HomeMy WebLinkAboutBuilding Permit #790 - 405 JOHNSON STREET 6/13/2006NORTq
TOWN OF NORTH ANDOVER
* °�'�_... ,r •' APPLICATION FOR PLAN EXAMINATION
,SSwCHUS- /
Permit NO: 7 G O Date Received: U
Date Issued: C,
I IMPORTANT: Applicant must complete all items on this Daae
LOCATION :OfHK%0/tJ 157-)Wj5—:7--
Print
PROPERTY OWNER ?iCTL--/Q `'FI eZZ-IIM
Print
MAP NOAC A PARCEL: A
ZONING DISTRICT:
TYPE AND USE OF BUILDING
—,, ) e 0
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
Addition
Alteration
One family
11Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED CQW1144T eNr— �5W/LL G?fe*Cuv—
&xz# Aleg-4 iaJ AD p Algo L 57-44,c, 6714 0-A6 E
Identification Please Type or Print Clearly)
OWNER: Name
Address: 405 / i
CONTRACTOR Name: i?Almog/p i5T-,4cyt*,y-b Phone: ?Z8-457— jQk4
Address: 4i s>9 _ /�! '/�,e< r3�9-JFo2�� M D ,?35
Supervisor's Construction License: 053 5 w Exp. Date: 06 -/ 5— 07
Home Improvement License: 144, 2 Sto Exp. Date: 64 —// "' 0 7
ARCHITECT/ENGINEER Name: Phone:
Address:
. No.
FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$ x10.00=FEE:$ � 0,00
00 0
Check No.:
Page 1 of 4
/3ep�
Receipt No.: /I' C/ / 2
TYPE OF SEWARGE DISPOSAL
y
Tanning/Massage/Body Art F1Swimming Pools 11Public Sewer
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑
❑ Permanent Dumpster on Site F1Private (septic tank, etc.
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner.
Plans Submitted ❑
Signature of Contractor
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED DATE APPROVED
❑ �6 a
❑Water Shed Special Permit
❑ Site Plan Special Permit
Other
r `/h Y -Ile A&
DATE REJECTED DATE APPROVED
CONSERVATI ❑2('
COMMENTS
0
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
DATE REJECTED
FV—
Comments
Comments
I
DATE APPROVED
Water & Sewer connection signature & date
Temp Dumpster on site yes ,ono Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
DIMENSION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use
I VvI
Page 3 of 4
Doc IN'PF.CTIONAI- SERVICES DF.PARTMF.NT RPFORM05
Created JMC. Jan.2006
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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 P
❑ Mass check Energy Compliance Report
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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of 4
Location 4 A MS d `y/ "
No. 75�d Date , T
f
MORT� TOWN OF NORTH ANDOVE�.
O R
f � A
i Certificate of Occupancy $
a � •
S�s'.•o.r'<�
Building/Frame /Frame Permit Fee $�
s�CHust 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # / Jf<l
1 2//(f
1 building Inspector
The Commonwealth of Massaehuselts
Department of Industrial: lccidents
Office of Investigations
600 Washington Street
Boston, AM 02111
www.inass.gvv/din
Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name tnusiness,Orgall i /at i►milndividual): � J (.tel`/ oe (F
;address: 4E 15Q
City; StaterZip:�F;0 M4, Phone #• �%7,4-- X57'- /D
.r -
.ire you an employer? Check the appropriate box:
1. ❑ 1 am a employer with 4. ❑ 1 am a general contractor and I
mployees (.full and'or part-time).* have hired the sub -contractors
2. �l am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity. workers' comp. insurance.
[No workers' comp. insurance 5. [1 We are a corporation and its
required.]
3. ❑ 1 am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. [J New construction
7. [ZRemodeling
S. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
1311 Other _
`Any applicant (hat checks bus 1? I must also fill out the section below showing their workers' compensation policy information.
L homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
Contractors that check this box most attached an additional :,beet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance fur my emph�vees. Below is the policy and job site
information.
Insurance Company Name:__ -
Policy '' or Self -ins. Lic. 4:
Job Site Address:
Expiration Date:
C ity; State!Zip:
,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 %lGL c. 152 can lead to the imposition of criminal penalties of a
tine 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 tine
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.
