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HomeMy WebLinkAboutBuilding Permit #232 - 92 FRENCH FARM ROAD 9/21/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION / Permit N0: 2-9-z— Date Received Date Is a :' " IMPORTANT:Applicant must complete all items on this page LOCATION >�i2e✓1G� l�91�/YI QJ Print PROPERTY OWNER NO 100 Year Old Structure yes MAP NO: 0% PARCEL: M-6ZONING DISTRICT: Historic District ye Machine Shop Village yen TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑A ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer D SCRIPTION OF WORK TO BE PERFORMED:�,al., �imvv� ��"� ➢ �'li�l�u�S' �vnG/ �"' �'��-C�S • -�����-� o�i�i i���,�t�e.e.�, f1r�c�e.-�r kc�.E71 Lc�n r Identification Please Type or Print Clearly) OWNER: Name: ,ep �' ���/J Phone: D y�rr' Address: �n- ce/? -781 q90- /?ya CONTRACTOR Name: Phone: 2X a.2- D 512,2L Address: Supervisor's Construction License: a �' Y-6 Exp. Date: lc2 //t Home Improvement License: ozo Exp. Date: l ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $- 466 znD Check No.: 1 (v 1 z Receipt No.: :;Is?- -�- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own � Signature of contractor Plans Submitted 11 Plans Waived 11 Certified Plot Plan 11 Stamped Plans ❑ Location�� i,���Ld �` No. Date 12, ® - TOWN OF NORTH ANDOVER s Certificate of Occupancy $ _(, LL Building/Frame Permit Fee $ o '#o Foundation Permit Fee $ Other Permit Fee $ 1 ,iI A, t $ TOTAL Check#� 25737 114Building 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 DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 n a DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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.$10041000 fine NOTES and DATA— For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 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 --o Building Permit Application ❑ Workers Comp Affidavit --o Photo Copy Of H.I.C. And/Or C.S.L. Licenses —o Copy of Contract g) Floor Plan Or Proposed Interior Work ❑ "Ettgmeeri ' NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract E3 Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 o 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) o Copy of Contract o Mass check Energy Compliance Report LD 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: Doc.Building Permit Revised 2012 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 ,Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CJ r C7n Ivy Address: `75� City/State/Zip:� yL�r' Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors , ,f + odeling 2. I am a sole proprietor or partner- listed on the attached sheet.t [ m ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 r thepains andpenalties ofperjury that the information provided above is tr to and correct. Si natur Date: l ' Phone#: a 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-7274900 ext 406 or 1.877-MASSAFE -vised 5-26-05 Fax#617-727-7749 tAORTH own o t E ndover O -. - 0 No. 232 - 15 "h ver, Mass, at coc"IG NewicK y1' A04ATED I",V, �5 S V BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System 0� .......... �. . ...... BUILDING INSPECTOR THIS CERTIFIES THAT ....................... .. .... Foundation has permission to erect ............... .......... buildings on .... ..... ... ... ...... ....... ............................... Rough tobe occupied as .............��1. L.. .............. ............. ........................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final 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. r PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 ONTHS _ ELECTRICAL INSPECTOR 46tr • UNLESS CONSTRUC ST S Rough Service .............. .... 7.01. ............ 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. IF SEE REVERSE SIDE 17w Heartwood Kitchen&Bath Cabinetry D 75 Newbury Street,Danvers,MA 01923 (978)762-7472 PROPOSAL Page#1 of 2 AB home improvement contractors ds subcontractors engaged in Lome improvement contra rim maims specifically exempt from registration by Provisions of Chapter 142A of the general lags,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director,Home Improvement Contract Registration,One Ashburton Pias,Room 1301,Hostom,MA 0210%(617)727.8598.Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A To: Lori Callahan Job lmation:Same 92 French Farm Road Date: 7/3/2012 North Andover,MA 01845 We hereby submit specifications&estimates for the following work to be performed and/or materials: Kitchen Remodeling Obtain proper building permits. Remove existing kitchen cabinetry and countertops. Increase size of cased opening between dining room and kitchen in existing non-bearing wall-according to plan. Remove sliding doors to sun room. Remove kitchen window. Dispose of all debris. Check for fire-stopping. Add proper insulation if necessary. Electrical: Provide and install recessed light fixtures and under-cabinet lighting,as dictated by plan. Provide and install electrical receptacles according to code and new kitchen design. Supply and install ductwork for range hood Make electrical comtections for all appliances. Install decorative lighting over island(fixture to be supplied by homeowner.) Install wall-mounted switch for range hood. All appliances and fixtures to be provided by homeowner. $4,000.00 Plumbing: Disconnect existing sink,faucet,garbage disposal,dishwasher. Re-route existing baseboard heat to toe-kick heater. Remove electric baseboard heat in sunroom,and replace with forced hot water baseboard heat(on separate zone). Note: $1,200 estimate for stn room beating is included in contract. Actual price may vary. Re-install existing garbage disposal,now sink,faucet,dishwasher, water line to refrigerator. $3,000.00 Construction/Carpentry Patch affected areas with bhleboard and plaster,Patch a xtenor with wood clapboard siding to match existing(Note: painting not included). Install oak hardwood flooring in kitchen and foyer-to match existing oak flooring. Sand,seal and apply two coats of varnish. Install file floor in sun room(Customer to provide tile and grout.)Supply and install new wood baseboard-to match existing-in affected areas. Install kitchen cabinetry and moldings,according to plan dated 7/3/12. install tie backsplash in"L"section of kitchen. Supply and install steel door to garage. $11,000.00 WORK SCHEDULE Coonoeter will not begin the work or order the materials before do wird day following the signing of this Agreement, unkss specified hue in writing Contractor will begin de work on or abora 9/4!12.Barring dday coned by eieamstmces beyond CorhRactoes control,the wart will be completed by 1015/12.the Owner hereby wito wledges and,pees that the sdtedWing dates are apprordmate and that such delays that are not avoidable by the Contractor doll not be considered a violation of this Apeemat WARRANTY The contractor warms that the wed Banished hereunder tdhaa be the ttom d eM in materials and workmanship for a pawl of five years following completion and shall comply with the requircmatts of this Agreement In the evert any defect in vrelmmhdip or mdwids, or damage canoed by the Cantraaar.tut subcomactora,employees or agents,is d000vered aurin ow year after complOdw of any job,mclulmg danop the Codreaor shall at ids owe asparx fortswgb remedy.repair,eorreat,ragmee,or curse to be remedied,mpsued,or m0moed,such A amage or web defect m mataids or wormnnft.The Soratpiny wartubes shall survive wry mrpectim paformed in oormeorioa with the work. We Propose hereby to famish materials and labor-complete in accordance with above specifications for the sum o£ Thirtyelotthtwsaidone hundmd elghtyseven and 5QN0O&Ms —1 8,187.50) Payment to be made as Mows: Upon starting work $12,729.16 ➢ Upon installation of base cabinets: $12,729.16 ➢ Upon completion of work: $12,729.18 Notice:No agreement for home improvement contracting worst shall require a down payment(advance deposit)of more than one4bird of the