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HomeMy WebLinkAboutAIR SEALING AND INSULATION (2) i i BUILDING PERMIT of"��T b"ti TOWN OF NORTH ANDOVER ''2 yam''' ,a OL APPLICATION FOR PLAN EXAMINATION -- A�0 > * Permit No#: Date Received 74A°RA7EG�Pp 4`� ACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page l ✓ :;f/ :J ..�,., ,Y ✓r :i,: r,✓ :-.f .:...a'.,.�f, .sr: f r' ""!r'H` L;, .' 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">, J r r<, r"r'�x� rs,,.,l r7�.. {x-Nr rf'3p,I f rrr '�,,.-� Ir rry7 flu r lf ��: „ >r• . .;: ,,:�.e�.y s rr, :',,,,: '. -? ,� ,i ,r F. l:/-. i .-e..,'..=y`,`, ..; .,rr� r`...6 rel'_H:x-'..r 'r�i��r,c; ,,.l�, 7u,.,- .✓ ,.. .,. ✓`,.: y r,�; rYr ::.; "r.rr�x-r>a ',r' a .fir a Mrd.;.,„�� �9".. >, ;��" �<:;:.,,%'I�u=��� k„nter,,r,*.,a"r:,'rrr�,;,rr re��N...,�f` ��,1 .�,J�, ,u,•`r.,'F �:s� ..rl�'x;rrr rr ✓:.. .� 7 r. ;,,:,;: 1 ~rtr,fr.r,�s r': + i � �. ...fr`l�'/f: r r:"6t y:. e '':r .r :f�rf h rr rU JrI n rs,ry,.,�:.;r' X. „?,,. 7„-, ;�r :♦ .r ,r r .`�x3r,'�/;r,1r f f tiler, f,r l rr rrr �lr� �x�rr�,r :k, r r,,r t ,, ✓r.�i lr' rk �f.+'`�rl �F��,�rf , , ,� �� Machine Shop Vtlla a es o TYPE OF IMPROVEMENT PROPOSED USE Res'dential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ? Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic; ❑Well ❑ Floodplain ❑Wetlantls ❑ Watershed District f ,r „�.,1Nater/Sewer j b � `r�' r f of r r r. . , ,v. ...:. .:... ..:. . :... ,h�„ .:,', ��- r_:.J r,".�r :r,. ,",.:,r„ ,,,,�,", , ,, "�� DESCRIPTION OF WORK TO BE PERFORMED: t` CSSrA insy4 R n r�0\0 : ��C S�a�►r�• �b�ralkSs ihknP �1� Ge y U �3&s-e M114 �ner R,,&J C�r Identification- Please Type or Print Clearly OWNER: Name: (��r b-r 6(had .s Phone: Address: S S L-irkr) S� rf r r * r > / Y l � $ l 1 r r°1'� r rr�s' .::fa rrr”' r.", �9.F/rrf r rr,.-'z.,..✓.�`,1,/�'.,,r r& it jr-ffrrr'Y... ✓r l �� n/ ra` rf ..f,1 s::..i f# .r`.1,.U✓` �l J :� :1{� i Yl 9" ,Y'� rrr' I d F � .+/. F rrr orf r"r /F r .r rf ,r. ,rrfyfif r/-o'r`s i x xr'Irr� .:s rl '� r f`h rtar � jf ;v: t* � r.3X,f r fJrJ r$.✓�..�rs'r c rr^—v;,� .r .s'„� 1"r^,�.`''v�„�s�+r� k a.,r` �''y ,! �Y �'r r' r✓�r” r £r,s r F ,rrFr,rff :.!� s. 7 rte, s t rt ��,J �`.,.my'.Jir;,,.;-r, ;;J &,.; e ,r �,x.r';.,.�, „rFr r.r,✓ -."r'r Fw' � �`�'u�F .✓?x r r ,*:: ,"r z Fir- t �� r' r:� :. yr, 7 � .✓r��; z�r y � J r y�r r'{s�r%`�`�. ,%",r�F" rr;rr °rrr � �6f�'ti ;f r s� 5 �S�pe tsorrsfConstructton,�Ltcense � rf� �� r �r � f Exp, Date �� x � �r r fj 'k. r r° rr �. r'.. �' ✓ :- r` �':. rnr r4..7.� t' r :t.. � d x.. r „r^ .l x rt i 7- �' rr 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: $ 2- S"$ FEE: $ Check No.: ) q I Receipt No.: DS q NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ownere U- `h Signature of contractor AM t,ORTH j"u v jr%r WTV 1%1 nclu V O • 0 3T 16 4 - VO;4L*— h 110 y ver, aSS' f coc"Ic Mf WlcK Q°4ATeo ►Pa,��(5 S U BOARD OF HEALTH FMKMIT LD Food/Kitchen Septic System THIS CERTIFIES THAT { .............. °' BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. ............. . :.......................5A.................. Rough to be occupied as ............. .h SJ.. .. . d.......'�.....�„!`!:!dw....... .4. .�i,.. ... .......................... Chimney provided that the person accepting this 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 E I ES IN 6 MONTHS ELECTRICAL INSPECTOR LESS I Rough Service ................ .................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Puildinor 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. GNI f.. Federal ID N RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of ThieLub Engineering CT Contractor Registration No 60 Shawmut Unit N2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT Is ENTERED INTO BETWEEN RISE CMA-HES ENGIN GG ERINAND E CUSTOMER FOR WORK AS DESCO O Carrie Richards (978)886-4448 04/16/2015 404668 00003 6 6SILLING STHeEr 55 Linden Avenue 55 Linden Avenue P North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Ant SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.)