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HomeMy WebLinkAboutBuilding Permit #658-15 - 445 CHESTNUT STREET 2/18/2015BUILDING PERMIT �... TOWN OF NORTH ANDOVER = 9 APPLICATION FOR PLAN EXAMINATION Permit NO: ��� Date Received ` 9 Date Issued: SSncHuse i IMPORTANT: Applicant must complete all items on this page LOCATI PROPEI MAP NO: '76 y PARCEL:_ ZONING DISTRICT: Historic District Machine Shop yes Do , TYPE OF IMPROVEMENT PROPOSED USE Identification Please Type or Print Clearly) Resid tial Non- Residential Ll New Building k -'One family CONTRACTOR Name:Phone: U Add' ' n u Two or more family u Industrial Ll Veration No. of units: U Commercial U Others: Repair, replacement U Assessory Bldg U Demolition U Other Phone: Septic U Well L1 Floodplain . U Wetlands U Watershed District Water/Sewer Total Project Cost: $ = _� i b `ON IM Identification Please Type or Print Clearly) OWNER: Name:Phone:1-0 y Address: JJ1 CONTRACTOR Name:Phone: Address: 6 We -ea Supervisor's Construction Lice se: r Exp. Date: . )if Home Improvement License: Exp. Date: 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: $ FEE: $ 1#VIZItyund Che k No.: Receipt No.: NCE: Persons contractingwithunregistered contractors do not have accessto Signature of Agent/Owner__. Signature of contra IM TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic❑ Well ❑ Floodplain p Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: ?` Address: ARCHITECT/ENGINEE Phone:` Address: Reg. No: - FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total -Project Cost/: }$ /I FEE: $ ' Check No.: "/ 7i� (p Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner _ Signature of contractor Location No. Dat TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $r - Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ I Check # 28494 Building Inspectors 0 r� Plans S&rnitted ❑ Plans Waived ❑ Certified Plot Plan ❑ StarT)Ped Plans ❑ TYPF'DF 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 COMMENTS Signature_ CONSERVATION Reviewed on Siqnature COMMENTS PlEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comme Conservation Decision: Comments Watery& Sewer Connection/Signature & Date Driveway Permit DPW, Town Engineer: Signature: Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 de use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit 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 ❑ 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 a 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) a 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 Doe: Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. 6 ' Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 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 DEPARTMENTMITORM07 Revised 2.2007 c-)0- voi ~ oI= Mo : -a -o _ N. :3o T O O ^• Q- 7 N �W U) o -� oO rt cQ CLo ' �m -COD o C cc .,, N zO - o Rh a' 3 �0 0 CL C �C C� W� �N r . f �am N � So O . � 3 O O (, m H � lD O M vCD ci � rt a,o o O CL Vf O (DD " O CO O N ±+ o m T d s C' z A T d :5. fnD 07 ma S m a GZ1 Nm O 00 S c Z S 3 O 3 OC d 0 C y m '6 n (D 3 O \ S ,p 3 W O O = Q z %o . 