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Building Permit #1245-16 - 216 FOREST STREET 5/31/2016
4d-d ftv-,-J BUILDING PERMIT of NORTH q A�iED /4 TOWN OF NORTH ANDOVER o _ om APPLICATION FOR PLAN EXAMINATION 1" '0 Permit No#: 2 �/�''�� • " �` Date Received �Rp°gATE°PPRy�5 gSSACHUs�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION _ - Print PROPERTY OWNER ae/� e /'�✓i f ,� _ Print 100 Year Structure � yes no MAP. ( r /6P CEL: 7f/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res* ntial 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, p Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: �-1� Address: ' Contractor Name:,/ „i l A /"�"t/- /-PNSone: Email: Address 'Z� (f+.✓� /z '�' "A,/�. -r �./� 1'3, Supervisor's Construction License: -I-:>c7 Exp.. Date: ._ Home Improvement License: . --.---.Exp.. Date: ARCHITECT/ENGINEER Phone: a 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: $_4/2 est' FEE: $ 7A Check No.: 1 -3 .k Receipt No.: -Fo x'37 NOTE: fersoff contr cting with unregistered contractors do not have access to the guaranty fund - . Sig,natur of Ag�____ y�__r- Si nature of contractor Location No. / ✓� Date • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ 72 Foundation Permit Fee $ Other Permit Fee $ 0 TOTAL $ Check# _ .1 << 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. ❑ Pennanent Dwnpster 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 c Water& Sewer Connection/Signature& Date Driveway Permit i DPW Town Engineer: Signature: Located 384 Osgood Street FIRE ,DEPARTMENT Temp:,Dumpster on, yes_ _____,__ _no, Located"at 1244 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 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 ❑ 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 E ❑ 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 ered 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 � NORTfy Town ofAndover � _ O 0 0 �6 h ver, M o� > Mass, COC NICNl WIC« �1• RATED U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........! .'.6. .. ...... 4'r /Y......................................................................... BUILDING INSPECTOR Foundation has permission to erect buildings on Rough to be occupied as ��1�.... ` ........................ ...�.........�................:.....................:..................................... Chimney provided that the person accepting this ermit 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 CONSTRUCTIO T RTS Rough Service 44 .............. ..... ............ ... ......................... 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. i Proposal AB Carnes Roofing,Inc. 30 Arrowhead farm Rd Page 1 of 1 Boxford,Ma.01921 978.887-1431 MA.CS-000230 and HIC Reg.176928 Proposal Submitted To: RORY MARTYN/CHRISTINE FRANCHI Date May 22,2016 216 FOREST ST Project Name SAME NORTH ANDOVER,MA 01845 Address 603-518-3219 We propose to furnish material and labor-in accordance with the specifications below: Five Thousand Six Hundred Seventy Dollars($5,670.00) Payment to be made as follows:$300.00 Deposit,Balance Upon Completion g7otice:All home improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exempt from registration by provisions of Chapter 142A of the General Laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and status should be made to the Mass.govAicenses website. ROOF PROPOSAL ® STRIP ROOF OF UP TO TWO LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH THE OPGRADEO RHINOROOF TITANIUM U20 HIGH PERFORMANCE SYNTHETIC UNDERLAYMENT MEMBRANE.COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE, ISI ICE DAL1 PROTECTION'INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVERALL HEATED AREAS SIX FEET WIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEY(S)AND SKYLIGHT CURBS WITH ICE AND WATER BARRIER. ® COVERALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. ® INSTALL GAF COBRA MIDGE VENT AND/OR❑ ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ® COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. ❑ REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF PLFT.WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK AND YOU MAY NEED TO HAVE A CARPENTER REINSTALL OR REPLACE THE SIDING THAT WAS REMOVED. / ® CHIMNEY FLASHING"REMOVE EXISTING FLASHING FROM ONE CHIMNEYS).CUT NEW REGLET INTO THE BRICK AND SECURE THE NEW LEAD WITH METAL ANCHORS AND SEAL. PLEASE ADD$400.00 TO E P (BLACK TAR USED BY OTHERS ISNOT FLASHING) ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK 240L LIFETIME W RANTY DESIGNER SHINGLES. ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH SIMILAR q A AD ITd NAL COST OF$4.00PSOFT. ❑ COVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF ® NAILING-'SECURE SHINGLES WITH EIGHT IN TOTAL COATED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS. ❑ SKYLIGHTS'REPLACE EXISTING SKYLIGHTS WITH NEW VELUX OR WASCO UNITS.WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.OUR LABOR CHARGE IS$90.00 EACH IF THEY ARE THE SAME SIZE.INTERIOR WORK IS EXCLUDE . ❑ REPLACE DEFECTIVE TRIM BOARDS WITH CUSTOMERS APPROVAL USING NO.2 PRIMED PINE,ADD$15.00PLFT TO THE ABOVE PROP S CLEAN ALL PROJECT-RELATED DEBRIS FROM OUTSIDE WORK AREA.THE PROPERTY OWNER AUTHORIZES AB CARNES TO OBTAIN THE ROOFING PERMIT.WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE.HOWEVER,SOME MARRING AND OR MINOR DAMAGE COULD OCCUR. IN ADDITION,WE CANNOT BE RESPONSIBLE FOR ITEMS FALLING FROM WALLS,SHELVES OR CEILINGS DURING THE ROOFING PROCESS. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES ALL SHINGLED ROOF SECTIONS OF THE HOUSE. UPGRADE SHINGLES TO THE LANDMARK 300LB HIGH DEF PREMIUMS,ADD$770.00 TO THE ABOVE PRICE.YES( )THIS IS OUR EXACT COST WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITH A PGRADE TO THE CERTAINTEED HIGH PERFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YES Ls EMAIL ADDRESS: �04f'GV GVl N/ �? r` '1/lt�0 t/ r ' ' Warranty:All work warranted against installation defects for 5 years;this warranty is limited to the installed item(s)and its repair only.Material is warranted by the manufacturer against defects for 50 years;see the manufacturer's warranty for exact warranty performance. Cancellation:Customer has legal right under federal law to cancel this contract without penalty or obligation within three business days from the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side. Dispute Resolution:All parties agree that any and all disputes relating to this proposal shall be settled by arbitration rov/,ed, the AAA.This forum is user friendly and does not re'q'uire lawyers.Please see reverse side. Signing this Proposal mean ,you have cepted the terms as stated on the front and back of t' agreement P a see side. *Date of Acceptance f/z(� a Signatu *Signature Sign ure Qwrier,Barry Cames PLEASE SEE REVERSE SIDE i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-000230 Construction Supervisor BARRY S CARNES - 30 ARROWHEAD FARM RD BOXFORD MA 01921 I Expiration: Commissioner 03/07/2018 f i - LJ 12P, a��1'Uyl'�2�cv�cr�f dwlm"�ef.; Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176928 Type: Corporation Expiration: 10/10/2017 Tr# 269957 AB CARNES ROOFING, INC. BARRY CARNES — -- - - 30 ARROWHEAD FARM RD -- BOXFORD, MA 01921 - -- ------ ---- Update Address and return card.Mark reason for change. Address Renewal ! Employment Lost Card SCA 1 fi 20M-05/11 -. - i i TOWN OF NORTH ANDOVER WASTE AFFIDAVIT As a result of the provisions of MGL Ch.40-s54, I acknowledge that as a condition of building permit# all debris resulting from the construction activity governed by this building permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL Ch.111-s150A. Waste Disposal or Solid Waste Facility: ALLIED WASTE Address: 300 FOREST ST Town/City, State, Zip: PEABODY, MA 01960 NAME OF HAULER: AB CARNES ROOFING, INC. DUMP TRUCKS DATE: 5-31-2016 SIGNATURE OF APPLICANT: �-� i The Commonwealth o 'Massachu f setts Department of Industrial Accidents a a I Congress Street,Suite.100 �i Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ihly Name(Business/Organization/individual):AB CARNES ROOFING INC Address:30 ARROWHEAD FARM RD City/State/Zip:BOXFORD,MA 01921 Phone#:978-887-1431 Are you an employer?Check the appropriate box: Type of project(required): I.E]I am a employer with Some employees(full and/or part-tune).