p,.,„� ,r1 '�',, k+ a/,�,>, ,..,.,. �7 1 , ,,r.., �,�;/ �.kl�i'WY,1�%4Y1NA//r11. ( � �r�i r7/�'Yyi/G�/rnoNs�Illrll//9f/1;1;'f f7 'JV tl, iwav,;,;r �°'Wi''I(rd,`✓�Y[fUfU,'NW Ja!%lWll�/l/ ,.,..,I1f41,{�Fi,%lW.�/%rd ! //.. k 1� ,fW( i JAY J f a2,W, W fff P f 4 1J y Y 1 Wtt DESCRIPTION OF WORK TO BE PERFORMED: pw a-1416, y Identification- Please Type or Print Clearly OWNER: Name: "�tin Phone: Address: r 9 I I i rt�i `li�IV'AICWII'CRiN i�rN i r dI1uTrc11wV m ry Mi m f� I��;�rr°Nrmra�r;�dorwFJlra",Wrrr., n a'6F�rur„W ,hwmnuGnr�rs vramauh,..... :e r ARCHITECT/ENGINEER LC--C- Phone: Address: q N � Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12A0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: 16276 Receipt No.: `° NOTE: Persons contracting i itl i r gistered contractors do not have access to uar nd ;or,. f v �far�i, ✓'//,..,, i /i rl,: I r f., 1. ,,,,,,,,r,... /ii,,./iiG/,,, r ?�,/,<..G/�/,/,r ,/�//r�//. / Si natu e ofrA(yent/Owner /% , J/f Signature of contractor , „/ ,//,/ �cvuc��caa../��.nL/olmu.,_o.��/�J'. ,tet.....J,«��._ .,,,� ./� /,_.o✓/„ Jr„//, //G/.L�z��`7.�� ,. �,r/,,,/ //r///Li/aJ/�,,,.� Town of ndover 0 No. 92,6145 LAK. h ver, Mass, COCNIC Nl WICK S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ......................... ........ .... .................. ..... ............... BUILDING INSPECTOR ......... 40 r. Foundation has permission to erect .......................... buildings on ..�.. .4.........y � ..... ....... .......... Rough g to be occupied as ......104t.r4AON.... ..... .....`..... ►.................. ... . ...... .... Chimney provided that the person accepting this permit shall in a 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 CONSTRUCTION S TS Rough Service .............................. ............................................. Final BUILDING INSPECTOR 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. V) Massachusetts home Improvement Sample Contract This form satisfies all basic requirements ofthe state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seeklegal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Company Name StreetddrT;(donotuseaPostOfficeB a dress) Contractor/Salesperson/Owner Name -v City oN State r 111 iZip Code 0VW Business Address(must include a street address) DaytrmeP one Evening Phone City/Town State Zip CMe Mailing Address(It different from above) Business Phone Federal Employer M or S.S.Number Homelmpmvemmt CootmdorRq.n o s Erpiratim&te Lon,requires that most home (A- impmrement contractors hove a valid resisfmt(on number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,?d grade of materials to be used,use additional sheets if necessary.) Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adher to unless circtunstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) �� Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,fiimish the material and labor specified above for the total sum of: (*) Payments will be made according to the following schedule: $ J,7 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) i $ /ZU by—5—,/p�-5or upon completion of $ �`r7 by_/ 10/ or upon completion of $__k6 upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipmentmust be special $ to be paid for _ ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be pal f NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of an special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty Is an express warranty being provided by the contractor? No❑Yes fall terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor render this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Aslc questions if something is rmclear. • Make slue the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for los insurance company information so that you can confirm coverage,or ask to see a copy of a"proof ofinsurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellatlon form r an explanation of this right. aT'Vden6 OT SIGN THIS CONTRACT IF THERE ARE ANY SPACESM opies ofthe contract must be completed and signed.One copy should go to the homeormer.Tlse r y e kept by fie contractor. Homeowo 5 Contractor s gnatur AnP �7 L Zf Date Date GSD Associates, LLC 146 Main Street, North Andover, TSA 01845 Tel: 978-688-5422 web: www.gsd-assoc.com Architecture + Design + Planning + Interiors + Development Consulting April 20, 2015 Building Department, Town of North Andover 1600 Osgood St. North Andover, MA 01845 RE: Construction permit approval for work at 146 Main Street, North Andover, MA To whom it may concern; I am the owner of the property located at 146 Main St., North Andover, MA The Cardinal Group, is authorized to pull a permit for interior renovations located on the 3rd floor of 146 Main Street per the attached plan. Renovations will include the installation of a countertop and new sink, and the construction of two small rooms within the existing office area. Associated mechanical and electrical