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HomeMy WebLinkAboutBuilding Permit #510-2017 - 54 COVENTRY LANE 11/14/2016TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 5 / 0 )0 ( Date Issued: I f `/ q -2o ('b LOCATION Or PROPERTY Date Received / I— / y- 01-01 fo IMPORTANT: Armlicant must complete all items on this page C4 MAP NO.: 16 q PARCEL: Y 11•� � D7_\►i7il.`7 971T�7 �i7i �I�i`►71�J Print ✓ ZONING DISTRICT: HISTORIC DISTRICT YES h TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ° ne family U& ddition Mwo or more family ^8 ndustrial vo Iteration No. of units: Aepair, replacement mssessory Bldg 2 ommercial EO „a emolition Ep ovin relocation 1'ther Mothers: nfl oundation only DESCRIPTION OF WORK TO BE PREFORMED — I 1% ► 6�i U LACE) sON � ,cam � `�V Identification Please Type or Print Clearly) OWNER: Name: i G l I ? 1�� �.� i h c� Phone: q7 i Address: J —) t CONTRACTOR Name: 3 uc , c 5 t , 1,t Cnr\ b�u Phone: Address: 198 i�o �v, 10,(\ A4 dpi) t .)nLLAK lihfi sol, Q.01 Supervisor's Construction License: (`) 4S V 1�2 it Exp. Date: Home Improvement License: l ©�-1 Exp. Date: 1 ` ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT.• $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$� 8 x12.00=FEE:$30 — Check No.: / Receipt No.: 1 Page 1 of 4 " zo, Location _S Lt dV'p,14- No. P,14-No. A� l U _ 00 1-7 � '� Date //� � ��- 01 O/ 6 T WN -OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / 6 /,3 /,Z44 Z' 6 17 9 V Building Inspector NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted 11 Plans Waived ¢01 ¢ Certified Plot Plan 4 tamped Plans 0¢ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No:, Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: DATE REJECTED DATE APPROVED 00 1 144 EQ Mater Shed Special Permit FE ¢ ite Plan Special Permit °° ther DATE REJECTED Ea ac• DATE REJECTED E4 00 Comments Comments DATE APPROVED EQ ¢o DATE APPROVED EA 00 Water & Sewer connection/Shwature & Date Driveway Permit Temp Dumpster on site yes_no_ Fire Department signature/date TYPE OF SEWERAGE DISPOSAL I FE-0159sEsti Tanning/Massage/Body Art an Swimming Pools Public Sewer nu E0 °° Well 94 Tobacco Sales Food Packaging/Sales nB 1001 EPermanent Dumpster on Site Private (septic tank, etc. 1 00 1 Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted 11 Plans Waived ¢01 ¢ Certified Plot Plan 4 tamped Plans 0¢ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No:, Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: DATE REJECTED DATE APPROVED 00 1 144 EQ Mater Shed Special Permit FE ¢ ite Plan Special Permit °° ther DATE REJECTED Ea ac• DATE REJECTED E4 00 Comments Comments DATE APPROVED EQ ¢o DATE APPROVED EA 00 Water & Sewer connection/Shwature & Date Driveway Permit Temp Dumpster on site yes_no_ Fire Department signature/date q Plans Submitted Plans Waived Certified Plot Plan - Stamped Plans ❑ iYPE-bF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ 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 v U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Signature COMMENTS N. HEALTH COMMENTS Reviewed on Sianature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: 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 3M Usgood Street no —y 11 -imension 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 lyes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine 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 ❑ 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) Ei 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 Pian ❑ 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 a Engineering Affidavits for Engineered products MOTE: 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: BandingPermit Revised 2014 v U� C � N0 -a O n Z y CD O CL �• N c O < vCD CD O C�= cr CD CD O a CD CD CL 0 O y. 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RAM ap Andover, MA 01 S45 North Andover, MA 01845 JOB DESCRIPTION ^F%Or.