* 7. []New construction 2.a 1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.tNo workers'comp.insurance required.] 3.O I atm a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduce all work on my properly. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole l 1.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contactos listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance., 13.a Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.(No workers'comp,insurance required.) *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who subunit this affidavit indicating they are doing all work and then hue outside contactors must submit it new affidavit indicating such. $Coutaclos that check this box must attached an additional sheet showing the name of due sub-contactors and stale whether,or not those entities have employees. If the sub-contractors have employees,dicy must provide their workers'coop,policy number. r attt an etttployer ilial is p,•oviding workers'cotnpenstilio►t insuranceJor my employees. Below is the policy and job site information. Insurance Company Name:TRAVELERS INDEMNITY CO OF AMERICA -- Policy Policy#or Self i(I-Lic.ik 6HU6-OG36156-6 15 Lx rat' ion Date:10/15/2016 4) Job Site Address: y �'�— —� — City/State/Zip: - Attach a copy of the worliers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to$1,500.00 and/or one-year imprisomilent,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I I do hereby certify un erns wird penalties of perjury that the inforurution provided above is true and correct. Signature: __ >'�_ �f ^� Date: Phone#:978-887-1 31 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 ate): 1.Board of Health 2.Building Department 3.City/'1'owu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Otttcr Contact Person: Phone#; i ACC) CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DDIYYYY) 5/31/2016 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(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: BRIAN L. PRESCOTT&SONS INS PHONE FAX 963 EASTERN AVE E-MAIL " (A/C,No ADDRESS: MALDEN,MA 02x4 INSURERS AFFORDING COVERAGE NAIC n INSURER A: INSURE AB CARNES ROOFING INC INSURER B: Travelers IndemnityCompany of America 30 ARROWHEAD FARM RD INSURER C BOXFORD,MA 01921 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMA E TO RENTED COMMERCIAL GENERAL LIABILITYIr PREMISES Ea occurrence $ CLAIMS-MADE 1-1OCCUR '—'��17 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ JC POLICY PRO LOC $ AUTOMOBILE LIABILITY rl E� BINED SINGLE LIMIT $ ANY AUTO u BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNEDPROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ r $ HI �11 UMBRELLA LIAB OCCUR II F] EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE!!!__ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION / X WG STAID OTH- AND EMPLOYERS'LIABILITY (/ Y/N TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? N❑ NIA �HUB-OG36156-6-15 10/15/2015 10/15/2016 100 000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under E.L.DISEASE POLICY LIMIT $ 500,000 F7 -E 1 -1-7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) ROOFING CONTRACTOR CERTIFICATE MOL ER CANCELLATION LNORTH YN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ST ACCORDANCE WITH THE POLICY PROVISIONS. OVER,MA 018 5 AUTHORIZED REPRESENTATIVE Brian N.Leary,PRESCOTT&SONS INS ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NOTICE Z W NOTICE N n F TO TO rn � '� O EMPLOYEES W EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-727-4900 — http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152,Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO MA 02344-1450 `"----� C(GHUB-OG36156-6-15) ADDRESS OF INSURANCE COMPANY10-15-15 TO 10-15-16 LICY NUMBER EFFECTIVE DATES / PRESCOTT & SON INS 963 EASTERN AVE -- �— °— MALDEN MA 02148 CAB I✓-OF,INSURANCE AGENT ADDRESS PHONE# a� RNES ROOFING INC �� 30 ARROWHEAD FARM RD BOXFORD MA 01921 LOYER --- ' ADDRESS a= EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of' employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee ma sel ecl _ his or her own physician. The reasonable cost of the, services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 000849 W20P1G15 TO BE POSTED BY EMPLOYER