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Building Permit # 9/1/2015
OORTH BUILDING PERMIT O��g�eo TOWN OF NORTH ANDOVER '0�, APPLICATION FOR PLAN EXAMINATION e _ Permit iqp4 Date Received C � �SSgHus�`� Date Issued: != PORTANT: Applicant must complete all items on this page r I r M l 1 , ,��. , � l�� ,. �� ll Jill�l .d7�II .�I�II;Y/�r��i/�'ll���f.�i. �///���/ �'/Y/7�iiri� �K,.,f/ /nrrr�r„r,r r/r�%J J�..,,,,, irrrr,�...fhiioorr✓�/i. TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial irkepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other / r l,J/ /, / / food lai d Wetly,ds/ / ,i ❑/ to, h d Disf t, �/ ,, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: <w + G4, S�® Phone: ' C4S Address: / / l / r i /�r✓//� „ li� f/ ( /(/ /, 1f , / ,f i '�/ �l f ro y, ,y�� //l//; ✓/ ,l�// ,� r / // //�l / ///�; /,�,, ,� r � �, ���� ��r�, 1,, �J����� / /r/�„/l(fir , / ,� l��I����f �✓,� �S�////iii r J;./r�l/fuul'7;1H�4Pnnrl�)1r�6h�rArlYAwl���L,�iiO �Priu,9;v�ni�md�reln+liaNmDLmRmBnriUirify�llNrti, '' ..:rrm�im'��r,�s�r„'�)�Shr,JN�ifrfm„�ryDrr._.. 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: $ ` FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ' ,, Signature of contractor NORTH own of 2 . � Andover O - 0 No. h ver, Mass, 11 COCNIC"e W.CN �.p A�RgTEO AP�,��CGJ S BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System 12d THIS CERTIFIES THAT ......... .... .e.1 BUILDING INSPECTOR ...................... . .... .................. ... .. ct .. . ........... buildings on .. *� Foundation ati on has permission to ereRough. . .Wsall ........+....... �................... Chimney be occupied as ........ . .. . ..... 4provided that the person accepting this permitin eve ryrespect 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 CONSTRUC9M uJARTS Rough 5 r Ldozoo Service .........X.::.......\...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. DocuSign Envelope ID:97C6D5CE-8308-4BF4-90D1.2297244666410 CATpn T FOR WORK 120 PRODUCTS SERV10E Conser atlon This service is brought to you through support from your local utility Services Group This Agreement is made by and among and Conservation Services Group(CSG) Edward Keisling Attn:RCS 9'Dudley St 50 Washington Street,Suite 3000 North Andover,MA 01845-3603 Westborough,lV1A 01581 Site ID:500050020475 Reg.No. 173484 Noject,lD:PD0050023330 Federal ID No.222457170 Customer ID:COQ050020706 (Mail completed contract to address above) Contract ID':20150723 ASEAL ' I, DESCRIPTION OF WORK TO BE PERFORMED professional manner and"'accordance with the terms of Contractor will perform or cause to be performed the following work on these"Premises"hi a this Contract,including the attached reconmiendations/work order describing the work in detail(the"Woriz')which are incorporated herein by reference: Quantity Location $505.92 Description _6......_..._Liwng Space_...__.._.._. ---....__......_.. ---...._...._...._._..._-$69.54 ... - - --- _g- __._._._..._._...._..__._.___.--- Perform Air Stalin _at Estimated 62.5 CFM50 Per_Hour__._.__.._....______._....___.-.--3- -N/A_._..____._..___....__..._...._..............._._._ -.. Door Swee -- - _ _..__.. _ $658.23 PP g - - - Sub Total: ---- Exterior Door Weather Stri_ m ___ $658.23 -- Utility Incentive Share $0.00 Customer Contribution too Printed:712312015 Page 1 of 2 For office use only as a Deposit. 11. PAYMENT 50 Washington St.,Ste. Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment.t#l:$ 0.0 as the final payment for the Work shall be payable to the Independent eInstalare of tl tion payable to CSG upon signing the Colas$ct t to O.00ceed 1/3 of the total retail costs).Mail check il contract to CSG,Air'the Utility 3000,Westborough,MA 01681.Final Paye Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Contractor("IIC")upon satisfactory completion of the Work.Caystomer understands that he/she will not be require Pal Contract price in the amount of$�8 23 Share. III.DISPUTE RESOLUTION this Contract,the RC may submit.such dispute to a private arbitration The IIC and Customer hereby mutually agree in advance that in the event that the TLC haNaordis�cute concerning r e ell all be required to slrbmit.to such arbiti on as pronnded in M.G.L c 14IA. nd service which has been approved by theOfflceofConsumer Affairs sigBusinessby at lace other than an address of the seller, provided telegram sent or by delivery, not later thin midnight of the third You may cancel this agreement if it has been signed by a party p Y, notify the seller in writing by ordinary mail posted, by 9 y ""'ss'`�!'a" 'following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES. y 7/23/2015 I��rhn�l hcable (OR) Initial here if you want -- Indicate your selected IIC here,if app the Program to assign a Date - -.rnr.-nn nen VaParticipating Contractor Customer S�igna�ure 7/23/15 Mike rne AMC v Date Name of CSG Representative(Printed) CSG Signature 3/14 TERMS AND CONDITIONS APPEAR ON TRE REVERSE. DocuSign Envelope ID:C91F5D63-EA54-40F8-AF77-C4CEA379BDEF p p NIRA T R Conser ation R U TS SERVICE WORK ServlceS Group This service is brought to you through support from your local utility This Agreement is made by and among alad Edward Keisling; Conservation Services Group(CSG) 9 Dudley St Attn RCS North Andover,MA 01845-3603 50 Washington Street,Suite 3000 Site ID:500050020475 Westborough,MA 01581 Project ID:P00050023330 Reg.No. 173484 Customer ID:000050020706 Federal ID No.222457170 Contract ID:20150723 WORK (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED rk on these"Premises'hi a professional manner and in accordance Bre of Contractor will perform or cause to be performed the following woi the terms n this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantity Location 1 062 40 640_........ Living_Space--- --..._....-- ._... --..._-....__........_$...._...._....._._._-. Attic Floor_Open__Blow Cellulose_9'_.____....._....__.._..__..._..._ _...._..__..__...__._. _._. ..__. $837.20 322.___..____Living_Space___________...______._................._..._..__..._...__...._......-----..._._.__-- Attic Floor_Enclosed_Cellulose Dense_Pack_8"__.___._......__...._____.__......_._.___..__....___._ $273.60 114 _Living.Space_ _ - - Insulate Rim Joist with 6.25"Fiberglass Batting__ __.... _._-...--- -$30.66 _ Damming--- -14 N/A_—.---------- $99_65 ----------------- 1 Attic 2 Install 8"Roof Vent ___ -------------- $137_97__ 1 Attic 12"Mushroom Vent - - $81.37__ _-- _--. 1 iving pace - ------- - Door:Thermal Barrier Pol iso 2 Attic _ --- _Y- � _ ___ - __.__ _ -. -- Sub Total. $2,522.85 Utility Incentive Share $1,892.14 Customer Contribution $630.71 Pre-Weatherization Incentive $250_00 Remaining Customer Contribution $380.71 Deposit Already Recieved on 7/23/15 Printed:7128/2015 Page 1 of 1 For office use only II. PAYMENT 126.00 as a Deposit Customer agrees to pay Contractor for tine Work,the Customer Share of the Contract Price as follows:Payment#1:$ payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail final.Mail for the contract toall CSG,Awl: payable R the 0 Wash n I Installation 3000,Westborough,lYIA n sats Final Payment:$-254.71 irelyp that y Incentive Contractor("IIC")upon satisfactory completChangestto hxlividual line itemsrand/or r re�previous ncentivesnot ma increase to decrease tpay the he is size ofincentive the Utility of the Contract price in the amount.of$-1892.14 - Share. III.DISPUTE RESOLUTION The IIC and Customer hereby mutually agree in advance that m the event that the IIC I>�s a dispute concerning this Contract the IIC may subunit such dispute to a private arbitrau IT service which has been approved by the office of Consumer Affairs and Business Regulation and Customer shall be required to submit.to such arbitration as provided in M.G.L c 1124. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided il atr than midnight of the thd you notify the seller in writing by orrdinaryis a reemeted, by telegram sent nt DO NOT SIGN TH 5 CON or by ma TRACT IF THEelivery, notIREe :AR ANY BLANK SPACES.Ir bu�'n8s'dWfd lowing the signing 28/015 r-y Date Indicate your selected IIC here,if applicable (�R) Initial here if you want Customov"3lgrihture- " Mike Varneythe Program to assign a 7/23/15 Participating contractor Mike Varney CSG Signature Date Name of CSG Representative(Printed) TERMS AND CONDITIONS APPEAR ON THE REVERSE. 3/14 RCS PLANVIEW DIAGRAM Home Phone: ( )" � Customer: Y S� Work Phone: ( ' Address: 7 _ )- 3�7 - Q�q — Cell Phone: C Town: Any limitations for access by large truck? No Yes If yes,describe: Any specific directions Or landmarks? NO Yes if y 11 es,describe: Reviewed by: Site ID: Sdodfov ZU`��t Energy Specialist: �l( 1 .. ,( }/ 3CEL0- ANA-,i: - ANA-,c wV%"A �}uoC y�� �� � _ (2) pWr s1rJe2Ql P Vol d S�M JAd t Nor 3 -Ys A w t'- 4`t { 1 b,lF ta5 VIA ,,Z, �� CdA4 wj yycr UAkr zv � NIT 7 t c is, Rio For Office Use Only Neighbor Proximity Pocket Doors Insert Radiator�S Fence(s) Bushes Ladder offit G=Gable Vents Note Inside Square R=Roof Existing Conditions X=Access = CDE=Continuous Drip Edge T=Triangle RV=Ridge Vent CS=Continuous Soffit Temp Unless Noted Otherwise C=Ceiling W=Wall S=Sheathing M=12.,Mushroom For Access Install O=New Access Note in Circle R=8"Roof S=Soffit G=Gable �j=Vents Note in Triangle 22D0u10y1•.TSu mass save �NMCMR O"roy Wadancy .o► PERMIT AUTHORIZATION FORM 1, Edward Keisling ,owner of the property located at: (Owner's Name,printed) 9 Dudley St. North Andover (Property street Address) (City) hereby authorize the Mass Save Home Energy Se ices Program ass' ned Participating Contractor listed below to act on my behalf and obtain a i! ng permit to orm insulation and/or weatherization work on my property. X Owner's Signature l � Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date W ` M 60 For office Use Only Rev. 12132011 L The Commonwealth of Massachusetts Department of Industrial Aceidentc Office of Investigations I Congress Street,Suite 100 Boston,AM 02114-2017 www mass.govldia Workers'Compensation insurance Affidavit:BuilderslC ontractorafElectri€ians/Plu.mbers A>arrlicant Information Please Print bmibly ri1CCi{Business Ylrgariirtltn,lndivclurtl}: S Address: 0 Z01 3Y4 City/State/1t t ; C Phone : t Are you an employer!Check the appropriate box. Type of project(required): 1.® 1 am a employer with 4- [] l ant a general contractor and 1 �6. (�New construction employees(frill anchor part-time),* have hired the sub-contractor I lasted on the attached sheet. . ®Remodeling 2.� l am a sole proprietor car partner 'Fhese sub-cuntractor:�have 8, Demolition ship and have no employi:c employees and have workers-'working for me in any capacity. 9. Building addition tNo workers'comp.insurance comp.insurance,, i0. i.lcctrical repairs or additions required.] 5. nWe area corporation anti its p 3.0 1 arts a hotneowtier doing all work officers have exercised ised their i i_�t�ltrmhin�repairs or additions myself, [No workers' comp. right of exemption per MGT. 11®Roof repairs insurance required.]+ c. 152,§1(4),and we have ate) employecs.[No worker' i t.