1 du hereby car ' y --hider the pains azul pena�yrf �rry that the information provided above is true and correct.
Si
!Yjichd use only. l)n nut write in tlris nr %►, to hc� ,: n,►rplctcd b y r. iq rir rnrwr ,�lfic inl.
City or Town: P+a mit/License #
Issuing ,Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk t. Veetric,al inspector 5. f lumbing Inspector
6. Other
Phone #:
T abed 9L£9 £89 8L6 T£:60 900Z'LO Nnr
-7Truss
�R225
Inc., Biddeford, M
-1-0-0
t-0-0
7o,,sE:sETw
pe i I Pty
POST 1100
6_8-2 -------- -- 11-0-0 15-3.14
6.8_2 4-3-14 4-3-14
4x6 =
4
woos structures me - norm
19940747
Inc. Tue Mar 21 14:37:55 2006 Page 1
22-0.0 23.0-0
fi-6-2 1-0.0
LOADING (psf)
/
LOADING (psf)
I SPACING
5.00112
15,. 11
12
1.5x4 .
TCLL 63.0
Plates Increase
.. '
(Roof Snow=12.0)
- -..... 5 13
(Roof Snow --63.0)
Lumber Increase
1.15
(Ground Sno O.0)
(Ground Snow=75 0)
(Ground Snot ---90.0)
Rep Stress [nor
YES
TCDL 10.0
CDL 12.5
TCDL 15.0
Code IRC2003ITP12002
BCLL 0.0
F BCLL 0.0
14
BCDL 10.0
BCDL 12.5
BCDL 15.0
`--/
-- --
.5x70=._...'..=_' a
-
5x70=(5x10MT20
at 10 degrees
8
(5x10 MT20 a
J to member 2-8)
5x10 -
Alienate 3x6 = Splice Plate
at 10 degrees
to member 6-8
)12"
I
12' maximum
cagtilever.,
with 14'and 8' chord lumber-
maxi
cantilever.
m
TJ10-0 i _
11-0-0 - I
-----.----- 21-0-0
-----,*222-M'
1-0-0
10.0-0
10-0-0
1-"
LOADING (psf)
LOADING (psi)
LOADING (psf)
I SPACING
2-0-0
TCLL 42.0
! TCLL 52.5
TCLL 63.0
Plates Increase
1.15
(Roof Snow=12.0)
(Roof Snow 52.5)
(Roof Snow --63.0)
Lumber Increase
1.15
(Ground Sno O.0)
(Ground Snow=75 0)
(Ground Snot ---90.0)
Rep Stress [nor
YES
TCDL 10.0
CDL 12.5
TCDL 15.0
Code IRC2003ITP12002
BCLL 0.0
F BCLL 0.0
BCLL 0.0
BCDL 10.0
BCDL 12.5
BCDL 15.0
CSI DEFL in (loc) Ildefl Ud PLATES GRIP
TC 0.94 Vert(LL) -025 6-8 >999 240 MT20 1971144
BC 0.87 Veri(TL) -0.66 6-8 >396 180
W8 0.36 Horz(TL) 0.09 6 rda n/a
(Matrix) I Weight: 75 lb
TOP CHORD 2 X 4 SPF 210OF 1.8E TOP CHORD Structural woad sheathing directly applied or 34-13 oc pudins.
BOT CHORD 2 X 4 SPF 1650E 1.5E BOT CHORD Rigid ceiling directly applied or 74-12 oc bracing -
WEBS 2 X 4 SPF 165OF 1.5E
WEDGE
Left: 2 X 6 SPF 165OF 1.5E, Right: 2 X 6 SPF 165OF 1.5E
REACTIONS Ob/size) 2=146510-3-8,6=146510-3-8
Max Horz 2=87(ioad case 8)
Max Uplift 2=-666(load case 8), 6=-066(load case 9)
Max Grav 2=1761(load case 2), 6=1761(load case 3)
FORCES (lb) - Maximum Compression/Maximum Tension
TOP CHORD 1 -2=0158.2 -9= -2826/1152,9 -10= -26481!165,3 -10=-2422/1166,3-11=-1896/911,4-11=-17851924.4-12=-1785/924,
5.12=18961911,5.13= -2422!1166,13-14=-264811165.6-14=-282611152.6-7=0/58
BOT CHORD 2-8=-90412431, 6-8=-90411431 r<.
