HomeMy WebLinkAboutBuilding Permit #790-11 - 66 LACY STREET 4/8/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO. ---72-0--// Date Received
IWORTANT: Applicant must complete all items on this pate
LOCATION 66 Lacy Street, North Andover, MA 01845
Print
PROPERTYOWNER Craig Robinson
Print
MAP NO:105. P PARCEL: CO ZONING DISTRICT: R 1 Historic District yes no
Machine Shop Village yes (n
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
k] Assessory Bldg s hh P r]
❑ Others:
❑ Demolition
❑ Other
.D�,Septic .:❑Well.
{Wetlands
`' ® Watershed3District
t]FWater/Sewer• f
-�
- - - - x - -- �_� _
DRSC'.RIPTION
OF WORK TO BE PERFORMPD-
Install a 10 x 16' Garden / Utility -Shed on property.
Identification Please Type or Print CIearly)
OWNER: Name: rra; g RnbJ ncnn Phone 978-836-7554
Address: 66 Lacy Street. North Andover% MA 01 845
CONTRACTOR Name: Reeds Ferry. Inc.
Address: 3 Industrial Park Drive. Hudson. NH 03051
Supervisor's Construction License: 2 6 2 3 4
Home Improvement License: 119 9 0 3
Exp. Date: 5/12/12
Exp. Date: 9/17/11
ARCHITECT/ENGINEER N/A Phone:
Phone:
Address: Reg. No.
FEE SCHEDULE: B ULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $___I - 4 3 9 - 8 7 FEE: $_ ,S,9 . 0a
Check No.: SO� Receipt No.:,;? 4117
NOTE: Persons contracting�with unr�istered contractors do not have access to the guaranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ID Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swimming Pools ❑
Tanning/MassageBody Art ❑
well 11 Tobacco Sales ❑ Food Packaging/Sales ❑
Private (septic tank, etc. 1 Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
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 384 Osgood Street
no
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions._
Total land area, sq. ff.:
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
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
❑ Flobr/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engin-eered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Tilas'o 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
AL the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
xst be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Location / G
No. 7,5;0 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # lr-2
LIM
24, % J / K
ilding Inspector
/µ°RTH TOWN OF NORTH ANDOVER
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OFFICE OF
40002 BUILDING DEPARTMENT
o 1600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE:_
JOB LOCATION: 4 G LAS S
Number Street Address Map/Lot
I,JOMEOWNER pww5oN
Name Home Phone
PRESENT MAILING ADDRESS GL LAtk Sfn,q�r,
Work Phone
City Town State .
. zip code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and
to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner
acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s) who awns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to
be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be
considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations. 11
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE �► �, Q,
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530
HEALTH 688-9540 PLANNING 688-9535
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1-11 AY 1 1
CONIISERVA.70;'
APPLICATION CHECKLIST Small Project
General Requirements - Wetland Protection Regulations:
Section 4.4 - The applicant has read and understands the applicable regulations
The applicant maintains that the project falls within the small project category below:
❑ A. Open slotted decks, without roofs, equal to or less than 300 square feet surface area, inclusive
of stairs and ramps, which are to be attached to an existing home, where soil disruption during
construction is limited to less than 50 square feet, and where no permanent soil alterations are
planned under the footprint of the deck
❑ B. In kind replacement of existing decks, regardless of size.
C. Sheds or other outbuildings of less than 100 square feet, which are to be placed on footings,
permanent ermanent foundations.
.
❑ D. Sewer system connections as required by the Town of North Andover.
❑ E. Unpaved pedestrian walkways for private use.
❑ F. Patios less than 300 square feet, not requiring excavation or grading
❑ G. Pruning of existing vegetation, planting of new vegetation and gardening.
❑ H. Fences and stone walls which do not alter the flow of surface waters nor alter wildlife habitat
or movement.
❑ I. Conversion of non -permeable surfaces to permeable vegetated surfaces.
J. Other similar projects of minimal impact,, as determined by the North Andover Conservation
Commission. (G L}
The local Wetland Bylaw filing fee of $25 has been included with this application.
