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HomeMy WebLinkAboutBuilding Permit #561-12 - 40 HITCHING POST ROAD 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �b f Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION O r D Print PROPERTY OWNER ��r' `b Ck( �5 t Pri t p MAP NO: PARCEL: �� ZONING DISTRICT: l Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial kAlteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition ❑ Other q'Septic ❑Well Floodplain ❑Wetlands WatersliedDstnct (]:Water/.Sewer _,1---. _. DESCRIPTION OF WORK TO BE PERFORMED: 6,r\ ` 51� o.�e �- --o crea, e- ;3 D a e_e_ -;3Dace_ Illentification Plg �-(ase Ty�or Print Clearly) OWNER: Name: G�f- ` C� r d e.5 5^1 Y1 ( S/1 Phone: Address: AC) t-�� � \ c o S-" �A, � R rt �C� l� �t © iq 5 CONTRACTOR Name: Re-en Q—a) y41 C),r\ CO , Phone: 7?--(0 9 ) - 5 2 i y Address: .Z.\ e � % ` I - Supervisor's Construction License: '7 (, 9` Exp. Date: _�1� (.Zt J� Home Improvement License: (CSS 3 3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.'$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5 51 d 5, c FEE: $ _c0 (� o , 00 Check No.: (�- t 4 3 Receipt No.: 2S` � 7�e NOTE: Persons contracting with unregistered contractors do not have access to t e g ara fund Signaturerof Agent/Owner nature of;contfactor. . 9 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 ❑ 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 a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Yn 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: Doc.Building Permit Revised 2008mi L 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 I i i �I ® Notified for pickup - Date Doc:.Buifding Permit Revised 2008 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 I 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 Water & Sewer Connection/Signature& Date Driveway.Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Location<//1 /7 ���I''^�S s AV No. s--6l ! /ZDate c /L NORTIy TOWN OF NORTH ANDOVER O F w 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 64o.(90 s CHUSt, 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6/g-�3 S 24974 Building Inspector NORTH _ T0VM 0 over . 0 VA No. - �, dover, Mass., � T O - LAKE �- COCKICMEWICK V o)'ATED P �CC �7 BOARD OF HEALTH Food/Kitchen ..PERMI .,T T D Septic System f BUILDING INSPECTOR THIS CERTIFIES THAT............................... yo >t.. ..... ........... ..... . '................................................................................. S Foundation has permission to erect.......... ..:. .. buildings on . ... cej : '� .................. Rough /" "� �� �J G. �'?�l r Chimney to be occupied as................... .... .............. ....... �.�.... � provided that the person accepting this permit shall in every resp t conform to the terms of the application on file in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR_ UNLESS CONSTRUCTION STARTS Rough ............................................................ .................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do- Not Remove Final 1 No Lathing or Dry Wall To Be Done FIRE.DEPARTMENT Until Inspected and Approved by the Building Inspector. TBurner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_ E F N n ly Sz 0c Jh Allcgs , Address: 9-1 H E W Ter City/State/Zip: D cJ t Phone#: Of 7 Are you an employer?Check the appropriate box: Type of project(required): 1.L"l am a employer with_1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] ;Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G t2t7 Policy#or Self-ins.Lic.