[ Other comp,insurance wquirA,J Any applicant that checks box#t must at�t tilt Stat the section bdow•shanying their t��rke?s°ciut pcmai4oT%policy isaf tmatitm. I ltotnwAnm�whir Submit this affidavit indicating thoy are doing at)work and then biro outside eontrutors roust subtrit a rtw afflidavit ind-acalmig such. lC ontrattots that ebeck this box must attarted an addittoft-1l shrel shttwintt the:name of the stab-conft-wtws atul state whether Ger not;how entiti s hm e etnplo} . if the attta-contrattots have crnployces,they mtm provide,iheir wilt)era`camp,policy numlaer. t am an employer than is providing ovorkers'comperuation it varartce f r Cyt enrpint ees l3eJow is rhe p{riit t'and job sire information, irrturrnoc Company Nattx:::.- Policy N or Self-ins.Lic.4:_..._ - . G f i(o t2 l .._� Expiration Date__._i ) �. ._I�.__ Job Site Address: �D L� CSA t;aty SrateiZip: �+ �. CLL, V Y"1 A � Attach a copy of the workers'compensation policy decitaration page(showing the policy number and expiration date). Failure to secure covcragc acs rewired under Sectimr 25A(if MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 anti/or one-year imprisonment,a well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that at copy of:this statement may be forwarded to the Office of investigations of the DIA for insurance coverage.verification, I do hereby certify under lire pours and penalties of perjury that the information provided above is true and correct. f0ffikial r:se only. Do not wr'i'te in this area,to he comps treed ley city c r town o cial. y or Town. «Perrttitll ren. T_....w --_-- .__... - Iswing Authority(circle one): 1.Board of Health 2.Building Department 3.C yfl'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other _ Contact person: Phone C DATE(MM/DDIYYYY) ACC?R® CERTIFICATE OF LIABILITY INSURANCE 7�7�2015 C 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 PRODUCER NAME: Nancy Usher Martin J Clayton Insurance Agency, Inc. PHONE Ext) (413)536-0804 FAXNo):(413)534-7874 _(aC AIL No, -� ----- - EM 1649 Northampton Street ADDRESS: _ P. 0. BOX 989 INSURER(S)AFFORDING COVERAGE NAIC# _ _—_ -- Holyoke MA 01041-0989 INSURER A.-Nationwide Mutual-Harleysville -NATIO_ —— -- --- - —- - INSURED INSURERBAl11ed World Nat_ Assurance Co Gauthier Insulation wsuRERc: ----------- - 44 ESSEX ROAD INSURERD _ ---- INSURER E. IPSWICH MA 01938 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. _ - --- -" ----.- ---r--POLICY EFF- POLICYEXPT- - ADDL SUER LIMITS INSR TYPE OF INSURANCE POLICY NUMBER M D MM OD LTR 1,000,000 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S - DAMAGEO RENTED- � $0,.000 A _]CLAIMS-MADE [XI OCCUR PREMISES(Ea occurrence)— - X GL43487F 7/6/2015 7/6/2016 MEDEXP(Any on.Pelson)._ 5 $,000 '_PERSONAL 8 ADV INJURY 1,000,000$ -_ —__-- 2,000,000 - _ GENERAL AGGREGATE $ -__ _GEN'L AGGREGATE LIMIT APPLIES PER: --- -- -- 11 r PRODUCTS-COMP/OPAGG $ 2,000,000 X 1 POLICY F]'ECT ]LOC --- -- -- OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accidents -_ BODILY INJURY(Per person)T$ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED - SCHEDULED _. - -- -- AUTOS _ AUTOS PROPERTY DAMAGE $$ — NON-OWNED _(Peraccidenl).—. HIRED AUTOS AUTOS $ g UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ -__ 1,000,000 - — :DED i RETENTION BE020792125-194985 10/18/2014 10/18/2015 PER OTH- WORKERS COMPENSATION STATUTE_ ER- -- -- AND EMPLOYERS'LIABILITY YINI E EACH ACCIDENT ANY PROPRIETOR/PARTNER/EXECUTIVE r l NIA OFFICER/MEMBER EXCLUDED? L E._L.DISEASE-EA EMPLOYE $ (Mandatory in NH) -- - _ -- - If yes,describe under E.L.DISEASE-POLICY LIMIT $ 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 INSUREDS) 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 THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 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 IMPIMStbd With pdfFactory trial version www.pdffactory.com 