HomeMy WebLinkAboutBuilding Permit #722-14 - 35 MERRIMACK STREET 4/15/2014ENO
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ' G[ -- I I Date Received
Date Issued: 41
h I i`T
I IIMPORTANT: Applicant must complete all items on this ease
LOCATION—
PROPERTY
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MAP 210 641
PARCEL:_
Print
ZONING DISTRICT:
Historic District
Residential
Non- Residential
New Building
Machine Shop Vl
Q�ST�,lC '6''NO\
i'r a., �'• 6 pL
0
p
4L
yes no
ves , no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
✓ One family
Addition
Two or more family
Industrial
./Alteration
No. of units:
Commercial
Others:
Repair, replacement
Assessory Bldg
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
RQ P1 aCP, 03UW'Q b00
or Print
OWNER: Name:
Arirlracc•
CONTRACTOR Name: cp r S rc e i Co. Phone• 031 -'&N -44V
Address: � ,e\(\t,Salem, mnq
Supervisor's Construction License: 92-) 3b Exp. Date: - ',-�, f ao %o 1 LQ
Home Improvement License:. t i tau Exp. Date: �2 ;
FA
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: $ 4 SO(loo FEE: $ +,h
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaran f
z
Signature of Agent/Owner u a Signature of contractor
0
Plans Submitted Plans Waived Certified Plot Plan Stamped F ns
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 Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
1
Planning Board Decision: Comments
c
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osqood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no.
Located at 124 Main Street
Fire Department signature/date
COMMENTS
foe
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 - Date
Doc.Building Permit Revised 2010
Building Department Nwt
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/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
Location �3L% -e �� `�e-�'jL—
No. Date ,+ h
Check # I 1 I
r
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee L
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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Owner's Nam
Job Address:.
SIDING - WINDOWS - DOORS
Phone: _
F l O dA JJ d
Lisa Breen 978-682-8381
35 Merrimack St,
North Andover; MA 01845
Cell# 978-815-1199
amr y wne n perate - r,
^.:e the u.vnerlsl or the premises mentioned below hereby contract with and authorize you to `,,m �h ac necessarymaterials, labor and :vorkmanship,
!o instal', cons!ruct and place the improvements according to me fo'lowing specifications. term and conations, on premises below described:
Brand:
Vinyl Shutters
(WINDOM SPECIFICATIONS
Provide Container and remove all
debris
Quantity: Build
Roof
Tie Into
Overhang
Low -E
Argon Screens
Metal PVC
Grids Trim Trim
New Inside
Finish
TOTAL $
yS�C'' co
Color:
Fluted Post 5%
Vinyl Fixture Accessories if needed
PVC Trim
Traditional Post 51/2
4' Corners
HIC ♦ / Registration • ^ CSr M
Yes No
Yes No Yes I No Yes No
Yes No Yes No Yes No
Yes No
611:cn Cie WOW! or rind m:'Ke, n advaoce,lo order and'or othemse obtain d0very of specof order
Double Hung
plat: ':s :.'.d tq. _:.m-n,.e 2tdpypr!-Jags ". '
Auttwnred soviure Y
Acceptance of Proposal - • _ cw- *' e p'.n; 7: ;peed; aborts and 001&01's salad. I understand that upon sgn!ng,ttt p•oposai berumes a b'111.1g cor ac! You are aumw¢ed to do the work as:geci!'~i. Payment w 0 be merle
as Cu!' -ed above. You,the auys.,may cancel nits transaction at any time prior to midnight of the third business day after an date Of this transaction. Cancellation must be done in writing. We reserve the
1/3Deposit$
Picture
DO NOT SIGN THIS CONTRACT
Slider
IN WITNESS W . O l the rties h eunto have signed their names this
' _day of 'J� 11 po
Signed_. _ _ _�
Astru.;^e Chargo x2%oft"auaio~a 0.^.`ncep.r maim w.! he coded to b.; .^,:a,r not
1/3 Startof Job $ / SU a (2,
Bow/Bay
Signed
Carden
-- ___--
Y9;.l em the (TwMr
_ :v9;h$�7.�%y Arb::;a'ralrh;rgo raadd:�g rpr�.phs'e rc'.erdm�Mriy7,•mtndumpsler
`— _
1/3 Balance Upon
t rL'
Cas/Awn
Completion $
NOTES:
,5 '-F
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10,,'Xcf.