#: Lt3 C O D 9'L q(n7 9 q a Expiration Date: ? Job Site Address: Gl0 P ccki n 5, Past P'A. City/State/Zip: k, /7)qd d1v—, N§ d t$4 5 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 the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cern td�erthDepain,�and� nalties ofperjury that the information provided above is true and correct Si ature: Z y / Z Date: 7 c Phone#: `-7 O • 3LO l 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 one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Massachusetts- Department of Public Safeh Board of Building- Romlations and Standards Construction Supervisor License License: CS 76691 ROBERT A KEEN 12 E WATER ST - N ANDOVER, MA 01845 Expiration: 8/16/2013 (l nnnissiuncr - Tr#: 3772 'vlassachusetts- Department of Public SafetN Board of Building Re!-ulations and Standar ds Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE N ANDOVER, MA 01845 fi- Expiration: 3/24/2012 t uuunuw,m'�' fr#. 20523 ��� _ � Office�t'�`o�mer airs dsiness egu a�,o� 1 _ HOME IMPROVEMENT CONTRACTOR Registration: ,X383 - ,:108Type: Expiration: $%1812012 DBA K CONSTRUCI`tnPl�g© Kenneth Keen 21 Hewitt Ave No.Andover,MA 018x5 -�-- Undersecretary KEEN CONSTRUCTION CO. GP agyp21 HEWITT AVENUE NORTH ANDOVER. MA 01845 PRgj Tel: (978)691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with Submittedt l the Commonwealth of Massachusetts. Inquiries about To: L _ .__ .... _ .............._ ... .. -.......... ._.._.... `� registration and status should be made to the Director, —D Home Improvement Contract Registration,One Ashburton - - �•- - I �_____.._._......__... Place, Room 1301, Boston, MA 02108 (617) 727-8598. � � Owners who secure their own construction related ' permits or deal with unregistered contractors will t' -._... ._ be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. EIN NO. '1 . -- q• I I # MA. H.I.C. 108383 26-0462904 > I C/S= Customer Supplied S+ I = Supply + Install See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: > Constr _�uc._.ti.on...........related....permits: _ — _ ,_. . . .......... - ------— .........................................._..........._.._........_.................................................................................................................................._............................................__..........................................................................................._................... _.,. .._ ........... ..._..._......... .. ......................................_...................................................................... ., ....,.................,,.....................................-................,.....................,,...............................,................................................................................_..........................._. WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contract r,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of t � F Payment to be r4ade as follows: dollars($S 3 5, ). ($ ) t!`j KENNETH B. KEEN / ROBERT A. KEEN upon signing Contract; } Name of Contractor/Designated Registrant ($ )Foricompletion �� imn � `' 21 HEWITT AVE. Street Address. - of N ANDOVER, MA 01846 C City/State - --- --- --- --- MGL c. 142A. PHONE DATE Z REGISTRATION NO. EIN NO. 3:212— (L Y�_'-- 53 q. I MA. H.I.C. 108383 26-0462904 > C/S= Customer Supplied S+ I = Supply+ Install L See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: .. t > Construction related permits: — ..•_.,,..,._.............._•.._-_-......w_.....--.,,..._....,......,..---------------------------------_....___.....................................................................................................................................................................,...........,......,.....................,...........................,....................................._............................... _...,. W._..._OR_....K. .SCH...............E..D......ULE.. .._.._._....._....... _........................... ................................................................................................................................................................................................................................................. .. ........................................................................ .._......... ..................... .__. Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period ofr�q f`- following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contrac r,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of ` _".- ___�`.,-- dollars($ Payment to be rJacle as follows: % ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant ($ )Von Tt ibn to, ' 21 HEWITT AVE. l Street Address �/ / N AN ° ,?$ mpletion of DOVER, MA 0184 \s City/State shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. Phone Fax Notice: No agreement for home improvement contracting work shall require a >down payment(advance deposit)of more than one-third of the total contract price Name of Salesman / or the total amount of all deposits or payments which the contractor must make,in advance, to order and/or otherwise obtain delivery of special order materials and A redgnature equipment,whichever amount is greater. Note: This proposal may be withdrawn by us if not accepted within days. Acceptance Of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Date Signature Date IMPORTANT INFORMATION ON BACK No- 21 HEW17`fi"AVE...., N. ANDOVER, MA 0184J& _. 978-691-5201"" K . 1 X ee nC omtrr.t ct'r Total cost does not include: D a Cost of permits ® Fireplace • Wet bar cabinets, electrical or plumbing • Bathroom • Stair components • Ceramic tile • Flooring materials rv „ ® Removal of Lally column o Changes required by inspectors Payment schedule,$2,500.00 due upon signing contract $7,000.00 due the first day of work plus.permit fees $8,000.00 due when walls are framed $6,000.00 due when rough electrical is complete $5,000.00 due when insulation is installed $5,000.00 due when plaster is complete $7,000.00 due when doors and trim is installed $5,000.00 due when ceiling is installed $5,000,00 due when flooring is installed $4,535.00 due. .when contracted work.ls complete Customer -B.B. Keen Date Date a Page 2 of 2 KEEN CON,STRUC'UON CO. 21 YEW17 T AvE. N. ANDOVER, MA 01845 978-691-5201 Ke .Ca- a�icc�ca�.Cc�:c;�vr�tf -- Pessinis, Karl &Cindy 40 Hitching Post Rd. N.Andover, MA 01845 978-686-5343 Contract#5033:,Appendix A Bate:January 17, 2012. Remodel Basement: • Frame walls to create approx. 1300 sq.ft. of.finished area as per drawings • Create soffit around center support beam and all HVAC ducts • Supply&install R-13 insulation in exterior walls Supply&install blue board on walls and plaster to smooth finish&plaster both staircases to smooth finish Install treads, risers, railing, posts and balusters of stairs* Wrap exposed Lally columns to match newel post •, Supply&install one 25-lite unit pair,two 6-panel unit pair and three 6-panel.interior door units (6-panel doors to be solid core Masonite with a smooth finish) • Supply&install two sliding or hopper style vinyl windows to replace existing units Relocate central vacuum unit to unfinished-area and add'two outlets to finished area • install ceramic file in entry from garage(approx.90 sq.ft.)* • Supply&.install Dune suspended ceiling with narrow track in finished area e Sgpply&install trim to match existing in remainder of house o Paint walls and trim (2 neutral colors,2 coat finish) • Install engineered"snap-fit"flooring* Electrical: • Supply&install twenty four recessed light fixtures(on dimmers except for general lighting) • Supply&install 20 position sub-panel. • Supply&install two zones of electric baseboard Beat • Supply&install one cable outlet and one HDMI cable to one TV area o Supply&install.PVC pipe chase from TV area to receiver area • Supply&install outlets:and switching to code *Materials have not been included and will be charged when customer has selected them. Payment will be due upon ordering, Total Price:'$55,035.00(fifty five thousand thirty five dollars) Page 1 of 2 8/22/2011 1:'36 PM FROM: Gilbert Gilbert Insurance Agency, Inc. T0: '+1 (;978)- 682-3231 PAGE: 0O1.OF 002 DATE:(MMIDDIYYYY) DM CERTIFICATE OF :LIABILITY INSMANCE 05/23;/2011 PRODUCER (,781')'942.