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Home My WebLink AboutBuilding Permit # 2/3/2016 NORTy BUILDING PERMIT oF�TL�o b�tio TOWN OF NORTH ANDOVER ®� APPLICATION FOR PLAN EXAMINATION '' '_ 0 Permit Not#: ' Date Received AreoWPPP`�5 CH11 Date Issued: I �SSA5Et IMPORTANT:Applicant must complete all items on this page LOCATION �� eel+ elyvx 1�1- n Print PROPERTY OWNER f<r h ee^C J J I Print 100 Year Structure yesCJno MAP PARCEL: ZONING DISTRICT: Historic District yes Machine 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 Others: ❑ Demolition ❑ Other Thy v I A-i® v, ' �w- DESCRIPTION epfrater�ScOF WORK TO BE PERFORMED: �}�r'Srglir�q /9�C ZkixSyIA71\04 va 1 -119 1-/ Identification- Please Type or Print Clearly OWNER: Name: Q,r� eem w;101-e S Phone: g;;�P-d Address: /r Cc, u4d rm Contractor Name: P 0 r r- t-ej1 (Cr Phone: l Yo -26, Email Address: D- C 4-5 7 ;,r-c. 57- �/�.'SIo w Supervisor's Construction License: Exp. Date: Home Improvement License: /01 7v-G Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3Qo- ® FEE: $ � Check No.: �r Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have acces o th guaranty fund , „.; 77 77 Z7 7n gp .rr s� :.� ,z � N®RTt'i -%' ver " dA Town of ffiffi � ®yam L]r�1 T �O LANE h Ver' ass, COC NICNEWICN CRATED S u BOARD OF HEALTH Food/Kitchen T D Septic System THIS CERTIFIES THAT // .................................. BUILDING INSPECTOR Rmk. F has permission to erect .. buildings on ... .!I!! Rough to be occupied as .......'4_140%00 ....... ............. . . .. . . :.> .�~......................... Chimney provided that the pers ccepting this permit all 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 CONSTRUCTIONS RTS Rough Service .......... .. ... ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough Displayin a Conspicuous Place on the Premises — Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. day Federal ID It 05-0405029 111SE 11,ngineering R1 Contractor Registration No 8106 MA Contractor Registration No 120979 RISE A division ol'Thic1sch FJigincering ENGINEERING* 611 Shavviout()all 112,Canton,AIA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT 13 ENTERED INTOGETWEER RISE CNIA-IIES E GINCEIRRO AND THE CUSTOMER FOR WORK AS DCSCRI13ED BELOW CUSTOMER PHONE DATE CLIERTO WORK ORDER Rebecca Wildes (978)258-19)8 10/30/2015 42,1670 00002 SERVICE STREET UILLING STREET I I Camden Street j'7' I I Camden Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 0 184 11-, North Andover,MA 011345 BARRIER:A Blower(Tool-TestII)nota lid otl -""'tItyour borne.due to the presense of asbestos. $0.00 BARIOER:We have identified a moisture issue in your home that needs to be addressed.I lorneowner is responsible for correcting this moisture Concern,prior to the installation of any vveatherization work. 50.011 BARRIER:We have discovered what appears to be It mold I mildew-like substance ill your home.This is being brought to your attention to identify it as pre-exisling condition to the insulation and air sealing work planned Iia'your home.Your signature is your acknowledgement ofthese conditions and agreement to proceed. $0.00 ............ AIR SEALING:provide labor and materials to seat areas ofyour home against wasteful,excess air leakage. This work will be performed in concert with the Use of special tools and diagnostic tests to assure that your home will be tell with,I healthfill level of air exchange and indoor air quality.Materials to be Used it)seat your home call include caulks,lbanisand other products. Primary areas for sealing include air leakage to attics,hasenlents,attached garages and other unheated areas(windows are not generally addressed.) This will require(6)working hours.A reduction in cubic feet per minute(efirin)of air infiltration will occur,bill the actual number of cfni is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,sI final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety ofthe indoor air quality. 