HomeMy WebLinkAboutBuilding Permit # 10/5/2015 .........................................
%%ORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Date Received ATED
Permit No#: ""2 Z2 :::.iA, Ss C US
Date Issued:
L
IMPORTANT: Applicant must complete all items on this page
13o4", b0l"ez)
LOCATION Print
PROPERTY OWNER -64/4 Print i oo Year Structure yes no
MAP 6?—& q- PARCEL: 0 AD ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Residential
El New Building G-6ne family Ei industrial
Ei Addition El Two or more family 0 Commercial
Ei Alteration No. of units:
z,Kepair, replacement El Assessory Bldg Ei Others:
El Demolition Ei Other
134"
W
.............
DESCRIPTION
ge, laxp A/
Identification- Please Type or Print Clearly Phone: 7— 6 79–
1--)IV R
e,4
OWNER: Name: e,4 3
70
Address: 0 �
-
Contractor Name: IN/W-f Phone: 617
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home improvement License:— -170 ?/6) Exp. Date:
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: $ 1, Goo ge, FEE: $ 2
Receipt No.:
Check No.: I-V 01 L+Ci
NOTE: Persons contracting wi Iz unregistered contractors do not have access tot e guaranty fund
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ignatubb-dL,
FORTH
-Town of Andover
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h ver, bass,
COCNICA..CK 'k-
ADRgTED
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BOARD OF HEALTH
ul� Food/Kitchen
PERMLT T Lw Septic System
THIS CERTIFIES THAT ....... BUILDING INSPECTOR
.............. ... ......... .......... .. ® ...... ................. .. ............
.. . .... ......
has permission to erect .......................... buildings on .. Foundation
OQ ` .............................. Rough
to be occupied as ............. ... ..........?�C. .. .... .. . .. ..... . ..... �wr. 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CTI ATS Rough
j . Service
. ..........
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 Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
������ MA Home Improvement Contractor
u ,� License#170810(Expires 12/23/2015)
byAndersen ''*` Renewal by Andersen Corporation Federal Tax ID#41-1918413
wlNtllW RrFLA.. tNl I,,
30 Forbes Ind. Northborough,MA 01532
(508)351.2200 Fax(506)-966-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
;Buyer(s)Name Date;
JOHN PLIAKAS - AUGUST 18, 2015
Buyor(s)Street Address city State Zip Code
370 BEAR HILL ROAD NORTH ANDOVER MA 01845
Email Address Home Telephone Number Work/Cell Telephone Number
J P I LAKASOCOMCAST,N ET 617-678-8662
)Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor"),in accordance with
the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement').
Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Est,Start Date, Method of Payment
Total Job Amount $ 21,607 kmount Financed$ 0
Deposit Received(33%)$ 7,202.33 Deposit at sig.mg$ 0.00 Check/Cash
,R-10 weeks
Balanco Start of Job(3316)$ 7,202.33 Chock#
Balance on Substantial At Subslanual Est,-Install'llme i, Credit Card
Completion of Job(3396)$ 7,202.33 Catnpe on S 0.00
1-2 days ((credit card Is sel-ected,please '.
No final a meat shell he demanded un?d all ones ate saut€d sea Credit Card Payment form
Buyor(s)agrees and understands that this Agreement constitutes the entire understanding botwoon the parties,and that there are no verbal understandings
Changing or modifying any of ilio terms of this Agreement. No altoratlon to or deviation from this Agreement will be valid without the signed,written consent
'of both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has road this Agreement,understands the terms of this Agreement,and has
xecotved a completed,signed and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was
Ioraliy informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Anderson
Corporation Buyer(s) Buyer(s)
By: (_l"l/L.JC1/i
Signature of Consultant Signature Signature
t X CARL BRYSON JOHN PLIAKAS
Pdolod Name of Comullant Piloted Namo Printed Name
i
E
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIG14T OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
i
------------------------------------- --- -- -- ------
NOTICE OF CANCEILtTION NOTICE OF CANCEt1,Vn ON
Date nf'il'anuadlon Iir'IiIJ I;i 1•ounsay(st,ol fill. I Date of Trau...oti6n 1{/111/1) Younryonnerllid.
