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HomeMy WebLinkAboutBuilding Permit #618-15 - 41 HERRICK ROAD 7/7/2014BUILDING PERMIT TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: 1 �� IMPORTANT: Applicant must complete all items on this page LOCATION `1 ,[�CR_%Zi C_ / �-c� , N6 d PROPERTY OWNER Sf g Print 100 Year Structure MAP _PARCEL: ZONING DISTRICT: Historic District Machine Shop Vill �• tt`e° �6��NO o co 9_ yesno yes no e ves no. TYPEOF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building .R'One family 0 Addition ❑ Two or more family ❑ Industrial e'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg 0 Others: 0 Demolition ❑ Other 0 Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer I DESCRIPTION OF WORK TO BE PERF ?MED: �; S' Cow C (U gLpi u �. - �jO t'ALK. 0&, -*h - 5, */- J Goi�l F+W �`'�.�4�uJ� �D e;K1 Fk0X Identification - Please Type or Print Clearly OWNER: Name: /�E,mAa/4 St. Phone: 178 dog Address: /,—At=3&A yb x,+4 f;do uch 214 4., Ot P, 9 - Contractor Contractor Name:(%[uce4Phone: 7 2 � (f o9 '70.? Address: o2Y dl fin. E- Uck. Au Supervisor's Construction License: DS VY Exp. Date: f f3DI/G Home Improvement License: l0; 2-76- - Exp. Date: 1�a,Z( , 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: $ /moi. FEE: $ Check No.: � � I Receipt No.: ,,"> NOTE: 'Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor �� 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 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS 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: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street 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 MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NU I t5 and UA I A - (For department use ❑ Notified for pickup Call Email Date Time Doc.Building Permit Revised 2014 Contact Name No 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 o Building Permit Application o' 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/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 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 2014 f Location4 � -JA-e 12 (2,,c),— P J - No. —(� (% — I Check # Date -� 1-7 ItL-1 TOWN OF NORTH ANDOVER Certificate of Occupa:ncy $- Building/Frame Permit Fee $ Foundation Permit Fee $- Oth6r Permit Fee $ TOTAL $ Building Inspector FM _v N� N n a O CD D O CL A)CL �. >co. N 0 v O n O v m o C�= Cr �' ? cD CD CD . O W CD O, �. O N CD O 0 � OCD 70 O O ° o o 2)= r y = < (D Cl) MU : O • (D n CD 0 m O 0 0.0 rt = c= v,• � �•CD 0 O O Q m N W CD M y m 2 o a a) -1 � y �• O C 0 —� U) a r. ,o 00 =+ m ID c CD.aM - r.Lp o 0 �• o < co y .* c o 0,CD a rt O D CD N O. y O C (o• Q. _ CO)O O L Q < N O CD Q N CD N 0 am * * 41 /m N 3 O O (D Ln - fOD �'+ z O W c D 1 701 my V1. Z T O Zl O O=0 S G1 H to -i 70 T O N O n N x O OCO S F- m 70 A r A T j ;o O OCO S � C w my A -n O n :rO 3 fD x OCC S T O O Q 0J ~ O W C ° Z m N rD . f1 N 3 T O Q \ S O > O D '- 0 c OP ID: S: ,4�o�roR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03/21 /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(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 Durso & Jankowski Ins Agcy LLC 198 Massachusetts Avenue North Andover, MA 01845 Durso & Jankowski Ins. Agcy. CONTACT NAME: PHONE FAX A/C No E4:AlC No E-MAIL ADDRESS: PRODUCER POLAR -1 CUSTOMER ID P INSURER(S) AFFORDING COVERAGE NAIC # INSURED Polar Bear In Co. Inc. P O Box 958 Andover, MA, 01810 INSURER A: Penn America 32859 INSURER B: Safety Insurance Co. 33618 INSURER C: INSURER D, INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PAC7022861 03/24/2014 03/24/2015 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEWL AGGREGATE LIMIT APPLIES PER: PRO LOC POLICY IiEcT PRODUCTS-COMP/OPAGG $ 1,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO 2100926 01104/2014 01/04/2015 COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ (PERACCIDENT) X HIRED AUTOS X NON -OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS -MADE PAC6906385 03/24/2014 03124/2015 AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below --T—t E.L. DISEASE - POLICY LIMIT $ i Ut51RIP I ION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD tOl, Additional Remarks Schedule, if more space Is required) G.L.C.A.C., National Grid Corporate Services LLC DBA National Grid, Action Inc, Boston Gas Company, Colonial Gas Company, Essex Gas Company & Columbia Gas Co.; are additional insured for general liability with respects to work performed on their behalf by the above. GLCAC11 G.L.C.A.C. i &Columbia Gas Co. 350 Essex Street' Lawrence, MA 01840 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 T ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents = Office of Investig, ations . a 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leilibly Name (Business/Organization/Individual): j tJL,t- �2 j2 tN S (/ �}.• Address: lam• O• 41� City/State/Zip: � ovF x_ M, 0L910 • Phone #: Are you an employer? Check the- appropriate box: am a employer with t] 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 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. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workerscom" p. c. 152, § 1(4), and -we have no . insurance required.] 't employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.0 Plumbing repairs or additions 12:❑ Roof repairs - L 13.[� Other.lyS{114-Tt�tN *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 tContractors 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: V fi-MA Policy #-or Self -ins. Lic: #: p O w e S-5 00 Expiration Date: Job Site Address: `y�=%1 C/! / C� • City/State/Zip: & o OM J019w, 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 $25p.00 a day againsf the violator-: Be advised that a copy of this statement maybe forwarded to the Office of . Investigations of the DIA for insurance coverage verification. I do hereby ertify under the pains andpenalties ofperjury. that the information provided above is true and correct Si ature:LU / _ Date: 71j y ane Orcial 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 12. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ACCOR o® CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 05/1312014 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 CONTACT NAME: Automatic Data Processing Insurance Agency, Inc.EArc 1 Adp Boulevard PHONE Est): Ar No): L ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC Roseland, NJ 07068 INSURER A: NorGUARD Insurance Company 31470 NTED PREMISES Ea occurrence $ INSURED INSURER 6: POLAR BEAR INSULATION CO INC Po Box 958 INSURER C: GEN'L AGGREGATELIMIT APPLIES PER: POLICY JPRO- CT LOC Andover, MA 01810 INSURER D: INSURER E: AUTOMOBILE INSURER F: COVERAGES CERTIFICATE NUMBER: 231099 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. LTPOLICY R TYPE OF INSURANCE POLICY NUMBER M F I EXP LIMITS ` GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F -I OCCUR EACH OCCURRENCE $ NTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATELIMIT APPLIES PER: POLICY JPRO- CT LOC PRODUCTS - COMP/OP AGG S $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS - HIRED AUTOS NON -OWNED AUTOS CO L $ CE, accident BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ _ UMBRELLA UAB EXCESS LIAO OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE E DED RETENTION s __ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Myyeussd" in NH) If DESCRIPTION under OPERATIONS below NIA N POWC550065 01/0112014 01/01/2015 X WC STATU- DTH - T YLIM I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L DISEASE - POLICY LIMITF$ 1,800,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) MASSAVE/RISE CERTIFICATE HOLDER Columbia Gas of Massachusetts 4 Technology Drive, Suite 250 Westborough, MA 01581 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 ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD ,aa�uaeka Office of Consumer Affairs &Business Regulation +i HOME IMPROVEMENT CONTRACTOR Registration: . 