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HomeMy WebLinkAboutBuilding Permit #587-2017 - 54 Harold Street 12/2/2016 NORTH BUILDING PERMIT ✓In`' � ( I/� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * i h Permit No#: .S ' ;Di 7 Date Received ( � " �' �' I �l�A°RATE° �SSACHUS� Date Issued: 19-a >-0 IMPORTANT: Applicant must complete all items on this page LOCATION' V� PROPE}ZTY OWNER; - _� Pnnt `10A Year Structure yy o.. MAP .1 - PARCEL: ( .4. ZONING DISTRICT: Historic O�str - es; no hive Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 9 Others: ❑ Demolition ❑ Other 11 Septic El Well El Floodplain Weflands ❑ V11,atershed`District n;Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: jqt('Sf,rf'rql ,tnrrcdg!lf k h TA*rWf Y �: is % 57- '�f Identification- Please Type or Print Clearly OWNER: Name: gAr-7- Phone: g7�h3-�1/r Address: S-G �i!'ol� S% /1• /9ndOd-�� Contractor Name: __. .Phone:-_ Address- Supervisor's Construction.,License: _ ld6.d I'> _. . Expo. Date: ., 11ag�i Home Im ,rovement License:___ -IOd-»- Exp. Date: 2�5 /_/e_ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ YD o- y FEE: $ Check No.: zz Receipt No.: �� 7 NOTE: Persons contractin with unregistered contractors do not have access o the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS r HEALTH Reviewed on Signature a COMMENTS p Zoning'L3oard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 1 Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: + LFoIcRaEted+Dat 124aIVJaiii7S_ w.. _ Located384 o Osgood Street EPARlTMENT TempDumsteron!sto ys: trot i . Fire Department sf nature/date __ 60MMENTS,- Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses D Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering g ng Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location No. 557-- a,o 7 Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ �� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 7 � f j/ Building Inspector � NORTI� own oIf ndover O - .4 46ah ver, Mass, ,` d �qCDC Nl WICK y1. S RATED 's-or U BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT �� O� �A Af j � � ,,,,,,, BUILDING INSPECTOR ...... ............................................� ...... ..................................... .... .... has permission to erect .......................... buildings on .... Foundation....... R.�.�°.. ............. '....... Rough to be occupied as .... ........ ..W.. 44........................... Chimney OF 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 CONSTRUCTi V TS Rough 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 Approved by the Building Inspector. Burner Street No. Smoke Det. r RISEeo she~8004 unit Z,cmgbm MA02M,839.=4= ENGINEERINGnqlm8mjngj= OWNER AUTHORIZATION FORM (Owners Name) owner of the property located at f ftp" ) Al -/. MOP U'�C• /W a O AT. -Y-5 - - (P y ) hereby s0oftei SCi I� r��' -ectr- T-A S,A�0 ti ( ) an audwrtzed bo or for RISE Erqlneering,tea act on my bef to obtain a budding pemdt and to perform work on my property.ThN form Is only valid with a signed contract. Ther Permit will be severed by the b mrisidOrr contractor.at no addillonal cost. It Is the homeoMmees respcnslub— to dose out this pemdt by cont oft their munldpalty at the completbn of this work. s Slgrs�urs UA N I?ate am ,t+ HAR V F�detsl ID i OiO RISE Engineering w Continue Rsaebsilon No M sttteoatrsctor Repisbwoa No tlOo7P RSG eT eoavoctu Rghiratloo ltowx 68 Sbawmnt frond,Canton.t►u o2ti2t 339-382-6333 FAX339-302.6443 CONTRACT -^� PROGRAM CMIA-HES 00 ROD FOR eusteelJt t uL mins a8 etmrn watetamsn WMIRMHatt (979973.93" 10/12/2016 43994 2390¢ a ttmarxe ttttsur crimen caner 56 Herold Street o ? 