A written narrative description/scope of work of the proposed project and potential impacts to all wetland
resource areas has been included.
The applicant has identified and clearly marked all wetland resource area boundaries in the field.
❑ Two (2) copies of a 1" = 20' scale (or other as deemed appropriate by the Conservation Commission or
agent thereof) drawing showing existing and proposed conditions and the delineated wetland resource
areas (see plan requirements below for additional detail).
Effective 10/ 11/06 1
A pre-construction/pre-approval meeting was held on site between the applicant and a representative of
the Conservation Commission %E I�-EI2, i-4�-jNE_�3) Date of Meeting: ��'/ V9116 11—
. The delineated resource area boundaries have been confirmed by the Conservation Department as
accurate.
Plan Requirements (Section 4.4.3 B):
Certified and/or professionally prepared plans are not required. However, the North Andover Conservation
Commission or its designated agent shall have the final authority to determine whether the submitted
plans/ drawings are adequate and include all pertinent information for review.
At a minimum, all plans submitted shall clearly and accurately show the present conditions and proposed
work and depict the location of all wetland resource areas within 100' of the proposed work. All plans must
be signed and dated by the person who prepared them.
The Commission may also require the following information on the proposed plans in addition to the
aforementioned criteria where applicable:
❑ Location of any subsurface sewage disposal systems.
❑ Locations of any drainage structures.
❑ Locations of any easements, including but not limited to, drainage and utility easements.
❑ Locations of any open space boundaries if (eg. if the lot is affected by the 50' open space boundary as
required in a Planned Residential Development (PRD)).
❑ Location and nature of all proposed alterations to the Buffer Zone Resource Area.
Date: 0_11b
--------------------------------
Signature of Applicant or Applicant's Representative
(TOWN USE ONLY)
❑ COMPLETE APPLICATION -The application meets the submittal requirements. Therefore, the
Conservation Department has prepared a written list of conditions necessary to protect any adjacent
wetlands for approval by the Conservation Commission.
This condition list shall be filed with the North Andover Conservation Department as NACC #
❑ INCOMPLETE APPLICATION - The following sections of the Wetland Protection Bylaw &/or
Regulations have not been complied with and as a result this Department is rejecting this incomplete
application w/in two (2) business days from the date of receipt (Section 178.4 North Andover Wetland.
Protection Bylaw). You may pick up this application and supporting plans at the Conservation Office and
re -file with the required supporting documents and information.
❑ NOT A SMALL PROJECT -The North Andover Conservation Commission has determined that the
proposed project as submitted does not meet the small project criteria and hereby denies the application.
As such, a Request for Determination of Applicability (RDA) or a Notice of Intent (NOI) must be filed.
Reason(s)
Signature of Agent:
Effective 10/11/06
2
Date:
The following Narrative is being submitted, as per the request / requirements of
the NA Conservation Dept. / "Small Project."
I have met (5/10/11) with (Jennifer Hughes) of the North Andover Conservation
Department at the site location (my residence) in order to review and to confirm all of the
requirements under the Conservation / Wetlands Act / By-laws for the purpose of this
project.
Additionally, a permit application, along with supporting documentation has been
delivered to the NA Building Dept. on 4/8/11. The Conservation Dept (Jennifer Hughes)
was subsequently notified and has been assisting me with this project.
I am requesting approval / permit to have a Shed (garden / utility - 10x16') 160' sq. ft' to
be delivered / set-up on my property by The Reeds Ferry Co., Hudson, NH.
The proposed project / scope of work are as follows:
Project is to have installed (1) garden / utility shed (10' x 16') at my residence. Shed will
be a non -permanent structure; it (shed) will be supported by concrete pavers / blocks.
(Reeds Ferry Shed Co.). The location of the shed shall be within the requirements as set -
forth by the wet -land / conservation by-laws 501t min. (See photo with dimensions-
65'ft.)
