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HomeMy WebLinkAboutBuilding Permit # 9/1/2015 1 NORYF/ BUILDINGPERMIT oF��LEo ,egR'o T OF NORTH ANDOVER °L APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ED �gssgcwUS�`��� Date Issued: — IMPORTANT: Applicant must complete all items on this page I 1 MIN v11 19 " l ii W11 i i � "'�`;r+rrrmnmrwr ✓Th,ivria va rx�irn � rr dJ" y a ��/ I r h c' � ��T l��r C►� 'G IS CT s ori,C�s;r c e A,';� 1 TYPE OF IMPROVEMENT PROPOSED USE Res i ential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial LIteration No. of units: ❑ Commercial MIAepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ,rill / r� ood � n ❑ et(ands/ /, ❑ Wa er hed istrr�ct DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: (,,g M6ir e Phone: Address: ' C "1a�' t / i ii ril//f%� No's �sii>�iii/ir�,i%i/lPi/lrr/„r/�/l,�y�i/i�//%ii l//i�/'�/�i1��//fl i,i,i�/��l///i/l l/rir iJ l/i l��i�,i%��/��//�l�i/✓�,//���i�//%��,.���,li!,i1i/�a/ r„ (� � �� �''�r r,\ e. e ” cense: e I o tl<i�u tf��/aio� -�No�R,r'inb�lV�fVN;�aauGr�i 4JviM�r�iJao�.lvrwn�f��rfif�>rlrwu&��dr��ne r6�„ _.. „,,.a✓�ar'V��'iiiur�i�ih w��nL7�_ ,. _.l�//,m 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: $ r,V� FEE: $ Check No.: ;dlo- Receip t No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Age,nt70wne'r` C ` Signature:of"66nfiractor NORTH -Town of2 E ,, Andover S - y( ® 1.' tW % _r T Y �' ver' ass, or COC LAK A. NIc"t-ICK S U BOARD OF HEALTH Food/Kitchen rER.MIT T LU Septic System THIS CERTIFIES THAT ... 4� �1,� BUILDING INSPECTOR ... .4'z. ........................ .... ........................ ......... 00jpombrr®® Foundation has permission to erect .......................... buildings on ... ............�...... ..vt .......... .............. Rough to be occupied as .. .. .N4 . . .. ............................ ......` ...� �....... Chimney iW provided that the person accepting this permit shall in every respect conform to the terms of 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 MO HS ELECTRICAL INSPECTOR Lai UNLESS CONSTRU RTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. Federal ID# RISE Engineering Rl Contractor Registration No MA Contractor Reglatration No A division orThietsch Engineering CT Contractor Registration No 60 Show w.ri i Ww � �p262 CONTRACT 339-502 .w.r rare .A1C3 502-6345 Pago 1 Ri +S" U11PROGRAM 7HtS eetlrnAeY IS EtliEnED n(TD 9EtYtEl9V NSE C(41.A-M EN6atW=ANOTnECUSTOMEaran WORK AS ENGINEERING DESCRIBED BELOW tO.CtTOMFJt — PROM "_...._�._.__ DATE CLjna WORK ORDER Elizabeth Crumrine cv (617)939-8143 0410912015 412433 _ 00002 Sew=WMEET •�� aaJAG S,MLLr 35 Meadowvlew Road 35 Meadowview Road SEIMCC CM STATE.YIP •--. ... '~.•'•�~ an10ir CnY,OTATE,BJP r North Andover,MA 01845 North Andover,MA 01845 i1 JOB MSCRIPTIO r AIR SEAL `Provid labor an aterints to seas areas of your home against wasteful,excess air leakage. This work will be performed in se orspeciat 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 seat your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows arc not generally addresser-) (9)working hours. At the completion of the we:uherrzation watt:,and at no additional cost to the homeowner,a final blower doer and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety o£the indoor air