The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #584-2016 - 45 HIGH WOOD WAY 11/10/2015 ScA>vN�d 11-12 -IS" BUILDING PERMIT TOWN OF NORTH ANDOVER y ''`- ` " 4° o0 APPLICATION FOR PLAN EXAMINATION 70 h T Permit No#: Date Received A�RA7ED,Qp �y III SSSS Date Issued: I Ib CHL IS Applicant must complete all items on this page LOCATION; j n tet, F 1 P PUROPERTY OWNER_-_ �� _ w Printr 1OO Yea Structure ,yes rn nd MAP" �_3 _ PAR EL ZONf:NG ®fSTRICT Hlstoric,Dlstnct yes F - >_- � z. 'M6 h* Village eyes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building eAbOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,p�Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septle ❑Welh ❑ Floodplain 01Netlantls 'r ❑ Watershed strict aWaterZSewer° w / DESCRIPTION OF WORK TO BE PERFORMED: � W ins w Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: t ontractof Name`�i�ty'Z.t� ;Phone _T Email Ad:dress Sup.ervisor's Co,nstruc#ion�iLicense DExpDa Home Im rovementYL cense �� a§ / p D Ex Dat 3 e 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: $ (' 365'0o FEE: $ --7&, Check No.: W Lt- lb 0 Receipt No.: � Cp NOTE: Persons contracting with unregistered contractors do not have access to tile guaranty fund igS natu.reRof Ag Th-ffowner, e �( Signature of contractor f Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dmnpster 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 R HEALTH - - - Reviewed on Signature COMMENTS i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments •. Conservation Decision: Comments r Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street IF`R DEPART E �' _� MNT�° =?T#em'p Dumps er�ton site Yves ono {scat datr 1K24�MainuEStreettom' :Fire 'Departrnent signature/elate ' COIVI,NIENT�Sx ;- " r $ I - - i 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 Call Email Date Time Contact Name Doc.Building Pennit 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 o 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) I ❑ 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 Location No. ��if" Date r . - TOWN OF NORTH ANDOVER r r Certificate of Occupancy $ .. Building/Frame Permit Fee 06 i �* � Foundation Permit Fee $ Other Permit Fee $ z TOTAL $ �� Cheek# � 29659 _= f' /+Building Inspector NORTH Town of . � E : ., Andover Z �h ver, Mass, �/- COCNICNlWICK y1. 7,�A°RATED s u BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .. .. . .. . .... ..... . ... .. Foundation has permission to erect .......................... buildings on ... ...... .. ... �!! � ......... .. ......... Rough ` to be occupied as ..... ..... ... .. �1 ... ....... .................................... .. Chimney provided that the person accepting t s permit shall in every respect conform to the terms of the application Final C on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS Rough Service ................. ... ........... .. . .. .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Renewal na Home Improvement Contractor �AnCe1�i. Renewal by Andersen Corporation tce7a810(Expires 12/2312015) ' vnaDOW REPUICEMEWTmuton ics.�aav Federal Tax!ID#41-1918413 30 Forbes Rd. Northborough,MA 01532 (508)351-2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGRFYmENT Buyer(s)Name Date: PA DALEY - SEPTEMBER 18, 2015 Buyer(s)Street Address Gity State Zip Code 45 t-IIGHWOOD WAY NORTH ANDOVER IMA 01845 Email Address glome Telephone Number Work/Cell Telephone Number DALEY45OCOMCAST..N ET 97861320612 Buyer(s)hereby jointly and severalty agrees to purchase the goods and/or services of.Renewal by Andersen Corporation("Contractor'),in accordance with the terms and conditions described on the front and the reverse of this agreement.and on the attached specification sheet(s)(collectively,this"Agreement"). Buyer(s)hereby agrees-to sign a completion certificate after Contractor has completed all.work under this Agreement Est Start Date Method of BWent Total Job Amount $ 6,365 wount Rnw"d S 0 Deposit Received(33%)S 2;121:67 