1 ■ -4O 0 O z U) = z V. h C s O O —• o O 0 � N (7 o O' C o0 CD 0-0 Z cLr�' m tr i Cl) �� c� co Q r m -0 4 � � M o Em 0 7—Iv y CL cn Cr �, � z N � — cD CD 3 (D 0CD O aou �. CD e� Qv�rz O cn b Cf)to to CD cu i Z cn o ; o� .a z C CD 0 0 �� z CCD z � cn O m O c-)0- voi ~ oI= Mo : -a -o _ N. :3o T O O ^• Q- 7 N �W U) o -� oO rt cQ CLo ' �m -COD o C cc .,, N zO - o Rh a' 3 �0 0 CL C �C C� W� �N r . f �am N � So O . � 3 O O (, m H � lD O M vCD ci � rt a,o o O CL Vf O (DD " O CO O N ±+ o m T d 0 S C' z A T d :5. fnD 07 ma S m a GZ1 Nm O 00 S c Z S 3 O 3 OC d 0 C y m '6 n (D 3 O \ S ,p 3 W O O = Q z %o 0 -4O 0 z = A.Ser3 ke Provider for Customer Info: Job #: N/A (80404846 Taylor) 3480 - Taylor, Loretta 445 Chestnut St, North Andover, MA, 01845 (603) 891-9124 (978) 208 -8265 -mobile FINAL FINAL QUOTE total: $0.00 Demo KTM Properties, LLC 25 Spaulding Rd Suite 17-2 Fremont, NH 03044 Phone: (603) 895-0400 Fax: (603) 253-2600 Company Representative: PJ Michals (603) 548-2469 pj@ktmproperties.com or Protection Protection of floors, walls and doors, and dust abatement and clean up. Removal Construction debris removal and haul away nce Removal Remove Range, Range Hood, Dishwasher and Refrigerator. Relocate from space., a1 of Countertopse Remove laminate, solid surface, stone, quartz, or tile countertops. al of Cabinetry Remove walls, base and tall cabinets. yard Removal Remove cardboard and cabinetry debris. Demo total: $1,728.00 cle/switch replacement Replace existing receptacle/switch-includes upgrade to GFCI (installer provides) Mount Light Install new surface mount light, ceiling fan, same location (customer provides fixture) ;her Wire dishwasher with existing power present add cord and box with outlette )wave Wire microwave and install box with outlet on existing power Fault Breakers Supply and install arch fault breakers as required by code Tical Permit Supply electrical permit and inspections Electrical total: $1,725.00 Connect to undermount Connect to under mount or integral bowl sink w/ faucet, disposal: within 3" of existing location. (Installer provides braided supply lines, shut off valves; piping and traps as needed) Cut/Cap Cut & Cap plumbing for new cabinet installation Toe Kick Heater Supply and install toe kick heaters Dishwasher plumb in dishwasher next to sink Permits Pull permit; rough & final inspections - includes permit cost Plumbing total: $2,982.00 /i 0 - Cabinets Wall Wali Cabinets Install Wall Cabinets Base Cabinets Install Base Cabinets Tall Cabinets Install Tall Cabinets WallBaseFillers Install wall/base fillers Tall Fillers Install Tall Fillers Knobs/Pulls Knobs/Pulls Installation CM Crown Molding Assembly/Modification Assembly/.Modification & install of loose parts Fridge panels Install refridgerator panels Aut o�\ �q Toe kick Install toe kicks at base cabinet Decorative panel Install decorative panels Shims Install Shims as needed Hole and pennitrations Make penetrations as needed COUNTER TOP DOES NOT INCLUDE COUNTER TOP INSTALLATION c:aninets total: i3,15u.tlu Total for all sections: $9,5:85.00 Total: $9,585.00 The above signature does not commit either party to the sale of the above listed items. The signature represents a full understandi price and scope of labor for the categories listed only. Prices are subject to change based on the final