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HomeMy WebLinkAboutBuilding Permit #017-15 - 16 MOODY STREET 7/17/2014 NORT1i BUILDING PERMIT o�ttyeO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:(i' �ED ey Date Received ��SSAc►+us�� e ED Date Issued: I*POVRTANT: Applicant must complete all items on this page LOCATIONA,, � 0��Y S� �• �d ouek, Prit PROPERTY OWNER 1 C_ha.��� (�C-y1 ;U k. Print 100 Year Structure yes no MAP ffid �PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building kOne family ❑Addition ❑Two or more family ❑ Industrial ,rAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain El Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 1-) o w N C 422.(u Loi C )'t F 44* Identification- Please Type or Print Clearly OWNER: Name. Uc�k.4 Phone: 229 SSD Dl%S Address: A0 d dMJ B10 Contractor Name.UlhK644e6(+,v- Phone: 9 2,0, IID?-764 9 Address: 02 y J+"4 dl 8W Supervisor's Construction License: X05 �j.�y Exp. Date: ZIO114 Home Improvement License: l Dd. 2a G Exp. Date: a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA ON$125.00 PER S.F. Total Project Cost: $ D �, °� FEE: $ Check No.: Receipt No.: 1 NOTE: Persons contrac ing with unregistered contractors do not have access to the guaranty fund ;Signature 6f AgenVb- wner 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 Siqnature COMMENTS HEALTH Reviewed on Siqnature 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 signatureldate 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 Pen-nit 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o 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 X; /9/I o -�,T No. (/ 17 U Date l TOWN OF NORTH ANDOVER ED Certificate of Occupancy $ �.� Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#jqF( 1 Building Inspector � ly Town of NORTndover o No. 15L4- h over, Mass, O L�Ke 1. A- COCN1C Kt WICK 7�A�A.ArEO S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .......... ... ...........�� . .................. ........ ...................... BUILDING INSPECTOR has-permission to erect ............. buildings on .........tko............. �,,�,�, Foundation 0 Rough to be occupied as ....... ` t.... ........... . +............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of 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 YPNT HS ELECTRICAL INSPECTOR UNLESS CONSTRUCT199 S S Rough Service .............. . ...... ... .... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. OP ID:S! CERTIFICATE OF LIABILITY INSURANCE °ATE`M03/21/201/20 4 14 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 Durso&Jankowski Ins Agcy LLC PHONE Fax 198 Massachusetts Avenue a/c No Ext: I Arc No: North Andover,MA 01845 E-MAIL Durso&Jankowski Ins.Agcy. ADDRESS: PRODUCER POLAR-1 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Polar Bear Insulation Co.Inc. INSURER A:Penn America 32859 P O Box 958 Andover,MA 01810 INSURER B:Safety Insurance Co. 33618 INSURER C: INSURER D: 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. ILTR TYPE OF INSURANCE POLICY NUMBER MM/DY EFF MMILDDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PAC7022861 03/24/2014 03/24/2015 DAMAGE TO PREMISES RENTED nce $ 50,00 CLAIMS-MADE Fx_]OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,00 POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 2100926 01/04/2014 01/04/2015 (Ea accident) $ 1,000,00 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (PER ACCIDENT) $ X NON-OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ A PAC6906385 03/24/2014 03/24/2015 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITSI I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? r N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is re cared) G.L.C.A.C. , National Grid Corporate Services LLC DBA National Grid, action Inc, Boston Gas Company, Colonial Gas Company/ Essex Gas Company & Columbia Gas Co.; are additional insured for general liability with respects to work performed on their behalf by the above. CERTIFICATE HOLDER CANCELLATION GLCAC11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE G.L.C.A.C. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN &Columbia Gas Co. ACCORDANCE WITH THE POLICY PROVISIONS. 350 Essex Street Lawrence,MA 01840 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD The Commonwealth of 1Vlassachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 ;h s wwminass.gov/dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/.Clectricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): ?6C A-tit 94EA12 tN S U ILGN CO . 1 wS Address: C) rry X 58 City/State/Zip: Awy ovE k(_ J1iGF. OL Rio - Phone #: �'� S (o. Are you an employer? Check the-appropriate box: Type of project (required): 1. I am a employer with q 4. ❑ I am a general contractor and I �.1� 6. F1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity_ workers' comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. D We are a corporation and its officers have exercised their 10.Fl Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11-❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs ff L insurance required.] t employees. [No workers' 13.[�] Other comp.insurance required.] 