quality. $680.00 AIR SEALING ADDER: (4)working hours. $340.00 DAMMING,Provide labor and materials to install a 12"layer elft-38 unlaced fiberglass baits to(50)square feet for damming purposes. $102.50 ATI3C FLAT':Provide labor and materials to install a 6"layer of R-21 Class i Cellulose added to(1479)square feet ofopen attic space. $1,862.28 KNEEWALLS:Provide labor and materials to install t"FSK raced semi-rigid fiberglass or similar rigid board insulation to(112) square feet ofk neewall arca. 5.31920 AT33C ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the curie access folding stair- A small flat surface of plywood will be created around the opening within the attic, This will allow the cover's integral weather-stripping to restrict air leakage. $237.65 VENTILATION:Provide tabor and materials to install ventilation chutes in(48)rafter bays to maintain air flow. $96.00 BASEMENT CEti.WG:Provide labor and materials to install(85)linear feet orR-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $148.75 OVERHANG:Provide labor and materials to install 10"R-37 densely packed Class I Cellulose insulation to(72)square feet of exterior overhang located below a heated floor area,by drilling holes in the overhang @om below. Elates drilled will be plugged. Plugs will be scaled with exterior grade spackle and tell in a relatively smooth condition.Finish sanding and touch-up priming/paintingwill be the customer's responsibility. 5288.00 GARAGE CEILING:Provide labor and materials to install 10"R-35 dcnsoly packed Class t Cellulose insulation to 460 square rect of garage ceiling located below a heated floor ares,by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs tvitl be speckled and left in a relatively smooth condition.Finish sanding and touch-up primingtpainting will be the customer's responsibility, $952.20 F Federal 10 ft ME Engineering RI Contractor Registration No MA Contractor Reglstration No A division ofThietsch Engineering CT Contractor Registration No IRS 60 Shawo,ut Unit 42,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339.502-6345 �G+ PROGRAM T er Page 2 R I S CONTRACT�srreDmniTau NME �1 CMA-HES puctnrEnM�eccusrnt RFOR WORK As ENGINEERING _ PHONE GATE CLIENTc WORK ORDER 617 939-8]43 Elizabeth Crumrine ( 04/0912015 412433 00002� somcE STAs£t _ an"M STREET 35 Meadowview Road 35 Meadowview Road at7?VICE CITY,S AT£TAT£7 ZIP 0"W Cr7Y.3TATE,AP North Andover,MA 01845 North Andover,MA 01845 .TOB DESCRIPTION RISE Engineering will apply ail applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas olrers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of t 00°lo for the Air Sealing measures up to the first 5684 and an additional$340 if savings ure justified by the auditor, For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air floe in your home both before the wort:is begun,and after the weatherization work is compictc.