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HomeMy WebLinkAboutBuilding Permit #730-2016 - 266 GRANVILLE LANE 12/14/2015I AAW `W IP BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#��-?�� Date Issued: IMPORTANT: Applicant must LOCATION (1raLAv*U ( Date Received all items on this PROPERTY OWNER-,) ri h n IIJ►Print i Print 100 Year Structure MAP 1 PARCEL -063 ZONING DISTRICT: Historic District Machine Shop Village Ayes no yes no yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building Kone family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: d a rnrn I r_cA . c r, 1-v lei I P, a,1-�u. h/t -s -Vb i k t , CtA/Q, ail, ► in OWNER: Name. Address: ZED U Contractor Name: Email: 6aJJ r/r_,r1 Address. 9(? i R �3y_ 34 Identification Please Type or Print Clearly 1,.36 11b 3�_6 WO •koe�--s-i6u3 Supervisor's Construction License:1 LOO Exp. Date: Home Improvement License: k 1-3 1 0 3 Exp. Date: l�O 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: $ 3l0 l Z. • &I FEE: $ 4-�j ,n Check No.: �i� Receipt No.: �V I 0 Z� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location 2—,'+' No. �— 1 24l Date Check #! TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ `' TOTAL $ 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 e U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature. CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street_ FIRE;l_DEP,ARTMENT Temp)Dumpster onsite ,yes_ rno ,Locatedlat 124�MaintStreet FiretDppaffiment, ignatUre/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.$10041000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email I 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application � Certified Surveyed Plot Plan 4. 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4; 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 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 r L J 2 c oc a 0 m t O LL E ice+ > N v Q N p Vf Z Z 0 m O -a 7 LL <V W T c U V Z O Q V C LL PQo � ANG ti �_ N C LL v0 a CA Z N Q (7 r L J 2 c oc a 0 m t O LL E ice+ > N v Q N p Vf Z Z 0 m O -a 7 LL s K T c U C LL Oa ui of Z Z m C G J d s K C LL of Z a u V W W s K �_ N C LL v0 a CA Z N Q (7 s .� C' C LL Z ui W a W LL v i m O z 0��1 N a+ 41 O N 0 :O 0 s. QLD. a. Z 0 Q "- 0 Z 0`=' CD � N : A' 0 _ c a IL Z 0L 0 do: J �_ �s L m a Z H �. AO — V > Cl)_! `� as W . c y 4)Q Z W 0 L, 0 0 a V �n N 0 0 dcn GCW Vf: >LLI J o Z CL m C3 o .U) a� C3 0 ~ L cv 0 Q L d 2 Q 4) N 0 N V CO 0 Nr+ W M — 0 0 �- LL y N) C 0 'a o Lu. L E 0 -or -0 O W i tj 4) V Q 0 .r Q Vi �, .0 0 4- c o H t 0 . CLOG) > Z w N S w Federal [D # RISE Engineering RI Contractor Registration No MA Contractor Registration No A division ofnitisch Engineering CT Contractor Registration NO 60 Sbawmut Unit #74 Canton, MA 02021 CONTRACT 339 -502 -WS FAX 339-502-6345 Page I R I S EPROGRAM TM CONTP= 19 ENMRO OM SUMM rJM CMA -RES ENGMEMCAMMOUSTOMFORWMAS ENGINEERING aescninso ear ow CWTONS" Mime We WWI WMORM John Willis (978)685-5663 06/11/2015 415252 00002 raw= 266 Granville Lane 266 Granville Lane 4% samea WY.STAM21P uniza OMSTAM51, North Andover, MA 01.845 North Andover, KA 01845 JOB DESCREMON AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air Icakage. This wof will be performed in concert with the use or special tools and diagnostic tests to assure that your home will be left with a he Invel or air exchange and indoor air quality. Materials to be used to seat your home can include caulks, foams and other prod am for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) This will require (9) working hours. A