5510.00 ATTIC FLAT:provide labor and millerills to install a 10"layer of R-35 Class I Cellulose added to(289)S(IUaI`C fleet ofopoi attic space, 5423,36 A*I'I'ICI-'[.A*I'-Ilrovi(lel:ti)orand materials toinstall it 14"layer ol'k-19Class I Cellulose added tri(144)square feet of open Z'—'; Space, '-243.36 CES-S:provide labor and materials to insulate the back ol'(2)attic hatch with 2"rigid Thermax board,Weatherstrip the perimeter. $120,00 vil-wrILATION:provide labor and materials to install(2)12-X 121,aluminum gable end attic vent. S229M VENTILATION:Provide labor and materials to install(3)8"diameter roof vent(s)to increase ventilation ill attic areas. The vent can lie supplied in(circle color)black,brown,gray or mill finish. S256.1)0 VENTILATION:Provide labor and materials to install ventilation chutes ill(24)rafter bays to maintain air flow. 54 fi.t10 BASEMENTCEUNG:provide labor and materials it)ililid,(9h)linear feet of R-19 Unlaced fiberglass insulation to the perimeter of the bilsellient ceiling at the house sill. 5171.50 Federal IQ#05-0405029 RISE Engineering Rl Contractor Registration No 8186 RISE -~ MA Contractor Registration No 120979 A division ofThlelsch Engineering ENGINEERING 60 Shawmut Unit HZ,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-5024)345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRISEOEELOW CUSTOMER PHONE DATE CLIENTS WORK ORDER Rebecca Wildes (978)258-1998 10/30/2015 424670 00002 SERVICE STREET - --- BILLING STREET I I Camden Street 1 I Camden Street SERVICE CM.STATE,IIP STUNG CRY.STATE,LP — -- North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION CRAWLSPACE:Provide labor and materials to install(144)square feet of R-19 unfaced fiberglass insulation to the crawlspace ceiling to be in contact with the subfloor and completely filling the joist cavity to be flush with the joist bottoms. Then install V polyisocyanurate foam board insulation. Seal all scams with FSK tape. $554.40 CRAWLSPACE:Provide labor and materials to install(428)square feet of 6 ml polyethylene over open ground in designated crawispace%artlran basement areas. $329.56 CRAWLSPACE:Provide labor and materials to install (90)square feet of R-10 rigid Thermax insulation to the cntwlspace perimeter wall up to the sill and against the band joist. $333.00 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 1000/a for the Air Scaling measures up to the first$680 and an additional$340 if savings arejustified 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 weatherization work is complete.We will also conduct a full assessment of the 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 Total: $3,307.68 Program Incentive: $2,600.00 Customer Total: $707.68 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS FOR THE SUM OF ***Seven Hundred Seven&681100 Dollars $707.68 UPON FINIAL INSPECTION AND APPROVAL.BY RISE ENGINEERING.CAOMERAOREES TO REMITAMOUM DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE OPIFR 70 DAY&.SEE REVERSE FOR IMPORT RMATION ON GUARANTEES.RIOHTS OF RECISION.SCHEDULING.AND CONTRACTOR REOI&TRATIOM DO SIGN THIS CONTRACT IF MLANK SPA SIGNATURE-RISE ng NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. AS SPECIFIED.� PAYYMENT WILL BE MADE AS OUTLINED AABOVE AUTHORIZED TO 00 THE WORK 4 OWNER AUTHORIZATION FORM 1 (OWees me) owner of the property located at C/eys �' (Properly Address) l` -ZA iiy14 (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. i l Owner's Signature M) 1' Date The Commonwealth o,fMassachuseUs Department of 1ndustria1 ACCMen1S I Congress Stree4 suite 100 Boston,AL4- 02I.74-20-77 wwsy mass govldio Workers'Compensation Insurance Affidavit:38uilders/ContraOocs/IEYeeWriaiisfPlumbers- 3®�€e'�li.,��vlrn�-I��Eiill�tY3`EiNC r�"�I�(➢l��1 ADplacamt 1atf0rM2U0n I'Yease�sa>Bt t Flame (Busincss/Or- bonMdividual)- ��ti �,\t l i J<< tr� /�- c:�`•°t /i i (`C Address_ City/state/zip: �� , , Z..