The shed will meet the building department requirement(s) — set / backs (Property-lines-
30'ft min.). Included are photos to help establish the location and to give dimension(s) for
both the shed and its site location relative to the natural resource(s) area. I have purposely
worked with both the NA building Dept. and Conservation in an effort to make sure that I
am meeting these requirements. The shed is built primarily at the factory, therefore there
is very limited construction needed or required at the site, plus the utilization of pavers
will create a non -impact to the surrounding area.
I recognize that the shed I am proposing is greater than the 100' square ft' dimension as
out -lined in the "Small Project," guidelines. However, some similar projects that do
qualify as "Small Projects" are permitted / allowed more (larger) square footage.
Therefore, considering that my project conforms to all of the other requirements and it
creates NO negative environmental impact with its square footage. I would kindly request
that you grant approval to my request / application.
Thank you for your assistance and consideration regarding this project.
Respectfully submitted,
Craig Robinson
E; 4,
NARRATIVE
Robinson's shed
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Location: 66 Lacy Street North Andover, MA
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To Whom It May Concern,
The following Narrative is being submitted, as per the request / requirements of
the NA Conservation Dept. / "Small Project."
I have met (5/10/11) with (Jennifer Hughes) of the North Andover Conservation
Department at the site location (my residence) in order to review and to confirm all of the
requirements under the Conservation / Wetlands Act / By-laws for the purpose of this
project.
Additionally, a permit application, along with supporting documentation has been
delivered to the NA Building Dept. on 4/8/11. The Conservation Dept (Jennifer Hughes)
was subsequently notified and has been assisting me with this project.
I am requesting approval / permit to have a Shed (garden / utility - 10x16') 160' sq. ft' to
be delivered / set-up on my property by The Reeds Ferry Co., Hudson, NH.
The proposed project / scope of work are as follows:
Project is to have installed (1) garden / utility shed (10' x 16') at my residence. Shed will
be a non -permanent structure; it (shed) will be supported by concrete pavers / blocks.
(Reeds Ferry Shed Co.). The location of the shed shall be within the requirements as set -
forth by the wet -land / conservation by-laws 501t min. (See photo with dimensions-
65'ft.)
The shed will meet the building department requirement(s) — set / backs (Property-lines-
30'ft min.). Included are photos to help establish the location and to give dimension(s) for
both the shed and its site location relative to the natural resource(s) area. I have purposely
worked with both the NA building Dept. and Conservation in an effort to make sure that I
am meeting these requirements. The shed is built primarily at the factory, therefore there
is very limited construction needed or required at the site, plus the utilization of pavers
will create a non -impact to the surrounding area.
I recognize that the shed I am proposing is greater than the 100' square ft' dimension as
out -lined in the "Small Project," guidelines. However, some similar projects that do
qualify as "Small Projects" are permitted / allowed more (larger) square footage.
Therefore, considering that my project conforms to all of the other requirements and it
creates NO negative environmental impact with its square footage. I would kindly request
that you grant approval to my request / application.
Thank you for your assistance and consideration regarding this project.
Respectfully submitted,
Craig Robinson
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CONSERVAl'!0 ,] cO��r .S!ON
"A°
Above diagram illustrates the "footprint" and lay -out of the
shed.
Shed will be installed / placed on concrete pavers / blocks per
the Builder — Reeds Ferry, Inc.
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SIZE: $
ROOF COLOR • Black
Ramps 4x3Single Door ---------------------- -----------------------------------
-------------- .... QTY
x$
6O.OUea. $
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4x5Double Door -------- ---------------------------- ---------------------------------------
QTY. ________x$
• Red
85.00 ea. $ ^
Lj Green
4x8Double Door --------------------- .... --------- .....
___ ........... ..... -___ ... QTY. x$
110.O0ea. 3
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4x7For Roll -Up Door. ___ _---------------------------------------------------------- QTY __x$
PmmaumTnea�d��Plywood FlooringPer Sq. Ft. cdF�ur---_--NO. OFSO. FT_____ -___.x$
135.0Oea. $
2l0ea. S
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Pool Filter Hole ------- -------- --_-'_____.-....... ................