'r,lransactim,without any ptnalty or obligation,within[!tree hushae..days from fist lrausaclion,\vithout any penally sa obligadon,within three bu»ine..days trout ilia-
above
iiaabove date.If you cancel,any property traded In,any payments made by you under 1 above date.If you cancel,any property traded lin,may pawuents mnde by you under
the Contract or Sale,and any negotiable htstrutuent executed by you\rill be 1 the Contract of reale,and any negotiable hvitrunnent executed by you willbe
(returned within 10 days following receipt by the Contractor("Seller") or your I returned within 10 Jaya following receipt by the Contractor("Seller") of your
I'eancellndann notire,laid any security irteresl arising out of the transaction will be f cancelladnn notice,and any security Interest ariving out of the Iransactlon vv'ul be
(canceled, if you cancel,you nm.,t make.available w tilt Seflor at your re.adence,in 1 canceled, if you cancel,)-ilia uuu.t ilia kr avaikublt to flat Stilt at your rrAdenet,In
I.ub.tit'll lot ly as good comUtlon as whin recelved,any good.delivered 1.you under 1 substantially a.good ro Within u.whin rv�cthetl,Rey gnotl.dtllvtrral la you\order
I dda Contract or Sale;or you nay,If you wish,comply with tat in.tructions of file I this Contract or Sale; or you nilly}If}'ou wta,comply witit the inRtructiou.of the
S eller regarding the return stdpment of lite goods at the Seller's expense and risk. I Scllcr regarding the return a alpnent of the goods at the Seller's expense and rick.
H you do make the goods available to the Seller and the Seller docs not pick them up 1 If yen do snake the goods available to the Seller and the Seller does not pick them up
;within 20 days of the date of your Notice of Cancellation,you may retain or dispose 1 \vital.20 day.of the date of your Notice of Cancellation,you tray retain or dispose
lof tilt goods witlmut any further nliligatinn. If you fall In make tit goods available of flat goods"about any further oblignflms, if you fall to make the good.ay.1 able
10 the Stilts-,or If you agree to rotor,,flat goods to Ilse Sellm•and rail to do so,then I to the Seller,or If you ogrut to return the goods to the Seller and fall to do so,filen
you renudn Ilable.for perfornivace of all obligation.under Hit Contract. ' n
Ib caed r t ynrelnaln flabit for perforrlanct or all n1111gador.under flit,Contract.Tat cancel
itbls Iran.ncllm,mall or dtl[ver u Sigurd and doled copy of fill.canreliation nolico I lids I.-an.."I mail or delver a signed and Haled copy of this cancellation notice
or any otter written notice,or send a telegratu to Contractor:Itenew-al by Andersen,) or any other written notice,or send a telegram to Contractor: Renovval lay Andersen,
30 porbes ltd. Northborougl,NIA 01532. ; 30lorbc.Rd.Northborougl,NIA 01532.
I HEREBY CANCEL TRIS TRANSACTION. 1 1 HEREBY CANCEL THIS TRANSACTION.
1
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ns,nra$ir,,n,rn Y'dra Nonan Rin I liu[m5l y.tr..,." PdnlNm.h� 0.v.
I
Renewal r Renewal by Andersen Corporation MA Home Improvement Contractor
byAndersen, 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015)
IwlflDow REPLACEMENT ,,,n,,,.;Rti,,,_,,,,,=.,,,, (508)351.2200 Fax:(508)-986-7072 Federal ID#41-1918413
Window Specification Sheet
jl3uyer{sl Name Date of Agreement
JOHN PLIAKAS TUE, AUG 18, 2015
The huyr r's"listed above hereby jointly and se%Vrally,rgrce to purdrasc the goods and/or services listed boots;in accordance uith the prices and terms described
on the Specification Shect imd the front and the reverse of the accompanying CUSTOM AND DOOR REAIODL'L1NG AGREFAWNT,of whidr
the Specification Sheet is part.