total contract price or the total amount of all deposits or payments which the contractor must make,in advance,to older and/or otherwise obtain delivery of special order materials and equipment whichever amount is greater. CantractodDesiymted Reeshint: Sdespessoa Paul Hanson Paul Hanson 75 Newbury Street Amharima s�uc Danvers,MA 01923 �_1-rs�, 7r �-.y-•-�- Registration#104904 This pmposal may be withdrawn by us if not accepted witbm 10 days. Acceptance of Proposal-I have read this document t and all attached documents and accept the prices, specifications and conditions stated I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified Payment will be made as outlined above. You,the Buyer,may cancel this transaction at any time prior to midnight on the third business day atter the date of this transaction. Notice of cancellation must be done in writing. r r sigmnne l Date Tam natuRDoe (IWORTANTm=N ON PAGE 2) ' _�rZ"..I^I<.IQt1-�-;1�N_�V�1 L�--—► I I X3f `��y"2-1 ES P l�F Tr � � _. DP �PrcE rnfs�RT �� „ /4 1- -rte 4z.A5;'11490 -rFA l c OF cowmg RFL-TOI -L Ari�NU � 'W�4�NSGD�� �fZR I �� xsc.- CP lNXl', LSTri.� W CID ANN, a9 K T _ �� r _-1=►1_ ." �'r► --L- __ _ 7 /(b Al NN PAN > 1 $EF'3' /C MN 1 7Cc�46fMK Z-si D,lrD 2: , CCAULAAAM HA O I+aARTWMD K lrU+rzNG DST slCl-���o NAY Tia— .- � i I DATE : + f I! Zl_gb-1� T'L1Q0-/Z __ n to I .. R`'h3 X 5!.' 7 From: 09/19/2012 12:59 #053 P.001 /001 '4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/03.2 9/19/2012 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(les)must 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 C ACT Rose Mun.OZ NAME: Wilson Insurance Agency PHONE (781)665-1034 Fax fth(780667-0301 109 West Foster Street EMAIL INSURERS AFFORDING COVERAGE NAIC p Melrose MA 02176 INSURED INSURERA:Travelerz Indemnity Cc of CT 25682 INSURER 13:' HEARTWOOD CUSTOM KITCHENS & BPAUL M. HANSON INSURERC: 75 NEWBURY ST. INSURER D INSURER E: DANVERS MA 01923 INSURER F COVERAGES CERTIFICATE NUMBER:CL1291900984 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. INS. ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M LIMITS _ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY A (Ea,occurrence) $ 300,000 A CLAIMS-MADE FXIOCCUR -680-9445C55-1-TCT-12 1/25/2012 1/25/2013 MED EXP(Any oneperson) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: 7PRODUCTS•COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IF,accident) _ ANY AUTO 'BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED PRpPERTY DAMAGE $ r accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ' DED IRETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMSER EXCLUDED? N/A E.L.EACH ACCIDENT $ ' (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE9 S DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mons space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED;REPRESI!NT{j.IVE Keith Bowden/ROSE �' ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005),Dt The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR - Registration: 104904 Type:. Expiration: ,7/15/2014 DBA H-A'TWOOD KITCHEN ,&BATH CABINETRY Paul Hanson 75 NEWBURY STREET: DANVERS, MA 01923 Undersecretary 'Massachusetts- Delru-tment of Public Safety ' Board of Building Re!ulatiuns and Standards Construction Supervisor License License: CS 20856 1 PAUL M HANSON 14 EMILE CIR �w MEDFORD, MA 02155 r; Expiration: 9/28/20,1.3:. I` ('ununissi mcr Tr#: 2038 .= i lo w GU.- WIr WC!� C.Piclr 11,KMT ij �Fcttc�c�- 1424, xsL-Z. -rE '-a-z�!✓g9a 740 Ms T o l�%,glnim _.'t c nscaaroc7 / xap, S7�VST i 1 REG-r©t--L _ GN�'tMFER`L- cj+AmFFfk &$ D�C�kj W�a NSCO p�,3DI3 $ t U M �ZI/� .2.�� K 34i'f STILE W x Cl? - aE 4r, L sTt La SC� G� ><acrwt�. a9, >< 1 W�tI Nl5corr BEPz- O R,10 5'`ggrr��n Z s/DEED CMUMN Z_ I �A!.l�fM1 K CA,"FER� R r_4 4I 6.R-L t+� t= KtrGt+C-Ns DFCTE Ms 1 Gt-N C R o NAN cy �- soN Two- 6404 I I DATE : toll! 1lz- X SM C��y-,fit ��RTWQ�D' 1'CtT�1}�,N.S NANCY }+A MW z M-GRpt ,4j-4'/4cvvF- rr coo IB/4 tl4' u � E 4 x4��-►5