design, layout of the kitchen an unforeseen conditions. We CANNOT start the work at your job until the necessary perm its have been procured and a signed "What to Expect Skeen' on file. Please contact us should.you need a copy of this. REMINDERS: this installation quote is based on normal working hours 7am-4pm, unless other arrangements have been made prior with KTM. Plumbing & Electrical work is based on 2 trips - one rough and one finish; finish will occur after countertops. Code or local inspector requirements not mentioned in this estimate will bean additional cost. Cabinets must be delivered in kitchen area or adjacent space on same level, which must have heat. If cabinets have to be moved by KTM, additional fees will be charged. Countertop templates require you to be onsite, no exceptions! Company Authorized Signature Date Customer SignatureDate Customer Signature Date This estimate was last edited by PJ Michals ((603) 548-2469, pj@ktmproperties.com) on January 31, 2015. The estimate may be withdrawn if not accepted within days. Wy �I o W° ! ao o X z q42 LL U)to o W i a0a OD W N O cc a of ms u q OUJ ro IL �o I x a W Nca z Wtu� om� I o ' y co ►I'WS 0 W a c _ z co a ti ur ro m M 0ciMco_ 0 — Q m 0 roI c O t��j`t Odd V Co OD 0 ate- N LLL Ill to O Q -2 LL W J z U 0 IQ �Wo mN��dpUj Q (Y }a} U1�J U Jy'j{AI'j IiizJ Ut0IC.. O F U)6,0, i hW,ZW4 Q� n �?2w � W m� ZO �pQ i a a jO aluja zaw rotUJUzgaco �mLL nc�F czOQ ! � v Z �w0 >- �om--C rz a � m� w 552 ALU �ZO<j QF5jrZr � o N zQwWQm 000 �uj�wou WZH XbtN- �000z 4! `� a°a °W (00)iv~i prnOVNoJILi z woNzma�m ! aoaWQZ DD ,-wUooawo a$>ozo�♦gooa� UUU �OOI]N000 2 OZi -M-MO I N Q 47LLLL¢u1 e a 0 e qA= v m$ m commu� a v ocorm o' am c o C .`y m $TEcm m NN N X XXX m(Am p $-- 3tp J, � v OCOI ;OmD (.A{000 p mJ t�f NO NOtN-NN NONO ( 6W E.0• -LQ `6i CE t9��D Ui ��$11 �11NN M �p`lfp9N MQON yC2.9 O VLCM CV� C0�M c07LLJN(q '��•11 LLF^IL i -h1-61 C�1�C� `6 .C�; � M- � m m m N mol � LL$ J 7 J 7 J 7 � S.p=�oUZmY v11D S�U �.. o{ii ri�aa�eo eio 10-8 .z N7OM070N J�(V clay)(C 1� Z6.i; N 3 ON G E V) 0 �+ � O 0b q �, 6 U � 3 t Q :3 o O GAy y' U 5 D q Rf O vl�A . C C ,0 Ocs O UC O V 0 E U O 0 CO m y .0 E N b b O Q '- 0 V U rhe' OfMasste -1 BEMIS Bosom; B—ITA 02114-207'. _ �+�i2��a�g (��»����as��m ��®r����Q A�emla��a �t��Q�1C�®�i'��i~ ���Q��nrs�a±�JIJ�➢tmm�ry�� A ➢���>�>t ll�ii®ae�a�a�lr� Lem F -M IL,eq&i Name (Businw2/0-,gs�tion ndividLal): ME A1�iyss: j 1 1 r � J-1� AQe�e® effipacyep� Chesl'x 61a 8�!1p8Dj�iilr fled �tiIIo � r � � ©$ �IIJ�Gs$ �PG�Li��� �Cu1�: 1 3 aril a eutployer wiih ,^ _ 4. I a gelto sout�or ted' 6� � New cowt-Mcdon employees (full andJorport-lime).° have hiredss>;-soa�^,toas l sted oar as�ch€d aheet. . . 9. ®erspdeli?ig 2. ❑ lam a sole proprietor or partner- -ship and have no employees Wiese sub-coraco-i9 bvz i;. ®eoll�ion working for me in any capacity. empoyees a�d'stave tvorksrs' l comp. r, ' _9. ® Bt_ailing aduion [No workers' camp. insurance 5. ® We are corporation and its IO•® Mectical rapdrs er additions rt:quired.] 3. ® I am a homeowner doa�g all wort; affice s have exercised their l l.�] P1 vs repairs mx mons IIYS= comp. lf.^^ o �lorYEYSt co runt of trxemntion-p6r r�Gi, 1(4), we have no 12.