(15)working hours. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $1,125.00 $0.00 KNEEWALL SLOPE:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(456)square feet of kneewall rafter area. $1,509.36 ATTIC ACCESS:Provide labor and materials to make(2) temporary access to an attic area.The opening will be closed with materials similar to those existing. Finish sanding and painting is not included. $170.00 BASEMENT DOOR Provide lab"" to insulate the back of the basement door leading to the bulkhead with 2"rigid board t�;mee t *n " - requirements of building code. Seal all edges and seams with FSK tape. V $72.22 SPR 2 2015 Total: $2,876.58 Program Incentive: $2,307.43 Customer Total: $669.14 TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICAMONS.FOR THE SUM OF "*"Five Hundred Sixty-Nine&14/100 Dollars $669.14 UPON FUTALINSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL WTERFST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID DALANCE AFTER iO DAYS.SEE REVERSE FOR IMPORTANT MFORMATKIN ON GUARANtM.RISKS OF RECISION,SCHEDUUHO,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CO PT TC 1TJCOC ADC AMV fit Auv QOAf-00 Signature: (24X'('Q R'_d_"'od C="XYe Carrie Richards(Apr 17,2015) cartla Richards ri7 2015 Email: carrie.a.richardsQgmail.com NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IP NOTC WMM DATE OF ACCEPTANCE ACCEFrANCS OF CONTRACT.THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US 30 DAYS. AS SPECOIED.PAYMENT TWWILL BE IdRADE AS OUTLINa AUTHORIZED TO OO THE WORK 1 i -i • •r• i - e r- � r Am am= NNUM 0 NOME MM umm ■1�■ ■�s r i WWA SII VA ■ ®■f/ '" e� t�i■■ .■ �___�■Y■ ■■■ BIWA ■■■■ . ■■► ■ ��-�■ ■■■■ i■ii ■■moi■■■■ W■ in Sam �i■�n��i■■■■��■tet■ ■�■■�Q�■�■■■■■�ii■■ ■ iii �t� VARJJIIWA INNIN ■T i ml a a a ro I SEE � ■■ MEANS ■/k ,� ■■■' lt' NIMBI L FEAR ■■■1��'�t■1r�t■■■�■tet■■■ ��■■■■■ �■■ � ,'jj /tt■t■■■ ' ■■ ■ � ' inn ®■■ i■1!�����'a■� ■■°fit■■■ ®■■®■ ■■ ■■■■■!� !'�t■■■#1■ �` ■int■■■■I�■■■■■f■!I�■�■I i ■ r'■C ' ■ ■r "■■■ Irk! ■ ■■■ ■■�' 1�■tl■■mit■■■®■■■■■■ ■ / ■■ �.��IE�,t�i��.v��r�lt�iit�-7i.�c ■sau. �in..0 r vi■ ,, ■ � P"� �.. �s��wn����a� X11■■; ■ Will■■■ t■■ it■■■ ■ ■ s ■ * q� �1l11■■���#�1� ■■i0.0 ce■!�i■� �!" ■ i ■■■l.u......�,i...�..�.�:�i■ tai...■�_�_ ■ ■�n■ii■� �"` ■_ ■■■■■■■■ ■ ■■■i■■■■ _ ■■ ■�i■ ■■ ,.- ■ ■ - 35 OWNER AUTHORIZATION FORM 1, CC? Y irr c 91-cliqr4es. (owner's ) owner of the properly located at _ �S � ;pl- ae ,n (Property Address) (Property Address) hereby authorize (Subcontractor') an authorized subcontractor for RISE Englneedng,to act on my behalf to obtain a building permit and to perform work on my property. 0 e akharda(Apr 27,20M) Owner's Signature Bate D r(Dcadc APR 282015 Department of Industrial rlrcidetttc Office of Investigations 1 Congress Street,Suite 100 t° Boston,MA 02114-2017 takww.mas.s.gcl Aria Alorkers'C'ompens'ation Insurance affidavit: ,Builders/ 'c tr° c ors/Electrieia s/Plum rs AAp 2 ieant Information Please Print Legit i Name fW 11 C Cl AS J 'W I-Y``! Cttv'f Stater " k .� Are you an employer?Check the appropriate box, Type of project(required): t.M I am a employer with � 4. [] I ant a general contractor and 1 6. 1`ei'-w Construction e=mployees (full and"Or part-tune;).* haste hired the snot contractors 2.C] I am a sole proprietor or partner- lasted on the attached shmt. 7. Remodeling, ship and have no employees These sub-contraetons have S. 0 Demolition working for the in any capacity, employees and have Aorkcrs` 4. Building aciclitiei€t [No workers` comp. insurance comp. insurance.= ra rewired.] 5. 0 We are a corporation and its 10.