--------------------------- QTY. ________x$
C) Clay
75.00 ea. $
C] Wedgewood
Pk�voudPa�hiuno-'8----_-----_-----_--___--------'_-----
QTY
x$
100.00oo$
P
Pk�voodPa�hiono-'1O''_----_-'_____-----------_--_----_.-
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125.00 ea. $
Plywood Pmrtitions--12'-...... ..... ____ -------- ------- --------
_-_------------------------ QTY.
xo
150.0Oea. $
NuFloor—Per Sq. R ---------------------- ----------------------------
-------------------- NO. OFSQ. FT—
x$
-<1.00 ea. $
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Additional Wall HT Pine Per Lin. Ft -----_------__-___
Additional Wall HTVinyl/Cedar Per Lin. R ---------------------------------
-------------------- .....
NO. OF LINEAR FT. x$
NO. OFLINEAR FT. ________x$
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5.00 ea. $
6.00 ea. $
Additional Large m8ndow(s�-_'_---__-------------_------_-_-'QTY___'x$
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NN
To Change Standard Window to Large. ---- --------------------------
Standard Window Box ---- ____ -.... -....... ------------------------
----__-------------- OTY______-_-x$
__--_... '_--------- -'OTY_____'x$
65.00 ea. $
25.0Oea. O
~~�
Large Window Box ------- ----------------- ___ ...... _------ ---_--_-_--------------------
OTYx$
35.UOea. $
Additional 8'RniohahioidDoor --------------------------------------------------------------------------
QTY.
x*
200,00 ea. $
5'Finiohohho!dDoor ._-'_-_-----------_-.-___----_-_.-OTYx$
250.00 ea. $
0Add�ona
�K �n
Additional 6'FiniahohieldDoor --- _----------------------------------------------------------------
OTY________xS
300.00 ea. $ '
Change 5'Door to8'Door ------_-__---_--------'
--- ... ___ ----------- -' QTY.
x$
50.00 ea. $
N
Additiunsl5'8Va*RoU'UpDooc_.-_.---_-_--__--_--__--_---_-'OTYx$40O.00ou.
Additional 7'SteoRoll-Up Door_–_-- ------------------------------------------
---------------- QTY. ________xG
$
45U-OOea. s
To Change 5' Finishshield Door to 5' Roll -Up Door ..........
......... ---------------------- QTY._
x $__x$
250l0ea. $
To Change BFinishohiaNDoor to 7Roll-Up Door. ...
_-_........... --------------- OTY________x$
300.00 ea. $
S
Loft4'x8'- ... _-__--.-------- ------- ------------------------------------------------------
Luft�u1�--------_---__-'-'-_-_-_---_-_---_-'--_--'__-OTY____-�__-x$
........ _OTY.x$
60.00 ea. $
8O.00om.$
Loft 4'x12'- --------- ---------------------------- --------- ----_-------
____ -------------------- OTY________.x$
100.00 ea. $
Solar Shed Light Kit__._-__'-OTY
Amhito�umlRoofShing|eo-----
x$
-�W&A--NO. OFSQ. FT. __x$
135.00 ea. $
1.00 ea. *
Other__-_--_-'------ _.-_-_---_----------- --_.--__
------------------- OTY__-____-_x$_______$
*Shutters included on all Windows
Lj_ LI -2
• White
L] Lt Brown
J Lt Gray
40Weathered Wood
ROOF COLOR • Black
C1
SHUTTER COLOR 0 Almond
la
U Blue
U Clay L) White
• Red
ray
Lj Green
Ll Brown U Burgundy
VINYL COLOR (3 White
U Gray
F.J Blue
U Flint Gray
• Beige
C) Clay
D Olive
C] Wedgewood
PLACEMENT 0f0OOR(S)AND WINDOW(S)
BACK
LEFT
SIDE
RIGHT I
—
-----
SKETCHNNTHE APPROPRIATE SYMBOLS
WINDOW DOOR DOUBLE DOOR
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-/Do/# �SAI:ESTAX
TOTALs 70
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OTAL AMOUNT DUE
UPON DELIVERY$
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CERTIFICATE OF LIABILITY INSURANCE =2010
ACC�RD�
PRODJCER rAn5l224_xti3 FAX lF5Tl2]4-AM 2 I THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION
The Rowley Agency, Inc.
