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HomeMy WebLinkAboutBuilding Permit # 12/14/2015 V%ORTH OF -"D 16 BUILDING PERMIT -4, 6 TOWN OF NORTH ANDOVER 1 01, APPLICATION FOR PLAN EXAMINATION o W.I K TED ? Permit No#:1,,)1- y Date Received 4Ac Date!issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print ioo Year Structure yes no Historic District ye no MAP PARCEL: ZONING DISTRICT:-Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential [I New Building [sern-e family [i Industrial Li dition Ei Two or more family Ei Commercial eration No, of units: 0 Others: rf'Repair, replacement 0 Assessor Bldg El Other El Demolition DESCRIPTION OF WORK TO BE PERFORMED: C, 61 IV" OVA Identification- Please Type or Print Clearly OWNER: Name: Phone:o( -M, I I S Address: qU IL Contractor Name: Mt C"r- Phone: CA')"k% S, b 3 Email: Ad d ress: P 0 tS 10'k 3 4" I V-V�,A Qa- \k-4 Exp. Date: Supervisor's Construction License: Supervisor's Date: �0 07� LSHome Improvement License._ 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. e-7 /I Total Project cost: $ FEE: $ Check No.: Receipt N NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'i�nature;01, F N®RTH -Town of Andover No. xi— 426 �, h ver, MasS4 ew,6w 1q_Av5 0 coc"Ic Hlwic V� �®AERATED S ►J BOARD OF HEALTH Food/Kitchen P E KIVI T LD Septic System a �•...•...•... ......._ BUILDING INSPECTOR THIS CERTIFIES THAT ...... ..0A .. Foundation has permission to erect ............... buildings on i. ...... •�*•�••••••• •• ..J....... e4o ® . Rough g to be occupied as .... ........ ......I... �R1i1ar ................................ Chimney .......................... provided that the person accepting this permit n 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final THS ELECTRICAL INSPECTOR PERMIT EXPIRES IN ON %i ' S Rough UNLESS t. Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR ecupancV Permit Required to Occupy Buildi Rough Displayin a Conspicuous Place on the To - ® ® Remove Final No Lathingr all 1 BeDone FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. E Federal ID# RI contractor Registration No RISE Engineering MA Contractor Registration No cT Contractor Registration No A,division of Tt7iclsch Sin9incerhut �^ Shart'nult Unit 112,Cuntnn,CLIA 112021 CON tl C t 33'5502-6331 FAX 339-502-fi34; page E'ttO(iRrlbt q THIS CONTNACYel ENYERED itno aETWE`m RISE IS E CINIA-HES DESCRIBED AND THE CUSTOMER FOR WORK AS �'✓ ✓ 4 ', OESCRIaED BELOW O-p n. ENGINEERING r-��Y ' i, t CLIENTI evoax n e t S 1 try _ i NONE HATE _ t cusToµEa � k� 47$)729-5173 0613012015 407:130 {100(}2... Russell Btlodeau NoSTREET SERVICE STREET 1 Sllnln7er Street 461 Sutllnier StrCet _ 01 ING CITY,STATE,ZIP SERvice Co-Y.STATE,ZIP t orth Andover',MA 0184'1 .. North Andover,NIA 0184 JOB DESCRIPTIO AiR SEALING:Pmvidc hltxlr and nmtcnals to scat arca~of your borne aEainst vvrtstclut,oxcass air lcaknge.ell ilh o Work atilt lie s to wSsUre that your home will performed in concert vvidairhquality-ti•+Vl lcrials to be mid ed todiag,�sc tl Your home call include caulks,foan stand ott7er e not healthful encprimary lY air ezGhangc Rnd indoor areas far seating include air leakage to attics,basements,attached garages and other unheated areas(tvindaul Hill not generally D'ea"addrSSCd.