Loading...
HomeMy WebLinkAboutBuilding Permit #732 - 45 FRENCH FARM ROAD 5/21/2010Permit NO: d� Date Issued: ��2�' to BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this nage I LOCATION 44-5- /- ? &,A) C-14 PROPERTY MAP NO: P. Z/ U 1 © CNC: R Print -ZONING DISTRICT: Historic District 13 !Machine Shon 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 Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 0 Su S -f-y y IQ 4 ( Identificationlease Type or Print Clearly) OWNER: Name: 60QC_ k4 W Address: CONTRACTOR Name: ) A r\'ZAi !iao-i 4 Phone: � I Y Address: �I t�, T eg ( t r24 /H ,-po /* S J Supervisor's Construction License: () C 9 (2- CI Exp. Date: Home Improvement License: 13 /? Q 5- q Exp. Date: f° 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: $ 44 1 00 i O O FEE: $ '— �f�l Check No.: d.51-- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Q Signature of Agent/Owne til Signature of contractor �- ^- Location �� nextiC.�+ No. -7- Date ` Z / -.J D "ORT/4 TOWN OF NORTH ANDOVER f p + ; Certificate Occupancy $ ; ��s'•••°•tt�' sACHUS of Building/Frame Permit Fee $ — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 30 S 1 2 S t, L) X2 -a -- - Building Inspector 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 PLANNING & DEVELOPMENT COMMENTS DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature 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 Located at 124 Main Street Fire Department signatureldate _ COMMENTS Located 384 Osqood Street yes 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 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 2008 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 ❑ 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 DEPARTMENT:BPFORM07 Revised 2.2008 ri W RS O �jq Qi O r�G v . °o w � >- a��i J) O z OO7 A C .0 r.W o w o pG , X U G w p U W .7 ato o w c w p W u U o c� cn w O F O I o c W w a w o 2 cn v 0 o cn 5 0 �m c O o � O H 7 v t.3 a c R W := O O Cc �a rm= �. O t _ _ ::s o sa y EE :.� D C, lo� • s CD m c CA GO • L � J: o cm3 CD y :3-_ y c c y O O :Em 4D a m y m ; _ = O o) C CDC C y fj Z `o cc o o CD CL c m H m = 3 C �C 0 CL COD .ca a=mc Z "r m •y O W �E c 'o cv o, U Od O-5 - wm oh� O w P-4 co O CD L O Z °D Q. O CO) a� a, I _v c_ ME m m 0 co = O � CD CD Cl Q O d CL cmQ E cL c tc O C3 J -M .0 Z t5 CD (..7 H O C C ev CL U) O LLI U) U) W W oc LLIW U) The Official Website of the Executive Office of Public Safety and Security (EOPSS) Mass.Gov Pubiic Safety yom E > CO.^.Stift CrDie IIDr: r _'u51^eBS Ll nsinc > er,se 7.4— ray 5usines AreE.> -;;;nr im raven en; ............. ... Home C improve ..mart Coll�raztor Registration Program Contracts - all contracts over $1,000 (One Thousand Dollars) must be in writing. The law requires the following FOURTEEN items to be included in any contract between the homeowner and registered home improvement contractor in al contracts for home improvement work subject to MGL c 142A 1. The complete agreement between the contractor and the owner and a clear description of any other documents which are part of the agreement. 2. The full names, federal I.D. number (if applicable), addresses (NOT P.O. Box numbers), of the parties, the contractors registration number, the name(s) of the salespmon(s) involved, if any and the date the contract was executed by the parties. 3. The date on which the work is scheduled to begin and the date the wort: is scheduled to be substantially completed. 4. A -detailed description of the work to be done and the materials to be used. 5. The total amount agreed to be paid for the work to be performed under the contract 6. A time schedule of payments to be made under the contract and the amount of each payment state in dollars, including all finance charges, if any. Any deposit required to be paid in advance of the start of the work SHALL NOT EXCEED one-third of the total contract price or the actual cost of any material or equipment of a special order or custom made nature, which must be ordered in advance of the start of the worn to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of al] parties. 