reduction in cubic feet per minute (cim) of air infiltration will occur, but the actual number of cim is not guaranteed. At the completion of the weatherization 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. $690.00 AIR SEALING ADDER: (4) working hours, $340,00 DANDAINQ Provide labor and materials to install a 12" layer of R-38 unf iced fiberglass baits to (20) square feet for damming pub. $41.00 ATTIC RAT' Provide labor and materials to install a 4" layer of R-14 Class I Cellulose added to (i 008) square feet of open attic Spam St.139.04 STORAGE BARRIER: Homeowner is responsible for the removal of the stored items blocking the installation of weatherization work in the attic. Removal must occur prior to the scheduled work start. $0.00 KNEEWALLS: Provide labor and materials to install 2' FSK faced semi-rigid fiberglass board insulation to (229) square feet of knwwall am $799.00 ATTIC ACCESS: Provide labor and materials to insulate the back of (1) attic hatch with 2" rigid Thcrimix, board. Weatherstrip the perimeter. $60.00 ATTIC ACCESS: Provide labor and materials to insulate (1) back of the knccwall hatch with 2" rigid Thermax board, and sea) the edge of the hatch with weatherstripping. $60.00 VENTILATION: Provide labor and materials to install ventilation chutes in (22) rafter bays to maintain air flow. $44.00 BASEMENT CEILING: Provide labor and materials to install (62) linear feet of R-19 unfaced filiaglass; insulation to the perimeter of the basement wiling at the house sill. $108.50 OVERHANG: Provide labor and materials to install 10" R37 densely packed Class I Cellulose insulation to (56) square feet of exterior overhang located below a heated floor area. by drilling hotel in the overhung from Wow. Holes drilled will be plugged. Plugs will be settled with exterior grade spackle and left in a relatively smooth condition. Finish sanding and touch-up priming/painting will be the costumes responsibility. i Federal tO0 RISE Engineering FU Contactor tte [ ation No MA istration No A division or nieisch Engineering CT Contractor Registration No r �t 64 Shawmnt Unit 1A2. Canton, MA 424Zi CONTRACT 7 , nsf F . 339-542 6335FAX 339 c?02 6US R i r S PROGRAM Page 2 PROGRAM TTS$ CONTRACT is E arm MTO aEromm ape. ENGINEERING CMA-HES ausrD►asRFORTYDrmas CUSTOMER PNONE DESOFUREDBELOW DATE Cuefro _. WORKOROER John Willis (978)685-5663 06/1112015 415252 00002 SEMM STRW 266 Granville Lane 266 Granville Lane _..__.._..... ._........ .. SMUE CITY. STATE, ZIP nWAG CM.$TAMZTP North Andover, MA 01845 North Andover, MA 01845 ,IUB DESCRIPTION $224.00 CRAWLSPACE: Provide labor and materials to instal! (32) square reet of R-10 rigid Ther max insolation to the cmwispace perimeter wail up to tte sill and against the band joisLTHIS IS UNDER FRONT DOOR ENTRY SPLIT! $118.40 tl V E JUN 6 2015 Total: $3,612.94 Program Incentive: $2,900.02 Customer Total: $712.93 wE A&nEE HEREBY To FURNISH sERNOES - comPCETE IN ACCORoANM mm ABOVE SPECIFICATIONS. FOR THE SUM OF *"Seven Hundred Twelve & 831100 Dollars $712.53 UPON FlNAt MSPECTKIN AND RPPRtlYAL 6Y RpTi FNOItaFRiNO. CUSTtlMEa aOIUIFS Tb RENT1'AMOUNTOUE IN FIR!. WTEREST OF Y%NtILLDE CNARGf� MONTNLYON ANY UMPAM APM=VA SEE AM IMPORTANT INFORMATION ON CUARANTEM MOM OF RECI$ION.SCREDUIMO. A(i,DCONTiU.CTOR ft94MTMTWW 00 NOT SI ISCONTRACT IF THERE ARE aN PAC SR;NA Aeerin9 - FEa AC ' TA .. NOTE THtB CONRGCTNVIY NE WI7NORAWtlnYUSIF Ntl't (7tECUTEOW[THM GATE OFACCEPTANCE ACCEPTANCE OF CONTRACT- THE ASM PRICES. 