WINDOW&DOOR DETAILS
App. Arrp. W. ExicnorAnteror Color Hardware Hardvrare L—Ea/ clthlie GAP* Gl
h ass
Room k u height U.I. Window/Door Style Detail Casings Ext-Int int color Style Ssrnartsun Gril',es Sa=_h 1r3 S 2 Dns Options
Bed 1 101 36 tit 98 DB sq rail equal insert slo ed sill L-Trim WN/PN Stone Standard FFG smartstin wwt 412 4/2
Bed 1 102 36 lit 98 DB sq rail equal insert sloped sill L-Trim WWPN Stone Standard FFG SmartSun tNnv 4/2 412
Bed 1 103 36 16 82 DB sq rail equal insert sloped sill L-Trim WHYPN Stone Standard FFG 3martsurlvnv 4/2 4/2
Bed 1 101 36 46 82 DB sq rail equal insert sloped sill L-Trim WWPN Stone Standard FFG SrRartsur www 4/2 4/2
Closet Mst 105 28 45 73 DB sq rail equal insert sloped siH L-Trim WH/P,14 Stone Standard FFG 3martsur Rmu 312 3/2
Bath 1 106 36 46 82 DB sq rail equal insert sloped sill L-Trim WH/PN Stone Standard FFG SnmrtSur INTW 4/2 4/2 Temper
Bath 2 107 28 46 74 DB sq rail equal insert sloped sill L-Trim WWPN Stone Standard FFG saiartsur INnV 312 3/2 Temper
Bath 2 108 28 .16 74 DB sq rail equal insert sloped sill L-Trim WHIPN Stone Standard FFG Smr[Sur INTvi 3/2 312 Temper
Bed 2 109 36 45 81 DB sq rail equal insert sloped sill L-Trim WWPN Stone Standard FFG SmartSUT: INnv 4/2 412
Bed 2 110 36 45 81 DB sq rail equal insert sloped sill L-Trim WWPN Stone iStandardl FFG SmartSur I-MV 412 4/2
Bed 2 111 36 45 81 DB sq rail equal insert sloped EAI L-Trim WH/PN Stone Standard FFG smanstiq IN7w 4/2 4/2
Bed 3 112 36 45 81 DB sq rail equal Insert sio ed sill L-Trim WR/PN Stone standard FFG smarts 11,0111 4/2 1 4/2
Bed 3 113 36 •1.5 81 DB sq rail equal insert sloped sill L-Trim WH/PN Stone Standard FFG lsmmansul INnv 412 412
Bed 3 114 :36 62 98 DB sq.rail equal insert sloped sill L-Trim WWPN Stone Standard FFG S martsu Irmo 4/2 4/2
Total. 0 BAY BOW&BUILD OUT DETAILS
APprox
StytoDetail! vidthl Approx_ Number 1, Frame WindowFrd Center LntVfi/ Roof/ Hardltaro
Room Count Style Flankers Want casays Angle Lites Interior EXVlnt Color Grin sash(,, sashes Screens Smansun Soffit Color
SPECLLLTY WINDOW DETAILS
FutitApprox. t.o«s/ Specelty BAY/B OW ADDITIONAL WORK NOTES
Roan Count Style insert U1 smartsun Grilles Grille Style ExtMl Cour %6ul-,}tsar i.-r 72 i"Ji.
than;,illt, :;niru::m +>I—
ADDITIONAL WORK DETAILS:
I No Contractor will wrap exterior casings with coil stock color of
Owner is aware that Contractor does not do any paintinglstaining or removalfinstallation of alarm system or window treatments/hardware.It is the responsibility of
the homeowner to have the alarm system and window tr eatmentslhardyrare removed prior to installation, We make no guarantee as to whether alarms or window
treatmentslhaidware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is,the amount will be dependent on the type
of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.Customer is aware and understands any and all
unseen rot is not included in this contract.Should any rot be found there will bean additional charge for time and materials unless so stated in this contract
s yes, Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of all job related debris,
windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued.
I Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the perrnit(s)Is Included in the total contract price.
I yes All discounts have been applied to this agreement.
r, ✓ Yi No Owner agrees to be present on the final day of installation for final Inspection and to deliver final payment/finance form(s).
(11 k al; l:utd undcntno<I by and beticcen the Parti rhrht this sp-il:.alioer Sht tt,:,Ion{chilli tIc CUS"I'0Nf l\'INDOTl'AND DOOR I 1\(ODIiT IAC \GREENIFN r.(nt thows,the emir,
ardor lauding 11a parsii and Ihsut an'nu'Yrf1a1 undrr.vurding,drul}nngor nuuilf}ing mry at the wren. Thi,sil,"ification Sheet nciy nr t M-(1:111"61 or iu terra'nl"diticd or,:,rind in
an}rrary unle l such lila;";it..in milin,Y and signed by 1an11 th:T1h}rtisl and Conita,u t Ru}'6ri i live lw aA mledg,tinct Buwe,, h.+s n:rri ilii;Spetilirniou Shirt_
Renewal by Andersen Corporation 811}e1
_�'T'
Signature of Consultant Signature Signature
CARL BRYSON JOHN PLIAKAS
j
Print Name of Consultant Print Name Print Name
i
r
Renev�ral
byAndersenn `:-
WINDDW REPLACEMENT an AndemlICatnpaoy
WoodNinyl Composite IF
•'=`. . =r�r '4''• Dual Argon Low B SmartSun
; Double Hung
100-00473518-010
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
UN29
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
OA2
Manufacturer slipuFatee that these ratings conform to applkahH NFRC prweduras for determining whoH product
ped.{mance.NFRC ratings are detarmMed for a fixed sat of environmantalconditiens and a specilla product sae.