} Thus\Vitt rCgUi(C iii}7YgrktflE hntlrs,!�ICdtIC11n11 in Cnbin fCt:r per IltiitUlC tClnt}Ot it'll h7ldir=tltOn twit fiCCllC,tall tbC aG1Ua) nunthcr of clot is not guaranteed. At the completion of the wcntheritntimt 7vork,and at uo additional cost to the hameotvner,n final blower char and/or comhastioo $650.00 safety analysis will be conducted by the soh-contractor to ensure the solely of tile indoor air quality. AiR SEALiNG ADDER: (2)working hours. 5170.00 A"171C ILA'I:Provide labor and materials to install it Ill"hiy'ct trf R 35 Class i cellulose added it)(,1)square feet of floored attic $i 95 space. t7Atv1MiNG:Provide labor and M, nals to install a 12"layer of R-35 unlaced frbergt;tss halts to(I 16}squats fLxt i`nr damming 5237.30 purposes. A'171C J.*Ij\ '.Provide Inhor and materials to install a 4"layer of R-1=t Cl.us i Cuilulusc added to 1770)squirt lcnz of open attic 5305.to space. A'i IIC LLAT:Provide laborand materials to instal an 5"layer of R-25 Class t -eliulose added to(716}square feet of Open attic $990V spacc•KITT(0x12 STORAGE! 5'1'ORACiE BARRIER:Numeovv'ner is respnusihlo for ttti:rcnu7vt11 of the stored items blacking the instaliatinn a€Wcathe:rivntion 50.00 work in the attic, ttcmoval must occur prior to the scheduled work start. A'I'rtC ACCESS:Provide tabor;md dmaterials around thctopcnini�}tvi hi t the;ltuL tnihistvn ilctilo ti'the covci s it7tcgraI it�Jat rt<'ript7in tt7i ,,at surface ofplysvood vv'dt he created - 5237.65 restrict lit leakage. 5� fader I s to nrlama n air flu7v. $64.00 VEN'Cit.A'IIt3N:PsovidG labor tmd materkuls to install ventilation choles in(.-1 y BASEIIEN'f Ch1L.INGi'ttle t�nus¢lsill,nd materials to install(32}linear let of R-f 9 unlaced fibeTl hiss insulation to the perimeter $S6.ti0 or(lie b.Lscnient ceiling c7VERt1ANG:Provide lobar and materials to install 10"R-37 denSCIY packed Class Lss t Culhllase insuiaIc tian to ed square 1•CCt of jxteri tv'lt he setdcd aced below tcxior gr tit spackle trot are ,It dbcloNN by dinilslrcitu s iyles lsn7tuoth ottdition1e nN,eillam-, 1Finish sandtng:u7dktouGhiupL plug�Cd. plugs I priminttpatnting Yvitl be rho custnntGr`s responsibility. Federal ICI 9 RI contractor Registration No I p�tt1B£I'iii MA Contractor Registration No GT Contractor Registration No S division of F'hicisclt t:nginccrin„ G{1 Shanmitt trait!#2,Cantnn,vi,l 4"_t12t CONTRACT 339-a4?-fr33b t'Atii 339St}•tt3d5 P2gC 2 �r FitOGRAM {1 P h ;lU3 CONTRACT tS ENTERED NrrO eETYR:FJ!RISE ', .�'" ,, 1 A-E{�''.5 "D INEERNIG AND THE CUSTOMER FOR WORK A5 �'�_ DEsCtUREO 80LON CLENT% VORKOROER ENGINEERING iHONE DATE CUSTOMER } i!,}'t `0' 75)729-5173 0613012015 407530 00002 Russell Silodeau _.. ... _..... � lit NO STREET ...SERVCE STREET v ..1 SUt11ti er Street _. 