1
WEBS 3.8=-11321471, 4-8=386/101 -1
8, 5-8=1321472 NO 31927
NOTES (12) c Q
1) Wind: ASCE 7-02; 120mph (Q241n oc.; h-35ft; TCDL=4.Opsi; 8CDL=4.0psf; Category 11; Exp C; enclosed; MWFRS gable end zone )o yFGtS1
and C -C Exterior(2) -1-0-0 to 2-0-0, Interior(l) 2-" to 8-0-0, Exterion2) 8-04 to 14-", Interior(!) 14-0-0 to 20-0.0, Exterior(2) �SyivAl �Gti
20-0-0 to 23-0-0 zone; cantilever left and right exposed ; Lumber DOL=1.60 plate grip DOL=1.60. This truss is designed for C -C for
members and forces, and for MWFRS for reactions specified.
2) Wind: ASCE 7-02; 134mph @19.19in o.c.; h=35ft; TCDL=5.Opsf, BCDL=S.Opsf; Category It; Exp C; enclosed; MWFRS gable end
and C -C Exterior(2) -1-0-0 to 2-0-0. Interior(1) 2-" to 8-0-0, Exterior(2) 8-0-0 to 14.0-0, Interior([) 14-0-0 to 20-0-0, Exterior(2)
20-0-0 to 23.0.0 zone; cantilever left and right exposed ; Lumber DOL=1,6U plate grip DOL=1.60. This truss is designed for C -C for
members and forces, and for MWFRS for reactions specified.
3) Wind: ASCE 7-02; 146mph r@16in oc.; h=35ft; TCDL=6.Opsf, BCDL=6.Opsf; Category Il; Exp C; enclosed; MWFRS gable end and
"Exterlor(2) -1-" to 2-", Interim(l) 2-0-0 to 8-0-0. Fxtenor(2) 8-0-0 to 14-0-0, Interior(1) 14.0-0 to 20-", Exterior(2) 20-" to
23-0-0 zone; cantilever left and right exposed ; Lumber DOL=1.60 plate grip DOL=1.60. This truss is designed for C -C for members
and forces, and for MWFRS for reactions specified.
4) TCLL: ASCE 7-02; Pg=60.0 psf (ground snow); Pf=42.0 psf (flat roof snow); Ps=42.0 psi (roof snow); Category 11; Exp C; Fully Exp.; Ct=1.1
5) Unbalanced snow bads have been considered for this design.
6) This truss has been designed for greater of min roof live load of 19.0 psf or 1.00 times flat roof load of 42.0 psf on overhangs
non -concurrent with other live loads.
7) This truss has been designed for a 10.0 psf bottom chord live load nonconcurrent with any other lino loads.
8) This truss requires plate inspection per the Tooth Count Method when this truss is chosen for quality assurance inspection.
9) *This truss has been designed for a live load of 20.0psf on the bottom chord in all areas where a rectangle 3-6-0 tall by 1-" wide wig fit between the bottom chord and
any other members.
10) Provide mechanical Connection (by others) of truss to bearing plate capable of withstanding 666 lb uplift at joint 2 and 666 lb uplift at joint 6.
l 11) This truss is designed in accordance with the 2003 International Residential Code sections R502.11.1 and 8802.10.2 and referenced standard ANSI/TPI Mc -Ch
12) Drawing prepared exclusively for manufacturing by Wood Structures Inc.
