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HomeMy WebLinkAboutBuilding Permit # 9/1/2015 TOWN OF NORTH ANDOVER %ORTH APPLICATION FOR PLAN EXAMINATION 4,0 o Permit NO: Date Received US Date Issued: 11 IMPORTANT:Applicant must complete all items on this pae LOCATION Print PROPERTY OWNER Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 11 TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential New Building One family /Addition Two or more family Industrial lt4 Alteration No. of units: Repair,replacement Assessory Bldg Commercial Demolition Moving(relocation) Other Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED ovi k,c-,)-) "C' J-AA r J Identification Please Type or Print Clearly) OWNER: Name: NJUV\kiv CLLM D�Aj Phone: J ml Address: lU3 CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: t -Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ i x12.00=FEE:$ Check No.: Receipt No.: Page 1 of 4 t%®RT H Town of Andover No. a6116 �AI(E �1 ver,� aSS9 O I� COCMICMEWICK S,9 RATED U BOARD OF HEALTH AN Food/Kitchen rER..M1.T, T LD Septic System THIS CERTIFIES THAT .. ,,,,,,,{.!!� .......,, BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ...... . .. ........W. . .. .. . ... ... .. .. Rough to be occupied as ............. ....... .1.... .... .....zv .I&. . . .. ........................... Chimney provided that the person accepting this permit sh 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 EXPIRES 0 IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIOJWTTS Rough VON Service ................ .............................zoo................................ Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to Occupy BulldinRough 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. Federal ID#054405629 RISE Engineering RI Contractor Registration No 8166 MA Contractor Registration No 120979 A division of Thielsch Engineering CT Contractor Registration No 620120 60 5hawmut,Canton,6fA 02021 CONTEr2 A %^C"I FAX 339-502-5197 AX 339-502-6345 V R Y$ Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING CMA—RES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW PHONE DATE CLIENTa WORK ORDER CUSTOMER Benjamin Campbell (978)621-7936 07/31/2015 419692 00002 SERVICE STREET BIW " NG STREET '' 478 Waverly Road 478 Waverly Road SERVICE CITY,STATE,ZIP BIWNG CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 (� 2 Zp151 JOB DESCRIPTION -- � PHASE ONE-Proposal for this calendar year. $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in conceA 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 and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)working hours. A reduction in cubic feet per minute(efm)of air infiltration will occur,but the actual number of efm is not guaranteed. At the completion ofthe 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. $680.00 AIR SEALING ADDER: (4)working hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass halts to(202)square feet for damming purposes. $414.10 ATTIC PLAT:Provide labor and materials to install a 13"layer of R-45 Class 1 Cellulose added to(1058)square feet of open attic space. $1,724.54 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $60.00 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose to existing bathroom fan(s). $50.00 VENTILATION:Provide labor and materials to install ventilation chutes in(80)rafter bays to maintain air flow. $160.00 BASEMENT CEILING:Provide labor and materials to install(125)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $218.75 BASEMENT DOOR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and seams with FSK tape. $72.22 RISE Engineering will apply all applicable,eligible incentives to this contract You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are 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 flow in your home both before the work is begun,and after the weadiercration work is complete.We will also conduct a full assessment ofthe combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. $90.00 n Federal In#0"406629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thieisch Engineering CT Contractor Registration No 620120 60 Shawmut,Canton,MA 02021 CONTRACT N 339-502-5197 CAX 339-502-6345 S E+ Page 2 ENGINEERING PROGRAM THIS CONTRACT{9 ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUENTO WORK ORDER Benjamin Campbell (978)621-7936 07/31/2015 419692 00002 SERVICE STREET BILLING STREET 478 Waverly Road 478 Waverly Road SERVICE CnY,STATE,IIP BILLING CITY,STATE,LP North Andover,MA 01 845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,809.61 Program Incentive: $3,109.99 Customer Total: $699.62 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred Ninety-Nine&62/100 Dollars $699.62 UPON FINAL INSPE ON APPROVAL BY RISE ENGINEERING.CUS7 PEES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE 10 YS.SEE REVERSE FOR IMPORTAN ORMATTD N GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. '.. NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTTIOR�O SIGNATU SE gf ng CUSTOM ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT.7HE OVE PRICES,9PECIFICAt10NS ANO CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WALL BE MADE AS OUTLINED ABOVE ENEM moommommlimm "�'Co'�iiis � �uTii�� mmmii .11 mimnm_i an= MMUMME ME an Immool MEMO INNION 11IMMUM ml'm"mm nimmms NO soon CCS■:�.:�:.. EN CC■..mis ��, ' �� �� �vI����Ni��n��r� \�N� At MO p1_B �\+a�aBiv� i� i��i�iri���w�GiJ �wn�ou ■ C���p � HOME No ol an =a IS ENE MINISM an I NMI �I an AMMM =ME= 01, ME mom a ME 0011 =am ONE JUNE a Into am 8=0 Sam '24111"M pp-w 0 ME 011 Mal JIM ME �tlVN�NNOME N�a � CnB ti � �a���momoa�i� MOEN �i�ions i= dui i �llk:Iu 3 NONE ME No am�i� mom Mimsinnii�nni u�i a� unaa■m ..SC�:■ '1CR� 111 a a �■ giNo MENEM311, MoI p.: � l :Wall fm �.�smanian Oman ��' �� Immom Bo�� �i�i �i iiuomr�imau�� � mommosso a�won� r� oSms �iMn �ou�' '��i n'C liamm =a NNE ION on Nunn alsomi�a�p u�nM �N�0 lonsimu'Lumm a a IN a W ��a��mossonsimsm N�i�NNi�iiii '11N�NN MEN■ '{.X���:��...... .. .:�OC:� CME CC': OWNER AUTHORIZATION FORM Benjamin Campbell (Owner's Name) owner of the property located at 478 Waverly Road, North Andover, MA 01845 (Property Address) 478 Waverly Road, North Andover, MA 01845 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property r Owrpf s Signature D11';�1 5 -P 1, Date/ The Common wealth ref= assaeltusetts Department of Industrial Accidents r � Office of Investigations I +-on ress Streel,Suite 100 Iicts'lon,.AIA 02114-2017 wwwmass.govtdla Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informatioln Pleas Print Legibly Nanie iHusiness`t)tganirstitsn?CarrfiY du sl?'._.__ to C i1 L.Y },.l aa. tht�b l4 City/State/Li ; _. Phone • 1 - U,° - Are you an employerli Check the appropriate box: Type of project(required): LN I ant a employer with 4• I am a general contractor and 1 employees(fill]and/or part-time),* have hired the sub-contractors 6 New construction I am a sole.proprietor or partncr- listed on the attached shtvt. 2. Remodeling ship and have no employees Thew sub-contractor:;have & Demolition working fir me in any capacity. employees and have workers' 9. [�Building,aefclition [No workers'comp,insurance romp.insurance.l 5. We arc,a co oration and its IO_ Hcctrical r<pairs or udditiT>ns reeluired.� ri 3.[ I am a homeowner doing al work officers have e,xercked their 11Plumbing repairs or additions m self: (No workerscomp. right of exemption per� G1, y p- 12. Roof repairs insurance required.] c. 1 a2,$t(4),and we:have no employees.[No work i!rs' I3.Q t�therT _ comp,insurance required,[ "Any appi;cam that chocks box tl mu.sz also till out the setPiin below s?arsx iiii;th4 f worker`compt.tsarim icy infixmatinn. t I lotneoAlnes Who iubink this atlidai it indicating they are doing all wti`K and sten hire i)ktretit^contrutors muse SubatiT a new a fridat ie indicating nuh. {::rmtr3s;tor Tr28t check thi's hox Muv ii"CNtl an aMitiotial sheet chiming the imine of the sub-c;miractars and r ittt whether oT nut tfio e emiii' a%t witilo}'Ccm tt tI3C 5{3t} ,Q[ktr i'iC�$3 Ite1i�'C CSII(itUVCCS,they mw pTovide tbtir �Yt)'!4'•rS`Ci14fl�1,t10511C}`FiUft7IA.'f i lam anemptot+er tlrnt Ls rr vtdl r u vrJ�ew'cnnrlten3urioir insuran i for my emp nth,,-, Below is the policy and job site information. Insurance Company Narm:: t i t t - J'Apiration Date:: I �.