Dapositats4hing 5 _ 0.00 ® GheckAGash 10-12 weeks I Balance Start of Job(33%)$ 2,121_67 Check# Balance on Substantial .Est.Install lime tuslmsunt°at R, Credit Card ! Comptetiorn of Joni(33%)$ 2,121.67 conte,S 0.00 12 daystt tx�R roti is selected,vease _- Noflnal tdmllbetlemantledurtda7 ereea�9ed-... _-- st>aCtadft�Card form Buyer(s)agrees and understands that this Agreement Constitutes the entire understanding between the parties,and that there are no verbal understandings changing or modifying any of the terms of this Agreement No alteration to or deviation from this Agreement will be valid withoutthe signed,written consent of both'8uyer(s)and Contractor.'Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyers right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation EAlyer(s) Buyers) II Signatureof Consuftant Sigttature Ire X DAVID 13ARRY PATRICIA DALEY Printed Name ofConsultsrd Printed Name Prirgtsd Name. YOU,THE SUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER INS DATEOF THIS TRANSACTION, SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGIIt NOTICE OF CANCErLtTION NOTICE OF CANCkLUTrON 1 Date of Transaction 9/98115 .Tnamsyeancelthis 1 Date ofTransaction 9/12/15 You may cancel this traosaction,without any penalty or obligation,within three business days from.the /ransactioa,vrithout any peoatty or obligation,within th—hmsiness days from the above date.If you cat et,.any property traded In,any payments mad,by yon under 1 above date.If you tweed,any property traded in,any payntents-made by you.under the Contract of Sale,and any negotiable instrument executed by you will he 1 the Contract of Sale„and any negatiaMe instrument executed by yon wM be returned within 10 days fuUawigg receipt by the.Contractor(•'Seller")of your I returned within l0 dsys following reeelptby the G`omraetor("Seller")of ynor cancellation nottee,and any security interest arising out of the muLsaction wM be 1 cancellation notice,cad any security interest arising out of the transaction will be canceled. If yon—nod you mast make available to the Seller at your resideace,In 1 cane". If yon cancel,you must make available to'the Setter at your residence,In snbstantlalip asgood condition,as when received,any goods delivered to you ander i substantially ns good coadition as when received,nay goods delivered to yon under this Contract or Satr,or you may,if you wish,comply with the instructions of the i this.Contract or Sale•,.or you may,.if von wish,comply with the Instruedotta of the Seltcr regarding,the return shi RenewalRenewal by Andersen Corporation MA Home Improvement contractor �?Y1fflE2YSF'.i1. .� s 30 Forbes rd Northborough,MA 01532 License 4170810 (Expires 12/2312015) wrnoow REPLAQrn9FOdT ..a u x c „< (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 Window Specification Sheet I3u els)Name I7att:of Agmrment. PATRICIA DALEY FRI, SEP 18, 2015 The buycr(s)listen above hereby,jointly and sc%,,QmHy ag=ree to purchase the goods and/or scn=ices listed below;in accordance with the prices and terms described on the Specification Sheet and the fmnt and the reverse of the accompanying CUSTOM WINID011'AND DOOR RFMODM.I.3NG AGRi:FAffNT,of which the Specification Sheet is pars. WINDOW&DOOR DETAILS App App. Atq>x Exterior/Inter or Color Hardware Rao&sre Lovr6i/ - Gane Groe Glass Room k wkteh nerslrc 'UL 11 Style Detail Casings Ext•.int Color Stria Saeens SmaAsun Grilles Sash ir3 Sa9h 2 Ufts Options Uvin 101 40 65 105 CSA full frame Int/Ext MF 908 HMIH White Standard FTS arts Gee 416 X Tem r Dint 102 40 65 105 CS:L full frame Int/Ext MF908 wwwii Whita Standard FTS smartsur GBG 416 x Temper Total 2 BAY.BOW&BUILD OUT DETAILS Approx DetaiRoom Counto s� II width/ Approx. Numbs Frame Window End Center LowEI Roof./ Hardware ha{ t Casings Angle Utes Interior ExtAnt Color Grilles sashes sashes Screens Smaitsun Soffit Color SPECIALTY WINDOW DETAns Fun/ Approx. t.owE/ spatially BAY/BOW ADDITIONAL WORK NOTES Room Count st a .Insert U.I. smartSun Groes