MAP MAY 4"aaifq Lcaiynrwrrcrtrf¢raa --^.b X*TE; ON1111S R Dt.4_LODSO M- MY KF,FF.QF"R�a.GkS l3i?7473 apmW"!i9Y 4515 N. Outer Forty. ��
Design valid for use on slh MTek connec-ors. This deign is based o upon orarretas shove(, and for an indhfdual buldi co nt. ' Suite 8300
H su p en . P gn ^�%bne ChPsterfir.M, MO W071
App6xlally of deign Pexerreniras and proper hcorpororon of component is resporaDiity of bolding desgnei - not truss designer. Bracing shaven
is far laical support of ndMdual veb membersonly. Addihonoi temporarybracing fo insure stotAty du4"gconsfructian k the responvbaEty of the
AR
erector. Addianof pc monmt bra®rg of The -all st-lure is the responsibility of the bukting designer. For gerremt guidance regarding
labrkafron- qua5y contoi. storage. defNery. creation and bracng, aonw8 A /TPII Quality Qitesta. DS8.89 and 8611 BWdinp Component MTek'
Sofety lyda allon available fomTnrss Plate Institute. W D'Onotrio Drta. ModWt 'son, 53719.
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Page #.--j of pages INN
a 7 -
Proposal Submitted To: Job Name Job #
Address Job Location
Date Date of Plans
Phone # Fax # Architect
W=herebysubmit specifications and estimates for: fQlll _ _�,..U�-.f yL[L... _.. C...,? : L _
1_x11...{�..?l e./... r.r..`. ' -r .r....-`f>.....Pvf:i y�"p?
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1 Ltd t C;'Li/rxr�/ J-E.N.4��,k�3"�l1%
NC tr/ 7-1f la S7_/4.1 -L _ 4,44 4-A tt—DP17 -1.41V f,,YV, /17-1a
,FLQLlruM7,w 4/,, .4 Wb f .L._G . F �P.ort !/1/C r /��G. S t. .1 I�E�r,f S ..r _.... ��..t�ul ....... 1-?4aF1;Vlc...
Aire-, >9 1 rra�IUI.11
.......... .... ... .......
........
We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of:
$ r r2 1 «r l Dollars
with payments to be made as follows:
Any alteration or deviation from above specifications involving extra costs will be Respectfully
executed only upon written order, and will become an extra charge over and submitted�9
above the estimate. All agreements contingent upon strikes, accidents, or delays
beyond our control. Note — this proposal m y be withdrawn by us if not accepted within days.
Rcceptance of Propont
The above prices, specifications and conditions are satisfactory and are
Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above. _
Date of Acceptance Signature
eff, NC3819 MADE IN USA
ENERGY CONSERVATION APtPLICATION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
780 CMR Appendix J
Applicant Name: iQna�nG� Site Address: 465.7"ohnsoo Sf.
own:
eAd—
'B24t wo&.1> oi&—._ Use Group:
D( F-3 5 Date of Application:
Applicant Phone: 979— -3 74 -,0465 Applicant Signature:
Compliance Path (check one): ,
❑ Prescriptive Package (Limited to 1- or 2 -family wood frame buildings heated with fossil fuels only)
Package (A through KK from Table J5.2.1 b): Heating Degree Days (HDD65) from Table J5.2.1 a:
(For items d. through i., fill in all values that apply from Table J5.2.1b:)
a. Gross Wall Area
sq.ft f. Wall R -value
b. Glazing Areal sq.ft.
c.. Glazing % (100 x b _ a) %
d. Glazing U -value U_
e. Ceiling R -value R -
g. Floor R -value
h. Basement wall
i. Slab Perimeter
j. Heating AFUE
R-
R-
R-
R-
❑ Component Performance: "Manual Trade -Off' (Limited to wood or metal framed buildings only)
Climate Zone (ffi om Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14
Attach Trade -Off Worksheet from Appendix J, [and HVAC Trade -Off Worksheet, if applicable]
❑ AL4&heck Software
Attach Compliance Report and Inspection Checklist printouts
❑ Home Energy Rating System Evaluation
Attach Home Energy Rating Certificate (HERS rating score must be 83 or higher)
❑ Systems Analysis OR ❑ Renewable Energy Sources
Attach Mass Registered Architect or Enincer Analysis
A T TER -NATIVE FOR ADDITIONS ONLY:
a. Gross Wall T Ccilini, Area sq.ft. b. Glazing Areal sq.ft. c. Glazing % (100 x b= a) %
❑ ADDITION with Glazing % (c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below:
z
3
Glazing Area may be either Rough Opening or Unit dimensions.
Based on NFRC listing. Applies either to every unit, or to area average of all units.
R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full 11 -value over the entire ceiling area
(i.e.- not compressed over e:aerior walls, and including any access openings.)
