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HomeMy WebLinkAboutBuilding Permit #561-16 - 11 FRANCIS STREET 11/5/2015 AORTH BUILDING PERMIT 3?meg"eO °���0 TOWN OF NORTH ANDOVER ° o �^ APPLICATION FOR PLAN EXAMINATION 'J l/' Permit NO: Date Received ` Date Issued: IMPORTANT: A221icant must com lete all items on this page LOCATION S Ck CIC PROPERTY 0NER �4 1N )e "z 2E PrwK MAP NO: PARCEL .!�;_,ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 D Septic ❑Well 0 Floodplain D Wd4nds 0 Watershed District ❑Water/Sewer &Ca � T Identification Please Type or Print Clearly) OWNER: Name: � -�,51 C�e Phone:q7 — O — 11-70 Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction Licenser: Exp. Date: Home Improvement License: Exp. Date: D 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: $ � l �. FEE: $ 73 --- Check No.: Receipt No.: a2 4 4 z o NOTE: Persons co acting with unregistered contractors do not have access to the guaranty fund __.. Signature of Agent/Owner _ Signature of contractor .Py . BUILDING PERMIT NORTH O��g1.ED 16�tiO TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION y Permit No#: Date Received �940RA7E0 PP`��y SSACIiUs� Date Issued: IMPORTANT: Applicant must complete all items on this page i 1 LOCATION Print j PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 ❑ Septic []Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp.. Date: Home Improvement License: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 6ignature of Agent/Owner Signature of contract(j Location No. ! Date f�r . • TOWN OF NORTH ANDOVER c Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#� Building Inspector 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 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street - - Fire Department signature/date COMMENTS 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 Permit 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ 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) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 NORTH Town of t 2 ..II, Andover O - .,` 0 No. 151ol 26 T Z y o�h ver, Mass, , A- COCNICMIWICK 7d ADRATED P7 1S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System ,THIS CERTIFIES THAT e..4. `........ .k,,........................................................ BUILDING INSPECTOR .................. Foundation has permission to erect .......................... buildings on ....0.......... �i'1 ,..�►......... I Rough to be occupied as ........... J. . � ......:}:... .5�:.......��.. Ll.`.`�........................................ 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONTAJ! 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. 57 Federal ID# RISE Engineering RI Contractor Ragltitration No MA Contractor Registration No A division of Thlelsch Engineering CT Contractor Registration No 605hawmut Unit#2,Canton,NIA 02021 CONTRACT 339-502.6333 FAX 339-502.6345 R 7Page € P1inGliAM r"CONTRACT is ENTERED INTO BETWEEN WE ENGINEERING CMA-HES 'scmmeDoa CUSTOMER FOR WOaucAs _ _..,.._ ......_.._..............__.._..._.......__..... ......... _.__._.............,..,._ _...___.,_.,....._ ...,.,,,,_,,.,.....__ ..._. ._....,, CUSTOMER ANOfffi DATE CUEKT• INC"ORDER Deidre Rock (970852-1170 07123/2013 411175 00003 _._._..___,......._.._._.... ___.._..__.._..,,.___.,_._._.,._...._.......... _..........__...._ __..__....,_.____.....__......,__.......................... ..._._.___... ffiERiI{CE STREET BH.t=STREET 11 Francis Street I l Francis Street _._._..._,...._..__............._.,....__..______. sErmcE env,sxATE,rr aatu+o aTr.-3-T'AT'F',zm North Andover,MA 01843 North Andover,MA 01845 .TOB DESCRIPTION PA SE ONE-Proposal for this calcnr!ar year. 50.00 Alli SCALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use ofspecial tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to scat your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)working hours.A reduction in cubic feet per minute(cfrn)of air infiltration will occur,but the actual number orerm is not guaranteed. At the completion of the wcathcrirmian work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $'680.00 Alli SEALING ADDER: (2)working hours. 