'Any applicant that checks box#I must also fill 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /y D 12 Q U A RA Policy#or Self-ins. Lie. #: P o W C S 5 00 6s Expiration Date: Job Site Address:-_ M!, St. City/State/Zip: 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$259.00 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 coverag�.verification. I do herebye�-ify under the pains and penalties ofpeijury that the information provided above is true and correct. Silzriature: Date: / Phone#: g 7 9 t1- 02. " G 3 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/To-*Nn Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) (`/ 05/13/2014 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 endomement(s). PRODUCER NAME: PHONE FAX Automatic Data Processing Insurance Agency,Inc. ac No Ext): (A JC.No 1 Adp Boulevard ADDRESS: / Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B POLAR BEAR INSULATION CO INC INSURER C; Po Box 958 Andover,MA 01810 INSURER 0: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 231099 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. ILTR TYPE OF INSURANCE I S POLICY NUMBER MM/DDI EFF MMIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES occurrence $ _ CLAIMS-MADE FIOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PR LOC $ AUTOMOBILE LIABILITY I $ a aeciderd ANY AUTO BODILY INJURY(Per person) $ AUTOS ALLOWNEDAUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Par accident $ $ UMBRELLA UABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC) I J RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X TORY L MITS ERANY _ A OFFICERIMEMBEREXCCtUDEOTECUn� Q NIA N POWC65006S 01/01/2014 01/011201$ E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In IF EE.L.DISEASE-EA EMPLOYEE $ 1,000,000 es,describe under nd DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) MASSAVE/RISE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Columbia Gas of Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 4 Technology Drive,Suite 250 Westborough,MA 01581 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs Business Regulation License or registration valid for individul use only !� -�irzHOME IMPROVEMENT CONTRACTOR 1 Registration: 102726 before the expiration date. If found return to: TYPe: Office of Consumer Affairs and Business Regulation ==y; Expiration: J!2/20.16 DBA - 10 Park Plaza-Suite 5170 POLAR BEAR INSULATION(J- Boston,MA 02116 Vincent LeBlanc 51 SO.CANAL ST.#5A. LAWRENCE, A.LAWRENCE,MA 01841 Undersecretary ----------- ___ __ Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and standards Construction Supervisor Specialtc License: CSSL-105924 VINCENT E LEBL-ANC 24 LANDING DR, n METHUEN MA 018441 . ✓ i� 'S )1 111 1 Expiration ` Commissioner 01/30/2016 $s CH USETTS DRIVER'S LICENSE . . _-- L:. as END Cd NUMBER 'L,NQ NONE S09063933 --C p 3 00a 09=301944: I �tati5_._-M12'REST 15 SEX M 10 NOT 5'09 NONE LEBLA 2 VINCENT E a 24 LANDING DR 01-"41 ` - MMUEN,MA 01844.5825 5 00 03.21.2017 Rev 07.15-2009 d f 1 Columbia Gas- of MaSSaC11tISCtiS A Alun C' Gas Account# Audits/-ltl�__LI_�I y PRELIMINARY AGREEMENT READ THIS AGREEMENT AND MAKE SURE YOU UNDERSTAND IT BEFORE SIGNING. MAKE SURE ALL BLANKS ARE COMPLETED AND ALL PROVISIONS THAT DO NOT APPLY ARE CROSSED OUT.THIS AGREEMENT HAS LEGAL FORCE. AND EFFECT AND RINDS THOSE WHO SIGN. ,` This Agreement SEr ent is made on f / e7I � -between Honeywell of 65 Shawmut Rd,Suite 4,Y°Hour,Canton, Mass��,rhuset)ts 02021,(8Q0-247-41 12)hereafier called"Adniiinistm ilrw Contractor"or"'Hmey�well"and /'"l•00� (Customer) (Address) -41 Hereinafter called"Customer."The Customer is the Own Tenant of the above-mentioned Premises. DESCRIPTION OF WORK TO BE PERFORMED In consideration of the Administrative Contractors agreement to select a qualified Installation Contlactorto Perform in a good workmanlike manner all work("the Work")set forth in the attached Work Order{s),the Customer agrees to theremrs and conditions of this Agreement.No Work may be Performed without the wTiuCn consent ofOaner.Customer understands that calculated energy savings are estimates only and are not guarantood. PRICE For field technician use only For the Work described in the Work Order(s)and shown on COMMENTS: the accepted Offer Slieet.attached hereto, IJ SEE HEALTH AND SAFETY FORM the Total Estimated Cost is S O OTHER The Total Due at the time of Installation from --- the Customer for the Work to be performed is: If the Installation Contractor determines that the{Fork cannot be provided for the Price quoted abnte,all parlies Bill have the right to terminate thiv Agreement Price quoted is PaNd for 40 days. • Owner of the Premises agrees to pay.Prior to the commencement of the Work,and Administmtive Contractor accepts. in full satisfaction for the Work the Price set forth above. • Tenant agrees to Pay,Prior to the commencement of the Work,and Administrative Commctor accepts,in full satisfaction for the Work the Price set forth above. RIGHT TO CANCEL THE CUSTOMER MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED AT A PLACE:OTHER THAN AN ADDRESS OF THE ADAIINISTRATINTE CONTRACTOR,WHICH MAY BE ITS MAIN OFFICE OR BRANCH THEREOF PRO"WED THAT THE.Ct-S%IOMF.R NO"TIES THE ADMINISIRA"YE CONTRACTOR IN WRITING AT ITS MAIN OFFICE OR BRANCH BY ORDINARY MAH.Pp$"1).BY TELEGRAM SENT OR BY DELIVER\'.NO LATER"IAN N/mNIGHT OF THE THIRD BUSINESS DAY FOLLON'1NG 711E SIGNING TE"HITS AGRE ENIF.NT.SEE NOTICE OF-CANCELLATION nN DUPLICATE)ANNEXED FOR AN E\PLANMION OF"i6 RIGHT. IMPORTANT:ADDITIONAL TERAS AND CONDITIONS ARE ON THE REVERSE SIDE By signing below you,the Customer.represents that(1)You read and understood both sides of this Agreement before you signed it:(2)You agree to be bound by the terns and conditions set forth on the from and back of this Agreement:(3)The Administrative Contractor(directly or indirectly)IRS made no mpresentatiom or warranties regarding the Work.other than those contained in this Agreement;(4)That at the time you signed the Agreement,it has been signed by the Administrative Contractor or its ad 'istr iv MIMSCatative,there Were no blanks that had not bemm completed and that the Work you requested Was proper descri have. H teywell S- attue - ate O s Date Tenant's Signature Date MAIL THE SIGNED AGREEMENT TO: HONEYWELL 65 SHAWMUT RD,SUITE 4,2"o FLOOR CANTON,MA 02021 Honeywell-White Installation Contractor-Yellow Customer-Pink Revised 1012070