461 S11titiller Street mWHO CtTY,5TATE4ZIP sEnvice ctY,sTAtr.Z11, North Andover,MA 01847 North Andover,MA M45 JOB DESCRIPTION 5125.44 curr RISE Engineering kilt apply ail appliayhlc,eligible incentives to this contract. You hill only he billed the Net amount. t)% ratty, for chttihie ntrzLsures,Coto tUc first t o(Ters all'all Int incentive,Hot 53Ati i'sav i�Itisto exceed 2nreijustilicd by the and tar,)per calendar yc;m arid an incentive of 141Y n for the Air Scaling measures up work is 0cgwt,and atter tlt lu lbertrTtion\sorb i ue of fi and is at nisi cost10you,nl ictal allom able1011 of . i'OT ttiC safely and hcaltdtof}'Our hoole S indoor air quahly \k,c 0111 be Co11ducting a blower dtxN l all IOSUC u the aY.HtnhiC air nPLY 111 your bonne both bel stem and\Yater heatLr,ftus has a s al tine combustion so1,cty of your heating s}' 590.00 tvcadrerirntion incentive is S3,110, Total: $2,951.42 program incentive: $2,309.10 Customer Total: $542.32 VIE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF $642.32 *" Six Hundred Forty Two&321100 Dollars P ANY zero 7MPtlnYANT INFORh1A AGREEiON Oil GUARAtJTEES,RIGHTSOF HECiSttlN..gCHEtlUIlNO,AND CONTRACTOR REGISTRAT10111 UPOR FINAL Ri5 OTIOt APPROVALO UE Et7GiNELRiN6.CU&YOhtER AGREES TO RCfAiT hMOUNT QUEM FULL INTEREST OF 1's V.TLL nE CttARCED hiONYHLY ON UNPAID OALA ,EA Oq Y _ CIO NOT SIGN THIS CONTRACT IF TNERE ARE ANY BLANK SPACES } AUTHORIZED SI TURF ISE i5nol" 'InU _ - DATE OF ACCEPTAI7CE -. .. D iF NOT EXECVATHIN pyQ pRiCE3,OPECIFICA710Ns AND CONDITIONS ARE Nom-n Is CONTRACT MAY BE WITHDRAY7tA Fly5 ttCtEPTANCE OF CONTRACT-THE AU EPTED.YOU ARE AUri1tlRtZEO TO DO itiC YIQR ^ATISFACTORY TO US'AND ARE HEREnY ACC AS SPECIFIED.PAYMENT WALL Be M. OE AS OUTUNED ABOVE 30 DAYS. S I r � OWNER AUTHORIZATION FORM (owner's game) owner of the property located at 1 4.'5u w xee t/ c& t (Property Address) v-6 /-sop0 19'k S' (Property Address) hereby authorize — (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform worts on my property. owns Ig re ` yrs Date ly Vit. Tl1e(:0Mn10nwe4111h ref,11assathusetts Department of Industrial Accidents w4w Office of InvestigrtiiOnsi Congress,Street,`iuite ItHuston,8 A 02114-2017 www.ltiass.gov/dia c�ctrieianslPlutrthers Workers"Compensation Insurance Affidavit* BuildersdContractorslEi Please Print U ibi � licant l(nformafiau 4' Nc1n1e let i�ht3t3 : Ci ,state/zip;_ Lit i T+r'IYe of project(required), Are you an canploser:(ta ! the appropriate 3 1I acct a gc'tierat contractor and T G, [3 New construction 1. l ant a employer with t hate hired thestab contractors Rem<xicl n t mploy'ce%(full an&Or art-titr 1. listen oil the attached sheet. ?, 1 am a sole pr€�pr carr or partner- t hcac"'ub-contractors,have 8. Demolition ship and Marc no ernployeea c rn¢alo}eci and have workers' _ [ ittiiding addition vvttrkirtg #i7r tni in any capacity, cc;mp irsaurantc. [ o wt}rl<crs'ctrtnp.insurance 5 t�ss are.a corporation and its lU.[ Electrical repairs or additions rt;quircd:l officers have ekercised their 11,0 Plumbing repairs ar additions 3,3 I twit a litrmcowner doing all work rig ht of txerrtptiort p ex tvf iL 12•C)Roof repairs myself,Llo work rs'comp. c. 152,a 1(4),and we Rave no other insurance;required,]t employees.