56 Harold Street 8111=11 Crlr.nirlTi,a► T t\ ouma Cfff1wMaY North Andover,M.A�Ot K5 © North Andover,MA 01843 JOB DF.SCwnm HEALTH&SAFETY: $0.00 AIR SFAUNQ Provide tabor and materials toad w ms of yc tw home wing v mdK excessair Ie2kW This m*will be perfOMW W concert With the rec of*CCW tools eyed digpostic lots to assrethst your home VA be left with a hmhhful levet of air exabettge and indoor oir gouty.Materials to be aced to sed your home can axlade anal-.foams and cher prodaets. Primary 8=1 for seating im h*dr ledWF to auks,baseraatts,attadmd garages and other tr*Med aver:(w hiltr s are not pa"ly ad3rtxscd)This will require(8)corking hours.A reduction in odic fee per mumu(arm)of air inGhration vA octan but the antral amber ofelm is not gm mooed At the compinion of the watlterimtion work.and at no aMttonnl cost to the homeawua.a Rud ttiovw door Mxft Combrstaa safety asst**0411 be conducted by the 96comtraaor to easw the surety orthe indoor ek gafty. 5680.00 KNEEWALLS Provide labor and motaids to instgn 2' FSK fund semirigid fiberglass board insidation to(130)s*w feet of kneewl arcs. $435.00 ATTIC ACCESS Provide labor god moscriets to 4asrdate(2)back of the knoecad1 hatch vrkh Y dZW Themmx bmdt and u l the edge orthe belch whh wmthnm g $120.00 BASEMENT CEILING; Provide tabor and materials to imtdl(30)square reet or R-19 faced fibaglas insolation to the b sante l ceiling 548.00 BASEMENT WDR-Provide lobar and meterrds to inadete the but orthe basement door leading to the bd khead with 2'rigid bound that meets the sections 1-316.5.4 and 316.6 rap*ements mf btdldLtgcode. Scat 811 ekes mrd seems a4th FSK taps 572.22 RISE!Enoftcrft w111 apply dl appdieade.dW*inmilva to this comron. You w1d only be bi l d the Net omem.Qxreally. for eligible memeaek CoimmW(las offers 7$%incwlve,not to exceed 52.000 per edo ndaryear.and on fuocntive of 100%for the Alr Selling meostma ap to the firm$680 and=gddithmol 5140 if savimgs ora jtatiited by the mdw. For the surety and bedth of yow bone's indoor air quality,ce vAl be conducting a Wow door Remak of the ave11sble air Row in yow home both before the vmrk Is bcg^and after the ceatkdmttom 0ork is Complete We 001 also conduct a full anent of the CotnbetIon safey of yoir heating system and vwta heater.This has a value of 390 and is at ao Com to yott Total 8110wft aeatheanclon Incentive isS3.110. $90.00 RISEosbmmtM@4cmwmm.maul COWMCT ftp 2 amm now � a WUm Elea (97887mm 1010/2016 430514 2M aaax n NMI sumomm X Huo1d Sheet 56 HmH Speer eaanoaaw.mft r wumaxamar Nomdl Andover MA 01845 WOM Andover.MA 01845 JOB DE9CR�'!'ION Total: $IA" P Moet1>lve: $I.MAI t serTotat: ii3m wo��mnsenanmxaa�ee.aaee�e�nwwm� aRauMar "'One Htdednad Senent�Ti:eee S MM Do118es slim oo NmiN spa ooNlRAcrtR 7NB N®Nnewac bj."Amil-1 e4-- aanaas aaewaoararoe 6 3 MM The Commonwealth ofMassachusetts - Department 0f1ndM$Ma1Accidents MEMO - Offwe of Invefta&M 1 Congress Stree4 Suite 100 Bost04,'AK4 02114-20.17 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A 1,►cant Information ---Please Print Ledbly Name(Businessiorganization/individual):_ fARRt-aC% .tr rnaTU%A Address: PO BOX 958 _ Y�1/ER ASA 01B'ltl �itflState/Zip: Phone#: Azmpi re you an oyer?Check the appropriate box: — -- 1.� I am a employer with _ 4. [( I am a general contractor and I �e of Project(required',: 2.❑ employees(fill and/or part-time).