® s of a' 8 1 c.152, g and , w .,a. - cam. iitst�ce rimed.) I �_ i *Any applicant that ehetiolM#1Muntaim fill Gat the Mim WOW ftcllgtheieero7�'ca�si�t'�&alieytinfo3�arion. f Honreownem echo submittbis Ada* indioa6ugtheY zse daingal! wank sn&thM hire a�Wdz ccntMcLM mwL mbmit a new nfdAvitindiettan such. �ContracMr that chit thio boy taunt attacl►ed a4 a3ditia�l ahs ohaaairrg the name afthe cab-caat�r#.�s aad tte'iz crhvber c^ rot thrse entities have employees. 1f the aub-coatregers have emplayeen, the, mum provide their �vrlcas' eetr�. paiieyat*rnber. - Il am an employer that k Pwwdh1s RY MPIOYM fed©t� P� �ag�®k�► �r�d���� s�Re Insurance Company Name; Policy' or Self -ins. I.ic. Expirad6n Job Sit@ Adthss:' f�l,m, , �, v ayrayrccr�au. Atttaeib a eoga3'_mP t�ec�®per' s®�pe�as�®� IOtrodicy mledla tl©m pagG Qettmwhg the PE&V EmMIber arsd enpilMid®M cute). Failure to secure.coverage ps required under Section'25A of MIG1r 6.152 cast lead to the it�ositioat Of cr9'Priaasai poa4lan 2 a fine tip to $1,500.00 andfor one-year ip ear it risotMeai, as well as civil podtit,s in the form of a STOP WORK ORMER aad .firte of -up to $250.00 a g$ st the violator. 3e advis ad tliat a copy of this staIMMt Keay be forswded to the moa of- Investigations fInvestigations of $rPTA fc ftins•+ira�iqc coverage vsrfigrAion. Y do hered ®' a Ireoa�d s ®�pe8,� also aEae d a ®t a�u�o-a pFvat�ed �&�e asr �e a Asad cis hs� Sisi2 — e; } � 9 r116Q use only. Bio rosea M& U ghis apes, to he CcMpL-1-.4 by dv or gcvm' Offldaf. City or Town: ��a�tflL�c�aase � - ilsealiaig Autr.}�oalrty ��tssl¢ ®ate): . - - - n. Bard of-Heslith 2. EiAd°ing Meparrtlreat 3. CRY['tTOM' C l eTU CMlectflW UmFeckag S,-PIUMIQE Imapeeacir • rIDo RD$1t�8' sir Contact Peffsttu: Phone #• - � ' CERTIFICATE OF U'ABIL! T Y INSURANCE DA–c(Mi,IrDDMyY, THIS CERTIFICATE 1S ISSUED ASA MATTER OF INFORMATION ONLY APJD CONFErRS NO RIGHTS UPON THE CERTIFICATE11/18f014 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER"VO THE S UPON T AFFORDED )3Y THE DOUCHES SEL01hl THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT EES HOLDER. THIS REPRESENTATIVE OR PRODUCER,, AND THE CERTIFICATE HOLDER. BETWEEN THE ISSUING INSURER S ( ), AUTHORIZED Ify1POIdTANT: (f the certificate hclder is an ADDITIONAL hUSURED, the policy(ies) must ba endorsed. if SUBROGATION IS VVAIVED, subject to ih the terrns and conditions of the policy, certain policies may require an endorseme �, certiflcale hDlder in lieu Of such endorsement(s), nA statement on this certificate dace not confzr rights to PRODUCER ' MARSH USA, INC. caNTACT TWOAW.ANCECENTER - NAP4E; 3550 LENOX ROAD, SUITE 2400 PHDiN c . ATLANTA, GA 80326 5MAIL�K I 'mac No), ADDRESS: 100492-NO1nED•GAW-14.15 INSUReR(S) AFFORDING COV`MC-. INSURED INSURER A • Sleadl S{ Insurance Cmr,pany NAiC THDAT-HOME SERVICES, INC. Zurich Amsli�n Ice Co ca Ca 20387 DBA THE HOME DEPOT AT-HOME SERVICES INSURER a: 16535 2690 CUMBERLAND PARKWAY SLHI� SOD INSURER c: New Hampshire Ins CD ATLANTA, -GA 30339 Illinois NaSanal 23841 Insurance Campary INSURER D ; 23817 WSURt:R 5. THIS IS TO CERTIFY THAT THE POLICIES OF• INSURANCE LISTED BELOW 1NDICATEIl ATL -0131242885-07 REVISION IUUINBEI:7 NOTWI7] ISTgNp1NS ANY REQUIREMENT, CERTIFICATE HAVE TERN BEEN ISSUED