The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #536 - 34 ELM STREET 3/5/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:� Date Issued: Date Received IMPORTANT: Applicant must complete all items on this naee LOCATION 41 EL PROPERTY OWNER.�d �04t--7 ' Print Print MAP21 0qO PARCEL: ZONING DISTRICT: 6v *1, 0 Historic District y s no Machine Shop Villaae ve6. no TYPE OF IMPROVEMENT PROPOSED USE Residential Historic District y s no Machine Shop Villaae ve6. 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 ]dil=181 ioennucanon riease i ype or mint ulearly) OWNER: Name: Phone: ` Address: 'Jq E�A c5T CONTRACTOR Name: &Cfe-&17t J�' 5 Phone;6 oq Address: G Supervisor's Construction License:Exp. Date: Home Improvement License: !' 1 Exp.. Date:_3 S lr ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDINGIT: $12.00 P $ OOO.O THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $_,P ! FEE: $ A Check No.:—//— �� Receipt No..: J�` NOTE: Persons contracting with unregistered contractors do not have access the&anj fund Signature of Agent/Owner Signature of contractor Location ✓Z ��`� s� No. Date TOWN OF NORTH ANDOVER 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH v COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comme Comments Water & Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS uocatea :384 USgood Street yes 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.$100-$1000 fine Doe.Building Permit Revised 2010 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 q Building Permit Application 0 Workers Comp Affidavit i�Photo Copy Of H.I.C. And r C.S.L. LI enses 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/Crossection/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 2008 m m m m CAm m _= S7 ' Cl) 10 0 CD n Z y CL o �, � O CL = y O o p CD CD O CLQ "C d CD CD o CD p p -. W CD CD CLO CA CO CD p y O 1 Z CD O CD O C CD z r C/) n O z I I_ c CD cm E C S O m o O C -,0 O- co, dC = d d �• N =rn.+n = m �--ro O O H O O ? O m 0 ZS.�1A O H I V' � O =r = CL CD m H O m CL CD H � 0CL cr H ca C � a �CCD CD y N _ W _ m ,y, .Ort C C', CDh CD �C: go a-o '. n ci Com: ci = co C"3 m T m C042 --1 ro z o ^ d H .� � y � O w �' a O al O C/)` m x r W O z 0 y 0 9 0 MPR -5-2010 10:59A FROM: TO:19786BB9542 P.2/3 ACORD„ CERTIFICATE OF LIABILITY INSURANCE DAT! (MttlDDIYYYYI o31as/2o1a PRODUCER Tom Nonan c% Hays Companies Of New England 133 Federal Street Third Floor Boston. MA 02110 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE MAIC N _ INSURED Surge Resources, Inc. 920 Candia Road Manchester, NH 03109 NSURERA ZuriCINAn9erican Insurance Company 16$36 INSURER B: INSURER c: INSURER D: • INSURER E: GpVtKAtit* THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION FINSURANCE POLICY NUMBER POLICYEFFLCTNE Y X TION LIMITS 1600 Osgood Street, Suite 2-36 Building 20 GENERAL LIABILITY REPRESENTATIVES r6`��QNTATNQ EACHOCCURRENC S IS 3 Eacureumlf COMMERCNALGENERAL LIABILITY MED EXP one f CLAIMS MADE ED OCCUR PERSONAL 8 AOV INJURY f OENHRALAGGREGATE s GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGO S 1.1 POLICY PRO• JFCT LOC AUTOMOBILELNIBILITY COOMBI9cod"NEDDSWRGLEUMIT f ANY AUTO ALLOWNEDAUTOS SCHEDULED AUT08 BODILY INJURY s �) HIREDAUTOS NOtiOWNED AUTOS BODRYINJURY f (Per moddsol) PROPERTYDAMAGE X GARAGE LIABILITY AUTO ONLY -FAACCIDENY S OTHERTHAN EAACC S AUTO ONLY; AGG f ANYAUTO EICEESIYMBRELLAUABQATY