Loading...
HomeMy WebLinkAboutBuilding Permit #732-2016 - 345 CANDLESTICK ROAD 12/14/20154)J`�Urr BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 1� i Date Received Date Issued: i 'Z—I I K KI IMPORTANT: Applicant must complete all items on this �10RT1•� O�,�TLeo �6�HC Q .�y LOCATION 34 (,a atfQ-, , to 01.04 Print PROPERTY OWNER r(01 Print 100 Year Structure yesno MAP 1p4� PARCEL: 2� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial 4Iteration No. of units: ❑ Commercial El"Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Sepik Well, 0 FCoodplam�Wetlands _F Es I]' ,INaters'hed IDstnct I P-'Wates/Sewer I DESCRIPTION OF WORK TO BEP RF RMED: irr stc-llua . (,p luec.t. t. n , YG Cvl OWNER: Name: (,hrl b)N I_.(&% Address:3�s Contractor Name: UA'(-tcu i Email: aoj.' itrihtUi fir\ Addres . PO t;c)k 34LI ISSW - Please Type or Print Clearly Phone: Z Q 1 -9 8 5 - y4 � 8 Phone: C1 115 1" 34 qZ 3 Supervisor's Construction License: Exp. Date: 4612 Home Improvement License: 3 O Exp. Date: V, —1 1 I �0 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: $ Z •� s FEE: $ Check No.: It 171 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location 5�e5 r .. Other Permit Fee . $ TOTAL . Check`#'�' ; Building Inspector r .. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Sody 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 COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature'. Reviewed on Signature Reviewed on Signature `Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ Board Decision: Comments r'gConservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street :.s.+5'"^is'�'S`...ClXl#ti.. L .7�: 'L VIENT Temp Dumpg r�on site; yes � no r „ t.x t §. a xF+ " , x i=f Y � 4z � �,'. t tye f-�}, ,• 3 '�, ,� Fly 5 a�r� i lZ� J 6.y .....n.,.-.:�... •�...-..:�%'s+.w. a�F 4�-F �M.` j r j r �'' tr Jti.r n: 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No Doc.Building Pennit 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 4 Engineering Affidavits for Engineered products ATE: 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 OTE: 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 4� 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 46 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 LW = J LL O O Q m v �c -6 O LL v � N O) N p U Z Z m c O C O LL OO O K ct t U C LL O W Z Z m J a UO O C 70 LL 0 W Z v v J W t UO O OC u to LL O W Q Lpp O CC C LL f- z W oC W W LL C m N O N a-3 N Y O (n vi aI � o v LU Q a � = z E m CD .9 16. ii. NGo Q PUE Z .� L O 1p * * 3 cn J O i�L-w a Z ~ � � v r v> =` �cc 'n w� o is � a Z O X O o W C.1 o H o =Nowrn '� tm W 40 a,'> c c W J �0E- �Z ` d m 0 w 'y O v c -a c = I- L 0 Q CD N N N 4).2 m cc _ W_ O -0-- OO " w uml I-- wM Z- :E LL C N C O i •E 2 z V -o r O �j• LJJ d .- L Q ti N06 d i eN m 0 O r O_ 1=- t ..0.. n0Ci > Aq w ti 5 d O E0 o z W Q CL � cc -0 o �0 0 cc OCL CL 0- c Q O = cc cc A.) J -0 CL O 4) � Z u O U cU c c CL U) 0 Federal IR # RISE Engineering RI Contractor Registration No MA Contractor Registration No A division ofThielseh Engineering CT Contractor Registration No 66 Shawmut'Unit #2, Canton, MA 0202-1. CONTRACT 339-502-6335 FAX 335-5024345 R I S E PROGRAM Page 1 THS CON'mACT � ExTEWtED UrtO 9EtYrEEN RISE CMA-HES ExotxEeRnntAeloTxecuatoatERFORtvoRscAs ENGINEERING DEscRtaEaeEtoma CUSTOMER PHONE DATE CUEHraf wORKORDER Christy Lusiak (201)988-4488 09/01/2015 418417 00004. �........._. _.... - .__............. _w .. --__._ ..__ _ _�__...._ _ __.. _, . SERVICE STHEEM MLUNG GTREET _.. 345 Candlestick Road 345 Candlestick Road t � 11l SERVICE. CrtY STATE-ZEP _,._......_....._.,_. ,..,,.,�....,,..,..,....., , ....,.,, ,.,_._....__._.,.... , ,..e2WNG CI STAM.ZIP q ? _ .. .......... .... ....m..,,_.. . _. 1 North Andover, MA 01845 North Andover, MA 01845 t (, . i d4�.:✓.