[No workers, comp,insurance rquited.] 'Any app€teant that e6cikc h:o?41 m4st al sr i#3 out the re dry:ng#a#t catF k and rt*,en lure pit side ei�n xa�ctors must submit'a wzw affi&%it u"li atin} t{inmcYzwc+cr Acs rubmit this attirtiavit indicating.the} of the +Cuniractc to that sttcct�thin boxick '',runt attached an ac#� i{ tvd t rcc rs #wli�sr iu 3t3cz aa3 scrti eft kr a�7as it t�sc mittacs haw enaptag tt'tf c sat cert at €s t arc cmt}tu} ., } P la+et'S, t�m stir employer that is prataidin� Belon,is the policy andjob site K.orker5'c, petLvgnan insurance for my e+up :t information. Insucanc:e Cat�ipany i*latrte:�. �.tls. �+�tS��c�.� i �-�� Expiration Date;�t� - - -1 I Policy#or Self4s,Lic,4, ✓�� ``�� i 1 t t �,vu�. nn (X �� ( itylstate zip'N' �h Job Site Address: g p iration date), �tiach a cope of the»orkcrs'compensation policy d"iaration page(showin to tile the obey ttuntbcr and cap Failure to secure cover as required under Seco�n��}?�iii�tcil penalties in t�2 call le form ofa}S i f3P WORK$ition of ORDER�d nlinal penalties a fine fine up to 1,500 000 anchor ane-vvar irn frrisonmcn of up to$250.00 a day against the violator_ Be advised that a copy of"(his stateritent may be forwarded to the Oice Investi ations of the DIA for insurance coverage verification. under the pains and penalties of Pe ury that the itif ortt wion providedbove is true rn I da hereby cacti(yrrect. I "11 tura ' { €'hc}tic# s- ofpcial use army. Do not write in this area,to be completed try city or lawn official, Perttut/lAce"se# ---- City or Town: #&,uing Authority(circle one): t,Board of Health 2,Building I}cpdrttu�ent 3.tr`ityft�ovs�n Clerk 4.t�i4<etrical(ra<�pcctor S.Plumbing Irma or ti.other contact _,._...-...�.......�—....-.._.._- ACCWE� CERTIFICATE OF LIABILITY INSURANCE 9I62t3I6 THIS CERTIFICATE IS ISSUED ASA MATTER.QI:I'�fORF9S xION-ON Fa4f CO ERS NO R.IG€ta5 tJ'ON THE GERTIA ICATE HOLDER.THIS CERTIFICATE DOES FRIT AEr`IRMATI'VE4Y OR NEGATIVELY AME;D,l"A°TZNQ OR ALTER T4E COVERAGE E Al tGROED BY THE POLICIES BELOW,THIS CERTIFICATE Clz INSURANCE 005 NOT CONSTITVT A CON TACT BETWEEN H* IS51.IINS li t}RER(S),AUTHORIZED RE'#,ESENTATNE OR PRCI'-,>It ,ANI)YHE CERTIFICATEE HOLDER, IMPORTANT;If tI c (Kate holder M an AI2€T IONAL 1N513REU,tt pclscy{A s',mint be endorsed.it St#KOaAffON IS WANED.Wbl-ct to the teow;and conditions of the Gal cY,certainPC:cies may tequ elm NndarSCsr;�nt.A statement or',this eetl _Me d0"rot ccrifev rights to the ceMficate holder in lieu of swh e on* 'C;' Berkley AS5€1ricd Rl5k ServiCes Clayton Martin.1 Ens Amey tnc ��3��. (t800Y54)634-4581D fi �r (865)2I5 RSI I I 1649 Northampton St PO Box 969 S3rv~ t kl y�4sk sr Holyoke MA 01041 eava�aea,. ns Tz lnw-ems a 3t3i` PO"If 344 1pavvich,MA 61$39 CO CEAtTIfICAT£AIUm 6EP: I2EYISIC]K IIUhIBER. N£ I3 Tf GERTc€f T} t7 Ttic PCN tGI£S OF�:5'UFI+tiLE USI BFLCI 4 HAVE 8} 3 MUEO TO THE[�SURE R .kI7 AffC�=FGA THE FGtDCY