7. All parties must sign the contract 8. There shall be a clear and conspicuous notice stating a. That all home improvement ccri, actors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Divisor, Program Coordinator One Ashburton Place Room I301 Boston, Mn 02108 Tel: (6I7) 727-3200 ext 252__19 b. The contractors registration number must be on the fust page of the contract c. the homeowners three day cancellation rights under MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. d. All warranties on the owner's rights under the provisions of 780 CMR R6 and MGL c 142A e. In ten point bold type or larger, directly above the space provided -for the signature, the following statement: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. f Whether any lien or security interest is on the residence as a consequence of the contract 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth. 11. Permit Notice: Every contract shall contain a clause informing the owner of the following; a. any and all necessary construction -related permits; b. that it shall be the obligation of the contractor to obtain such permits a the owner's agent, c. that owner's who secure their own construction -related permitc or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12. Acceleration of payment: No contract shall contain an acceleration clause under which any part or all of the Page 1 of 2 http://www.mass.gov/?pageIB=eopsterminal&L=4&LO=Home&L1=Consumer+Protection... 12/5/2008 rage 2 or balance not yet due may be declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds due under the contract, which are in possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No wort: shall begin prior to the signing of the contract and transmittal to the owner of a cop), of such contract 14. Arbitration: If the contractor determines that in the event of a dispute, the contractor wishes the dispute to be settled by arbitration. this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The following format is acceptable (in 10 point type or larger); "The contractor and the homeowner hereby mutually agree in advance that in: the event that the contractor has a dispute concerning this contract, the contractor rnat' submit such dispute to a private arbitration service which has been approved bt+the Office of Consumer Affairs and Busiriess Regulation and the consumer shall be required to sub it to such arbitration as provided in MGL c U2A. Owner Contractor: NOTICE: 7Vsignatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated hr the contractor. The owner mar initiate alternative dispute resolution even where this section is not signed separatelt+ b1, the parties. " © 2006 Commonwealth of Massachusetts http://www.mass.gov/?pa�eID=eopsterminal&L=4&LO=Home&L1=Consumer+Protection... 12/5/2008 lYmassachusetts Home Ira rovement Sam le Contract T hiss all basic requirements of the state's Home Improvement Contractor Lain (MGL chapter 142A), but does not include standard ct homeowners, Seek legal advice If necessary. Any person planning home improvements should first obtain a copy of "a sumer guide to home improvement" before agreeing to any work on your residence. You may obtain a Erse copy by calling the er Affairs and Business Repnilation's Consumer eing t iionany wotlinerk o of Your residence. or u may283 3757. Homeowner formation v C -} L- Contractor Information ame I r "i x _ •' sir^ ' `"tel � mPanY arae Street Address (do not use a Post Office Box address) ( U h NJU,..,^ �� n�tr"a(e"tor/`S 11 SIxt: ri11 nerName Ciryllown /f'� / ' I ( V 6`hV� " (V?Al* i 1 G'' Smm ,Zip Code usiness Address (must include a street address) Daytime Ph Eve ling Phone State ' Zip Code Mailing Address (lt differ®t fmm above} Business Phone ederal Employer ID or S.S. Number. . ' L•' req,.:... Wrt moat home �• I Home tro[so�mmtLovuanortug. Nmnber I Ex - PA•�mltapQWmi level penmen tlrte The Contractor agrees to do the following work for the Homeo me —srnaw nombn ms Required Permits - The following building.permits are required proposed Start and Completion Schedule -The following schedule will. and willbe secured by the eontractoras the homeowners agent, be adhered (Owners who secure. their own permits will be to unless circumstances beyond the contractors control arise excluded from the Guaranty. Fund provisions of s • MOL chapter 142A:) ab on contractor will begin contracted work. 1 2 46Data When contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, furnish the material and labor specified about for the ental sum of: Payments will be mad, according to the following schedule: S b upon signing contract (nor to exceed 113 of the toml'contract price Zr the $ cost of special order items, whichever is greater) y or upon completion of b_� /_ by _%_/_ or upon completion of S 4' 14�i upon completion of the contract (Law forbids demanding rang full payment until contract's completed to both party's satisfaction) Tae following material/equipment mustbe special S' ordered before the contracted work begins in order .S to be paid for to meet the completion scheddie.