❑ "StP ROOM" addition (greater than 40% blazing -to -wall and ceiling gross area)
Attach "Consumer Info}nation Form" from 780 CI\/fR Appendix B.
Official's 1`40me: — Official's Sitrnat'sre:
S
�♦♦ I II u. a a 3
1�� A �
BOARD OF BUILDING REGULA'TIONrS
I
f Building Regulations and Standards .hiseruse INSTRUCTION SUP�ERVISQR
Board o t05
t 3532 t
� � - AlumbeGa C� i
HOMEIMPjROVEMENT CONTRACTOR.
100
Registr l;'Uh, 146286 �i I it bre � O�u7
y_ 1112007
�� ' _ � :Fie •� t ���� ((�u�
�� ��.�'" 1:" t , � � - YMOND ST � • � ?',�% � 1,
MY CARI'trlTEitj2d; I l 49rc� PINS
RAYMOND A M
A� HAVRHILLr Q1j
ST83 Commrs`soner
r p �.
49 S. PINE ST
H'AVERHII L, MA 01835 Administrator -_
License or registration valid for individul use only
t before the expiration date. If found return to:
Board h,Building Regulations and Standards
One Ashburton place RM 1301
Boston, Ma. 02108
na ure y
Npt valid without sig
I 00 - 35,000 cf ehclosed space
f (MGL CA 12 S.60L)
f 1A - Masonry only
1 G - 1 & 2 Family Homes
Failure to possess a current edition of the i
Massachusetts State Building Code
is cause for revocation of this license. e
€ a
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i
t— DIG SAFE CALL CENTER: (888) 344-7233
SEEKAMP ENVIRONMENTAL
al -07.
' CONSULTING, INC .;*
April 28, 2006
Peter & Alexandra Mezzina
405 Johnson Street
North Andover, MA 01845
Dear Mr. & Mrs. Mezzina,
129 Route 125, Kingston, NH 0:3848
Tel: 603.642.8300 Fax: 603.642.8,go0
Seekamp Environmental Consulting, Inc., (SEC) visited 405 Johnson Street, North Andover, MA
(the site) on April 26, 2006 for the purpose of evaluating the site and adjacent properties in
accordance with the Town of North Andover's Wetlands Protection Bylaw, in order to determine
whether there were jurisdictional wetlands within 100' of the proposed addition. [The site
appears to be within the Watershed Protection District.]
In our opinion, there are no locally jurisdictional wetlands within 100' of the proposed house
addition.
Sincerely,
Seekamp Environmental Consulting, Inc.
Michael Seekamp, CWS
Principal / Senior Wetland Scientist
JUN -7-2886 03:27A FROM:
TO:19783740549 P.1
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ACQRC?. CERTIFICATE OF LIABILITY INSIJR'k NC 06/0r�;D2006,
CE 06/07/2006
PRODUCER FAX
THIS CERTIFICAI=J IS ISSUED AS A MATTER OF INFORMATION
DeAngelis Insurance Agency, Inc.
283 Merrimack Street
ONLY AND CONE S NO RIGHTS UPON THE CER'T'IFICATE
HOLDER. THIS C ' TIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVE AGE AFFORDED BY THE POLICIES BELOW,
INSURERS AFFOR�, NG COVERAGE MAIC #
Methuen, MA 01844
INSURED Raymond St Amand - -
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INSURERA, a --i' -- --Y�-- - - - ---- l
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DBA: My Carpenter
49 So Pine StreetHaverhill, MA 01832
INSURER B.
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THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F
TME POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC "TO
WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL(-.:
HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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holder listed below.
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iCertificate is subject to company conditions and exclusions. !"
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SHOULD ANY OF THE: OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
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EXPIRATION DATE TH EOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 GAYS WJMAA1fC
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
BUT FAILURE TOUCH NOTICE SMALL It.,POSC- NO OBUOATION DR UA6ILITY
Peter Mezzina 40S 3ohnson St OF ANY KIND UPINSURER, ITS AGENTS OR REPRESENTATIVES.
No Andover , MA 01845 AUTHORIZED REPRESENTIVE
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OACORD CORPORATION 1988
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