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has avaluc of$90 and is at no cost to you. Total allowable weather-Untion incentive is$3,1110. $90.40 Total: $5,116.68 Program Incentive: $3,110.00 CustomerTotal: $2,006.58 WE AGRE£HEREBY TO FURNISH SORVICEs-COMPLETE IN ACCOROANCEVA'rH ABOVE SPECIFICATION&FOR THE SUM OF ***Two Thousand six&5#1100 Dollars $2,006.68 u�rmauA FMAL A,*ren AND AUYsp stet n v�eR�z raR r oaTAur�iuvTaauA�ne[alit GUARANAN EES eNr R 4W"ot"�scNEGTERMour'iow YA m ar Aect=roRReaisn+�Aiime rr - 00 NOT SIGN THts Ct)NTRACT IF THERE ARE ANY SLANK SPACES - �t/Yj a�aNATLRa•RrSEWsD�necflAg cHSTaaEa ecErTrA,rCE NOT--THIS CONTRACT NnvBEWrOWRAWNBYUSIF Not EXECUTED WTMW OATS OF ACCEPTANCE- ACCEPTANCE CCEPTANCEACCEPTANCE OF CONTRACT.THE ABOVEPR,CES,SpeoF DATIONS ANO CONDmONa M aATtSFACTORr 10 US ANG AFM HEREBY ACCPPTED.YOU ARE AV MoR¢£U To 00 TNSWORK 30 GAYS. AS SPECFfEG,PA"ONTWRL RE MADE AS OUTLINED ABOVE W.G OWNER AUTHORIZATION FOM Q'a-abeth Grurm Nz, ummk &mar of the propeol located at 35 K"aD vvvk'ow 'lo d flr�Addms) Kofkn h6ovvr, KA ofb45 M"eny Addraw) hereby,au"wom ��+,nana�rsctor} an authodwd sum f"MW Eroteeft,to act on my hehaff to otrtM a bulkft permit and to perform WWlt on my property. Gam' 3bg�Nte 03015 Date [ CNC �VIE a JUN 302015 CASE# SIDING C 0)VINYL I ALUM I ASB/BRICK ROOF CAR:C �3-TAB I COLOR aLYO�`V) �1014� OK FOR WORK Y I N VENTS BATH FLAPPER x RIDGE ROOF xPLAABLE X&Z SIZES VEN SOFFIT: NONE(4�O ALUM/VINYL DEPTH COLOR-_ STYLE rl c? -J- A ADD VENTS FLAT C3 KNEEWALL WALLS DAIR8EALING 0 MAKE ACCESS t___.)SLOPE CDKWFLOOR CDKWSLOPE f7SILLS CD []EXISTING ACCESS Tire Commonwealth of t'assarhusetts Department of Xndustrialticcident5 Offire of Investigations I Congress,Street,Suite 100 Roston,AIA 02114-2017 wwwmass.glovlt is Workers'Compensation Insurance Affida-vit: BuilderslContraetors/El€ctricians/Plumbers Al)lplicant Information Please Print.L�ilt1Y Natty{business t)rga�i�tic>n Intl °itlutl`1;. I 1A�3�Ci 1 tr.. .I 1x1.1 tea s i- l +--kit ' - >+tltitiTess: City/state/zi : '�Lh fl. 3 q Phone Are you an employer. Check the appropriate box. Type of project(required): 1,M I am a employer with `t• 1 ant a general contractor and I ti.7. New construction employees(full and/or pari-timc). have hired the sub cdtntracittrs listed on the attached ihect. Rettto€iclin g . 1 am a sale proprietor to partner Th r sub-contractors have; 8, ®Demolition ship and have no employeesemployeesand have va�darlct.-rs' working for nae if]arty capacity, 9, Building,addition insuranc. [l90 workers'coat}',-insurance carnp, 1t1. 1Icctrctl repairs or additions 5. We are a corpotation and its required.] oEfioers have exercked their 11,C]talumbingt repairs or addition 3.❑ tam a holneowner doing all+.orl right of exemption tzar M01- 12.®Roof repairs myself. [7clo workers,'comp. insurance requirerE.]' e. 152,.§l(4),and we have no employees.[No workers' comp,insurance regUiTC&I "Any appticart that checks hts r#)must of o flit Hilt the s oon bedew showing their ursrkets°ccxn�tCnzattitft ptzticy itafirrtn;A60n. t Ilomttsw-ncm who stibaut this affidavit indicatingthsy arc d Ang all weat lo work and cheat out$tde contractort tnt?St tnbrmit a nrw t ftidas tt rn`ice ink such. :Contractors that check this hox must sttashcd an admional sheet showing*z nattte of the sub-contractor atul ztate w iefficr or not those Oliriai 11:';c ernp9uyr If the tft etttatraLtcas has a employees,tdtry mast prcati°itle their workcN,dump,pc+licp nutnbet. t am an employer that Xsprr viding wtv rkers'compensation nFararree(or nit errapty#ens Beivw tx tire policy acrd jnb xite information. ,r -_�.t.- — Insurance Cotatpany hlatrx;:_ , tt.�t°�.