139 Loudon Road
P.O. Box ill
Concord, NH 03302-0511
INSURED Reeds Ferry Small Buildings, Inc
3 Industrial Park Dr.
Hudson, NH 03051
COVERAGES
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. —
INSURERS AFFORDING COVERAGEi NAIL #
Nu' -.=ERA. Peerless Insurance Companies
r.ic• PF;s Excelsior Insurance Company -- —
wrs,.FE The Netherl ands Insurance Co.
j rd31 SERC' I
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMIITHSTANDING
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR"ADo------ ---- -- —.... -- _ -- ------ —POLICYEFFEZ
LTR NS TYPE OF INSURANCE POLICY NUME,E_S ! DATE (I IMIDONY W) DATE (MWDDffryy) t
—
UNITS
3ENERALLIABILn CBP8157302' 06/02/2010
06/02/2011 ; EAc. "cc_a-pENE
S
1.000 000
I._X tAtt h -1A E^FIA: .'A$Lm' I
IEB unen el
$
,
100,000
I A".rr :A^F
�--CG
ro�ED F(Aryr,,rtepernnn's
i-UF=•�
g
'---1
5,000
C I I X CG0001
^.NAL a AC^J I"4ipy
¢
000 00O
'--'--
I I- �
j. %F t ER - --E
—
.;,cn:EF't•: AQGFE';ATE g
t-F•F
-1._---
2,000,000
�E
' •:EtiL q, �:iYEGAT'L'9C 'EP�
IC'I'i j. �('1r;UhjOnS
2,000,0
f • AUTOMOBILE LIABILI'Y BA8158001, 06/02/2010
06/2/2011
a -
I
LX Ar.T I;, o
,�O!7RINE:��JPJ�i.E tIP!iT
ca,,:u�enti
g
1,000,000_
ALL ^r'rNEO ?.UTO _
I
B I - SCHECIiJLEpt•.;ii�'� I
----`-----.—.—
-------------
X HIRE,, :-IrUS
—X N0N- CD
,A AJTJS
----
R"IFEFo C..A4'AGE
P.n a...�I"
i
---- — ---- —
'
I L�AR,AGE LIABILITY
---- ---
A, I$
rrE;'r1A1J—_-+---------
-----
EXCESS; UMBRELLAUABILrrY CU8159803' 06/02/2010
06/02/2011 j =_Ai c' cJFkEN E
a
4,000,000
.4vrr-E ; F - -
,_
4,000,000
A-
�...— TIBLE
j X RE- ENTx4N g 10, 000
C--- -.---
—
— -----
WORKERS COMPEN N
1 AND EMPLOYERS' LIABILITY { WC8152302. 06/20/2010
06/20/2011 1 X Tnc,Y MTS_
EP_!
ptr =�o=RI=Tr raR°t.:eFt_: ee ; 11'ION 3A STATES: NH/MA
BOFF -ABET
E _ �C� ::a4ENr
L.
i
SO_0, 00.0
(,E", EX' [Di
I(MandatcrytnNH) INO EXCLUDED OFFICERS
_—_-._ ._ ---_.-4
E_D;EASE-EA?!APCJiEE
___.__.
g
_ ._
500,000
IIt YPi.lj2S::lU��lf.��!
. SPEUP.L r":�\451 :;P.'- Galea I �
-
u�E se. P-1-I,:v,l t
I T C£
500, 0
OTHER
j
I
I
DESCRIPTIONOF OPER4'IONS I LOCATIONS! VEMCLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECI4L PROVISIONS
overing operations of the named insured throughout the policy term.
''exce t 10 days for nonpayment of 2remium
%.arc i irik-#A 1 c nvL.UCY%
GANGtLLAI WN
SHOULD ANY OF THE ABOVE CESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING iNSUPER WILL ENDEAVOR TO MAIL 30' DAYS wRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Da SO SHALL
IMPOSE NO OBLIGATION OR LIABILrTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Rhonda Nobl
The ACORD nanT$ and logo are registered marks of ACORD