S'- it Gt 041:
— fi�ic:
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/21
Mdir aJr N."( j
(SIDING) SPECIFICATIONS
Apply— _over body area of house. Type of insulation _
Strip off Existing Siding
Vinyl Shutters
Roof
Provide Container and remove all
debris
Window Mantels
New Gutters
Cover Fascia & Soffit
Door Surrounds
Gutter off & on
Door Window Casing
Ceiling
Fluted Post 5%
Vinyl Fixture Accessories if needed
PVC Trim
Traditional Post 51/2
4' Corners
HIC ♦ / Registration • ^ CSr M
Noce tko a9reemeot for harm imprm -me-91 owraceng wane shy'. require a dovrn payment (advance
a2dpr
d:pol of n r e man -504; of Our 1,0131 con'!srA fxza or the tutal amount of aldeposits or payments
Name of sa n
611:cn Cie WOW! or rind m:'Ke, n advaoce,lo order and'or othemse obtain d0very of specof order
plat: ':s :.'.d tq. _:.m-n,.e 2tdpypr!-Jags ". '
Auttwnred soviure Y
Acceptance of Proposal - • _ cw- *' e p'.n; 7: ;peed; aborts and 001&01's salad. I understand that upon sgn!ng,ttt p•oposai berumes a b'111.1g cor ac! You are aumw¢ed to do the work as:geci!'~i. Payment w 0 be merle
as Cu!' -ed above. You,the auys.,may cancel nits transaction at any time prior to midnight of the third business day after an date Of this transaction. Cancellation must be done in writing. We reserve the
right to check your credit
DO NOT SIGN THIS CONTRACT
IF THERE ARE ANY BLANK SPACES.
IN WITNESS W . O l the rties h eunto have signed their names this
' _day of 'J� 11 po
Signed_. _ _ _�
Astru.;^e Chargo x2%oft"auaio~a 0.^.`ncep.r maim w.! he coded to b.; .^,:a,r not
Yos. I am the Owner
p:9 a-irdn9 to Pmts o!cmtrm^t or, comw;ion o(rw,,,,a Maa;mum hold back 70%
ON START OF ALL JOBS -HOMEOWNERS MUST REMOVE ALL ITEMS FROM WALLS & SHELVES
Construction related permits: if the homeowner obtains his own construction-reiated permits for the work described unit this agreement ilhe homeowner is hero by advised
that in the event of dispute, judgment and nonpayment of the contractor the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by
Chapter 142A, M.G.L.
WARRANTY Year fU vws y unupk'sn c'sl s u wnpy w;Vi tl.
nRwe AWTI WectnwakrL:nu"porrr^'2rti:,•or&nager,::MbY"s Y� or gr, Sed_tae'eer.th.none ye:rafhxrmi,. n,cr r 1x1".a cit a �^nr K ..^rr cav�erpona,fa'�C•.Y'f+��me']y,repay,caract,reDlaceac2Jrebbercmee.-^d.rCpa:ed,arap%aCMe,x,hd. .':t; ma,unC.sorworkTans!!p.ThdforegekgxaTanePs
s, . o . • • -X- an (R r r n t c r v m -)y w'h ",is'2'�J-upon work. No gcarntoe m gutta bade up n roof,no guaranies on Ice � up and ro guarw,^e on IMI., M v7; S'd �g BROOKS docs oat do any PCL't a s:: n^g.
EitOr'1'.:.. Ii -pa•- p . w �� Crr^.' ac a can: >cea aFrd erg cor•7d r ,t",+n9 from a Uae ro Pte ex,tirg coM:tbrs. BROOKS i:. not resp=ds'Or a^y "^n xgad `ar. of ex ,+.:ig vrolk. 8 rot:".cd wxd's round En zddl`ona� cn.:rge
v, De rr a °nOC•t, . ;-;)c y NP. -CM -1 piss MWKS ar not recppnLta.o for ri or m :dew. A: x27artes or guawilees rew a Deck to 'hi rmm. ac,arar Un(fX &LIGh rrsm"x* .rss warra^"m 1ne Owrk, mcy be recii,..ed b
1'.',. - , , I * - n u ;'^ t. 'Y �C a Ory 2M U:9 Ol toren eryL� menf n ader'n aCJYat2 sucn warren^a$ NO nglHy "itW,A [!P hP. d bxk due to TT� _^.:ff s SC'Y:CC:nd fapalr. 1 n9 fk:-iGY'S ta':lfe'A 1"VA ,n a'Bgl,ier
not crcale any res sd N qty M the comwor io wxasty such equ'pmer.!. MkOACTLnER BLARANTFFs LABOR AND MATEn:ALS,WOT BROOKS SIO'NG. A sW.ce
M. c, `.° 'pr J 0... •.^: p^ .a�� w dr antled ro ba'vxe Nrrot p_'d acwrd'rg to tem, s of confract an cvrn,'e!ron of ca•hact Mrxrmum hdd 0.^ck t D;e rexr..n;ng 4Fance a last payment nor clkrveramamt is gess
w ed Add Non ch-rga taadd.v non-A site rc.:atee mated,:>c� Into dumpYec
TOTAL.$
Brooks Vinyl Siding • Windows • Doors
Payment to be made as f0ows.