•t JOB DESCRIPTION PHASE ONE - Proposal for this calendar year. �» $0.00 AIR SEAUNIGr Provide labor and materials to scat areas ofyour home against wasteful, excess air leakage. This work will be performed in concert with the use orspexial tools and diagnostic tests to assure that your home will be left with a heatfitui level of air exchange and indoor air quality. Materials to be used to seal }sur home can include caulks, foams and other products, Primary areas for scaling include air teakage to attics, basements, attached garages and other unheated areas (window's aro not generally addressed.) This will require (8) working hours. A reduction in cubic feet per minute (cfin) of air infiltration will occur, but the actual number of cfm is not gumanteetl. 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 orthe indoor air quality. $680.00 AIR SEALING: Provide labor and materials to scat areas of your home against wastefut, excess air leakage. This work will be performed in concert with the use ofspeeial tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seat your home can include caulks, foams and other products. Primary areas for scaling include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) This will require (4) working hours. A reduction in cubic feet per minute (cfm) ofair infiltration will occur, but the actual number of efm 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, $340.00 AIR SEALING ADDER: (4) working hours. $340.00 KNEEWALLS: Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to ('202) square feet of kneewall area. $707.00 KNEEWALL FLOOR: Provide labor and materials to install a 6" layer of R-21 Class I Cellulose added to (164) square feet of open knecwall floor.. $196.80 ATTIC ACCESS: Provide labor and materials to insulate (1) back of tlme kneewall hatch with 2" rigid Themmax board, and seal the edge ofthe hatch with weatherstripping. $60.00 ATTIC ACCESS: Provide labor and materials to install (1) cusity moved, insulating cover for the attic access folding stair. A small fiat surface orplywood will be created around the opening within the attic, This will allow the cover's integral w athcr-stripping to restrict air leakage. $237.65 VENTiLATION: Provide labor and materials to install (2) insulated exhaust hose to existing bathroom rnn(s), $100.00 Federal 10 # RISE Engineering RI Contractor Registration No MA MA Contractor Registration No A division ofThieisch Engineering CT Contractor Registration No 60 Shawmut Unit #2, CNIA 02021 Canton. CONTRACT `. 339.502-6335 FAX 339-502-634t5 R I S Page 2 PROGRAM CNiA-HES EENNIIM.F.ERINAOAAND THE CUSTONTEREDMFDRBETWESINIFO KsAS E is C I NEE RING OeSCRIDED BELOW .............e..............,...._..___ ........ .............,.,....._.._... ..._......_.,,......_._..,_.,..,......_._....,....... _.. ,._ ..._.. ..�._..._......_..._.. .,. CUSTOMER PHONE DATE _ CUE" 0 .__. WORK ORDER Christyiusiak (201)9884488 09101P2015 -t3fl SERVICE STREET BILLING STREET^ 345 Candlestick Road 345 Candlestick Road a— __..... _.... .... .......4 I SERVICE CRY, STATE, ZIP INLUNO CTIM STATE ZIP2 21915 4 North Andover MA 01845 North Andover MA 01845 ; 1 JOB DESCRIPTION VENTILATION: ILATION: Provide labor and materials to install ventilation chutes in (18) rafter bays to maintain air now. W $36.00 RISE Engineering will apply all applicable, eligible incentives to this contract, You will only be billed the Net amount. Currently, for eligible measures, Columbia Gas offers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 1001/a For the Air Sealing measures up to the first $680 and an additional $340 ifsavings are justified by the auditor. For the safety and health ofyour home's indoor air quality, we will be conducting a blower