(") to be paid for NOTES: (•) inciodiog a0 finsuee charges'(".) Law requires that any deposit err dovm-pavment required os' die contractor before work begins may not exceed the specter of (a) d in advance of toe tocol he comp)riprice or (b) the actual Cos' of any special equipment or custom made material which must be special ordered vi advance m meet the completion schedule. Subcontractors - The contractor agrees to be solei �N ,cugracromr..1 rye yam. e0 terms of the warrantv.mos-t be attached to the contract y respotrorftible for coletion of the work described re,•ardless of the actions of any third partylsubcontractor tstilized by the contractor. The contrnctsi further a Materials and labor. tinder this agreement Steri to be solely responsible for 811 payments to all subcontractors for Contract Acceptance - Upon signing, this document becomes a binding contract uncle this document the contract shall not imply that any lien or other security interest law. Lhvess otherwise noted within carefully before signing this contract interest hes been placed on the residence, Review the following cautions and notices • Dont be pressured into sighing the contract Take time to read and full • Mike sure the contractor has a valid Home lmnmvcm t Contmcto y ' tin The law understand it Ask questions if something is unclear. subcontractors to be registered with the Director ofHome Improvement Contractor Registration.i ores uminay inquire Improvement emen v contractors and registration by writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 ' by calling 617-727.3300 or 1-800-223=0933. • Does the contractor have insurance? Check to see that your contractor is properly, insured • Know your rights and rsspoanbilides. Read the -important Information on tine reverse side of this form and get a copy of the Consumer Guide to the Home improvement Contractor Law, You may cancel this agreement if it has been signed at a place other than the contractors normal place of business, provided you notify the contractor in writing. at his/her main office or branch office by ordinary mail posted by telegram sent or dine third business day following the signing of this agreement See file armched nonce of cancellation nten for an. m cry, not later this n idou t of th, DO NOT Si'G]V THIS CONTRACT W TF�RE ARE Arty BLANK SPACES!+! Two idemrral cgh opies of the nonan moat be compined and signed. one mpy ll,oto the bora oWd g eornaz. The other. cold be kept by the COn,..=,. HomV;1;1�11ccrsignature Co tor's Sign rate Date / ✓ l7 Date L%m Contractor Arbitration . The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in courtunless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor'Law. The contractor and the homeowner hereby mutually agree to advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to sub t to such arbitration as provided In Massachusetts.G eneral Laws, chapter 142 P Hom wn s SignatureC ctor s Signature NOTICE: The signatures of the parties above apply only to the agreem f the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowner; may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeownerswhosecure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor' Law. The contractor is responsible for completing the work as described, in'a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness- for a particular purpose, An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below). Execution of Contract The contract must be executed in dupIicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Amy modification to the original contract must be in writing and agreed to by both patties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day recission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. With of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer -fights, or if you wish to obtain a free copy of "A Consumer Guide to the Home ImprovementContractorLaw," contact: . Consumer Information Hotline. Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787 or 1-(888) 2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component ofthe Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business,•call: . Consumer Complaint Section Office of the Attorney General (617) 727-8400 AND/OR Better Business Bureau (508) 652-4800 (508) 755-2548 (413) 734-3114 NI Chia->rane•ys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED -REBUILT -CAPPED Expert Masonry Work Mass Toll Free [?: X3000 f_ezfrs CLicensed & Insured Locally O.vned B• Operated Sirce 1976 !"" 