NFRC does not recommend any product and does not warrant the swlehir y of any product for any specitic use.
Consult manutaclurar's laemture forothar product pe rforn)ance infonaation.
r s WWW.nlM.otg
s'Qrik .X This product meets Green i• tF
�F� Seal's anvuonmanlai amo• %.j ••.., •iy<:�:••^r';Ft, '...
:.
standarAs governing anergy 5}n�a,°O:. r)., •';'�'•1.,,
f the ianfraena a Bary mataN in
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t.'M consumer educational
••rrix
19 �' ______________________
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mtaets or exceeds M.E.C.,O.E.C,L I.E.C.C.Air InfFh rat too requirements WMA Naffn—k Certification Program.
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The Commouwealds of'Massachusetts
Department of Industrial Accidents
Office of Investigations
600 K'ashington Street
Boston, .MSA 02111
www.mess.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Ilnformation Please Print Legibly
Name(Business/Organization/Individual): RENEWAL BY ANDERSEN
Address: 30 FORBES ROAD _M_
City/State/Zip: NORTHBORO,MA 01532 phone#: 508-351-2200
Are,you an employer?Check the appropriate box: Type of project()required):
LM I am a employer with 30 4. 0 I am a general contractor and I 6. 0 New construction
employees(full and/or part-time).* have hired the subcontractors AV
2.n I am a sole proprietor or partner- listed on the attached sheet.1 7. Remodeling
ship and have no employees 'These sub-contractors have 8. Demolition
workingfor me in an capacity. workers'comp. insurance. 9
y p ty� ❑ Building addition
[No workers' comp. insurance 5. We are a corporation and its
required.]
officers have exercised their 10.❑ Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp, c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]r employees. [No workers' 13.n Other
comp. insurance required.]
*Any applicant that checks box#I 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.
Cc»ttractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is•providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: OLD REPUBLIC INS. CO.
Policy#or Self-ins.Lic.#: 1 1J 30 43700 — Expiration Date:_10.01_16
Job Site Address: 2z) /?°,r tyt /q City/State/Zip:/uv !®n��y Vq*
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 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DTA for insurance coverage verification.
I do hereby cert fy u r the pains antipenalties of perjury that the information provided above is true and correct,
Si nature:
Phone#: 508-351-2200
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#:
ANDECOR-01 YADAVYO
CERTIFICATE LIABILITY INSURANCE FDATE(MM/DD/YYYY)
10/1/2015
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).
PRODUCER CONTANAME: Willis Certificate Center
Willis of Minnesota,Inc. PHONE /C
877 945-7378
c/o 26 Century Blvd A/C No Ext:( ) (A/C No): (888)467-2378
P.O.Box 305191 ADDRESS:Certificates@willis.com
Nashville,TN 37230-5191
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Old Republic Insurance Company 24147
INSURED INSURER B
Renewal by Andersen LLC INSURER C:
30 Forbes Road INSURER D:
Northborough,MA 01532 INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE D SUBP POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE ® OCCUR MWZY305440 10/01/2015 10/01/2016 PREMISES Ea occurrence $ 500,000
MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
X PRO-[ JECT PRO 1:1
POLICY PRODUCTS-COMP/OP AGG $ 4,000,000
OTHER: $
AUTOMOBILE LIABILITY EOMBIINdEeDtSINGLE LIMIT $ 5,000,000
A X ANY AUTO MWTB 305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS Per accident $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE
AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER _
AND EMPLOYERS'LIABILITY Y/N X STATUTE EERH
A ANY
OFFICER/MEMBER EXCLUDED?ECUTIVE rN J N/A MWC30543700 10/01/2015 10/01/2016 E.L.EACH ACCIDENT $ 1,000,000
(Mandatory in NH)
E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under '..
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 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
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Evidence of Insurance ���
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
MOL
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supemisor
License: CS-090125
Wnl
,1 i fti
JAM L MORIN=
86 GARDINER Sy
LYNN MA 01905
Expiration
Commissioner 10/06/2016
I
"fice of Consumer Affairs&Business BeSviation
OME IMP"R0V11t NT CONTRACTOR i
RegtsY{ litcs#t 1 Type ,`{
ar ttt 7 OfiS- Supplemim
RENEWAL BY ANPEEP-ORATION
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JAIME MORIN
104 OTIS STREET
NORTHBOROUGH,MA 01532
Uudersecretary
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