boor diagnostic of the available air flow in your home both before the work is begun, and after the weatherization work is complete. We will also conduct a Rill assessment of the combustion safety ofyour heating system and water heater. This has a value of S90 and is at no cost to you. Total allowable weatlicrization incentive is $3,11 O. 590.00 Total: $2,787.45 Program Incentive: $2,363.08 Customer Total. $424.35 WE AGREE HEREBY TO FURNISH SERVICES . COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE Salt OF ***Four Hundred Twenty -Four & 361100 Dollars $424.36 UPONFIKAL NAND AI By MSE-EEMNO. CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF i% WILL BE CHARGES MONTHLY ON ANY UNPAID ce R EC DAYS. S R ET UIPORTANT INFORMATION ON GUARANTEES, MGM OF RECISION. SCNEDUUNG, AND CONTRACTOR REOWMATM. _ DO NOT SIGN THIS CONT..... .. . �_...�........_. _ _.,.____ _ RACT IF THERE ARE t , tANtt SP CE AU SIONA:URE •, S ng CUSTOMER ACCEPTANCE ROTE THRI CONTRACT AY WITHDRAWN DYUS IF NOT EXECUTED WITHIN DATE Of ACCEPTANCEM " //J ACCEPTANCE OF CONTRACT. THE ADM Pffittk SPEMCAT10NS AND CONOntONS ARE 3t) SATISFACTORY To US AND ARE HERESY ACCEPTED. YOU ARE AUTHORIZED TO 00 THS WORK AS SPECIFIED. PAYMENTW" BE MADE AS OUTUNED ABOVE m 17 FTv f VT. 00 =-11, , owner of the property located at Cr 40C - (Property Address) hereby authorize (Subcontractor) � I , 7111 "M SEP an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my properly. /1-11 Dots The Cornmonveaxlth of Massachusetts kvDepartment of IndustrialAccidents Orke of Investigations I Congress Street, Suite Ili Hoston, MA 02114-2017 — tvw muss gat{1dhz Workers' C€ mpensation Insurance Affidavit- Buflders!Contractors/Electritianst.Plumbers Applicant Information Please Print Lelizvft Name 4 trsittxs� i tiaxta lrtclavidu$ti) � Ld Addwss. So 13 x 344 am Art you an etnpinsO Cltecit the appropriate fix: 1. M I am a employer with, S 4. 1 am a general contractor and I cmpl •t (full and),or part -tine * al] 1 am a sale proprietor or partner- ship and have no employees working for me in any capacity. [No rkors° tempt insurance required] 10 1 am a homeowner doing all wont myself: No workers' comp. insurance required- t have hired the sub -contractors listed on the attached sheet. i'h Cott€ aete�rs have emplv5 and have workers' cramp. insuraam.a 5- We are a corporation and its officers have c_�ercssed their right of exemption per MGL C. 152, § 1(4), and we have no employees. fNoworkeW comp. insurance required.]I MU ,rype or project i mqulired); 6, New cctmMiction T Inc ling. S. [3 Derrtcalition ;i- [3 Building addition 10, [) Electrical repairs or additions 1 l .[3 Phunbing rcpai s or additions 11[3 Roof repairs 13,13 Othr 'Arty applkant that ncvc4 b 41 s2istat atm roll out the wxi= Wow �howing lhmf peficy information- 1 nfor nation_+ Homemvnm who suirmit this a(Fi iavit indwa itag they are doing alt wo* at,sF *= him outO& r -aa tamest submit a new affidavi I sindicALing, writ. �Conwcwn that clink this box must amwbal ar additionil stat showing the Deanne of the uAtmem a act and state, wbether of testa those Cnfi cs have rmpbym- it the sutra -cera t &* s, a tey must pr&ride t: rat t rc ' arra tn, tit a urt tacx. am an empdhpurtiab site zsaf:�rrnatt�. Insurance Company Policy # or Self -ins. t:ic. � .. � O.?l 3 1.)__..... Expiration Date:��t� job Site Addrm,. 