Name of Contractor/ Desgnated Registrant
1/3
254 N. Broadway - Breckenridge Mall
t$. . -_ , Upon signing Contract;
Street Add -
1/3 I$_�_ _ _ _ . _ _� Sten or Job
Salem, NH 03079 (603) 894-4488 www.brooksswd.com
Cay/Stele PMne waneu,
1/3 is _ _ _ _ _ _., Ba!ance upon completion
101682 99730
Nc!- 4 C, ncr W Aft -1 Dai'. 5" of R'm.:'::sg 8^'c^Ce ` Non-ROfundab!P.
HIC ♦ / Registration • ^ CSr M
Noce tko a9reemeot for harm imprm -me-91 owraceng wane shy'. require a dovrn payment (advance
a2dpr
d:pol of n r e man -504; of Our 1,0131 con'!srA fxza or the tutal amount of aldeposits or payments
Name of sa n
611:cn Cie WOW! or rind m:'Ke, n advaoce,lo order and'or othemse obtain d0very of specof order
plat: ':s :.'.d tq. _:.m-n,.e 2tdpypr!-Jags ". '
Auttwnred soviure Y
Acceptance of Proposal - • _ cw- *' e p'.n; 7: ;peed; aborts and 001&01's salad. I understand that upon sgn!ng,ttt p•oposai berumes a b'111.1g cor ac! You are aumw¢ed to do the work as:geci!'~i. Payment w 0 be merle
as Cu!' -ed above. You,the auys.,may cancel nits transaction at any time prior to midnight of the third business day after an date Of this transaction. Cancellation must be done in writing. We reserve the
right to check your credit
DO NOT SIGN THIS CONTRACT
IF THERE ARE ANY BLANK SPACES.
IN WITNESS W . O l the rties h eunto have signed their names this
' _day of 'J� 11 po
Signed_. _ _ _�
Astru.;^e Chargo x2%oft"auaio~a 0.^.`ncep.r maim w.! he coded to b.; .^,:a,r not
Yos. I am the Owner
p:9 a-irdn9 to Pmts o!cmtrm^t or, comw;ion o(rw,,,,a Maa;mum hold back 70%
Signed
rem:: rrg bar^nee a !:,"l cel nr:;a wfa.dvtty rrnount .s rasr or tht 2% w wee chcrge
-- ___--
Y9;.l em the (TwMr
_ :v9;h$�7.�%y Arb::;a'ralrh;rgo raadd:�g rpr�.phs'e rc'.erdm�Mriy7,•mtndumpsler
`— _
Ot
Massachusetts - Department of Public Safetj
Board of Building Regulations and Standards
Construction Supenisor Specialh
License: CSSL-099730
MARK DIPRIMA;
r "
18 HAWK DRIVE
SALEM NH 030779
l �
d[o;. ` `:` �'
expiration
Commissioner
02/20/2016
. .. I;.
Office of Consumer Affairs & Business Regulation
}TOME IMPROVEMENT CONTRACTOR
Registration: 101682 Type
Expiration: 6/29/2014 Supplement
BROOKS CONST. CO., INC. OF LAW
MAR DI PRIMA
254C N. BROADWAY STE 110 « —
SALEM. NH 03079 Undersecretary
J,
View Worker's Affidavit Page 1 of t
The Commonwealth of Massachussets
Department of Industrial Accidents
Office of Investigations.