[] Electrical cal repairs or additions 3. I am a honaeeoo.n s doing all work officers hive exercised their 11.0 Plumbing repairs or additions myself: [No workers' comp. right of exemption per M(31. 12.[] Roof repairs insuranarc required,] c. 15?, ix t(4),and we have no employees. [leo wotkem' 13.0 Other, crimp, insurance required.] *Any applican,that uhccl s box t must also fill out the�,eoioan below showing th;it° policy infiwraanim 9 IlcimmA-nem-.0o submit this aft davit indicatingthcy:ate cuing all wuci,:and then hire oulsrdc eunLrdctars roast stlbrnit e new affilmit indicating swig. ,Contractors tractors rhat check this box must ar chcd an additiunal slit sPo xing the natt;of the sub-contractoo and state W>hrtlsrr i r rttt th 1s. er trtie,�194ik e onpluyres. IPthe sub,-oantractoi&have craptoymi,1hey mts4t provide theit t%,ork rv'cornp,policy ttuftibe: I am an employer that tr providing 4,orkers'compensation iaar rance for my employees. beton=is the pollen and}ob site information, Insurance Company Narri: �- � a tkGO Policy#or Self-ins. Lie_ ; ... t _ 1 to U,1 0 ko I:xpirationDate, Job Site Address. e r\ ftodAVcrhok Ok$`�s Attach a copy of the workers' compensation policy,declaration page(showing the policy number and expiration date). Failure to secure coverage,as required under Section 25A of MGL c, 152 data lead to the ijnpaOSiticart caf"crirtrinal penalties of line: tap to S1,500M and./or lane-year imprisonment,as well as civil penalties in the forin of a STt31'WORK ORDER and a tine of up to$250,00 a day against the violator. Be adki ed that a copy of this statement may be fomrardcd to the Office,of Investigations of the GIS. for insurance coverage verification, I do hereby certify under the pains and penalties(if perjury that the infimmation provided above is true and correct. 5ianattarc:� Official use onto. Do not write in this area,to be completed h}cite or town official. City or Town: Pernait/License _. .m,. Issuing Authority(circle one):. I.Board of Ilealth 1 Building Departinent 3.City/TowYn Clerk d.Electrical Inspector S.Plumbing Inspector 6,Other Contact Persona. Phone _ _ A111.� ® 10/29CERTIFICATE OF LIABILITY INSURANCE D0/29/2014IDD014 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: y NanC Usher Martin J Clayton Insurance Agency, Inc. PHONE (413)5536-OBO4 FAX .(413)534-7874 1649 Northampton Street E-MAIL P. O. BOX 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harle svi1le NATIO INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURERC: 44 Essex Road INSURER D: INSURER E: I swish MA 01938 1 INSURER F: I Ell COVERAGES CERTIFICATE NUMBER:CL148800843 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 I ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE wyn POLICY NUMBER MM DD MM DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50 ODD X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE aOCCUR GL43487F /6/2014 /6/2015 MED EXP(Any one person $ 5,000 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- LOC $ T FACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ '.. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIABOCCUR E020792125 0/18/14 0/18/15 EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 '.. DED I I RETENTION $ WORKERS COMPENSATION WC LIMIT 0ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) '.