work, new carpet and paint will also be included. If you have any questions regarding this, please do not hesitate to give me a call Office: 978-688-5422 x203 Cell: 978-204-4770 GSD Associates, LLC ovll� Gregory P. Smith Architect/ Owner cc: Bill Held The Cardinal Group Michael Sullivan The Cardinal Group Linda VanDeVoorde GSD Associates, LLC Initial Construction Control Document F To be submitted with the building permit application by a M Registered Design Professional d for work per the 8a,edition of the �q �< Massachusetts State Building Code, 780 CMR, Section 107.6.2 w �M She Project Title: The Cardinal Group Office Tenant Fit-up Date: 04/20/2015 Property Address: 146 Main Street North Andover, MA 01845 Project: Check(x) one or both as applicable: [X] New construction [X ] Existing Construction Project description: Tenant fit-up of two small rooms within existing office space on the Third Floor. Project also includes plumbing for new sink, and addition of electrical outlets at countertop. Remaining tenant space will remain and new paint and carpet will be installed. I Gregory P Smith MA Registration Number: #86$$ (Architect)Expiration date: August 31, 2015,am a registered design professional, and hereby certify to the best of my knowledge, information and belief,that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning]: [] Entire Project [X] Architectural [ ] Structural [] Mechanical [] Fire Protection [] Electrical [] Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services in accordance with the Professional Standard of Care, and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to detennine if the work is being performed in a manner consistent with the approved construction documents and this code. The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods, sequences and procedures, and for construction safety. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. When required by the building official, I shall submit field/progress reports(see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building , 5 official a `Final Construction Control Document'. �' �"� ° w haw" Enter in the space to the right a"wet"or p g electronic signature and seal: Phone number: Cell: 978-204-4770, office 978-688-5422 x203 Email: ith@gsd-assoc.com Building Official Use Only Building Official Name: Pennit No.: Date: AIA MA&Insurance Aooroved Version.Initial Construction Control Doc I I ' I � I i I I I I I EXISTING CONFERENCE ROOM 30T '..,.., I I I I I I I I I I I I I I I I NEW CARPET i AND BASE 5---------- ----------- I I� I I EXISTINTG OPEN OFFICE --- --- LA I I DESKS I I I I NEW WALL NEW 3/0 DO R NEW WALL i KITCHEN I OG I NEW 3/0 DOOR RELOCATE THERMOSTAT — AND LIGHT SWITCHES AS NEEDED. ---------- PRIVATE FhCE NEW COUNTERTOP G i AND SINK NEW ELECTRICAL OUTLETS TON WALL TO BE GFCI i J EXISTING WOMEN'ST ILEI 304 IX IG . LI --- —S 1 ------- ON I I -777 0 EXISTING I I I o I I NW lAlrlv.!,1J71t�1��rYl EXISTING , / COMMON LO 30 ` F'T' C u {r EXISTING EXI NG T� R y STORAGE 30 1M�EN'.S�TOILET F 'l ILa 13011 I I I lay q`(lfiddito,luetTc_fi, "31 { MAIN ENTRANCE PROPOSED 3RD FLOOR 11JLA/lVY THE CARDINAL GROUP SCALE: 114*=1'-0 GSD Associates,LLC 146 Main Street,North Andover,MA 01845 Tel;978-688-5422 Web:www.gsd-assoc.com l" Architecture+Design+Planning+Interiors+Development Consulting i i i i i EXISTING CONFERENCE ROOM 307 i i i i i NEW CARPET AND BASE i EXISTING OP-EN OFFICE --- -- UJO ---------- i i DESKS i NEW WALL NEW 3/0 DO R NEW WALL KITCHEN i OL ------------ NEW 3/0 DOOR RELOCATE THERMOSTAT AND LIGHT SWITCHES AS NEEDED. PRIVATE FhCE NEW COUNTERTOP - AND SINK NEW ELECTRICAL OUTLETS T ON WALL 70 BE GFCI i EXISTING WOMENS T [LET 304 Exm[c DN Oi i i OEXISTING EXISTING STORAGE EXISTING COMMON LOB EXNG 30 STORAGE 30 MEN'STOILET 11011i 3 i t t MAIN ENTRANCE PROPOSED 3R®FLOOR PLM THE CARDINAL GROUP SCALE. 1/4"=1, GSD Associates,LLC 146 Main Street,North Andover,MA 01845 Tel:978-688-5422 Web:www.gsd-assoc.com Architecture+Design+Planning+Interiors+Development Consulting � c X �` ZWdWd I I I I I I I I CONFERENCE ROOM 301 I I I 1 1 I I I I I I I L �I �I I I I I I I I I I I OPEN OFFICE 7777777,___n 06 I I ------------ I I I I I I I I I � i I I 1 1 ro I 1 W QILET 304 DN OI I I o I I I I I STORAGE COMMON L 30 STORAGE 30 M4STOILET 301 3 Z i I I I I MAIN ENTRANCE PROPOSED 3RD FLOOR PLAN � SCALE 1/4'=1'-0` ��ve� I I I I I I I I I I I I I I I 1 CONFERENCE ROOM I 30l 1 I I I I I I I I I I I I t � I I I I 1 I I I I I I I 1 I I I OPEN OFFICE 5----------- - 306 I I I I I I I I I I f I i 1 t i 1 1 I � 1 1 1 WOMENST ILEI 304 ON I OI ................ 