PtRfiCt Li3CHCA7 hKATW1tTItSTANC3It GAti°REOLnr*#£atE}IT,TEW OR C0t9 1ICN, OF AW CONTRACT OR OTttER DOCUMENT VvII#f RESPECT TO Y4III;##THZ CERTIFICATE MAY 6E II SOW OR MAY K$k1Aiff,TKE'44WR -5 I?ESCRIS;O t:EREift IS SUMECT TO ALL TkE T cP,#k5. EXCLtky OKS Ar,R.1 CONI(TIONS OF SUCH POLICTS.LMT.1;544OWN MAY RMIE BEEN REDUCED BY 006Z CANS, - iTp 'TS'c�£'fi'»?h3tSR3t f iN:o x 'A'ti°sF ftiA i:,Y t4i.NR3'`'? ,hffid 'q 4�ri ^L#b''JCst h4^6 L''"is G6AffMAl6AALaiU7'S' EK*•4sr'4�fra:k r.ARcwL:;A#irrxA�;, Irr c�ras�ts���� �s + m� 7Ei d ATJV Rd.J�i' $ arm iiEtws:S+Ri-AYaAsES,'aiT¢ r"x —ZT, ii.'i j�.EST 0 ioc Xt#T ... 8S#BLLdTY I—. W N Ai;'T;3 67rA,Y pu: ^t.4s c=ca'tr:* A6L4 O'Kf[3 r�l S £{FJIEL XOd 6D 44.Y laa"-.A�Yi ;aar m 24st sta_ .•_._ AaTin -winA, �'} WteE 'Pee aaRle�r�s t7v rfCLt iiia I Ca CUR _} cAi.sC a LR:a«:E i EXCf LLib CZA4A&VAb. YA88 CtY>wErtS+imdA '.. :_:r�Y Lw$ E?2 M.IEOkMS.pVolt tGil�ti'1! A4Y6 UBrA4E'rok01'ATt.£ktha:t�rlu£ YS AtdARP;ICN3 '7 :Ii�;su.�0'S S;Ir;#6;?QtB ELEA.. aFy t. —..._,_$..�5'A'A `�i A s>€ici Rbcs.° + fko—"-"t M Kf+l _- ttres, �scT�c+=ar�ngt�.rzu gy �s� .,ta«.+'LY.tir 3 T,�'Y i El El ff . ,¢iL MsJ•n .tet-� +,�s. .2:'c9t.ky a'Ea..cr'.: 7 7Z.a Tvq'ti;� "errs Y;�i'sp >err,=A.✓-. #�Sr ti erstas�:w:e a omw s _ CERTIFICATE HOLD CANtFLUATION S#'rta4D A+"OF THE Ati<Y t ut5CAi3ED P uLiC E5 B€CANCEL_1E Ev B&FCRL CEBdteSt�t TH £ PRATtk4{3hTE HE€isGi',dQ`t E ru BE OELN FF_D=,V ACCORDAn'CC%TN T1'E Pt?s..�CY VtS!IDN.. Contxactcr Svcs ;.0« _-P_ A .: / y .SQ WBShIngt*n Stmot Y4 egtoor"h,MA 01601 $RAC 3139 Ar—OPD 25(2010/05) DATE(MMIDDIYYYY) 7/7/2015 AC®R®® CERTIFICATE OF LIABILITY F11 N11 S ORANCERIGHTS ON THE CERTIFICATE HOLDER.THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY A CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANCE HE CERTIFICATE HOLDER.UTE A CONTRACT BETWEEN THE ISSU If SUBROGATION SING EWANED,subject to REPRESENTATIVE OR PRODUCER,AND IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the dors(tee) must be endorsed. terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the the certificate holder in lieu of such endorsements . CONTACT Nancy Usher —_ FAX --(4 NAME__— (413)534-7874 PRODUCER PHONE (413)536-0804 - - SAC N,r. ------.-- Inc. All C No.Ext:-- __ ___ Martin J Clayton Insurance Agency, E-MAIL --------- M -- ADDRESS:_ -------- --- - -- NAIC#_ 1649 Northampton Street - I- URE_- A) FFORDMG COVERAGE-__­­- NATIO - NATIO__-__ p, O. Box 989 INsuRERA:Nationwide Mutual-Hayle svi-1 e MA 01041-0989 — - -------- Holyoke_ INsuRER a:Allied World Natl AssuranceCO ---- INSURED INSURERL_--- ---------- _. . Gauthier Insulation —-------- INSURERD: ---- 44 ESSEX ROAD - - INSURER E:__--_-_--------------------- INSURER F IPSWICH MA 01938 REVISION NUMBER: COVERAGES CERTIFICATE NUMBER:CL157701379 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, UIREMENT,TERM OR CONDITION OF ANY COPTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THIS IS TO CERTIFY THAT THE POLICIES OFT F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY PoucE B POLICY