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GAUTHIER INSULATION ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel Sullivan/SARAH ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. MF?rdrMWd with pdf Factory trill''vd(!'0fi'oogoyl-p fff=rnV:ddM-' -9 Ar^Mr% +� L)1., 1'1111 1L/10/2014 1 :21 : 37 PM MAGE 2/002 Fax Server I DA'[d;A+L4UL`xty`/; I CERTIFICATE OF LIABILITY INSURANCE 12!10l20i4 THIS— THIS CERTIFICATE IS 1553.1E0 A5 A HATTER OF INFO OrILY AND CONFERS Do RIGHTS UPON THE CERTIFICATE HOLDER. THIS I CERTIFICATE DOES NOT AFFIRMATIVELY Olt NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED HY THE I'OLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEI1 THE ISSUNIG INSURER(S), AUTHORIZED RE1'It£SE31T'AT3VE OR PRODUCER,AND THE CERTIFICATE HOLDER, 11,111ORTAIIT: If Lhe Certificate holder If an ADDITIOIIAL IIISLIftED,I:he polis)(les)musC be endorsed. If SUBROGATION IS WAIVED,subjecl,to the L�+ms and condlllome of the policy, certain poilcies may require an endor6ement. A statement on Lhl: certificate does not confer rights to the celtilteate holder in lieu of-such endorsement(,,). PJiC!]t1 L't fi (:ON7 AL'I ------------- s `Akin Berkley Assi ned Risk Servicos Clayton Martin J Ins Agency Inc 1649 Northampton St 800634.4589 In._. Nn; 866 215-8118 ML PO Box 989 n-r_,mFss. PolicyServicesciJtaerkleyrisk.eom I Hai Oke MA 01041 *°�stER s n=roRutnc ccvtttncE NNt,P + IN" ERA kSURSU Gauthier Insulation Inc _I Lrr_RF-- ---'- - - ----- --- PO BOX 344 Ns OR CR FNS CR ER Ipswich, MA 01938 tNsu•EIeE INS LR ER r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 10 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T)THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMErfr,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE(;r TO WHICH THIS CERTIFICATE MAY BE ISSUED OR f IAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE: TERNJS. EY.CL(XIONSAND CONDITIONS OF SUCHPOLICIES.MMS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, J (:INSUQANt:F ' L7R i< T�—OINjR Y2VD P�'IICY Nl11.iPFR AI A1(Clp(1^!`(Y) mm'T)nrY,'YY'" I.1 A4T8 O EJtER AL LSA BILITY l AUTOM0131LE UABILITY i 4YORKEM CONPEWATiON i t'STAItt• AND ENPLOYERS'LIABILITY 1,+N IORYLILfI�S ER AkY P(100Rjrr OR r,,ARINe11 ! EL.FAC'"ASCI:)r Nt S 500,000 A ornct:,T CrtL==re r:xcLunet) N:A WC-20-20.001861-Ofi 10/3012014 10!30/2015 {LLu!A HInrY i,r NII) i :t T»:.d•,c„I,e,,,ae, 1E L DISCASP.,A EAIPI SEE S 500,000 nrarn:r+T rN::r oJ'ei............... I 500,000 {iISEAC _PnL;'.YLmil $S i LOCA`IS}N£/VCJ!I['LE.,(ntn cl:L,t;ORn 1G1,A.a Li�tn,l It>1:(1;+Sni,n�•rk,d ino.e .'P1 'z res Coverage Election Category Elect.Status Nine State(s)_All EhNtieS/Locations Officer Exclude Kutt Gauthier MA Gauthier insulation Inc Officer include Brittnie Aiello 44 Essex Road Ipswich, MA 01938 C F TE OLDER CA CELL 10 SH(.)ULDANYOF THE ABOVE DESCRIBEDPOLICJES BE C:Aq ELLED BEFORE; THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Mass Save ProgramlConservation Services Grou Inc ^Lx O(�DAr :E V'1rrH'rHE POLICY PROVISIONS. P, 50 Washington Street West Borough,MA 01581 i9ntorG: ` ACORD 25(2010,105) BRAC 3139 y5�MOIR .:4 ✓ /'V L' $..�.'a�9_ `k/C/L/'�1." � 'S [ Y(' -�.�� G � vcl 'L' L+T✓J"i. !✓l.�a� 1 Office of Consumer Affairs and Business Regulation f _ " 10 Park Plaza - Suite 5 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 101112016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER __.........._. _�_.. ____ �.�___._ P.O. BOX 344 __ _____ __ ..._ _ .._...__ IPSWICH, MA 09938 _ __ __.. _..... ................................... Update Address and return card,Mark reason for change. Address + Renewal i Employment Lost Carc SCA f C� 20M-051111 '%�e �'r trr sur,rr✓ref=trt�l�c j r,ff�..<r<✓r rr,,n�{; , \ Office of Consumer Affairs&Business Regulation 1 iCezise or registration valid for indlvidul use only before the expiraton date. If found return to: 3"QME IMPROVEMENT CONTRACTOR aitegistration: 17341 C} Type: office of Consumer Affairs and Business Regulation ,�,,, expiration: 10l1f2016, individual IO Park Plaza-Suite 51713 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER �r11 44 ESSEX RQ <.�..�, 3�._._.__ r IPSWICH,MA 01938 U-nderseeretary 'ot valid wi out signature Massachusefts nt ai publicSafety and Of Suitding Regulators mnd Standards 62 V, xa KMT R CAtauf r. P.Ck BOX; 4rwkh MA 0 14, o Expir do 'WrItssioner WM2017