^L.am: I-TO%Ift IjW ala ffjrgcis to "d xm of lftw m Your 891kw W%nmd n mcm with dw umOf SPmW b* OW diagnostic to to aaM 11w-k*w This wok will w w exdWp ad Ww sir qudy.mda a beWdm kW will ha of areas for seating include w itowiMoadyawbom ON mdsk COUPW OWN sad wJw pa6maL primary bamm". OWW PIW ad aft (WWM we r4t pw* fiddfmW.) This will rewim (4) W*iRg hhewn.A f0fttioh in cubic fed per ndauIe (whoW Uftdig) of * infillridw will 00m, bw tm actual number of e% is not PW=Wd At the mVkfim Of1he "*� wok ad ser -mmclar to mm ft Sg* 0fdw Ww nit miry. UkY W01*9 will be wn&xW by the ob no W"O'W cm 10 d11 bcmwww. A 6M blower door oft =Wmfm L4 kv-s At "r.CWAU. UARE: ftVWe Wa oflomewan mfw ares /05 41 swuWam UWUU USUIUM 10(105) upjrjt fog - 5d CA mmtwuK to insUll 2* FU fused semi-rigid fiberon board iasnhuim to (20) sqm knftwafl am Za C)C-- Zl' If ;W- rmwmc nm arra m"N"M 10 Wmdft the beck of are mticdwwi* r �eWd 71m�=Wwl and wal=&&oft� With wewww*ft to fewid air imaimp I- 1� I' C d octz so VENTILATION: ft" 4W* MOW* 10 k" V=filmld—nW in (22) rdw bays to-mailmlin air flow. 22 (F(-,rf 01viye 15 GARAGE CIULING., ftV* MW ad MW* to kma IV R-35 dwAy padded am I cdwm im $00 squaw Am of balm ahmal Swum bydriffialgholm W rho telling fim below. 11014601alwill baphWd, pie's will fespmibility. AKA WLAMLt: PVOVM MW W4 MMUM to jMWI (15) SqM hg perimeta wall up to the sill and spiam the bmWjok of R-10 rigid Tbaraw—WWom to ft aWAq=0 -Y\ cvvjt5face --77- 01kA 5340.00 S367.S0 $70.00 $73.91 $44.00 $1,03S.00 $277.So JOB DESCRIPTION Total: $2,207.91 Program Incentivo: $1,740.93 Cusl omsr Total: $466.98 WBAOM W&W ro MUM jUM="=M=W &000FAWM VM Aa "SMMMMea. Pae INe SW of ""Four Hundred Sbdy-ft &981100 Doftm $486.98 r +Whwnmi►a�ar►rais. �`.'.`.. as �aa►rwce .._._.._..,...�._ _.._..,,.....__ +aTeneoowen�crwrwvriea�wwwrrore ani+ aaanaoer �0A.0 ..._ 38 4-w. Dc psi} 4 104.00 CK 0 1 o3I P to/1811C Revise Energy WwWA tEn.rB 4cm How PWormoft Conernecor s s ee sMmtr stmt„ 4-r dt" MA x1833 CONTRACT FAX (401) 7843710 PIP 2 PROGRAM CMA -HPC Mattpagostino '_ ww ,_—..._..._vow OVA" (978)681-5617 10/18/2016 441999 00001 54 Coventry Lane 9 U -M °TWW 54 Coventry Lane 9 •manna cnr,a�nca. _...�_---- _ ______._ __,...__..___. North Andover, MA 01845 ea sum mtrAmIm - - . „ .......... _ North Andover, MA 01845 JOB DESCRIPTION Total: $2,207.91 Program Incentivo: $1,740.93 Cusl omsr Total: $466.98 WBAOM W&W ro MUM jUM="=M=W &000FAWM VM Aa "SMMMMea. Pae INe SW of ""Four Hundred Sbdy-ft &981100 Doftm $486.98 r +Whwnmi►a�ar►rais. �`.'.`.. as �aa►rwce .._._.._..,...�._ _.._..,,.....__ +aTeneoowen�crwrwvriea�wwwrrore ani+ aaanaoer �0A.0 ..._ 38 4-w. Dc psi} 4 104.00 CK 0 1 o3I P to/1811C I /LG YVGULL/L Vf lYl UJJLLL/L"JGLLJ oi.5ica. Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Building Science & Construction Address: 300 Trade Center Suite 3690 Zip: Woburn, MA 01801 Phone #: 781-353-2455 Are you an employer? Check the appropriate box: 1. ❑■ I am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time). 2. ❑ 1 am * have hired the sub -contractors a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.* 5. ❑ We are a corporation and its 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. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.7 Roof repairs 13.❑■ Other Weatherization *Any applicant that checks box #I 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. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hartford Underwriters Insurance Inc Policy # or Self -ins. Lic. #: UB -9F620983-16 Job Site Address: 54 Coventry Lane Expiration Date: 4/11/2017 City/State/Zip: N Andover MA, 01845 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 $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 certify under the pains and penalties of perjury that the information provided above is true and correct. Kyle Martin-'- 11/4/2016 Sianature: °° Date: 781-353-245 Official 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 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/28/2016 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 have ADDITIONAL INSURED provisions or 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 D'Agostino Insurance Agency Inc 7 Christys Dr Suite 1 Brockton MA 02301 CONTACT NAME: Mark D'Agostino PHONE 5085860414 AIC No Ext): AIC, No h-MULADDRESS: mazkd@rfdinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: MARKEL 34754 INSURED BUILDING SCIENCE & CONSTRUCTION INC 300 Tradecenter Ste 3690 Woburn MA 02181 INSURER B: COMMERCE INS CO 25496 INSURER C : TORUS NATL INS CO 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 AUUL INSD mutsm WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_x1 OCCUR X 2CW9728 05/16/2016 05/16/2017 EACH OCCURRENCE $ 1000000 _ PREMISES Eaoccurrence) $ 50000 MED EXP (Any one person) $ 5000 X PERSONAL & ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECOT- F—] LOC OTHER: GENERAL AGGREGATE $ 2000000 PRODUCTS - COMP/OP AGG $ 2000000 $ B AUTOMOBILE X LIABILITY ANY AUTO WNED SCHED OAUONLY AUTOS TOS ULED HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BCCB81 04/15/2016 04/15/2017 Ea accident $ 1000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident $ C X( IEXCESS UMBRELLA LIAB LIAR X ri 1 OCCUR CLAIMS -MADE 73023TI60ALI 05/16/2016 05/16/2017 EACH OCCURRENCE $ 5000000.00 AGGREGATE $ X DED I RETENTION $ 5000.00 $ ORKERS COMPENSATION- ND EMPLOYERS' LIABILITY Y / N Y PROPRIETOR/PARTNER/EXECUTIVE ❑N FFICERIMEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CONCFI I OTION s, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU�TjHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE rDATEamwDIYYYYI oICATE RTI 181SSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS•UPON THE CERTIFICATE HOLDER THIS rli[CIATE ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE I.. PORTANT - It the Certificate holier Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject do terms and conditions of the policy, Certain polloles may require and endorsement A statement on this certificate does not confer rights to certificate holder in Hou of such endoreem s . PRODUCER CONTACT NAME: RONALD F DAGOSTINO INS PHONE FAX 7 CARISTYS DR SUITE I (A►C, No, 94: (A1C, No): BROCKTON, MA 02301 E�- ADDRESS. 26WIL INSURER(S) AFFORDING COVERAGE two* Hokum INSURER A: HARTFORD UNMRWRrrMtS II18URANCE OJ1IpANY BUILDING SCIENCE & CONSTRUCTION INC INSURER IS: INSURER C: 300 TRADE CEISTER SUITE 3690 WOBVRN,•MA 01801 INSURER D' IIS URER L. U�RER F: COVERAGE$ CERTIFICATE NUIlMo : REVISION NUMBER: INSURIONIS B -M PMJ�OpABOVE FOR PO PERIOD INDICATED. NO7IMTHSTANDING ANY REIiUslBMENT, IERII OR CONDnLON OF ANYOONTRACTOROTNER OMn ENT WRH RESPECTTO WN THIS CERTIFICATE.MAY BB HUED OR MAY PWAW, THE INSURANCE AFFORDED BY THE POLICIES MOM IS SUBAW TO ALL THE Mp M % Wi0C MKM AND CONDIIIONB BUOII POLId1E9. LDAITB BIIOYYN MAY HAVE 8E@I REDUCED BY PAID CLAIMS. IM1 YM-1TYPE OF L48URAM E ADD L B R POLICY NUMBER POLICY EFF DATE (a Nxwnl ) POLICY EXP DATE (MM MYYYV) Lam GENAL LIABIIM COMMERCIAL GENERAL LIABILITY ftH OCCURRENCE $ TO RENTED $ REMISES(Es aoourte =) CLAM MADE rj OCCURAGE _ EXP (Any one person) $ L AGGREGATE LIMITAPPLES PER: ERSONAL & ADV INJURY$ENERALAGGREGATE $ 5POUCY13 PROJECT ❑ LOC RODUCTS - COMP/OP AGG $ AUTOMOBILE LIABIM ANY AUTO ALL OWNEDAUTOS SCHEDULE AUTOS COMBINED SINGLE $ LEGIT Ea aootden BODILY INJURY $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Pet acrid PROPERTY DAMAGE $ (PereaddwM UMBRELLA LIAROCCUR 13 EACH OCCURRENCE $ EXCESS LIAS CWMS.MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYER'SLIABIUTY YIN ANY PROPERRIER EXCLUDE EXECUTNE EI OFFICERIMEMBER EXCLUDED4 NIA UB0620988.18 04M1/201e 04/11/2017 X LIMITS ORY OTHpi E. L EACH ACCIDENT $ 1.000.000 (Mendelory In NIq N M deealbe under E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS bd w DESCRIPTION OF OPERAMONBLOCATIONSNEWCUNfitE$TRICTIONSISPECIAL RENS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROWSIO AUTHORIZED REPRESENTATIVE –..'L-..`1 4 nw nww 9Mu0 Gua WHO UM WHIMUM Mara$ Of AUUW 7800.2010 ACORD CORPI'J TIOIWE 70141 MA reserved. f'RIP VY-MAW0 "111.4 f/'- ll" ✓tJ �. OfBela�CeaaanerA�a $�k�Lee IiE NPROVUM CONTRAMOR PANOWAGM: 1475 7iM tlon: 17 DBA p CARPENTER PgRIG.L JACKSON U CEUPMAN $1: 14:- - 4� 1ti DORCIESTER. Ulk OM24 D 2dmmr wy or !"t$CSoeo= ST iM V` � y" 9 � IR •� ae.. .07124=, 17 or