5170.00 VENTILATION:Provide labor and materials to install(1)insulated exhaust hosc with soffit mounted flapper vent to exhaust existing bathroom fan(s). $118.73 WALLS:Provide labor and materials to install blown in Class I Cellulose to(192)squwc fiat ofcxtcrior walls through an interior surface drill and plug method. Plugs will be spackled and Icf1 with a rough finish.Finish sanding and touch-up priming/painting will be the customer's responsibility, Invoicing will occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will return when weather permits to check for any voids with an infrared scanner. Any major voids that may be found will be filled at no additional cost. $384.00 WAILS:Furnish and install blown in Class 1 Cellulose to(864)square feet orshingle and/or clapboard exterior walls.The butt orthe upper course oryour wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed,will be the customer's responsibility. Invoicing will occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will return when weather permits to check for any voids with an infrared scanner. Any major voids that may be found will be filled at no additional cost l"EXISTS! $1,598.40 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gass offers 75%incentive,not to emceed$2,000 per calendar year,and an incentive of 10(r/a for the Air Scaling measures up to the first 5680 and an additional$340 irsavings arejustified by the auditor. For the safety and health oryour 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 tveatherization incentive is 53,110. O � \VV/ 890.00 JUL 2 4 ?�15 Federal ID# RISE.Engineering Ri Contractor Registration No MA Contractor Registration No A division orThieisch Engineering CT ContrucWt Registration No r 60 Shmmut Unit f#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-302-6335 R SPage 2 PICOGRAM REMEEN CMA-HES ararTM CONTRA" � c OMERFORW R13As ENCINEEAIN(; Descrimmow ._..,_.,...__,,...,..___._.._........................ _._._..___......._......_..._.,._....._.._._____.-----__----------__.__..._... ...... ..........____._,.-._.__.__.,..,._...._W_ CUSTOMER PHONE CATH CLIENTS WORKORDER Deidre Rock {978}852-1170 0712312015 411175 00003 __...._.._...__..._._................----......... ......... .................,._.___..._..._____................._....,..._______.__.. ......d....._ __. .__...__._.......,.,,.,,..._._..___........_.._..........__..... sERVIGE sTRIET BOAM STREET I I Francis Street l i Francis Street __..._..._._----___............__.Y.._..._.__ ,....................__.. .................... .............__._.___..__.._.._._._..__. _..... _ _............ ........... . .._. _...___............._. seaWCE CITY.STATE ZP BAJO CM.STAMEM North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,041.15 Program Incentive: $2,318.86 Customer Total: $525.29 WE AGREE HEREBY TO FURNISH SERVICES-COMMETE IN ACCORDANCE WrTH ABOVE SPECIFICATIONS.FOR THE SUM OF ,"Five Hundred Twenty-Five&281100 Dollars $525.29 UPON FINAL INSPECTION AND APPROVAL BY RISE ENWNEERM.CUSTOMER AGREES TO REMR AMOUNT DUE IN FULL INTERESTOF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER]D DAYS.SEE REVHRSEPOR IMPORTANT INFORMATION ON CUARANTEES,RIGM Of REGI M4 MCNEDAJW,AND CONTRACTOR REow"TKNL . .. �.._.__.�...�., ..,,,...a.-._,,.,._.._....__._._.,.,,.. .-._....,_. .... ,...._,._.__......... ._.....................______...___._...._.._..__.___.__..._,.,,,...,_.._......_.__....__.._ NOT SIGN THIS CONTRACT IF THERE ARE ANY SLANK SPACES r ._.._..... ..� .,,_,......__.,.,,.,,..._._...._........_.........__ . ...._..._...._............ ._._.__..._....�,......f........ ......... _.__.„....,.,_._.,,,..,._._.__.,_...... __._.... -RSSEEApinenir�O CUs CE NOTE:THIS CONTRACT MAY HE Vfl3tiDRAYtN DY US If NOT EXECUTED YATYBN DATE OF ACCEPT►JiCE .._" __..,....__. _.........?!......f,./__.......................... ._,,,....�.__.. ,... ACCEPTANCE Of CONTRACT-THE ABOVE PRICES,sPECtRCATIDNS AND CONDITIONS ARE ' DAYS. SAMPACTORY TO US AND Aft WAM ACCEPTM YOU AFM AUTMOMW TO DO THE WORK AS SIECIRED.PAYMENT VMBE MADE AS OUTU NED ABOVE The Commonwealth oj'Massachusetts I Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-578-9275 Are you an employer? Check the appropriate box: Type of project(required): 1.