* have hired the sub-contractors 6 ❑Drew enstruction I am a sole proprietor or partner- listed on the attached sheet ?. Remodeling ship and have no employees These sun-conuactor;have working for me in any capacity. employees and have worker' $ ❑Demolition [No workers,comp.insurance comp,insuranee.t 9. ❑Building addition 3.❑ required.] 5. C7 A'e are a corporai:on and its I O.El Electrical pairs or additions I am a homeowner doing all work Of have excised their I 11-El plumbing repairs or additions myself.[No workers'comp, right of exemption per MGL insurance required.]t C. 152,§1(4),and we have no l 12.C]Roof repair employees.[Iv*o workers' i3.[.J Other I comp.insurance required.) °�Y applicant that checks box�l must also 511 out the section below showing their workers'com emation policy information. Homeowners who submit this affidavit indica theydoing all work and then h outside contractors must =Cant MCtors that check this h• _++ are t submit anew affidavit indicating such. ix_este employ m acrdiianal sheet shows,Se rAme of the arab conl:ac�rs�d t�:Meth;:or na Was;,erni5es Save employees. If the sub-contracrors have eployees,they must provide their workers' .th p policy number. i!gym an emphayer that 1s p.-ojWng iporke;s'cGrnparsstiAr sar4ree nor adv a �, , information. .r ployem Belo.. rs a-zePONCY andjob situ Insurance Company Name:_ �" VA S a 1. h re n rn�G tit Y Policy#or Scl#ins.tic.#: Expiration Date- ofo) ah fob Site Address:_ G N,t Iry (d S �, �:ty/stat-,lZip:�/J. Aft?-,-h a COPY of the workers'compensation policy declaration page shown; + Failure to secure coverage as re P g (showing.he Policy number and expiration date). fine up to$1,500.00 and or one-year imprisonment,ass well as Evil penaltiess tan hto form imposition of criminal penalties of a of up to$250.00 a day against the violaror. Be advised that a copy of this statement miry be forwarded W to the OWORK ORDER f d a fine Irf'lastigations of the DIA for insurance coverage oe verification. da herEby cerci u tiler the aiirs and. enakfat of er'uy that Me20forina&n provided above is true and correct. Si awm J_W `L''X� Date. �� r 3d /` Phone#: t 7& J�cial use only. Do not write in this area,to be cosnpketed by city or town of,ficiat City or mown: Permit/License## Issuing Authority(circle one): L Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing 6. Other g Inspector Contact Person: Phone#• 6/10/2016 —�--�— Preview:Certificates of Insurance ACO'RL7® CERTIFICATE OF LIABILITY INSURANCE OATE(N1WDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 10/2016 CERTIFICATE O/COIR THIS 10/2016 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: c the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WANED,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 NAME: Automatic Data Processing Insurance Agency,Inc. PNONE 1 Al Boulevard 'N°'E`I` lac.No Roseland,NJ 07068 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC k INSURED INSURERA: NorGUARDtnsurarcecompany 31470 POLAR BEAR INSULATION CO INC INSURER B: PO BOX 958 INSURER C: Andover,MA 01810 INSURER D: INSURER E: COVE RAGESINSURER F: CERTIFICATE NUMBF,: 503567 THIS IS TO CERTIFY THTHE POLREVISION NUMBER: AT ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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. ITR TYPEOFINSURANCE ipso WVD POUCYNUMBER COMMERCIAL GENERAL LIABILITY MMIDDIYYYY) 1MIDDIVYYY) LIMITS CWF,IS•ttADE �OCCUR EACH OCCURRENCE S PREMISES(Ea oaumn.) s MED EXP(Any one mwni 5 GENL AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY 5 POLICY❑ECT ❑LCC GENERAL AGGREGATE S OTHER, PRODUCTS-COMIP.'OP AGG S AUTOMOBILE LIABILITY $ ANY AUTO (Ea occiaenp S' ALL OWNED SCHEDULED BODILY INJURY(Per Iy_.