Grits S . SP=- ADDITIONAL.' Gustm er is awnm rhm L ith tm•/bm,,wincMua undo 72!.rhes rhexc will b"g,fi-.q0m loss ADDITIONAL WORKDETAILS- Middle b{to be a horizontal FDL to simulate dmiblehmig window I Yes Contractor will wrap exterior casings with boil stock color of White Owner is aware that Contractor does not do any paintinglstaining or removallinstallation of alarm system or window treatments/hardware.Itis the responsibility o1 the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to whether alarms or window treatments/hardware will fit after replacement Customer is also aware in some cases there will be glass loss. If there is,the amount will be dependent on the type r.i of exishng winnows,type of installation and window style.We make no guarantee as to the amount of glass loss.Customer is aware and understands any and all unseen rot is not included in this contract.Shouldany rot be found there will be an additional charge for time and materials unless so stated in this contract. s Yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of ail jobYelated debris, windows,doors,storm windows and vacuum nightly included. Upon completion of the lob and payment in full,a limited warranty shall be issued. 4 Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the permits)is included In the total contract price. 5 Yes All discounts have been applied to this agreement. 5 r lk� 0 No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s). It is agreed and tindtmtood by and hentreen the parties that this.Specification Sheet,:along with the CUSXIM WINDOW AND DOOR'RFMODELING AOR I h9 N'T,constitutes the entire understanding between the parties and there are no verbal understandings changing or modifying any of the terms..This Specification Sheet may not he changed or its terms modified or%aried in anytamy unless such chnnge_a nm in writing and signed by both the Buwh' i)and Contractor.Buyers)heAlty acitnowledge that Boyer(s)has read(]tis S1 mcification Sheet. Renewal.by Andersen Corporation Bu}er(s) Btrymr(s) Signature of Consultant `Y 9 Signature Signature DAvit)BARRY PATRICIA DALEY Print Name of Consultant Print Name Print Name I I V Do not rentave until final code Inspedflan. Save label for Uu.re reference, tr o rscomrraoa■ •nwm.s:oea. . N C'p 7 g E uAAA LLJ ,II i •Yov C Ix Renewal byAndersen WJXUuW ■aueBYa■r .n�.deuad�mwn• AND-N-102 Wood/Vinyl Composite Dual . Argon . Low-E4• Product Type: Casement g� ENERGY PERFORMANCE RATINGS i U-Factor Solar.Heat Galn Coefficient 0.29. 1 .65 0 .28 U.SJI-P Metrtc/SI ADDITIONAL 'PERFORMANCE RATINGS Visible Transmittance 0.48 dMMM.mmmncanP�mems pOtlps Mr.fmd WW NFHcptMo Rrm F Pa t P° NFPC r�tlnv+v.pmdMd —Ma.tol oMrtume+R�7 emYmlu"..Pm ptemat �pc mm mtremmncN ury prvmane dou mtamotvn . CetpuRmneumn.ro ld�eloraeirpoeuetpemm�ornunueoM1 . wwme.ory Andersen CoToraporr.RhA Casementn _ r rnmmmum. Standard Rdng RAF-rM.AA vwmuwca+taus.TM4aas DP psf DP36 • ��g�,Qt nmp,m,em.m . . .GMM Bob . !� '�o,wrt,o nem• meht+ dy %ti m.�r,pm.oso, �a ' - 100-00613972.ODi ' .. weenr�mr�n.c�•a�ca.iweeuv�m.�emtrmimmi worv�n..mkcesnem PmQron. j \ 4 The t<bi+unrouweauk Of Ma sacbr s D*-tfM lft of 1ndwb'kd kcWna Orllde Of "Mto Ions 6"Washinon&red Demons 92111 ' .- wwwrl ,g�ovldtrl Workers' Cornpenution Insunikee Af davit:'I udders/CoutraetoWElectrklanWPlumbus Am0cnot:-for-mtZdon p1e�Print s Name(BusmenlOrgenindonilndividual): RENEWAL BY ANDERSEN Adm: 30 FORBES ROAD City/StatefZip: NORTHBORO,MA.01532 phone . 508-351-2200 Arty"an emapioyerY Check the appropriate boa: 73'lpe of pro3ed(required). 1.9 1 win a employer with 30.._� 4. (] I an a gear onbutar and I 6. ,New wmtruction. employees(full and/or part-time).* have hired the 2.❑ I on a sole proprietor or partner- listed on tete attached sheet t 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me is any capacity. workers'comp,insurance. g, ❑building addition [No workers'comp.insurance 5. ❑ We are a coriwration and its 10. - Flectrk'a1 reqs] otf<c have exercised their ❑ ar additions 3.