1 1 a I I I I I O STORAGE COMMON LOB 30 STORAGE 30 ME4STOILET 301 I I I I I 4 MAIN ENTRANCE PROPOSED 3RD FLOOR PLAN � SCALE 1/4'=1'0' GSD Associates,LLC 146 Main Street,North Andover,MA 01845 Tel:978-688-5422 Web:www.gsd-assoc.com mA .I Architecture+Design+Planning+Interiors+Development Consulting April 20,2015 —A00N Building Department, Town of North Andover 1600 Osgood St. North Andover,MA 01845 RE:Construction permit approval for work at 146 Main Street,North Andover,MA tA.re r A«o aAta To whom it may concern; ----------- I ---------- I am the owner of the property located at 146 Main St.,North Andover,MAGo ;---------- The Cardinal Group,is authorized to pull a permit for interior renovations located on the 3rd floor of 146 Main Street per the attached plan.Renovations will include the installation of a countertop i and new sink,and the construction of two small rooms within the existing office area. Associated mechanical and electrical work,new carpet and paint will also be included. If you have any questions regarding this,please do not hesitate to give me a call. Office:978-688-5422 x203 .---------- Cell:978-204-4770 Na.aro ooaa aawue ®n06TAT IION}WTQ®GM Maa--- M6Y oadTama i ANO OX[ "�Y41�TO lO(dq T GSD Associates,LLC n, BaSNNG O ODMING Gregory P.Smith nMfING (AMNON Architect/Owner %FL—ji cc: Bill Held The Cardinal Group Michael Sullivan The Cardinal Group Linda VanDeVoorde GSD Associates,LLC MAIN OMN2 PROPOSED 3RD FLOOR PLAN u IGSD A—,oats LLC 146 Main Sheet.North Andover,NA 01845 Tek 978-688-5472 Web:w 49d-aSSOGCom AlYhi[acture+Deggn+ONnning+Interiors+Development C—Icing The Commonwealth of Massachusetts ' Department oflndustrialAccidents „ d 1 Congress Street, Suite 100 'a Boston,MA 02114-2017 ti www mass.gov/dna Workers'Compensation Insurance Affidavit:Builders/Contractors/l lectricians/Plumbers. TO BE PILED WITH THE PERAUTTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individnal): Address: 62�Y 1-21ne j- 6 L/t-!3 �✓� City/State/Zip: /je/ ✓;V/lJS Phone 701 Are you an employer?Check the appropriate box: Type of project()required): L❑Tama employer with i employees(full 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.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.[-]T am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E]Electrical repairs or additions propzietorswith noemployees. ` ' 12. , lumbing repairs or additions 5. am a general contractor and T have hired the sub-contractors listed on the attached sheet, 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance,t 6.Q We are a corporation and its.offf cern have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] , *Any applicant that checks box#1 must also till 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-c6nirac6s Eve employees,%cy must provide their workers'comp.policy number. Iam an employer drat ispiovidiiigworkers'compensation insurancefor my employees.'Below is thepolicy and job site information. Insurance Company Name: r- ' I /c 7 e-41— Policy#or Self-ins,Lie.#: S {�° �� Expiration Date: 45� ' fob Site Address: �,Y6 /1'°rs �`� City/State/Zip: A/ r0%19,0 D Attach a copy of the workers' compepsation 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 u7Z3 - s dpenalties ofpei;juiy that the information provided above •s true a d correct. Signature: - Date: /� �` / Phone# e 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 Person: Phone#: 4/21/2015 10:97 AM FROM: John A. Pierce Insur TO: 19786889592 PAGE: 002 OF 003 ACORD, CERTIFICATE OF LIABILITY INSURANCE D 4/21/2015 TE 04/21/2015 PRODUCER 781,729.8770 FAX 781.729.0053 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John A. Pierce Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 934 Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Winchester, MA 01890-1994 INSURERS AFFORDING COVERAGE NAIC# INSURED SJE Landscaping Inc and Steven J Eddy INSURER A: Travelers DBA: Greenleaf Garden Center INSURERB: Travelers Casualty Ins Co Amer 19046 298 Amesbury Rd INSURERC: Utica Mutual Insurance Co 25976 Haverhill , MA 01830 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLIC(MMID. TIVE POLICY EXPIRATION LIMITS LTR NSR DATE MMIDD DATE MMIDD GENERAL LIABILITY 660-5273X41A 04/05/2015 04/05/2016 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 CLAIMS MADE [K] OCCUR MED EXP(Any one person) $ S'000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO-JECT LOC AUTOMOBILE LIABILITY BA6095X984 04/05/2015 04/05/2016 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY $ B 1xxx SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION 4420145 04/05/2015 04/05/2016 X I WCTORYSTATU LIMIT-S ER OEZ AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ 1,000,000 ANY C OFFICER/ME BOER EXCTLU ED?ECUTIVE ❑ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL North Andover, Town of IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1600 Osgood Street REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE [Kevin Pierce ACORD 25(2009/01) FAX: 978.688.9542 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD —Board of Building Rcgula.jons and Standar& ('oma trucrion Super,%kor License: CS-08445 i iy3 ��, STEVEN J EDDYr` 298 AMES13URY RD Haverhill I� 019 30 G 1 Expiratiof"t 06/27/2016 Commissioner