EACHOCCURRENCE S AGGREGATE f OCCUR r-1 CLAIMSMADE It f DEDUCTIBLE f RETENTION s A WORKERS COM 4RUT1ON AKD EMPLOVERS•LIABILITY ANYPROPRIETORlPARTNERIEXECUTNE OFFICEPJVONERGXCWOFOT WC 48-65-850-02 10/01/2009 10/01/2010 x WC STAT W OTFR- E.L.EACHACODENT_ f 1,000.000 E.L. DISEASE -GAEIIPLOYEE f 1,000,000 E.L. D1$EASE•POLtCYUM1T f 1,000.000 X doscAbounder SPECIAL PROVISIONS below OTHER l ocation Coverage Period: 10101/2009 10101/2010 CBRlflcete!!: 09NH0p1780299 CBentil: 715 -MA DESCRIPTIONS OF OPERATIONS I LOCATIONS f VKICCLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Rich Bowe 34 Elm Street, Nath Andover, MA 01845 re point foundation, Mall skirt on north wall Coverage is provided for orgy Basemant Systema of New Hampshire, Inc. those employees leased to NO SPECIFIC LOCATION I but not subcontractors of: BOSTON, MA 02134 �� uw1 w111 f-Amil r 1 AT1"w1 ACORD25(2001108) WANVnW%.%+rarvly+nvn .�.... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BMT FAILURE TO 00 e0 101ALL Angela IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR 1600 Osgood Street, Suite 2-36 Building 20 North Andover. MA 01845 REPRESENTATIVES r6`��QNTATNQ ACORD25(2001108) WANVnW%.%+rarvly+nvn .�.... MPR -5-2010 10:598 FROM: TO:19786889542 P.3/3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(iss) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25 MAR -5-2010 10:52A FROM: V a ��Cy i3 Basement Systema of Now HampaMro www.barlh.coal s 18" 378 4966 Bill Abwd 230 main arrest Plalstsw, NH 03865 MAN 382 24W aaaaeraat a10"Opete Ved~ M0146119 I DATE: 01/20/2010 l susunimm Rick BoweDD Ij ADDRESS 21 Wnth Streel Charlestown. MA 02129 roe LOCAnON: 36 Elm Street North Andever, MA 01"S 6k. i EW&W Baaamam Vkndows I I s I My und~W and eaoe fk We hemtarabla weriamy provided, which omm or4y Ore wood the bournark addntpd and does not doves wales dar ape. Partly Pal 101e1 roteft any a Il rr I WWMV. damp pumps ata owered by a feperaW menubdurGrwamerdy. InSWIN110n MIND system draw not kwkWs pairWnp iin4lted rairperkry, mnNlding di dope grip, dad" work at 10-0rix:n0d floor tits a cwpdit Cw&aaw cannot be respondMe for how dsrtlrpe Ines without an taGuant dondarardon, damp apo demlondim water onm pumped tram nouns. window wad 00011110 a foal terra or IWO. Customer shell park contractor a 60 der dghtto wmsdy any problem easy teported. 1 lonnowom reepons@le for moW9rp objecM away hdm wins Mrd PO, Some dust should be eq*O d from work PaynaNs to be nada In toll upon coov0stion. X_ TO: 113 (tibtjb':t>We V. r: For Otfite Use Only #5280 amtt.: RICk.bOws�amswlrts HOME: — WOW — CELL: 0786 0�d4 FAX: TION DATE: MAIM CRAWNOAWAWIM Type of wan: stone E*dng wan finish. Plain Exlatlng floor flnlsh: Concrete. dbl Discharge Cris dn;fls array *Orn house: We Propose to famish matertel and latxm-complete In scmnlenco With above WOCMCudone, for the den of Total $8,945.00 Deposit mgwmd 30% $2,683.50 Deposit paid $2,683 Due Upon Installation $6,262.00 At mabrie4 is gumarkmd to ba n spedfled, Al wok b be txI ng to the sferdad pradloee Any akera6on fioeri abous eiteaksd rrPdn wt9en onleM aid wW become en oda dares. Ag apreananb cantn9sM upon eoctderka a delays beyond our eonb Our wodteis arofury cdvWW by wodanan's Comperisalbrt Inarsnoa. Manaorrrar auunaa ri respofltll>flty for tlsnnaw baa to bfsaRape d mp fidden fusYu1111y aaWaa Bras. arorplr wa wIl do 0w bast b ardd au0h damps Allpopads based orYridllr