TD THE INSURED NAPAED ISSUED OR MAY EXCLUSIONS ABOVE FORTH POLICY PERIOD OR CONDITION OF ANY CONTRACT OR OTHER pOCUNIlED 1MTH PERTAIN, THE INSURANCE INSRI AND O AND CONDITIONS OF SUCH RESPECT TO AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL POLICIES. LIMITS SHOWN MAY HAVE BEEN WHICH THIS LTR TYPE OF INSURANCE DL SU REDUCED EY PAID CLAIMS. THE TERMS, A GENERAL LIABIL17Y SRLWVD FOLICYNUP/19ER GL048877i4.04 POLICY EFF P OICY EXP MMIDDA YYy MMIDO LIMrrS X COMMERCIAL GENERAL LIABILITY 03/01/2014 03/01/2015 EACH OCCURRENCE $ 9.0w,000OAMAGE70RENTED CLAIMS -MADE a OCCUR LIAdITSOFPOLICYXS PREMISES Eaoeeurrence S i,000,000 OF SIR: SIM PER OCC MED EXP (Anyone person) S EXCLUDED PERSONAL & ADV INJURY S 9,000,000 GEN•LAGGREGA7ELIMITAPPLIESPER. GENERAL AGGREGATE $ 9,000,000 X POLICY JEGT LOC PRODUCTS-COMP/OPAGG S 9,OC�7,000 B AUIUMDBILE-LIABILITY BAP2938883-i1 S X aNYAUTO 03101/2014 03/01!2015 COMBINED SINGLE LIMIT Ea accident g i3OD0,OD0 ALL OWNED AUTOSAUTOS SCHEDULED SELF INSURED AUTO P,HyOMG BODILY INJURY(Perperson) S HIRED AUTOS NON-OMED AUTOS(peraccident) BODILY INJURY 5 PROPERTY DA MAGE Per aCcideM - S UMBRELLALIABOCCUR S EXCESS L(AB 7— HCLAIMS MASE EACH OCCURRENCE S DED RETENTIONS AGGREGATE S C MRKERScoMPENsgT1ON- C AND EMPLOYERS, LIA91LRY WC049t01882(AOS) 03!0112014 5 ANYPROPRIETORIPARTNERIIXECLJTNE YIN D OFFICERJMEMBER EXCLUDED? NIA W(3049101884(AK) 03/01/2015 X WC STATU- 0TH TORY LIMITS R 03/0112014 03/0112015 It (Mandatory In NH) WC049i01883 (FL) E.L. EACH ACCIDENT 5 Q3101I20t4 03/01fZ015 1,OW,000 DYSS,RIFrIOeunder. DESCRIPTION OF OPERATIONS below EL DISEASE -FA EMPLOYE g 1,000,000 C WORKERS COMPENSATION WC049101885 (KY, NC, NH, VT.)03/ot2Dia E.L. DISEASE- POLICY LIMB S 1,000,000 C 0310if2D15 (EL) LIMIT WC04910iB86 J 03101/2014 03101/2015 UDD,000 DescRlPttoN OFOPERATIONSI LDCATIONSIVEHICLES (Attach ACORD iot, Addolonal Remarks Schedule, tfmore space Is required) EVIDENCE OF INSURANCE TE THD AT-HOME SERVICES, INC. DBA THE HOME DEPOT AT-HOME SERVICES 2455 PACES FERRY ROAD ATLANTA, GA 30339 SHOULD ANY'OF THEASOVE DESCRIBED POLICIES 13E CANCELLED 13EFORE THE EXPIRATION DATE THEREOF- NOTICE WILL BE DELIVERED TN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Of Glars)f USA Inc. Manasht MukhPriea .. r�.' i i +: i a •S t. j ,+ . y.�' J=1 •i'�� i �3� l � • -} .d 1Fi�' b- !. r .r.: � s d* � � 'l�l� r� v �� !�'�� � ��`.i`.� v _'r�� 'r � :� "`�,y � , r 3. �„'!?.3_�'%-�; �?.. +„a-�j'?`.�r��� t'��.:i��?`��:J.'`•� �`d�.~3Ld'<:3�1`7 �`�.'!.a.t�•t�'^'...-- .fchuspctts. 02 Home ImprOVOMM 0 -Type: Supple-mcni Ca:1 Rvhllon. 85015 T.MU AT HU h SERVICES, INCL ' '00 -CUMB8R id PARKWAY SUITE 300 - ATLANTAY SGA 2433 -- Vpftte Addr= xnd muni u, i i Lrk mmll for clmlgc. Addr S Los:C„d ,�, ���r �r-�.v�r.�rre:�%1� re ^-I!r„rfrl,n>•tl- . F Ofplc. of CoRnmex A'a in"Is Baklae�i Reg a6oar�tr�,9on valij for Miviou9 iso, only v t� tai E�Ib�°:1sx? iYa�� 2fietiar�s If �aaG a rr t�ac V�J.�9 ., r.. :.: .... ._•.-�.➢�]7it:fS��v3M�fl'ou?V�3�SA2E'�v�F��jui3StR�is:+r':���q.".:SC� `�•-`}:��'; 'ls�p�ora��ro. Ii1�0�� 5v�©1e-rn�nfCar� I �ii�NA�tI� F,4LLQIdE • , . �+�50 CCIMB&LAN9.t?ARKI1UAY S �—•- . � i p��yyir�yi�;((�gpgg. EFYa�}p.i;VjprF{e f�4nSE�!704- _ ANT -11 # � m c �ri�tsTs:�t tar -to