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HomeMy WebLinkAboutBuilding Permit #717-15 - 212 MIDDLESEX STREET 3/17/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: -717-15 Date Issued: 211,7S IMPORTANT: Applicant must LOC, PRO 1VIAP Date Received all items on this `nnacnine 5nop vin V tt Lcv 8646 YO\ no -no no TYPE OF IMPROVEMENT PROPOSED USE Residential no -no 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 p. Well ❑Floodplain ❑ Wetland's U Watershed District Water/Sewer OWNER: Name: Address/5/A,(, Contractor,Name Address621 'T)9_ DESCRIPTION OF WORK TO BE PERFORMED: - QVlease Type or Print Clearly Phone: hone:__6 7- y /A— ,9 `J _ " Supervisor's Construction License __/t ;'� _ _ _ Exp. Date: Home -Improvement. License` _. ,Z_i l' _ _Ex _ ____�_,_.� _ __ _ _ p. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTTBBASSED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ �✓ %� Check No.: C0 U / I / d` NOTE: Persons contracting with 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 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 G r. 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 p Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE' D"EPARTMENT - Temp pumpster on site ,,yes_ Located,at'124'Main� Street Fire#De.partment signature/date_._ COMMENTS Located 384 Osgood Street no 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.$1oo-$1000 fine Nu i tb ana UA I A — (F=or department use ❑ Notified for pickup Call Emai Date Time Contact Name Doc.Building Permit Revised 2014 Location Q�19/-2- No. Date//�/` Check # / W 4 28564 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ruilding Inspector 0 v rl J LU 2 LL D m C L u +_ O LL E n to v fl_ (U V) H z z D m O Y a 7 LL sc by O d' T E U — LL 4 O Z zV J a s bA CC — LL Z LU t bo d' �_ l/) — LL O z s bD LL z LU 0~C Lu LUm LL a`i C m z 4� W O0 Ln } 41 O Y O Vl 0 �. 1+ _ 0 V .N CL Q% ai Q 0 . o N o E Q, • L N 17) 0 •�: . E 0 4t3AMP: yCS: 1U� J m 0�°N'o ...t U - -0� 0 N m - � E aLo� 0 z �r� - U,00 :E •U, _ tm o0 L � � c ;,46, _ -o 0) ~ o cn (D.2 m uiN W = -0 +�-+ o O L% '2 w _ CL o �' = 4-. &. W E �'� -a m N a m > ;F. � _ o = o H t Z. 0- 0 0 as IL A _ cc a► co m L 0 co _ .E 0 N d 0 z O a J O I 2 Z O Z W w a. W H W CL N w r., text step [Mmg, (Droz This agreement Is made by and among Laura Loiselle 212 Middlesex St North Andover, MA 01845 Site ID: A177003 1. )ESCRIPTION OF WORK TO BE PERFORMED Next Step Living, Inc. ("NSL") 21 Drydock Avenue. 2nd floor Boston, MA 02210 phone: (866) 867-8729 22 -Dec -14 NSL will perform or cause to be performed the following work on the customer's address above, in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the "Work") which are incorporated herein by reference: Description Quantity Investment J1# #heriza#ort tTnA lops $ 7 f 54 Work Location: Wall Insulate Vinyl Sided Wall With 4" Dense Pack Cellulose 2,710 $1.65 sgft $4,471.50 75 % Weatherization Incentive up to Program Max $2,000.00 Estimated Annual Energy Savings from the Above Improvements $575.00 2. 'AYMENT: CUSTOMER agrees to pay NSL for the work as follows: Payment #1: $100.00 -Credit Card or E -check deposit is due at the time the Work is scheduled. Required payment information will be collected over the phone by a customer service representative at the time of scheduling. Deposit is not to exceed 1/3 of the total retail costs. (Note: Mastercard; Visa, and Discover accepted) Additional Payments and Final Invoice: $2,371.50 -Additional oavments for the Work shall be due upon completion of the Work_ If the final invoice is being paid by check, credit card information will still be required at the time of scheduling. Notify the customer service representative that you are paying by check and your card will not be charged unless we fail to receive payment within 5 days of invoice. { 22` . Jan 22, 2015 Customer Signature Date 2)e16/0X&/ F"ZzeXro.-, �� Cetcran Palle lor, iJ 21 2N5 NSL Signature Date DeboraNFpwN@mulder Name of NSL Representative The Terms of this Agreement are contained on both sides of this page Next Step Living - 2.1 Drydock Avenue,, 2nd floor Boston, MA. 02210 (866) 867-8729 inquiry@nextsteplivinginc.corrn - www.nextstepIiving.com TERMS OF AGREEMENT 3. PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time, subject to the availability of subcontractors or materials, or to delays attributable to the weather or other events beyond NSL's control. 4. CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116.617.973.8700. 5. PERMITS NSL will obtain any necessary permits as the Customer's agent. Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6. PERFORMANCE OF THE WORK AND CHANGES. 