on honrsosnara dseerlpddn d problem Waraiy does not cows webs dameps Tlrs ptop0ad may bsvAoxtaaar br us 9 not acssPled w" 120 drys Au*"ixed signature Dab ACCOPW a d PropbseF—The atlova pkas, spedBascara, oI -111— ad aspire waralpy am Cwmnar his nerved a wpy Of "'MY aslidaofory and wobweby socepdd. Vau ere aLdwiInad fa da the work es specified. Papnent v A be made B=wn@rk Sdenos or'CwA Specs SdoW1r book )I us gL&vd ate. A tug pedineW system was raanMiertded %t A TdplaSde Pumpinp Syalem w= remrnnlenikd X_ Signature X Data Cuttanef k No dwanudy X - PAaE t OF 4 MAR -5-2010 10:59A FROM: TO:19786BB9542 ACORD,� CERTIFICATE OF LIABILITY INSURANCE DA03/0 200 0 PRODUCER Tom Honan c/o Hays Companies of New England 133 Federal Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, TYPEOFINSURANCE Third Floor Boston, MA 02110 INSURERS AFFORDING COVERAGE NAIC N INSURED INSURERA' Zurich -American Insurance Company 16535 INSURER B: Surge Resources, Inc. 920 Candia Road Manchester, NH 03109 INSURER C: INSURER D: .. INSURER E: CnVFNRAf3FA 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Oman 001. TYPEOFINSURANCE POLICYNIJIMER POLICYEFFEGT11fE POLICY XPIMTION LIMITS IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENT$ OR North Andover, MA 01845 GENERAL LIABILITY AUTHORIZED REPRESENTATIVE h� sACHOCCURRENC 5 S 3 Ea w S COMMERCIALGENERALLIABILITY CLAIMS MADE D OCCUR MED EXP (An one person)S PERSONAL SADVINJURY S GENERAL AGGREGATE S GEN'LAGGREGATE LIMIT APPLIES PER. PROOUCTS-COMPIOPAGG S POLICY[ ago, LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT S (C-11,) BODILY INJURY (Perpelson) S ALL OWNED AUTOS SCHEDULEDAUTOS SOOLLYINJURY (Pereoeldere) S HIREDAUT02 NOM-OWNEDAUTOS PROPERTYDAMAGE (Pereco") GARAGE LIABILITY AUTO ONLY- EAACCIDENY OTHERTHAN EAACC S ANYAUTO AUTO ONLY; AGO S EXCEBBIUMBRELLALIABILITY EACH OCCURRENCE $ AGGREGATE s OCCUR CLAIMS MADE S DEDUCTIBLE $ RETENTION S WORKMOCOMPOMATNONAND X WCSTATW OTH- A EMPLOVERS'LIAULRY ANY PROPRIETORIPARTNERIMCUTIVE OFFICERMEM11EREXCLUDED7 WC 48-65-1350-02 10/01/2009 10/01/2010 E1.EACHACCIDENr_ S 1,000,000 E.L. DISEASE -EA EMPLOYEES 1,000,000 SPUy dexAbeunder ECIALPROVISIONS below E.L. DISEASE - POLICY UMrc 16 1,000,000 OTHER Location Coverage Period: 10/01/2009 10/01/2010 Certificate!!: 09NHOO1790299 Cllenw: 715 -MA DESCRIPTION OF OPERATIONS I LOCATIONS IVEMCLES 1 EXCLUSIONS ADDED BY ENOORSENEeT I SPECML PROVISIONS Rich Bowe 34 Elm Street. North Andover, MA 01845 re point foundation, istall skirt on north waD Coverage is provided for only I Basement Systems of New Hampshire, Inc. MM empbyees leased to NO SPECIFIC LOCATION but not subcontractors of: BOSTON, MA 02134 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001108) ®ACORD CORPORATION 1191111111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, our FAILURE To DO so wALL Angela 1600 Osgood Street, Suite 2-36 Building 20 IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENT$ OR North Andover, MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE h� ACORD 25 (2001108) ®ACORD CORPORATION 1191111111 MAR -5-2010 10:47A FROM: TO:19786889542 P.2/2 Stan rds opt &.4,h�tsndlrds if iuuftd 92 C3 98518 gletio" TrM 98518 -nmo!HY WICK%- P.Ljjs STREET . niv, LO � 1 y R r O _ O C Q N U GK cn U g F-@ Z c W N°. E �) y O O U a ° a R Q to Z N � �p > W 2 LL, M (L bD o W Z a :. p. Ca ~ Cl) y� O W _ N X W LO W ap ~ O Rm V O = R� W } m = Q� w Z W m Z