�,°nl 5 AUTOS A- S NON-OYJNED BODILY INJURY IPa accitlCnl) S HIRED AUTOS AUTOS IPe�aadtslll S UMBRELLALIAB OCCUR S E7CCESS UAB CLAIMS-MADE EACH OCCURRENCE S DED RETENTIONS AGGREGATE S WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY X ANYPRCPRIETOFI:PARTI,EREXL-CUTIVE YIN STATUTE ER - A OFFICER+ry in BERM)£JCCWDED? Y�MIA N POWC772258 E.L.EACH ACCIDENT (MaodatorylnNH) 01!01/Z016 01/01/2017 S 1,000,000 if yam,tlesui"antler DESCRIPTION OF GPERATIONS btlw. El DISEASE-EA EMPLOYEE S 1,OBO,000 E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTON OF OPERATK)NS!LOCATIONS/VEHICLES(ACORD 101,AdtrMional Remakq Schedule,may he attached;!morospam is required) CERTIFICATE HOLDER CANCELLATION THE SHOULD EXPIRAOF THETION DATEVTHEREOF,DESCRIBNOT CEWILL POLICIES BE BE DELIVERED N Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood SL 1 suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25(2014101) The ACORD name and logo are registered marks8of ACORDORD CORPORATION,AO rights reserved. A`C)PIR©® CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 6/10/2016 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(les)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 endorsemen s. PRODUCER ACT -NAME: Linda Bogdanowicz Insurance Solutions Corporation PHONE(AIC FAX -2034No;(603)382 60 Westville Rd E-MAIL ADDRESS:lindab@isc-iasnrance.com INSURER AFFORDING COVERAGE NAIC! Plaistow N8 03865 INSURER A.Western World INSURED INSURERS Nautilus Insurance thou Polar Bear Insulation Company Inc INSURERC: PO Bos 958 INSURER D: INSURER E.- Andover NA 01810 INSURER F: COVERAGES CERTIFICATE NUMBERCLi632326134 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 ADDLSUTYPE OF INSURANCE B POLICY EFF POLICY EXP LTR POLICY NUMBER Y MIDQJYYY LIMITS $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ACLAIMS•MADE $ OCCUR DAMAGE TO R100,000 ENTED PREMISES Ea occurrence $ UPP8274967 3/24/2016 3/24/2017 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY❑PRO- JECT F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per Perm) $ ALL OWNAUTOS ED AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$ AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION P R OTH- ANDEMPLOYERS'LIABILITY Y/N STAME ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) r E. It yes,describe under L.DISEASE-EA EMPLOY $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addttlonal Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE - Reith Maglia/SJA O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rmmaon Office of Consumer Affazrs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA - Expiration: 7/2/2018 Tri 413291 POLAR BEAR INSULATION CO. Vincent LeBlanc _ P.O. BOX 958 ANDOVER, MA 01810 Update Address and return card.Mark reason for change. sca i 0 20nt-05/n Address ❑ Renewal El Employment Lost Card � J!c`�cr��inai,�oeri/fl+af'C%1`jriun>�rlse!(S Office of Consumer Affairs&Bumness Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 102726 Type: Office of Consumer Affairs and Busmesc Regulation Expiration:. 712!2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION CO.,: Vincent LeBlanc 51 SO.CANAL ST.#.5A LAWRENCE,MA 01841 Undersecretary 11 V fiat valid without sipature I Massachusetts-Department of Public Safety Board of Building Regulations and Standards C„nRrttrElutt Suprri�„r Sp,:c't:�It� _:cense: CSSL406017 PETER A LEBLANC 2 BAST PINE STREET Plaistow NH 038CS �xpi ration Commissioner 04128/2018 i