102726 Ex iration: 7/2/2016 Type: p DBA POCAR BEAR INSULATlgIV GO:! Vincent LeBlanc 51 SO. CANAL ST. 95A LAWRENCE, MA 01841 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02I16 Not valid without signature Massachusetts - Depaftmen# of Public Safety Board of Building egula�ions and btandar- Construction Super, icor Spccialty ;c:ense: CSSL-105924 VINCENT E LEBLANC= . . 24 LANDING DR METHUEN MA 01844 l T��1 iN .1.�w....�. fJGe�,r -x p i f'a't i o n Commissioner 01/30/2016•' ZJ us DRIVER'S = LICENSE 92 END 4d RWIBER . - P ---?.03.20.2013 NONE S09D.63933 ' 4-0� EXP - 3 DOR 1s 01:301943; I D' WREST NONE .'s SEX A �D riot 5 09 a t U" 3<l id 2 VINCENT E D 24 LANDING DR DDi941 MMUEN, MA 01844.5825 s DDo]-2L1Du Revp-15,2 g s ,;k. 4f Gas Account # Audit Ramat # L PRELIMINARY AGREEMENT REM mrs AGRt3EtYif;NT AND MAKE SURE YOU UNDMWAND IT BEFon SIGNING. MAKE SURE ALL BLANKS ARtr COMPLffu AND Ax.L PRoWSJONS THAT DO NOT APPLY ARE CROSSED OUT. THIS AGREEM M HAS LEGAL FORCZ AND >&WWr AND BINDS THOSE WHO SIGN. This Agroomont is mule on ' � � / Y M between 00nCYwe11 of 65 Showmut Rd, Sultre 4, rd floor, canton, 1 busel►asetts 07021, (800 247.4113) nu<ftec called �Ve Cont uMf or "Honeywell" and f _ '�' ! l,� rj {Cuotomor) (Addme) • ,+�! � d r • I � ' d' U Cry' ' ei .eats~l<,� J� � )� o �, r ,. (Address conn) (Telephone) Hereinafter caned "Cudomer," IU -C ratomcr is the,er 1 errant of the above-mentioned Premisos. I DESCRIPTION OF WORK TO BE'PERFORl M In consideration of the Administrative Conftddoris agreement to select a qualiScd lnstaliation Contractor to pwform in a good workmanlike mwmr all work ('"the work") act forth in ttto attadW Work Ordm(s), the Customer agt'ees to the terms and conditions of this Agreement No work may be performed without the written consent of Owner. Customer Un&Tstaads that calculated energy savings are estimateu only and are not guaranteed. PRICE For fhjd w*nw ;sn use onlIC F6r the work dawribedi in the Work Order(g) and shown on COMMENTS:' the accepted Offer Sheet, attached hereto, C SEE HEALTH AND SAFM FORM .'the Total Estimated Cost is $ O OTHER The ToW Due at (he theCustomer for the WarisOf telladon from to be performed is: L . Ifthe loWaUation Colurtaetor datemdnes that the Work vatawt be provided for the price quoted ttLave, aR penes will have the rigAit to teminate this4greem" Price quoted is valid for 9.0dqm ti Owner of the Premises agues to pay, prior tothe commencement of the work, and Admitiis6tivcContrai4ar aucepLs, In full satisfaWoc•for the Work the Nee set forth *we. • Tenant aV= to pay, 'prior to the commencement of the work, and Adminishvhve Contractor aampts,'in full satisfaction for the Work the price set Rath above. RIGHT TO CANCEL WW CUSTOMiP.R MAY CANCa T'!IN AMt"IRfr Or IT BAS.686N UMED AT A PLACE OTHER THAN AN ADDREBS"OF TEMAMINSTRATMN CONTRACTOR, ED THAT -THS CUSTOM* NOTIVIRA ADMINISTRATIVE COwNTIACTOR IN WRITING A VS MAIN OSVICZ OR C11.MY= MAY BE ITS MAIN OFFKZ OR BRANCH INERROF OBOINARY.MA}L POSUM, BY ' TMZGRAM SUNT OR BY DEUVMY, NO LATER THAN bUDNKiST SOF THE THUW BUSIMM DAY FOILOVI NG TBE SIGMG OD SIB AOUVW NT. SEE NOT= OF CAWCEr•LAT'ION Mq OUPUCAT&) ANNEXED FOR AN EXPLANATION OF THIS RIGHT. � I IMPORTANT: ADDr"ONA>C.'I wm AND t oNAI'i'[ONS ARE ON THE REVEA5E'5II►E E�E� b tomET, represents that (1) You read and Wdemood both aides of TMs Agiteemectiftfbi+o you akWA-. ; d by tate terrus and ow4tio ns set forth an the f mt and back of this Agrocanvnt; (3) The ' (directly ar iirecdy) has made no mproWntadoos.of warranties tegardittg the -Work, otbear than;4Lm ' -c t � i ii ('�'lbat time you signed t Agrte� t, it has bdxn eignod by rho AdminiMtive Contractor enlative Cas re nob completed and that the work you val osted wim. PropterlY, dAsccrribed Honeywci igoaiure tc O'wner's $ignatum -Date ' • , T'enant's Signator" Date., . AML THE SIGNED AGREEMENT TO: 'HONEYWELL 6s SHAWuuT RD, SUrrE 4, 2' FLOOR C�4NI°ON; tt1A 02021 Iioneywell-Whit" InstallationContractor. Yellow Customer- Pink f%vi d dO/Z010 'j�VC C�+�•-rt+ • *•u� CaN i r►ar` JI'►t �lrj.,�r /•;r*�.,.d. /t1�^�' �'%��r�h /V�''<:aI T� ��Jr Ir'�n,sv+.'P ,• , .