❑✓ 1 am a employer with 100 4. ❑ 1 am a general contractor and 1 have hired the sub-contractors 6. ❑ New construction employees (full and/or part-time)."�. 2.❑ I atn a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition employees and have workers' working for ine in any capacity. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §l(4), and we have no Insulation employees. [No workers' 13. ✓❑ Other comp. insurance required.] *Any applicant that checks box 41 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. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an emplgver that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Indemnity Insurance Co of North America Policy #or Self-ins. Lic. 4.V0 —`����� Jr Expiration Date.6/30/201 Job Site Address: (\[' City/State/Zip: Aga ®[ U - `� 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 DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 2. ... :�] Signature: Date i ISS Phone#:603-324-1974 Oficial 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#: DATE(MM/DD/YYYY) A�oR� CERTIFICATE OF LIABILITY INSURANCE 06/24/2015 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 m certificate holder in lieu of such endorsement(s). N PRODUCER CONTACT -a NAME: Aon Risk Services Central, Inc. Southfield MI Office (ac No.Ext): (866) 2s3 7122 (FA/C.No.): (800) 363-0105 a 3000 Town Center E-MAIL p Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Old Republic Insurance Company 24147 TOpBuild Corp. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570058348882 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. Limits shown are as requested INSP LTR TYPE OF INSURANCE IPOLICY EFF POLICY EXP NSD VVVD POLICY NUMBER MM/DD/YYYY MM DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 1 1b EACH OCCURRENCE $2,000,000 CLAIMS-MADE X❑OCCUR DAMAGE TORENTED $2,000,000 PREMISES Ea occurrence MED EXP(Any one person) 125,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 14,000,00 co X POLICY ❑PE� ❑LOC PRODUCTS-COMP/OP AGG S4,000,000 N OTHER. o n A AUTOMOBILE LIABILITY MW I3 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT m $5,000,000 Ea accide X ANY AUTO BODILY INJURY(Per person) O Z ALL OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS AUTOS NON-OWNED PROPERTY DAMAGE V X HIRED AUTOS X AUTOS Peraccidenl r C) UMBRELLA LIAB OCCUR EACH OCCURRENCE L) EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS EMPLOYER COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 j( STATUTE EORH LIABILITY YIN All Other States -- ANY PROPRIETOR/ E.L.EACH ACCIDENT $1,000,000 C OFFICER/MEMBER EXCLUDED? NI NIA SCFC481S190 06/30/2015 06/30/2016 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000- FF DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage lI�J r--.I 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. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBUild Company 260 Jimmy Ann Drive Te , Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD — _.—u_ (^:f �?'j �'>�'•y`�i rd r I 4. 's� i;e of 'onsamner A _airs-and Busness keg Uiati 'on =- 0 Pari: Plaza - �uite J 170 Boston, Mlassachusetts 02 116 Horne improvement Co,,itractor Rcgistr tioii Regnlra#ion. 179141 Type: Supplement Card _ Expiration 6!25!2015 BUILDER SERVICES GROUP, INC. RICHARD SCHWAR T Z 110 PERIMETER RD NASI HUA, NH 03063 i uciat,address and rrturn cark Mark reasc;n No change. —.iidrr;; ;ienC•F+:ti r-:ri)t1':o`ment t.c;st C'.:rci r. r:;Q'tins»mcr A;fa;rs G: Wintss I2r;:ula;s<;n LlCt•nse or rrg.Sir.siii)n.12))t1 No i(iLls'!(;a1 uir i;nl', E.:y.`. 'Jh�iE 1t;9rFDV�f�!Elt?i�flN1 R CTL3R behure the e;.,)irehon daw U found ri turn to: _; 4?fi;ce of Consumer AMs and $usim s Regulw"n "Registrar.; . 179141 3'y pc- ;t1;��r; nla�a_ _ _ 01 Lire Expiration: 6725/20i6 Supplelneni Boston.+ s 021 16. JILD_R SERVICES GROUP it\j';. f TZ YTGi:.,BEACH. =L x'11' r,drrsc:.:i r Not niid'hithout si�nziurc 4 � 1 {4,0C CSSL405992 RICHARD SC HM,AR'►Z %lanchewer 001 11.3102 1 Re5trided To C55t S i ft itt d t Ft E(( ure to >,e,s° rent im 'F. of r... Tam E.Tur.cltng C:,; a;„�. c�4oc..;ti"' , . .... ,