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer 6.2 This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement, amendment, or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times, our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents. Such concerns can include but are not limited to ventilation, potentially hazardous materials such as mold or asbestos, or structural concerns. In the case of health or safety concerns being identified, NSL reserves the right, per section 9.2 of this contract, to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and incentives available from the Mass Save® Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However, at times our weatherization team discovers situations in the home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations, NSL will communicate such changes to the Customer, including any impact on amount the Customer would be expected to pay for the Work. The Customer will have the option to remove from the Contract the work elements that need adjustment, or set up a separate contract for performing the adjusted work. 6.5 NSL represents and warrants to the Customer that (a) the materials and equipment furnished under this Agreement will be of good quality and new, (b) that the Work will be free from defects, and (c) that the Work will conform with the description of the Work described in Paragraph 1. 7. INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration (No: 162111) and the necessary insurance required by applicable law and normally maintained by prudent contractors in NSL's field, including, but not limited to, Workers Compensation Insurance for all employees who will perform the Work. 8. QUALITY OF WORK. NSL agrees that the Work will be performed in a good and workmanlike manner, and that NSL will repair and replace, at its own expense, and promptly upon Customer's request, any defects in workmanship and materials provided by NSL which appear up to (1) year after completion of the Work or within any longer period as permitted or required under applicable law, provided NSL has received final payment as provided herein. 9. PRE-EXISTING CONDITIONS & PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall, moisture damage, non -code construction, cracked or fragile siding or shingles, old pipes and fittings, rotting wood, etc. 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos, mold, or any other potential health risk to the Customer. In this event, the Customer is responsible for remedying the at -risk situation, including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect, including dust protection, any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not properly protected prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law, to have, file or maintain a mechanic's or material men's lien, or to file a notice of intention to lien, and to take any other steps to perfect and enforce such a lien, if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this Agreement, they are not relying on any representations, warranties or terms other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. You may cancel this Agreement if it has been signed at a place other than the NSL's normal place of business, provided you notify NSL in writing at its main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. See the attached notice of cancellation form for an explanation of this right. 11. ENERGY BENEFITS. The Sponsoring Utility Company (the Utility) is entitled to 100% of the energy benefits associated with all Energy Conservation Measures, excluding the value of energy cost savings by the Customer, but including all rights to all associated ISO -NE Energy, Capacity and Reserves Products. NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. 12. NOTICE CONCERNING SPONSORSHIP. Customer understands and acknowledges that NSL is not an agent, vendor or sub -vendor of The Sponsoring Utility Company (the Utility) with respect to the installation of an energy efficiency measures. In the event of the failure of an energy conservation device to perform as expected, Customers sole recourse is to Contractor and not to Conservation Services Group (CSG) or to the Utility. The Utility and its operating companies shall not maintain, remove or perform any work whatsoever on the energy conservation measures installed. Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. Customer agrees that it shall not hold CSG, the Utility, their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement, for failure of the energy conservation measures to function, for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13. LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14. CONTRACT CANCELLATION Under Massachusetts law, you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or a branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Planview Diagram Team 1 2 3 Customer b pie Advisor Name: Address ,71.1 ,71.1 Advisor Phone #: /9M) !&L- V�, Town eA Any limitations to access by truck? Site ID NOTES Any work scoped outside of Best Practice? Approved by: �14 S1�rrci� C 2-' t Cm, 9P s' 31' 6 2= 1/ Al Z,C)f Zt� ' . - Office ®f Consumers AffaiA and Business Reg lat on 10 Park ]plaza o Site 5170 02116uBoston9 Massachusetts Home Improvement Contractor Registration NE®CT STEP LMNG INC. ROGER OUELLETT°E 21 ®RV®®CK AVE. 2TH FL BOSTON, MA 02210 -CA1 is 50M -04104-G101216 :%ju fnnEr. r�rn nue*xl(� o� , l�izss�r��u�,ila ,s_ office off Consumer Affairs & Business Regulation —' AiOME IMPROVEMENT CONTRACTOR 4 Registration: 162111 Type: Expiration: 1/1412017 Suppiemeni Card NEXT STEP LIVING INC. ROGER OUELLETTE 21 DRYDOCK AVE. 2TH FL���-- BOSTON. MA 02210 Undersecretary Registration: 162111 Type: Supplement Carol Expiration: 1/14/2017 Update Address and return card. Mark reason for change. Address F� Renewal r -j Employment [] Lost Card License or registration valid for individnul use only before the expiration date. bff found return toe Office of Consumer Affairs and Business Regulation 10 Park plaza - Suite`517D Boston, MA 02114 ti r o 'i oV" alad without signature Y A. Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Super%iror SpecialtN I_►cense' C SSL -1®2 1ti1 ROGI R A OVELLETT it 55 STAMMORlE ]lam WaMck ISL 0£�'.°J Expiration ►:or7►n►►ssic?►}er Reetdctsd To: CSS OGe Onsulation Contractor Failure to possess a current adition oftthe kliassachuse= Strafe Building Cole is cause for revocation of this licensee For DPS Licensing h ortnation e sk: VJwt'II3-U@s>-GOvQ®PS The Common -i ealth of Alassachaseffs Department of Industrial Accidents ©ice of Investigations I Congress Street, Suite .100 .Boston, MA 02.114-2017 N"l www.;mass.gov dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibLy Name (Business/OrganizationAndividual)a Next Step Living Address.. 21 Drydock Ave Boston, MA 02210 Phone #: (866)867-8729 Are you an employer? Check the appropriate box: 1. I am a employer with 660 4. ® I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ®I am a sole proprietor or partner listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' No workers' comp. insurance comp. insurance.t required.] 3.E1 I am a homeowner doing all work myself. [lo workers' comp. insurance required.] t 5. [] We are a corporation and its officers have exercised their right of exemption per MGI, c. 152, §1(4), and we have no employees. [No workers' insurance Type of project (required): 6. ®blew construction 7. ® Remodeling 8. ® Demolition 9. ® Building addition 10.Electrical repairs or additions I LD Plumbing repairs or additions 12.® Roof repairs 13.® Other Insulation *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information, t homeowners whey submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $C'ontractors 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. If am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Flame: A.LM Mutual Insurance Company Policy # or Self -ins. Lie. #:"���®®"7®30026d2014A Expiration Date: 9/30/15 Job Site Address: 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 forth of STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage fi�tion. I do hereby certify under the pains a� pdaa es perjury that the information provided above is truce and correct Si ature: Date: 10/ 01/1 Phone # (�� Official use only. Do not write in this area, to be completed by city or town official. City or Town, Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: i�R-- 777 NEXTS-1 QP ID: EL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYY) r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O%y AND CQNf ER$ NO RIGHT§ UPON TH9 CgRTIMPATF HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ASTER THE COVERAGE AFFORDED BY THE POLICIES 13ELI)Vy. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), APTH,0Rlz9P RRP FSENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 9110P RTANT: If the pertlficate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION Iq AIVRQr q9 6$ g the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to (nR certificate holder in lieu of such endorsement(s). PRODUCER McLaughily isurance Agency 826 Lynn ¢elps ParkWpy Melrose, MA 02176 John E. McLaughlin Jr. CONTACT NAME: Er111 Lyons H N E,a:7$1.665.2775 a Ne ; N E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE MAIC 9 INSURER A; Nautilus Insurance INSURED Next Step Wving, Inc. 21 Dryd®nk Avenue, 2nd FloorINSURER Boston, FAA 02210 INSURER a. Commerce Insurance Company 3475 C: A.I.M. Mutual Insurance Co. EACH OCCURRENCE $ INSURERD:AMS Insurance Company 15510 INSURER E: PERSONAL &ADV INJURY $ 4+ A INSURER F: GENERAL AGGREGATE $ CFawW®,AQ flnUMPAIMPA 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 PERI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICa I 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. I TR TYPE OF INSURANCE ADOL R POLICY NUMBER (POLICY EFF POLICY EXP LIMITS A COMMERCIAL GENE(?AL LIABILITY CLAIMS -MADE ® OCCUR ECP2010198-12 09/80/2014 09/30/2015 EACH OCCURRENCE $ AMAGE TO RENTED PREMSES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 4+ A GEN% AGGREGATE LIMIT APPLIES PER: POLICY ❑ JEC 7 LOC OTHER: GENERAL AGGREGATE $ CFawW®,AQ PRODUCTS - COMP/OP AGG $ $ E AUTOMOBILE LIABIPTY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS �° AUTOS 14MMBOKKON 09/30/2014 09/30/2015 COMBINED SINGLE LIMIT $ 1 00p ®® Ea accident +. + BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMIAGE $ Per accident $ ® UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE Ep U783547012014 09/30/2014 09/30/2015 EACH OCCURRENCE $ 5,000 00 0 AGGREGATE $ COUP! DED RETENTION $ $ ®� C WOR COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Ya OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA O BE ISSUED BY CARRIER 09/30/2014 00/30/2015 STATUTE ERH E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 909, Additional Remarks Schedule, may be attached it more space is required) FOR INFORkIAT10N ONLY INFO -01 For Information Only ACORD 25 (2014/91) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ITiTiT:R ilahts reservad.