❑ 1 am a homeaumer doing all work right ptiomnnption per MOL I l.❑Plumbing repairs or additions myself,[No ubders'comp. c. 1522,.$1(4),and we have no 12.❑Roof repairs itsunance required.]t employees.[No workers' 139[l t comp.insurance required] - — "_UY applieent dW checks bat e I must 6w fid out the szdicm'odow shming dwir wmim l caa�poifry kmnsdom .t Hwaemun who submit tt6 Adsvit indic"S they,are do*all work mid dice hire outsuk M nuc swbmka>mri at�rit.# such ;ora acmes drat c6a this box meat dtw*bd an additioiW slae�pt:st:ti the Panne of the atd►ooaG'�ooap ad OW vrorlaarrs`otnpp.iwlici'6tf xmatiou I ani an eo4*yer tkt is provi&W vorim l eomq nsadm bus iwxe fivr aV emqkyeea, below Ls j*R policy dndM ske information. Insurance C„ornpany Dame: OLD REPUBLIC INS.CO. Poliev#or Self4rm Lic.#t: jAKQ 3054 Q_ w __ L Vira#ion DM:_10-01-16 Job Site Address: 45 HIGHWOOD WAY City/StatVVP::NORTH /ANDOVER. MA 01845 Attach a ropy of the workers'comptasation policy declaration psge(showing the pol*nUwber sad expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the' penalties of a fine,, to 51,500.00 and/or one-year irn nsonment,as well as cKil of STOP WORK O1tbfiR and a fine i 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. I do hereby cern under tike pains and penaWn olpryary that tke Wora r pr+avld'ed above Is true and cornart, Phone i#: 508-351-2200 (ficial ase"4k Do not write In skis arm to be cvnrkle-d by clb or town oJlp City or Town: Permitucetase# Issuing Atttbority(circle one): 1.Board of Healtb 2.Building Department 3.City/Tows Clerk 4.Electrical lavector S.PlQMbisg Inspector 6.Oifer Contact Person: Phone#• ANDECOR-01 YADAVYO CERTIFICA`a OF LIABILITYiWSORAR'CE F 10/1/2015 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),AUTHORWED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polisy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditlons 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 Wills of Minnesota Inc. NAME: WI!!Is Certificate Center cdo 26 Century EIR E :(877)945-7378 Ne• 888 467-2378 P.O.Box 90511H ` :Cer" III&- Nashvllle,TN 37230-6191 Cam AMRDING COVERAGE NM NI INSUREDINSVRER A:Old Re ublic Insurance Coinpany 24147 INSURM 0: Renewal by Andersen LLC INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01532 INSDRExIE: 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. 1LTR TYPE OF INSURANCE POLICY NUMBER TEFF M LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,0W1 CLAMS-MADE ®OCCUR MINZY 305440 10/01/2016 10/01/2016 PREMISES oommuml S 500, 00 MED EXP am parson) S 10,0 PER80NAL b ADN INJURY S 1,000, GEWL AGGREGATE LMrr APPLIES PER; GENERAL AGGREGATE 3 4.OWr X POLICY 0 JECTPRO LOC PRODUCTS-COMPIOPAGO S 4,000 OTHER s AUTOMOBILE LUU31UTY MBI(NED 81N1'i Ea aoaderd S 5,000,00 A X ANY AUTO MWTB 305438 10/0111015 10101/2016 BODILY INJURY(Per peraan) $ ALL OVVNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aoddenq $ HIRED AUTOS NON-ONMED S AUTOS Per eoIdelrt - S UMBRELLA L1AB OCCUR EACH OCCURRENCE S EXCESS LIAO CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION AND EMUU31UTYPER A ANY PROPR�I ARTNERIEXECUIVE YIN �30r�7� 1D10111015 10!01!2016 X Em R OFFICERIMEMBER EXCLUDED7 I N, N I A EL EACH ACCIDENT S 1,000 (Myarxhtory it NN) E.L.DISEASE-EA EMPLOYEE $ 1,000 S C ROF OPERATIONS below EL DISEASE-POLICY LMR S 1,000, DESCRIP71ON OF OPERATIONS I LOCATIONS/VEHICLP.S(ACORD 101.AddithmW R*=ft sch*dul%may be attached IN mora apace Is requhad) f CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL I EI)BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORI7ED REPRESENTATIVE Evidence of Insurance rd�` ®1988-2014 ACORD CORPORATION. Ail rights reser ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD ved, Massachusetts-Department of Public Safety Board of Building Regulations and Standards _ Construction Supen-Jisor L cense.'CS.090125 i U GARDEUBR IYW?M"UA U1W OT99 r Expiration • i Commissioner IOA)WM6 i Gp�O } 1 {�, �� ]��. :.. ,�'7i!R•t Ali IYAl AIA- E VCt j