EXP LIMITS EXCLUSIONS AND CONDITIONS OF SUCH POLI slue LIMITS SHOWN MAY HAVE BEEN REDUCED BY PPO MMDCLAIMS 1,000 1NSR _ POLICY NUMBER TYPE OF INSURANCE EACH OCCURRENCE 7-$s——------ LTR DAMAGE TO RENTED — 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES�Ea occurrenceL - 5,000 CLAIMS-MADE 8 OCCUR 7/6/2015 7/6/2016 _MEDEX_P(Anyonaperson) $-- 1 000,000 A X GL43487F PERSONAL ADV INJURY $_-_ -- -- GENERAL AGGRE_GAT_E__- $ 2,000,000 _ 2,000,000 PRODUCTS-COMP/OP AGG $ — GEN'L AGGREGATE LIMIT APPLIES PER: I - - $ X POLICY DECO- C� $ LOC --. COMBINED SINGLE LIMIT OTHER: IEa accden1--- ----- _on) $ --- AUTOMOBILE LIABILITY BODILY INJURY(Per pers . BODILY INJURY(Per accident) $ _ ANY AUTO PROPERTY DAMAGE SCHEDULED $_---------- ALL OWNED I AUTOS Per accidentL._ --- - AUTOS - NON-OWNED $ HIRED AUTOS AUTOS $___-j100_0'1000 — EACH OCCURRENCE AGGREGATE $ 1,000,000 x UMBRELLA LIAB OCCUR ------------- - EXCESS LlA6 �CLAIMS_MADE 10/18/2014 10/18/2015 OTH- B LI — BE020792125-194985 ER --------- DEDUI RETENTION STATUTE — — WORKERS COMPENSATION E.L._E_ACH_AC_CIDE_NT_ _ $—------- AND EMPLOYERS'LIABILITY YINE.L.DISEASE-EA EMPLOYE $------------- _ ANY PROPRIETORIPARTNER/EXECUTIVE CJ NIA _ I OFFICER/MEMBER EXCLUDED? J E.L.DISEASE-POLICY LIMIT $ (Mandatory In NH) If yes,describe under DESCRIPTION OF OPERATIONS below NON-CONTRIBUTORY BASIS NAMED AS ADDITIONAL INSURED(S) ON A PRIMARY AND UMBRELLA COVERAGE. DESCRIPTION OF OPERATIONS I LOCATION UIEH�ICIL)ESA(RAEORD 101,Additional Remarks Schedule,may be attached If more space Is require AND TEI, AND ANYONE ELSE REQUIRED TO ANY OTHER INSURANCE CARRIED BY TSI, UNDER THE SUBCONTRACTORS GENE RAL 30 DAYS NOTICE OF CANCELLATION CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. HE EXANCEIO WITH ATEPOLICY PROVINOTIICE WILL BE DELIVERED IN HE 195 FRANCIS AVENUE CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD MPPIM11bed With pdfFactory trial version www pdffactory- Massachusetts r Departmentof Public Safety Board of 8uilding Regudation.s and standards 6'�ae� ta�ec'6iiso-tixazt���^�'w,t:�'�a>;:csatra Ucermse.C"L-"IOM2 KUKtRGAIl1 P.a 001344t Ip*wkh 1kIA Ql9.A a a Expiration ,r 2cll , �?�d1?,SCI h7.. z ' pffice of Consumer Affairs and Business Regulation }' 10 Park Plaza- Suite 5170 , Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Tr# 257812 Expiration: 1011(2016 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 _._. IPSWICH, MA 01938 Update Address and return card.Mark reason for change Address Renewal i.7' Employment ; Last Card SCA i u roti-as 1 «rrrrcvrf+-taf f Iltr,;<frtrrt.:f License or registration valid for indiretul use only '� Office of Consumer Affairs&Buriness Regulation Before the expiration date. If found return to 1,� OME IMPROVEMENT CONTRACTOR Office of Consenter Affairs and Business Regulation Type: r�t� egistratiort: 173410 10 Park Plata-Suite 517U u" Expiration: 1 0/1120 9 6 Individual Boston,MA 02116 KURT GAUTHIER f KURT GAUTHIER �� 2 __-- — ure r ._ 44 ESSEX RD _._ °at valid wi out signature IPSWICH,MA 01938 Undersecretary