�1_._.,t tl b€ 1 Lo U 1 0 1:xpirttimt Date:__ Policy d or Self ins.Lie.#.__ ._.,�, Job Site Address: Cilylstaate/zip:___ _-.-- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coveragc as required under Stiction 25A ofMGh c. 152 can lead to the imposition ofcriminal penalties Ofa fine up to$1,500.00 an&or one-year imprisonment,as uell as civil pt ualtirs in the forltt of a STOP WORK CORDER and a tine ofup to 525UJO a day against the v=iolator. Be advised that a copy of this statement may be forwardcdl to the Office of invcstigAations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided alcove is true and coact. Dater_...,., 5lMatzrn »hntte�• '"!� )�CLD �`�' � .,. oflivial use only. Do not write it,this area,to be completed by city or town officiat. City or Town: PcrmitfLicensi Issuing Authority(circle one): t.Board of health 2.Building Department I City/Town Clerk 4.Electrical Inspector �.l4urnbing inspector 6.Other Contact Iverson: Phone#: _ 0 DATE(MM/DD/YYYY) AC(:>R V CERTIFICATE OF LIABILITY INSURANCE 7/7/2015 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). CONACT PRODUCER NAME, Nancy Usher Martin J Clayton Insurance Agency, Inc. PHONE (413)536-0804 FAX (413)534-7874 �A/ No Extl:_( --- -- ---- AILS N°)= -.-- - _- 1649 Northampton Street E-MAIL ADDRESS.*--- P. 0. BOX 989 INSURER(S)_AFFORDING COVERAGE NAIC# _ - Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville__ NATIO INSURED -INSURER B:Allied World Natl_Assurance Co__ Gauthier Insulation INSURERC: 44 ESSEX ROAD INSURER D: INSURER E: IPSWICH MA 01938 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 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 ADDLjjSUBR - - POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM D MM DD YY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - DAMAGE TO RENTED 50,000 IX] A CLAIMS-MADE X]OCCUR PREMISES Ea occurrence $ - )� X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person)_+$ 5,000 PERSONAL&ADV INJURY $ 1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.,_000 X POLICY PE LOC PRODUCTS-COMP/OP AGG $ ... _-_2,000,000 OTHER: $ AUTOMOBILE LIABILITY _C(°Me INEDt )SINGLE LIMIT $ ANY AUTO BODILY INJURY,(Per person) $ -- - ALL OWNED - SCHEDULED BODILY INJURY(Per accident) $ AUTOS _. AUTOS -- HIRED AUTOS NOONNSWNED PROPERTY DAMAGE $ (Per accident)__. I X UMBRELLA LIAB I OCCUR _EACH OCCURRENCE --_ __ $_ _ 1,000,0.00_ B EXCESS LIAB CLAIMS-MADE AGGREGATE .__._11000,000 DED RETENTION �BE020792125-194985 10/18/2014 10/18/2015 $ PER OT WORKERS COMPENSATION _STATUTE EERH__ AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE [7N/A E L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POPI Mbd with pdfFactory trial version www.pdffactory.com Ii•� L'r1n 12/10/2014 1 :21 :37 PM MAGE 2/002 Fax Server I �.J,-?iz,i,'SIAtE ih!LUUfm'Y,^!i CERTIFICATE OF LIABILITY INSURANCE 12110/2014 THIS CERTIFICATE IS iSSUP0 AS A MATTER OF iFIFORMATION ONLY AND CONFERS 00 RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES HOT AFFIRMATIVELY Olt IIEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTirICATE OF INSURANCE DOES NOT COHSTITt)TE A COIITRACf BETWEEN THE ISSt11NG 1NSUREA(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE- CERTIFICATE HOLDER, 11411ORTART: If the certificate holder Is an ADD11101`IAL HISURED,the polic)(ies)mw;l:be