1 �1 1Hn 12/10/2014 1 :21 :37 PM PAGE 2/002 Fax Server I CERTIFICATE OF LIABILITY INSURANCE 12/10/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 110 BIGHTS UPON THE CERTIFICATE HOLDER, THIS CEIITIFICATE DOES HOT AFFIRMATIVELY Olt NEGATIVELY AMEIIU, EXTENT) OR ALTER THE COVERAGE AFFORDED BY THE POLICIES i BELOW. THIS CERT1rICATE OF INSURANCE DOES NOT COlISTITUTE A COUTRAC'T BETWEEN THE ISSUING INSURER(S), AUTHORIZED IIEPRESEIITATIVE OR PRODUCER,AND THE CERTIFICATE HOU)Eit, f IMPORTANT: If the certificate holder If an ADDITIONAL INSURED,the policies)mu.1:be endorsad. If SU81lOGD AT10H IS WAIVE ,subject to the Lerms and condillon. of Lhe policy, certain policies may require an endomemenL. A stal.ernenL on thK certificate does not confer right. Lo Lhe certllicaW holder in lieu of such endoirement(s). `Ok'^'L" BoNe Assigned Risk Services Clayton Martin J Ins Agency Inc in'c 'AA, N.E., E100634.4589 1649 Northampton 5t Nn. A66 215-8118 A LSS. PolicyServicesCvberkleyrisk.o)m PO Box 989 nNiERi nFYORu"NG IXV!RAGE Hal oke MA 01041 m,, E 1 N;uREu Gauthier Insulation Inc PO Box 344 iN>IRER C lNS ll2ER n Ipswich, MA 01938 NSU'ERE "wstr.Eli r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLiC ES OF ItNNURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NANIED ABOVE FOR THE POLICY PERIOD IIDICATF-D, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHK;H'THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLIXIONSAND CONDITIONS OF SUCHP0LICIES.L#A11S SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS, � TYI'G OF INStIRAkt:F pOl iI;Y I,;, LTt2 ;NSR WVLI (AAAI/DD/YYYYt AIAs,T)17fYY7Y GENERAL LIABILITY AU70 MO RILE LAAMITY WORKERS COIAPEMATION W C STAt U. OTH- AND EMPLOY ER5'L)A8ILITY Y'N I TORY LI\tilt F.R ANY PROF'RIE T ORtPAR7 NEn,EXE,I:t111VF- �IEt EAI:It lJ:CI(7FN1 $SOO,000 A ornr;t,aclaRCRcxrtuornT WA � WC-20-20.00166;1.06) 1013012014 h(V30P2015 !i 500,000 }a; Ov�ri�Uw vi,de� I"SE ASr�� eMP� YFE $ L Et l;ISE AS -PCL;''-YL A!il 500,000 (%r_5t'";!PTr,+N:f'LPG A71ONg);QCA51U'!S IkC111[C_,.(AI!„'1:fJ:ORn IOi.�-0dltn it Re,,yrk;.Snlnd•,iq,f,np.e u�-,it r.q„igdl Coverage Election Category Elect.Status Nalne State(5)_All Entities/Locations Officer Exclude Kurt Gauthier MA Gauthier Insulation Inc V Officer Include BrittriieAiello 44 Essex Road Ipswich, MA 01938 CE TEH15LDIER CA CELL TON 31-iOULD ANY OF THE ABOVE DESC RIBED PCILICIES BE CAW,'ELL ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mass Save Program/Conservation Services Group,Inc A0rOf2DAt'1:E WITH THE POLICY PROViSK)NS, 50 Washington Street West Borough,MA 01581 signature'. - 1: ACORD 25(2010;05) BRAC 3139 Msssachusetft_Department o1 Public Safetymrd Of Building Requiatiefts and t2nde^d License,c w-io KMTRGAVTHO i' 9 CTO r <. C �i arbee )on t l # p�i7 .e 1 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 1011/2016 Tt# 257812 KURT GAUTHIER KURT GAUTHIER __.............._......__......._..___ .... _ _.....— P.O. BOX 344 _. . ... __. . ...- .. _..._. _. IPSWICH, MA 01938 ......................... ___ _ ... .. _.......... _ �._......._ _....... ........._.._ Update Address and return card.Mark reason for change. Address L11 Renewal J-7 Employment Lost Card SCA t G 20M,0511 ...... .. ... '.;�/rr�Yr'c,rrrvrrircrrrAal�t�+`�"ffr�rar>rrrw�ll. , Office of Consumer.affairs&Business Regulation License or registration valid for individul use only aid � ,POME IMPROVEMENT CONTRACTOR before the expiration date If found return to- R'' 17341(), Type: office of Consumer Affairs and Business Regulation ` dr� xpiraUon 10111201& Individual 10 Park Raza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER (f 44 ESSEX RQ % C IPSWICH,MA 01938 __..._ s.� —__._ .. ._........ Undersecretary 'ot valid wi out signature