� �3 Policy#f or`�ckf-ins, Lae '�:, _. IoD Job Site Address: + -A'� l t;3yi5ts�te Ztp��s V 11 &r)V.CC._f-Irr m qi Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure:to securer coverage as required under Section 25A of iN4GL c:. 152 can lead to this imptxition oferiminal penalties of a line tip to 51,500.00 and/or one-Fear imprisortment,as well as civil penalties in the femur of a STOP WORK ORDER and a fine of tip to 5250.00 a tiny against the violator. Be advised that a copy"of this statement may be forwarded to the Office of Investigations of the:IIIA for insurance coverage verification, I dei hereby ceriify under the patens and perttrltic.s of perjury that the information 111, vided cai6ovr is true and correct. Sicmature: 13 etc: �. . ' . Official use only. Ike not write in dais area,to be rompleted I?v cky or town q ficial. City or Town: _ _ _ ..PermiVLicenw . Icing Authority(circle one): i.Soard of health 2.Building Department 3.City/Town Clerk 4.Rlccirical Inspector .,Mumbing Inspector 6.Other Contact Person:_ � .. __�—�„.. ___ phones =DATE(MWDD1ffYYYy) A� CERTIFICATE OF LIABILITY INSURANCE 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)., coNTACT NAME: Nancy Usher _ -- - PRODUCER "-- — FAX (413)534-7874 PHONE (413)536-0804 (AICNo) -_ --- - Martin J Clayton Insurance Agency, Inc. (AIc No Ext:-_ - -.-- EMAIL ADDRESS: _--- _--- _-- 1649 Northampton Street —- - - INSURER AFFORDING COVERAGE NAIC# P. O. Box 989 --- MA 01041-0989 INSURERA:Nationwide Mutua_-Harle sville NATIO Holyoke - zt --- wsuRERB:A11ied World Nat_1_Assurance Co_ INSURED -- INSURERC: _- ___ Gauthier Insulation - - INSURERD: 44 ESSEX ROAD __----- --__ —----_ -- INSURER E:,-- —_-----" IPSWICH MA 01938 INSURERF: 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 PERTHIS IOD CERTIFICATE MAY ING BE ISSUEID OR MAY ANY EPERTTA NE THE INSURANCE AFFORDED BY THE POLICIENT,TERM OR CONDITION OF ANY CONTRACTS DESCRIBEDDOCUMENTR OTHER HERE N IS STUB TH ECT TO ALO HERESPECT TI TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ---- - - -- —_---_ — ADDL SUBR -- --- —" - _ POLICY EFF POLICY EXP LIMITS INBR TYPE OF INSURANCE I POLICY NUMBER MM DD MM DD 1,00 0,000 LTR EACH OCCURRENCE __S X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED — _PREMISES�Ea occurrence— $ __—_ -- - - - A ]CLAIMS-MADE LXl OCCURon5,0_00 X GL43487F 7/6/2015 7/6/2016 _MED EXP(Any e person) $ __ — _ - -- - _PERSONAL&ADV INJURY $ _ 1,000,o00 GENERAL AGGREGATE—�$ _ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1$ _ ,2,.000,000 PRO- X POLICY I__J JECT E LOC ----�---- $ OTHER: COMBINED SINGLE LIMIT $ _Ea accident)— —_ _------- AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ._�ANY AUTO ,—. BODILY INJURY(Per accident1$ ALL OWNED SCHE - — -- -- -- AUTOS 'T AUTOS PROPERTY DAMAGE $ NON-OWNED I _LPeraccidegt)__— —.. -- -- `_ HIRED AUTOS — AUTOS $ EACH OCCURRENCE __- $ 1,000,000 X UMBRELLA LIAB OCCUR1 000,000 - _A_GGREGATE —_—. $ _. _r. - EXCESS LIAB CLAIMS-MADE B _ ' DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ LPER ( ER_ WORKERS COMPENSATION STATUTE- OTH- I ER_ — AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENTANY PROPRIETOR/PARTNER/EXECUTIVE L N 1 A I E.L.DISEASE-EA EMPLOYE OFFICER/MEMDER EXCLUDED? - (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSURED(S) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THIELSCH ENGINEERING, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 195 FRANCIS AVENUE CRANSTON, RI 02910 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 011SPtt'b'gtled with pdfFactory trial version www pdffactory•com ,J)•� L'Hn 1t./10/2014 1 :21 :37 PM PAGE 2/002 Fax