endorsed, If SUBROGATION IS WAIVED,subject to the terata and condinons of the policy, certain Policies may require an endomemenl. A Ciatflment on this cen.iffcate does not confer rfghls t0 the cell.lhcale holder in lieu of such en dolsement(s). F: UJ t't it Clayton Martin J Ins Agency Inc 4' t3erkle asci nod Risk services 1649 Northampton St nx, Na E„ 1100 834.4589 ;n:. Nc.; £b6 215-8.118 PO Bax 989 ADJREss. PolicyServices«berkieyrisk,tT)m I Ie,MA 01041 nsCn2WS AP0RUING 'GVERAUL Nava En Gauthier Insulation Inc N5 Lr2 ER B. PO Box 344 Ng 172 ERC Ns s:Er,n Ipswich, MA 0193$ INsa:ERE INstr:ER r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TU CERTIFY THAT THE POLICIES OF IPCURANCE LISTED BELOW HAVE BEEN ISSUED TO THE dJSURED NAA-IED ABOVE FOR THE POLICY PERIOD INDICATED, NO'R%1ITHSTANDING ANY REcJUiREMENT>TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHKC H THIS CERTIFICATE MAY BE ISSUED OR f,1AY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERA4S, EXCLWIONSAND CONDITIONS OF SUCHPOLICIES,LIMRS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � D,:INSURANCF .❑,, INSR YdVp :'�'IICY NU AiAFR (MAi/ODfWYY) A1A5,Ti U1?Y:Y'• UMTS GENERAL LiARILITY AUTOI.{OBILE LIABILITY i & WORKERS comrENGATIO f! WC'S7A7 U• OT H. AND EMPLOYERS'LIADILITY VN l0!2V LI\til.<, F.R Ak VPROnRIFT0f2feAR2N=R.+XE1`t11'IVF Q� A nra:;x r.iRrr,GK,;Cuncn> N:A WC-20-20.0018(;1.00 fO13(Y2014 110/30!2015 eCEACNnrcinFNI S500,000 (Wold w.q i,,NNy u Y4..e•,sa:he,nay' I�r-as c:.G,a-Mal vee $ 500,000 'r6 Sri2;P7 l.N;:t'riP 612 A'II�N56ntga - [ASEAS �L�.vC�,n .S 500,000 UGSCR!PTe,}N+f OPGRA 2IU NS f t(r�A;tOFJ£!t'C Ni('4..(Attgrl.AJ;f}r2D,61,A'iGd ronal t2gmgrF;Snlnevk,d nm.q aU,.-.c a rq 5,ig01 Election Category Effect.Status NamCoveragee States) _ All Entities/Locations Officer Exclude Kurt Gauthier MA 0fricer include Brittnie Aiello Gauthier Insulation inc 44 Essex Road Ipswich, MA 01938 CER11FICKIE HOLDEKCANCELLATION SI-)ULD ANY OF THE ABOVE DESCRIBED POLICIEtISIECAf�XELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE ELIVERED IPI [510 ss Save Pro gramlConservation Services Group, inC A(X C)17DAP).E WITHTHE POLICY PROVISIONS, Washington Street st Borough,MA 01581 ignature: ,1..., _. ACORD 25(2010;05) BRAC 3139 r C?x ""' ter - AMMI11 ' Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type_ Individual Expiration: 10/1/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER _ _..._ ___.................. P.O. BOX 344 IPSWICH, MA 01938 .._ _�.. _._.._ ..._.u.....�...._._... ......._�...�_..______...... Update Address and return card.Mark reason for change. Address ( Renewal j Employment Lost Card SCA Y 0 1 •....... Office of Consumer Affairs&Business Regulation license or registration valid for individul use only "" BIOME IMPROVEMENT CONTRACTOR before the expiration date if found return to: Registration173g1p Type: Office of Consumer Affairs and Business Regulation xpirntion: 10I1f2E11& Individual 10 Park Plaza-Suite 5170 r ;c Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD r IPSWICH,AAA 61938 _� _. _. ..... ...... . ____�____._....._ ........_ Undersecretary of valid wi out signature _.k M . achusetts Board Of Building flea ��� tar�cFu et 6`rsas t ®ages sca xa x n e:R`t Not, License,CUL-1 �>4V F S 2 X"T R CA ', i ' r MA oto �4 tar Expiration �f7`