3PECt MIGNS AM CONDYRM ART: 30 DAYS. AABSPE=MPAW SEfWILLLDE"MASOU lTAABOVVEE altiHORRED TO DO TriE WORK OWNER AUTHORIZATION FORM -yd,12�1 owner of the pity I I i , at - RN10o v hereby a 8n &Catmd mor farR{SE ftneeft, to ad an my bdu f m 1 6 2015 PGM* and do patorm Wolk cn my praperty. I& The Commonvedth of Masachmetts Dep arint ent of Industr&l Accidents Qffice of Investigations I Congress Street, Suite 100 Boston, MA 021142017 wwwin"sgorldia WorkeW Compensitdon Insurance Affidavit.- Builders/Got ractors/Electritians/Plumbers AnUcant Information Please hint togift Name (Businasoorganizatimifnvvidw Address: $0 $OX 344 Phone-#: "V -LO-34S — , V'rl- IS 3 An you an tm*yer�.' Cbeck the appropriate box! Type of project (required): 1 1 ant a ernploycr with S 4. tj I am a general contractor and 1 0 ti �ftl 141,11 indlar"a* rt-th-A have hired the sub -contractors 6, New cons"con I I 2, Q 1 am awic proprietor or partner- ship and havc no Mployces vv king for m-. in any capacity. [No workers' comp. insurance R*Ted-j 3, 1 am a hotwowner doing all work my'self- No WotimW corms. insurance rquired.] t listed on the attached sheet 'rhm stria ntttrasttrrs have Mployces and have workers comp. 5. [3Wc are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no cmployees_ [No workers' comp. ins%nance fequiredj 7, 0 Rcnvdcling & [3 Dentolition 9. (3 Building addition 10.[3 Electrical repairs or additions 1113 Plumbing repairs or additions 12.[] Roof repairs 13.[3Other *AnY'WP0j0W9th4C1VXkS box tit Mwatm fill aw tilt waimbekm dmitkiagibar I Hmmm-m-s who sutiinitthio afFtdavitging ibe.v we doing all nm of dzvitiwicAtingsmh. box mug ;sheet sham; the mmeoaf tht Wb-omtrurmand sate wtPentm or not tmimfilicshave raftryem ff the sub-cw.uxw6 Yaw or-pWy=,, i1tcy nwt pwndt 6eir pant cy rumw, Brlowisthe poicy andMshe information. Insurance Company .-.„_____._____.m....... Policy # or Setf-ins. Lac. #.-_ 0 Expiration late= 0 ID Job Site Address: 1&1–WL1ff4\V cityistate-zipti I fty\-CLkvv t"104, Attack it copy of tht workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under S e -tion 25A of 146L c. 152 can lead to the imposition of criminal penalties of a fine up to S1,5WOO and/or one-year imprisommm as well si civil pmltics in the form of A STOP WORK ORDER and a fine of up to $250.00 a day against the Oolator. Be advised that a, copy of this statement may be forwarded to the Offloc of investigations of the DIA for instuanec coverage veTifization. I do hereby erMfy under the pains and penaWes of pedury that the information proWed above is &ae and rorrect, rZift"n"try, tat-»- t ?,I t I I �— Official use on(y. Do nat wrUe in this area, to be completed by city or town official. City or Town: Pern*111feense #. Issuing Authority (curie me); 1. Board of Heafth 2. Building Departnicul I Cityffown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: . .... Phone ACOAle CERTIFICATE OF . F WIM15 1 THIS CEATiFTCATE IS SSSOM AS A ►tf4TTEA OF INFOWATICw O,*Tt,'t ME Fo-PEAs ilo €€OW's— U" Fir C TIRCA-M Z1.BtZ TMSs CERWICATE DOES NOTVrlk,"ei IVELY CA NMAT?'d MY UTEND OR ALTER THE Cia"'VUAGE Af"- OW BY THE POUCIES BELOW T)." CERMCATI or INSURAKE 00k5 NOT CONSSMFM A CONTRACT UTWEM THE tS +4 lura f 4iRER (s;, Ayr—MMEf RVRESWUM—t OR P ON)CER, ANO THE MMMATE TE HOLM, '"P ATAHT: v the 4 to Maxus ";; 7M IC° AL Ns— E5, Nwy(ws) muR to endoMeO. 