Server 1 DA'.E tbtlllUC;7:"r�"/� 1 CERTIFICATE OF LIABILITY INSURANCE 12%1012014 THIS CERTIFICATE IS ISSLIEO AS A MATTER OF INFORMATION OhILY AND CONFERS DO BIGHTS UPON THE CERTIFICATE HOLDER, THIS CER71FICATE DOES NOT AFFIRMATIVELY Olt IIEGATIVECY AMEND, EXTEldb Olt ALTER THE COVERAGE AFFORDED 15Y THE 11OLIC1ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A COItTRACT 6ETWEEH THE ISSUING INSURER(S), AUTHORIZE1) REPRESENTATIVE OR VRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT; If the Certificate holderis an AODITTONAL INSURED,the poflCl(Ies)nw.,I.be endorsed, If SLIUROGATIOt'1 15 4PA)VED,subject to the Leans and condilions cif the poll(--y, Cerl;341 PORCIeS may require an endorsement.. A SLaiemeriL on LhK Certificate does not reefer rights to Lhe certificate holder in lieu of such endolsernent(s). ---- - --- -- - --- — -- --------- -...-------- IiCU-1 L't,R t:0141 AC'I " AR 13etitle Assi ned Risk Services Clayton Martin J Ins Agency Inc rix No Ea, £C00 834.4589 ;n'c No; 866 215-8118 1649 Northampton St PO BOX 989 n2ZI;ss. Polfcy5ervices(vherkieyrisk,o)ni in�ui7titrs nvTORUINc L'cvEt7nGE N,vl;a Hol oke MA 01041 Nz A Ns,REuAmffini •> . Gauthier insulation Inc NS u7=R�- - ------ _.._----•.--------___._.___....---.--------------.__---_.--- IN�,$7 Pd Box 344 rHS lR ER n Ipswich, MA 01938 Ns utERE IN$LRER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLIC.Es OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWS'ITHST/8.1DING ANY REOUIREMENr,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH F2ESPE(;T To WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS. EY,CLCISIONSAND(X)NDITIONS OF SUCHPOLICIES.LIt•ARS SHOWN MAY HAVE BEEN REDUCED BYPAK)CLAIMS. aliTV'I•P Ot INSURANCF ` .I" L7R INS R WVL) POiiCY NIJUAFR 0.J 0.1/nOfYYYY) h7Ai,A f7lt1'YV'. IIABTi GENERAL LIABILITY AUTOnOBILE LIABILITY ( i 1V0RKERS comm ENDATION iW('S'T A7 U• OTN AND EHPLOYER S'L1A81L ITY Y.'N TORYLI!AI'i.<, F.R 4NYARi?'RIEit�RlehRTNCR'EXL't:U1'IVE Et-EAi:N if CI!:IEN1 5500,000 A ornra:,NLtaRrr.I:xcCunrci� WA WC-20-20-OOt8B1d16 10130l2014 110130/2015 {L4uIA nlnrV iu Nn) ;e yu,,dv.ci:Gn vr:tlee :I�F4SF. ERIPi OYEE $ 500.000 WO R:pl 1C`Il til'iiAEi7 A'I I!:NS boEaw - V c .500,000 r T SiN.^.r O!'MAVOIvS I!. CA1 MIS r S'CNI('C_S tAttA,ACO!"101,P.ddd,dnal R?,earl:.Sclndv'r:.A n:n:e=u,ct.,+r¢Si,igdS Coverage Election Category Elect.Status Name State(s)_ Afl Entities/Locations Officer Exclude Kurt Gauthier MA Gauthier Insulation Inc Officer include Brittnie Aiello 44 Essex Road Ipswich, MA 01938 CF-1411FICATE HZ5Lr)LRCANCELLATION 3N:)ULDANYOFTHE ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Mass Save Program/Con30rvation Services Group, Inc AC.C;ORDAN(:E W1TH'fHE POLICY PROVISK)NS, 50 Washington Street West Borough,MA 01581 Signature:_. ...., Y ACORD 25(2010;05) BRAC 3139 t .. Office of Consumer.Affairs and Business Regulation , - 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 1 0/1 12 01 6 Tr# 257812 KURT GAUTHIER KURT GAUTHIER GAUTHIER ............ P.O. BOX 344 _-------------------------- . .__.......... ...._ IPSWICH, MA 01938 _..... ._ .._.__._ _. _. ..._.... ___...___.......... Update Address and return card.Mark reason for change. 7_I Address [ j Renewal :, Employment Lost Card SCA 1 0 20 0511 Y""nrrirn`arrrstc {�"�jar Fu J:rt.:Pfl Office of Consumer.Affairs&Business Regulation License or registration valid for individul use only �MfiIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: a. `Registration: 173410 Type: Office of Consumer Affairs and Business Regulation y r Fxpirationz 10/1/2016 Individual 10 Park Plaza Suite 5170 Boston,MA 02126 KURT GAUTHIER KURT GAUTHIER r/J 44 ESSEX RD ^ r IPSWICH,MA 01938 -- __..__..........._ Clndcrsecrefary "at valid w� out signature maas achusetta m DepartMent of Pubuc Safetv, 130ard of SWIding Regufations and Standards C,fwadra ctdaa g'aaa xe a wbow SsIcc iaatia Ucen ,CS$L-I(IM2 max,r Iv °j", K[TiFtZ'�"G'AlfTl1 P.O.B+ma 344 I*wkb MA 01938 G r t � Expiration so rer `MM17