600 Washington Street
Boston, MA 02111
www.mass.aov/dla
Workee s, Compensation Insurance Affidavit: Builders!Contractors/ElectdclansPlumbers
Applicant Information Please Print Legibly
Name(BusinesslOrganizationlindividuai): Brooks Const. Co. Inc. Address: 254 N Broadway
CitvlState2io: SAip_m NH o An7A ohnng&- A 1R_RAd-AARR
Are youan em to er? Check the appropriate box'
1. tam an employer with 4 erripbyms (full and/ar part-time).'
2. 1 am sole proprietor or partnership and have no employees working for me in any capacity. [No worker's comp. insurance
r uired
3. U I am a homeowner doing all work m self. No worker's comp. insurance re uire +
4. I am; general contractor and I have hired the sub -contractors listed on the attached sheet.++ These sub -contractors have
worker'scomp. insurance.
S. U We are a corporation and its officers have exercised their right of exemption per MGL c. 152, S 1(4) and we have no
employees No worker's con . insurance required)
Type of Project (required)
6. r New Construction 7 r Remodeling 8. r Demolition S• Building
dd'ttion
1
10. r 9ectrical re airs or additions 11. Plumbing re airs or additions 12. 1 Roof re airs 13. Other
*Any applicant that checks box #1 must also fill out the section below showing their worker's compensation policy information.
+Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new
affidavit indicating such.
++Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their worker's
oomp-_policy Information.
I am an employer that is providing workerls compensation insurance for my employees. Below Is the policy and job site
information.
Insurance Company Name. xcelsior Insurance
Poli N or Sell -ins. Lic. #: 8836275
Expiration Date:
Job Sine Address: M CK
Cityfstatwip.
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 form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Se advised that a
copy of this statement may be forwarded to the Office
of Investigations of the DIA for insurance coverage verification,
i do hereby c/elrrrtty un �,andpenalties of pelf ury that the information provided above is trite and correct.
Signature. UV1 Date. �i/t 1 Ick
Phone#: b W38
Official use only. Do trot write In this area, to be completed by city or town official.
City or Town:
PermitlLicenseft:
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4 Electrical in for 6 Piumbin 1 t 6 Oth
Contact Person:
Phone *
pec g nspec or er
http:l/permit.citvofinediuen.net/PrintwTkaffidavit.asp?app id=6234&process id=2... 7/31/2009
`--�
L.. R CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
2/25/2014
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(les) 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
INSURANCE SOLUTIONS CORPORATION
60 Westville Rd
Plaistow NH 03865
CONTANAME: CT Linda BogdanowicZ
PHONE-TF—AX(603)382-4600(603)382-2034
E-MAIL
ADDRESS: lindab@isc-insurance.com
INSURERS AFFORDING COVERAGE NAIC #
INSURERA:PeerlesS 24198
INSURED
Brooks Construction Co. of Lawrence
DBA Brooks Vinyl Siding, Doors & Windows Co
254 N. Broadway
Salem NH 03079
INSURERB:EXcelsior Insurance 11045
INSURERC:
INSURER D:
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER:CL1391613110 RFVISInN NIIMRFR-
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
LTR
I TYPE OF INSURANCEADDLSUBR
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
GENERAL LIABILITY
}� COMMERCIALGENERAL LIABILITY
CLAIMS-MADE5Z OCCUR
BP8945793
/16/2013
/16/2014
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTE
PREMISES Ea occurrence $ 100,000
MED EXP (Any one person) $ 15,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY JECT F-1 PRO LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS NON -OWNED
AUTOS
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person) $
BODILY INJURY Per accident $
( )
PROPERTY DAMAGE
Per accident $
$
UMBRELLA LIABOCCUR
EXCESS LIAB
HCLAIMS-MADE
EACH OCCURRENCE $
AGGREGATE $
DED RETENTION
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
C8836275
/16/2013
/16/2014
X WC STATU- OTH-
E.L. EACH ACCIDENT $ SQQ 000
E.L. DISEASE - EA EMPLOYEE $ 500,000
E.L. DISEASE - POLICY LIMIT $ 500 000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
"� • • •� •"^ "'""-�` GANGtLLA I IUN
Breen Funeral Home
35 Merrimack St
N. Andover, MA 01845
Arnon ne MA4AIna1
IN'-' 025 rgntnnm m
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
th Maglia/LJB�-7 —
v Ta0t%-ZUTU AUVKD GURPORATION. All rights reserved.
Tho Af`r11011 name and Inn^ aro ronlafcrerl manta of Ar non