�` �— i�_F= f-%1% Phone#_ 7 �' e`� Art you nrn employer ci;the approprin �tc hos: 6 of pro9`�Ery uired)- _ I. I am a rmployc with i_ joyccs(full nnd/o-part tic)_' 7_ f E New con.,=Gtion 20 I am a sole proprietor or partner--hip wd have:no®ploys s working for tic in 8. e i Rcmo&lg any eap-rty-[No workers'comp.ion=nee t-Nir�J t_ 9- ElDC7nOl1ti0D 301 am n homeown x doing nil work mysdC(No workers'comp-inv=nee rcxxrutod]r 10 i Building addition 4_�I am a hom�wna and will be hiring contraconduct to uducs nIi work on my property_ I will casurc that all cantrnctots atb r have workers'compensarion innuance or ate sole 1 i-E]Electric al repairs or additions proprietors with no employcm 12_R Plumbing repairs or additions 5-0 I am a gmaal amaractor and I have hired the sub-coria-zaom listed on the attached sheet_ 1--i• These sub-contractors have cn nployccs and have wofkers'comp-inntran�Y 13 L�}ROOf 7�a1i5 6_0 We arc a corpocatioo and its offices have cccrcisal their right oFocc-ptioo pa-j+gGL c 34.00ther _ 152,§1(4).Bud we have no employocs_(No workers'comp_tasurance rcquhrx3.J `Any applicant that checks box#1 mast also till oat tbesecdon below showing their workers'compensation policy information t llomcowncrs who submit this affidavit iodiesting they arc doing all work and then hire outside contractors must submit a a:w amda,ir indicating---h- lcoatractors that cheek this box mm=aff bed as aMitibml shca showing the name of tbcsub-coa=ctors and state wbcttxr or not those wtrties have cniployccs. If the sub contractors have employces,they mast provide their workers'mmp.policy number_ f atm,an employer that is providing worketrs'compensation insurance for any employ-em Below is the pojiey andjob side information, formation, '.. s Insurance Company Name: 0 0L• �;��; Policy#or Self-ins-Lic_ Expiration Date: 4!21/v 11: O/ Job Site Address: City/Stato2jp: • �kl Ci -f Utach a Copy ol<tthe workers"compensation poHcy declaration page(Showing the Policy HUMber and e3tpjra$10r?date). Failure to secure coverage as required undca•MGL c- 152,§25A is a criminal violation punishable by a fine up to 51,500-00 mdlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a Jay against the violator"A copy of this statement may be forwarded to the Office of investigations ofthe DIA for;r,ar C= ;overage verification. t do hereby cerfafy under the granas and penaldf s ofpeg-ury that the inforrraatwn provided above es titre and eorrTErt `�`' .-t'� _ C - >i2mature: i c r Date 'hone Oj_7 ciad use only. Do not Write in th&area,to be completed 6y city or town 0fiWaL City or Town_ 1PermitiLicettse-9 Issuing Authority(circle one)- 1_Board of Health 2-Building Department 3.City!d'ovm Clerk 4.IElectdcal Inspector 5-.Plumbing IInspedOr 6.Other Contact Person: Phone& POLABEA-01 JONEILL DAT (MM/DDYYYY)CERTIFICATE F LIABILITY INSURANCE 1/6/2016 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 endorsement(s). PRODUCER CONTACT NAME: Durso&Jankowski Insurance Agency PHONE 978 658'7000 FAX 11 Saunders Street Atc No Ext (.-__) _ _ (A/C,No):(978)688-7001 E-MNorth Andover,MA 01845 ADDRESS: — _ __ --_-- _---- _- --.INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A:Nautilus Insurance Co. 17370 INSURED INSURER 13:Safety_I_nsurance Company 33618 Polar Bear Insulation Co.Inc. INSURER C: Peter Leblanc&Steven Leblanc P 0 Box 958 INSURER D Andover,MA 01810 INSURER-E:--- INSURER NSURERE:___INSURER F: I 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 (ADDL SUBR; ' POLICY EFF POLICY EXP T--- LIMITS LTR TYPE OF INSURANCE I INSD WVD I POLICY NUMBER MM/DD MM/DD/YM A I X COMMERCIAL GENERAL LIABILITY L EACH OCCURRENCE $ 1,000,000 f—� X� NN538691 03/24/2015 03/24/2016 °AMAGE To RENT>D I 50,000 I CLAIMS-MADE U OCCUR PREMISES Ea occurrence) $ __ r -- MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 -- -- -- GEN'L AGGREGATE LIMIT APPLIES PER. i GENERAL AGGREGATE $ 2,000,000 PRO- --- X POLICY(�JECT I�LOC I PRODUCTS-COMP/OP AGG 1,000,000 —OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Is 1,000,000 Ea accident B ANY AUTO ,2100926 1 01/04/2016i0110412017 BODILY INJURY(Per person) _a$ ALL OWNEDSCHEDULED i AUTOS �X AUTOS ' BODILY INJURY(Per accident)�$ — — NON OWNED PROPERTY DAMAGE f$ X HIRED AUTOS XI (Peraccidena___ AUTOS � I � i j$ i UMBRELLA LIAB XOCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB CLAIMS�v1ADE ! ( __-- -_- i AN019284 03/24/2015 03/24/2016 AGGREGATE $ DED ; RETENTION$ WORKERS COMPENSATIONI I' 1OTH- AND EMPLOYERS'LIABILITY STATUT�- ER Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE I E.L.EACH ACCIDENT 1$ OFFICERIMEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEi$ - If yes,describe under E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS below I I I j DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insulation Work-Mineral Insulation Work-Mineral;Additional insured for general liability per blanket additional insured endorsement with respects to work performed on their behalf by the above insured is Thielsch Engineering CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thielsch Engineering Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE i n+000 nn+a Armon rnonnr3A"Am An ---A 1/4/2016 Preview:Certificates of Insurance CERTIFICATE OF LIABILITYINSURANCE DATE Il:7hL'DDiYYYY) �. 0110412016 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 CONTACT NAME: PHONE A Automatic Data Processing Insurance Agency,Inc. Pic.No.EW: 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE MAIC 5 INSURERA: NorGUARD Insurance Company 31470 INSURED INSURERB: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 Andover,MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 429703 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.NOT'ddITHSTANDUIG ANY REOUIREIAENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCULIENT b:'ITH RESPECT TO VFHICH THIS CERTIFICATE MAY BE ISSUED OR LIAY PERTAIN-THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SH017tl 10AY HAVE BEEN REDUCED BY PAID CLAIMS NSR UU -POLICY F POLICY EXP I LTR TYPE OF IN SURANCE IYND POLICY NUMBER IP4YI ILVAITS COMMERCIAL GENERAL LIABILITY EACI-OCCi'RHH.CE - CLAIMS-LF.DE ElCCGL•I, PIiEIJ15Es It.'.u[a2%n","I LIED E•.V IAr.7 ora p_rort '.. PERSMAL S«U'.'IIJLRY GEI,L i QCHEQA1 E Lll:111:d'1'LIES PER. GENEHAL AGGRECAI E 5 PCLIC� LUU EG I 1'FiUCt;C IS-r_r,1.1('CI'•:Gti S jH' AUTOh'ABILE LIABILITY CUI.1 D LEJII'Ll OritI iLac❑9cn11 .V:'r dI1IU BCUIV IHJLI:Y d;,pi-! S ALL r.;LED SChEDLLED HCDIL'i IKJUIiY If'—.— S AL•!CS AUI CS r.(t r". .FU 11HV't t DAf.AGE 1-u:EU ALTCS ADICg d'�r polr:uUF S UttJ3RELLA LIAR ^CG-UF: E,ICH CCCUNKEKCE EXCESS LIAB CLAUS r.IADE AGGH..E.0".1 E S DED HE I Et:IlOI:S VIORKERS COMPENSATION X AND EMPLOYERS LIABILITY Sii�(U IE t1,r YiN F}19 rPlatlrl PARI LUV E<ECU11':E EL EACE rGlc•EI:I : 1.000.000 A rFFI E(f:Er16E( Et:GwL�tG; aNlA N PD1,venz25s 01,101,12016 01/01/2017(!1 datoryin NH) E.L 1319E.sE E:EEIPLCYEE S 1,000,000 0E3CIi1PTICN CF C PEiAIICPs ao . EL.UIS6'SE-PCDL?W.fI S 1.000.000 '.. DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD 1111.Additional Remarks Schedul,may be anaehed if--p-is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Theilsch Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE AG 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD f J Mrs and.gusjues Offir efConsumer 10 Parkplaza 6 Suite 170 116 oStOD, sachi�w� s pion rov t cioutr Oor ipme Seg o ''dw -1()2726 - - TVPW-- naA s VaOJ R BEAR INS�3Lp-flo"Co- 'Vincent o- V"incceent LeBlanc P.O.80X 958 reason for chanPa ANDOVERA 01840 updateAdd►ressandrewcn� Lost , Nl Address rn 'Renea --3 Qpg.CA1 *:a 54Ri1012t6 9 ftasSc, a a nor mow' rM7CS J r�,G#- 7PRU N ET g�8�5gOY7 NE OM65 042812048