-222.5 FAX {781)94.2-2.226: - 'THISCERTIFICAT.ElSISSUED_ASA MATTER�OF:INFORMATION . Gilbert Insurance Agency, Inc:: ONLY AND CONFERSN;O;RIGHTS UPON T.HE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOTAMEND;,EXTEND+OR- ALTER.THE COVERAGE:AFFORDED BYTH'E P..OLICIES BELOW: R'eadi'ng, MA 018.67-39.22 INSURERS-AFFOR.D)Nd-COVERAGE NAIL# INSURED Kenneth Keen & Robert Keen :INSURERA: NORFOLK &,DEDHAM. INSURANCE 23965 DBA: DBA ..Keen Construction Company INSiI ER B: Granite State- Ins. Co.. 0077 21 Hewitt :Ave. INSURER C: North Andover, MA: 01845 INSURER D: :INSURER£: - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE..BEEN ISSUED TO THE INSURED NAMED A80VE+F6R-THE POLICY PERIOD INDICATED.NANY REdlJ!IkIEMENT,TERM OR OTWITHSTANDING MAY PERTAIN THE INSURANCE A NDITION OF ANY CONTRACT O.R OTHER'DOCUMENT.WITH RESPECT TO WHICH THIS CERTIFICATE:MAY BE ISSUED OR FFORDED'BYTHE,POLICIES,D.ESCRIBED-HEREIN IS SUBJECTTO.ALLTHE TERMS,EXCLUSIONS,AND CONDITIONS OF SUCH P.O.LIEIES.AGGREGATE LIMITS SHOWWMAY HAVE.'B.E.EN REDUCED 9Y"PAID CLAIMS. INSR DD'INSREITYPEOF.INSURANCE POLICYNUMB.ER POALICYEFFE&We POLICY•EXPIRATION- LIMITS GENERAL LIABILITY ND P-01007.8/000 0.3/13/201.1 03/13•/2012EACH OCCURRENCE $ 1,000,000 X COMMERCIAL,GENERAL LIABILITY _ DAMAGE.TSE O RENTED `$. 5O,OO .CLAIMS,MADE a..00CUR.i _ .-. MED,EXR(Any one person) A .. - PERSONAL&ADVINJURY ;3 1. OOO':OO :. GENERAL AGGREGATE OOO,OO,, GENI,AGGREGATE LIMIT:APPLIES PER: :. PRODUCTS-COMP/OP AGG $., 2,,000„OQ X 'POLICY EJ ` lOC . . .. AUTOMOBILE IIABILfTY - COMBINED SINGLE LIMIT ANY AUTO $ - (Ea accident) ALL.OWNED ALTOS - - - - SCHEDULED AUTOS - BODILY INJURY $_ ;(Per.person) 'HIRED:AUTOSBODILY . - NON-.OWNEDA (PevacUTOS - INJURY $ - .(Per�dcddent) PROPERTY DAMAGE $. (Per:accident): GARAGELIABILITY AUTO ONLY-EA ACCIDENT ;$ ANY AUTO OTHER THAN EAACC'. $. _ . - - AUTO`ONLYc AGG ,.$.. -':EXCESSAIMBRELI-ki- BILITY EACH OCCURRENCE $ OCCUR DCLAIMS MADE : AGGREGATE DEDUCTIBLE RETENTION W00096I i-,4,6942, 08/03/2011. 08/0.3/2012: WORKERS,COMPENSATIO.N-AND - —."WC.S7ATkl�- � `O,TH= - - EMPLOYERVLIABILITY .WC CERT TO BE°MAILED. B ANY PROPRIETOR/PARTNER%EXECUTIVE .�:E.L.EACH ACCIDENT $. l0O 00 ' OFFICERIMEMBERD(CLUDEW DI ECTL'Y VIA INS CARRIER IPyes; E,L.DISEAsE-EAEMeLOYE -5 L00,.00: ? describe under SPECIAL'PROVISIONS:below E.L.DISEASE-POLICY. .LIMIT...$ :500,00: OTHER' .. . .. `. . DESCRIPTIONOFOPERATIONS)LOCATIONS/VEHICLESIE%CLUSIONSADDED,BY.ENOORSEMENTI SPECIAL PROVISIONS - - vidence of Coverage :CANCELLATION . SHOULD ANY.OF THE-ABOVE DESCRIBED POLICIESM E.CANCELLED'BEFORETHE EXPIRATION DATE:THEREOF,THE.ISSUINGINSURER.WILL,ENDEAVOR TO`MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE,TO MAIL SUCH-NOTICE,SHALL IMPOSE:N&OBLIGATION'OR•LIABILITY OF.ANY KIND.UPON THE INSURER'ITS AGENTS-OR REPRESENTATIVES. fV.ldenCE' Of COVOrageAUTHOM&DREPRESEWATTVE ` Mark Gilbert .CIC ACORD 25(2001108) OACORD CORPORATION.1988 1 - - ti ti r : I : ; ! i I , I , I I ' I i I I I i J I I I s - I I , _...... f I I 1 I I I I I ; I f ' 1 I 1 , I. I I I ; , i I - I I i I t i i. I I I I I i .J. 1 I I I I I I , I I I I 1 , 1 ! t i , T I -- - i �,!---- im -- — ---! --� - --r-----i -- - I I ' i I ; 7 I I li ; ' I �- I � I I i 1 T I I ! i I ( I � i ! ! , I —{--�--- _J � —L I �—. ---r—�— I •I I �— ' ---I--- 1 ' ------ -----— -- — ' - -� ._-