3 `t s "4 CifStat ip or- , cQ,� ► e�S Atiach a copy, of the wasrL-ml compensaltion policy declaration pale (showing the police number and capiration date). Failure to securecoverage as required render Section 25,A of MGL c. 152 tate lead to the imposition ofcriminal penalties of f ne up to $1,500.011 at car one-year imprisonownt, as wcll as ci vil penalties in the formofa STOPWORK ORDER and a fine ofup to $250.00 a day against the N iol;ator. Be advised that a copy of this: statement maybe forwarded to.the Office of hivLstigations of'the DLA 'or insurance coverage 'verification - I do hereby turfy under *e pains and penalriex ofpajury that the information provided abvvv is true and comet. D tc° -phone ; S's- 1111d 3 Official an only. Do not write in his area, to be completed by rite or town official City or Town: Permlo-imnse # ruing Authority (Artie one); L Board of ;health 2. Badding Department I City own Clerk 4. Electrical liuspector 5. Plumbing Inspector ti. Other Contact Petra: Phone #: ! CERTIFICATE OF LIABILITY INSURANCE yes THI§ CUMFICATE 15 ISSUeD ASA AATTK CSF 174FMMATXM ONVf AND C ONFFEAS NO WGtVS UPON DER THIS CUMFICATE DOES MOT AFF'"ATfVEs Y OA N%A ELY 0400, O ND OP. ALTER TCOVERAGE JlMROE3 BY THE POLICIES BELOW. TMS CMIRCATE OF DOE$ NOT COUST "T A e r CT MWEEN THE ISWNG t REACS;, AUTMAMED PURESEWtetl4 OR ER, AND Tf afLnflCA°RTa IMPORTANT; U ttWuEtWiCate GU9 r. ata AM MOML" INSURED ttae PtA%l crau3't tme ERz3$Q,�, 77 97MM-APION IS t£3AEVEx'1, jEtt to tt terms " wncfcri s of the poky, C Cam PoRdn may *egu 3i"nWrA. A MtFn*M on M s ceniflcW, don riot wnW riptAs b the tecwhate hottfe In lieu of vichPROMMM �a race). Chia Martin J bm A nW Enc SO Morthmptan St PO Sox SO Ho"" MA 01"i . Ass rind Risk. SeraaC .i - ' Y reNkBER _ �YY" v"! loxcomywj .. BAIW3iP:87Y t*autb*r Imaff"an bta as± i%bZGCAµiE9E 1pswk; >MAOtt asema F23arx%e-: vVVx"%euca fm; irr"A I = jw6qwfcw." : Ktvjblwmr4vp4Stw CI fsAT THE F Cif V T�Q HAVE 1M ASSUM TO T%�. tf�£ NW. . VP E " t1:5 pV CATEO, MSr iIfO.ANY REOLMEMIENT, TEti7a# OR CONDO** QV AW C T OR 07 n+a T SW$tfi RESPECT To 4' 41C" T S CERTMCwA SMAY be fSSU-00 ORMAY STAN, THE MSURANC6 MTORDE D SY ThE POLIOES OLSMSED flPMW M SURJEC& TO ALL T)aE TERM Ex "°b.f f.S� AND CONOrrx OF StX" POLWXS, L 4iTSSHOW i WAY KM)E BE ;w -D #:mBYPAM CLAN& T C* r as .i - ' Y reNkBER _ �YY" v"! loxcomywj .. BAIW3iP:87Y i%bZGCAµiE9E $. 4"Tc nmlaonkA41-ov - S eiE'MP9i $S3RN3 44/A1,7' Optalospi, �..... 00 2 Mi.Ca�"F/iin �rt"Lwa ALMS eW:R4.Y i1c: J4Y SFM tiLY ,Y+r„rn.�nww a a'SU E. 3.`x43 a IICL7flR.__ Ll £!v'#C S 2 s A cFF CR. Jf'2h`�h '1 6xi'Mt+en €3Tt r ±!�-trY+e mta2et Its PMOW taex is iawio16 ',.Et EAc-"A kJ. "z 10r/Y ;ti -E Ar�R L^fA�ta'1zsaatiY: SRT} TUT RMUM{jNp .. _..... cksmsuft ShOULD AW, e AbOlt OESaCSi3i$ED PG rrIE$ ED rAE EX..P3RAT*N DATE HEREOF, ! Mri t WLL BE i ,%jPMf rV s tE{Aashbigto ► .Stre*t W"tbwo"t4 MA 01S81 t d 25 ( 0iwos) 8UC 1139 AC 40RV CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 P. O. BOX 989 Holyoke MA 01041-0989 CONTACT Nancy Usher NAME: y _PH NE Ext: (413)536-0804 FAX No�_(413)534-7874 ADDRIL _ INSURERS) AFFORDING COVERAGE I NAIC # INSURERA:Nationwide Mutual -Harleysville NATIO INSURED Gauthier Insulation 44 ESSEX ROAD IPSWICH MA 01938 _ INSURERB:Allied World Natl Assurance Co INSURER C: D: -INSURER INSURER E: _ 1 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. INS LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR GE TO RENTED 50,000 rPRREISES (Ea occurrence)_ $ EXP (Any one person) $ 5,000 X GL43487F 7/6/2015 7/6/2016 ONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO [7]LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE $ Per accident) NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ 1 AGGREGATE $ 11000,000 B EXCESS LIAB DED I I RETENTION $ BE020792125-194985 10/18/2014 10/18/2015 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N I PER I I OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSUREDS) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 FRANCIS AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MrvdIfb9tbd with pdfFactory trial version www.pdffactorV.com - 1 w co a � wrg i'IMI d cn a, m �. CT O CD rn co 3 FA I Q CL 1 a � G �