O W W 0 (vAd 00 g Q m N d MAR -5-2010 10:52A FROM: a V C C d Basement Systems of Now HampsMre Wanabart MM to 1 877 379 4808 BNI Aboud 2MI main sbow PWdm. NH 03M FAX:aat 3e2 2M ®afeMOat R M0145119 DIRE: 0112WMO suaumEDTo: Rick Mawe ADDRESS 21 Nh th Street Chartastkown. MA 02129 dW LOCAnON: 3e Em Ob a North Andover, MA 01248 Eva. 1 sissy unorstand ted ~ me auahareeka wrrrartit ptovldO, wadi ooasm anter the Mass of its bntenaart addrsead and doss mat Dover wow dMmpe Pardd pmtrrlttar sysume dory ■ nrttstd waff". CumP psmpt aro ooverad by a aepeatte ewkukaatwatwanaty. brotaltasEon arths sydam does nd bWkw+ Pd�ag, tirdehod carpenvtr. extetking dlmtiaarpe tinea. slsdrkd waR «reptasameet of noon tis « oMp@ ft Colluador etnlat to "MpWWbb to fmmtn dsdWdSa ams wfltrout an loDOWMA amderattim►, damp spat dw ole aum waw am pmnpW ham house. Wlndav wen taod ft Of Md twrt ar inn. Cummer day qMrd o. a clo a eo day rWic —neop any pmblan alter reported. Ifomsse aW reeponslbie for waArap tib** sway ham want and p4dL Some dust dwA be 0400W ham wank Ptymektto be mWs in fug upon aompidian. X— TO:19786889542 P.2 Fa owvp uto Celt' #5280 r�All: Rlokb�araarira HOME: — vw�fef: CELL: 97d$Eb-0Z84 FAX INSTALLATWN OATS OMASO QiAW DGATMWER TWO of Well: Stone Exislbtg Weil SnUM Plain Existing floor flnish: COMIC CM Dladaerge fine length away "M house: We Propose to {umish NoWtsi and labor--wmpisle In aa:ordance wrdi above spedflod ns. for the sum of Total $8,845.00 Deposit mpdred 30% $2.083.50 Deposit paid $2,633 Due Upon instaMon $8,282.00 M mdo W it om kwd to bo n apsdtbd. Ad work b be mrtrpsdod m mdra to nor dwANd Pn dlaes. Any art mo" hem above spedtka8ons wM ba exeated adv upon Wrrdgn otdms, and WA bet ortle an dorm drags. AN OWMr MltB amIC,pmt upon aodderte «deseyt beyond err a«trol. Our workers we f* covered by waft—'a CompMudion inwrreoos. HortaewMr auaarrlet as aeaporlofblitit lar dtmlpas dud to btsaa pe d ww Itddw fudW 1p servlet grass slam vre WE do sur tart to avail eueh darrWO& M wapowle based Pikmopan hem mo ws dttalptiom of prod— WOnWy Wes not Cover water dMr RP TM 1111 d may t* WWrawn bl ua k not a000P d Will" 120 days. Aut1weaW signature tate Aaoeplmae of P►opbssl—The sbova Pokes, t GNMO W ard "Ptd WWMW GM CusEoansr has r mtw d a Dopy d aro'Dry nfida toy and aro hereby ... Itd. Vou are aWhodnd oro do tbt wok ore epWnW. Pvpwt vM be made Basanaaat Sdonoe Of Tra M Spatia Sderwe bank X as wAk ed ebm. A ful parwebr spw. was MMMaae AW X A TAplaStfe PumPInO System was reoaatrlended X ---- Signature X, Date Cuttww w www of warranty X__ MAR -5-2010 10:52A FROM: TO:19786889542 P.3 jogLOCATION: 34 Eint street North Andover, MA 01646 a® Mortara rld Fin ® A 0.t:CON4END@D STIlUC7U0.AL RCpAI0.S prow 30ft !ft a4 laches Chimney (OWAa end 0106 KneaWan form msd 1111 W1ph Wncrete LA13ELS: A. repahrlill and Insula apron SPECIFICATIONS: 1. (A) Vfa vM Mq* and point -pin in above Wade teeaorl offowul H, n 901 id 0' Rtlee the Wade to top d! Mdrad sedlon to mamo 30[1 by 21 by Airwh W* apron. Indd wire mash and MW as thA I I I - (8) WIN will IWO 18 fast Of COrlpete Mwwell approx. 301rhGMa high b/ 10 Indian 1lhiok To ouppmt wWwn*" pmem of wat. bata8 tebW as owded. (C) dye w81 form end ftl ro "plass mlablp pwom ol hjnarneyjDotkhp Is included. (D) FOnn and fBi mialnp seldlon of eros wall nerd to bulkhead. CONTRACTOR WILL CUSTOIr1ER WILL: ADDITIONAL NOTES' 31GndUFG DW PAGE 2 OF 4