11 It$tMA—M15 WAVED. )ett to tM t*mt W4 t:Co"Ons at' 04 0011;+', "OAt n DcAd" f"Y m4 i** an W40rtea' wmt. A statP� on Utm cr t" ka do" rot et *.,fw tnptAs to the cedl=w herder iRtteu t ' � stds . CU)*m WArlFs°t J Ins Agott y bw 1648 *Ah"cm cm St PO Boz tt; vom MA 01041 11 Berkley ZSS f ed R►;k 9;rAm *Yc. ($W9 634-450 } its -ells �tT, ti�Ti�JaT'tt$11'AfiRi3aEt� Af+``! T T. c�: ctTt t�' �r CCtNTT a� Tt�R eS'at�rc'T � �S;T v,�ae�f Ti°�S Ott x ak�r>rsue gt Mw�ll mer it3ttlti tG Po Box 344 VONICK MAO'+ m Jetta LgOS �� a WVD F; to 25 > 2SJI os) BRAC 3139 �tT, ti�Ti�JaT'tt$11'AfiRi3aEt� Af+``! T T. c�: ctTt t�' �r CCtNTT a� Tt�R eS'at�rc'T � �S;T v,�ae�f Ti°�S CERTW"TE it &V BE € UEDOR MAY PERTAK tsiE WSVA"CK WORDEDOY TWE POUCES OE.SMSEO f^f REW 8S SU&IECT TO ALL Ii:ETERMS, EXOAMOW AN02ae 0t+45 OFUX8 POLICTS, QTS SHOWN MAY HkVT BEENREWCM BY PAW C AM- LgOS IYOf £ dJ43, 044 WVD 1�4.1w'#',�A.7b�ER yvr� *hCg`"s°6 - L#?fFTS ..._ ,r...,...r�..,, Do 0AA0.10f 0 0 $ .r...,,r.. 9,�'G s3C# 4rJ3a xn� wrWM+4 '".mW A AR'6FAdfilRF 71 3tatS •t�fK�4'G�f.W�T w�€pF�i a^kR $�°S- YrA'i c'S pm.- L AwTowoftkii9iiytE;7@'IP f Afi.'f' MAP � 1i11'1`S$ "8S3tNLY �^.!J#.EiS &sf Fs«�?.'%nw.rrfacs:.s r.uu.- �e srsrh wi.Y WWI 0 I,Y }4'idpW dR¢kPteta! � 's G..3 IlIny OMidM uQwvx*smoowqw- fY Pis At.7 �1�tl1 S 17M ," i X'ti � §,..�'. �g;l � �,^ ;may ,p },d. �'i>1rYPS. d }EF+�� t pgr�yy�� y, i�r'+BA�"fV�S1 -rwrwrrn w w >mi icr4r�t 3 S�f34D? at tkuw ut j CFTeewe. fsCppovt Es�dir,;y t«rr ,na2r,x�� 7E �if►ER SHOVADAWOF TW ABOVT (X3CRWb PO=iES6EG leDW cuff"Uft TttE f^XPWT04 0AIE THMOF. W)TME fBr"" MOMNERMN Gootraawsv" Aci WTW.TK POLACY Ppov*;ONS, 50 Y4fnhftton Strict A° to 25 > 2SJI os) BRAC 3139 ACOROr CERTIFICATE OF LIABILITY INSURANCE �..�1 F DATE(MM/DDNYYY) 7/7/2015 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 certificate holder in lieu of such endorsement(s). PRODUCER Martin J Clayton Insurance Agency, Inc. 1649 Northampton Street CONTACTNAME: Nancy Usher PHONE (413)536-0804 FAX (413)534-7874 _AI( C No Exp: _ _ (A/C N,: ADDRESS: P. O. BOX 989 _ INSURER(S AFFORDING COVERAGE NAIC# Holyoke _ MA 01041-0989 _ INSURERA:Nationwide Mutual -Harleysville NATIO____ INSURED INSURERB:Allied World Natl Assurance Co _ INSURER C: ' Gauthier Insulation INSURERD: 44 ESSEX ROAD 7/6/2015 INSURERE: IPSWICH MA 01938 INSURER F : COVERAGES CERTIFICATE NUMBER:CL157701379 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 r LTR POLICY NUMBER DDIYYYY) IMM/DDIYYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE WESTBOROUGH, MA 01581 EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) 1$ 50,000 X GL43487F 7/6/2015 7/6/2016 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE— $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FPRO- ❑ JECT LOC $ J 2,000,000 PRODUCTS -COMP/OP AGG '$ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ ANY AUTO $ BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOSNON-O BODILY INJURY (Per accident) $ OPERTY 1Perr accide t) AMAGE HIRED AUTOS AUUTOSWNED $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1 000 000 AGGREGATE B EXCESS LI _ 1CLAIMS-MADE I $ 1,000 X000 DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YF FIER 1 STATUTE J ___L ERH - --- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A --- -- - - - ---- E.L. DISEASE - EA EMPLOYE (Mandatory in NH) $ If yes, describe under DESCRIPTION OF OPERATIONS below - _ ---- -`- E.L. DISEASE - POLICY LIMIT -- ---- $ I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ,&.0Mlyd9tbd with pdfFactory trial version www.pdffactory.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE WESTBOROUGH, MA 01581 Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ,&.0Mlyd9tbd with pdfFactory trial version www.pdffactory.com "C3 :Fl"v A x (nbcc X;o --i --i 0 G) G) :zx>> CWCC > MAXM ;o X 0 tQ c 52, :Fl"v A x (nbcc X;o --i --i 0 G) G) :zx>> CWCC > MAXM ;o X w co i 020 -4 CL rr