1 -800 -WAIT -4 -US ® _fie License #034200 x((924 -8K487) yy y} IKO C',aee, ' azw Oz �9vhw We- Work Year Bound A" 't'-W'V /t 31':. 11" Proposal To: Fred & Mary Boucher Date 5/12/10 Street: 45 French Farm Rd. N. Andover,MA Invoice 1. Remove all existing siding from entire house. 2. Remove all existing window trim on older win- dows. 3. Inspect all wood components of entire house. Any compromised material will not be left. Any exist- ing damage or rot will be discussed with home- owner and replaced. Replacement of up to (2) sheets of sheathing is included in total cost. Any further compromised material will be replaced at an additional cost of time and material. 4. Install Tyvek breathable housewrap to entire house. All seams will be taped. 5. Install new 1x4 pine trim to all older windows 6. Install 4" standard vinyl corner posts to all house corners. Color same as house body. 7. Install Quest .046 double 4" vinyl siding to entire house. Color: Cape Cod Grey custom blend 8. Soffit area: Drill holes in all rafter bays for added ventilation. Install vinyl perforated soffit panels. Color same as body color. Soffit ceiling area of front breezeway not included in proposal. 9. Install j -channel to all areas that need to accept vinyl siding. All j -channel will be self -flashed and angle cut for clean professional appearance. 10. Install custom bent aluminum trim coverage to all windows, doors, fascias, and rakes. Color: Ander- son terratone/sandtone. 12. Install all new vinyl accessories: light blocks, split blocks, meter block etc. 13. Building permit included 14. Removal of all work related debris 15. Limited Lifetime vinyl siding warranty from MFG. , not contractor. 16. Contractor workmanship warranty: 10 years 17. On rear of main house: Install .032 seamless alu- minum gutter and downspout. Window and siding projects included in total cost: Total: $44,900.00 Siding upgrade: $900.00(included) 1st payment due: $13,000.00 (windows) Please make check payable to: All Under One Roof 30 Temple Dr. Methuen, MA 017-844 'x Thank you! X �� 4.in�r elf 0 G F- Sao U - 0 X N W wZW� ?Z<m �F- Qo oM i I C O ct Q C * E o° 4.in�r elf 0 G F- Sao U - 0 X N W wZW� ?Z<m �F- Qo oM i I '"Ty Insurance Agency LLC 122 Chickering Rd. RI 125 "I"th Anduver. MA 01845 -N-----_ — svRr-.1� --- -- 111 under One Roof W I elnplc. Drive '141--thuen. MA 01844 ISSUE DATE 1011.112009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 0I41 Y' AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. "PHIS CERT IFICATF DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED UY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE i COMPANY A A.I.M. Mutual Insurance Co LETTER I "ISIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F'JR THF. POLICY PERIOD INDICATED, NOTWITH%TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH "i'I IIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, 771E INSURANCE AFFORDED BY THE POLICIES DESCRIBEn If -REIN IS SUHJf-( I" 11) Al 1114V TF -RMS PUrl t MION , ANn (Y1N)7rrinv-q (1F CI I('FI pni-l(`IFC F nlArm CIdf1UM AAAV UAVC 92a:9:u DMT V`Cn DV DA In f•I A u.0 ru I.IR 'rVrk Ot INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MMA3DJYY) POLICY EXPIRATION DATE(AIMIDDIM LIMLIS CE�ENAI. LIeBII.)TY GENERAL AGGREGATE 1 PRODUCfS-COMP/OP AGO S =COMMLACIAL GLNLRAL LIABII III PERSONAL ADV INJURY Q I= CLAIMS MADS;= OCCUR C-1 O -A NER'S & CON rl(ALTOWS PROT _ ----^-"•-- EACH OCCURR[]vCF. FIRE DAMAGE (Aolnnr lucJ MED. EXPENSE(Ao"w po ) S"--� A(I)'OAIOBILE LIABIIJ'rV COMBINED SINGLE LIMIT AUTO ALI. OWNED AUION SCHEDULED AUIU5 BODILY INJURY (KI pentyl! NANY HIRED AUTOS NON.OWNEO AUl'OS GARAGE LIABILrfY BODILY INJURY (Pn W4w* d) PROPERTY DAMAGE S- ' EX"-Vi(.IABILM EACH OCCURRENCE �- IJMURtL(A IURM - AGGREGATE (rn(ER THAN UMBRELLA FORM '+, TAT LIMITS STATE )rHER MA WORKERS COMPENSATION ANSI EMPLOYERS LIABILITY CE PROPRIETOR/ A AJW AS4F_YEC.(nlvt FElcrr: J ARL IN(:I. .�LxcL 7009454012009 11/09/200 11 /09/2010 EL EACH ACCIDENT 100,000 EL DISEASE --POLICY LIMIT 100,000 EL DISEASE --EACH EMPLOYEE I UU.U00 --ar-,. ow ur-a%-mr I owiN Vr (9rr KA I IUP(J UK LUC:A I-IUNZi: 'kI.L UNDER ONE ROOF IS NOT COVERED BY THE WORKERS-COMPENSA770N POLICY. )ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE L"iPIRATION DATE I B(EOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1ILWRITTEN NOTICE TO THC- CER11P1L'A I EI LDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE. SHAT.( IMPC SF NC,) 001.IGATK)II LIABILITY OF ANY KIND UPON THE: COMPANY, ITS AGENTS OR REPRESI N I A'I IVE S GOWN O*NI)OVF.R MILNIK)VER,MA 01810 AUTHORIZEDREPRESENTAIIVE