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HomeMy WebLinkAboutBuilding Permit # 12/11/2015 %AORTFH BUILDING PERMIT o�<t`Eo ,6'6 TOWN OF NORTH ANDOVER # APPLICATION FOR PLAN EXAMINATION 4 _ Permit No#: ! Date Received +areu PPa �y �SSACwus�t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �� ec° 1� LkA-k Print PROPERTY OWNER ���Y� Print 100 Year Structure yes no MAP � PARCEL: f ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE ResicJential Non- Residential ❑ New Building CrIbne family ❑ Addition ❑Two or more family ❑ Industrial ®"Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic f ❑Well ❑ Floodplain: ❑Wetlands ❑ Watershed District r r f "" rrr r / r ✓ rrrrl ` /� i7 r❑�11%ater/Sewer„ r r r ' DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Pe'A a\ Phone:LQ 1 I Address: q,0 G,A c ' LL�ries Name: + fit Phone: 3 ` �A�3 ,e. i)Q,k 3J �'s Construction License: 0��S Exp. Date:ovement License: T-3"A 1 Exp. Date: t� t , 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: $ FEE: $ 31 -1- I Check No.: _Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .T t%ORT H To w' n of �( f 2 ��'' ndover 0 24 C% LAKE h ver' ass, COC N'CNt WICK S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT �— `�1 S BUILDING INSPECTOR ............ .'.... .................................. ...............r................ .......................... has permission to erect buildings on 6EFoundation Rough tobe occupied as .... .... .. .. ....:!t....... .................................................... 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS TT RTS Rough Service ............. ..... ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. RCS PL.APIVIEW DIAGRAM Customer:PC r i C L.OV(5 _ Nome Phone, ( l01-7 _) 00 a Address O� �� d-9..°�5_ Work Phone: Town: kcl r-jjk An over/ Cell Phone: Any Limitations for access by large truck? No Yes If If yes,describe: Any specific directions or landmarks? 1401'e5 If yes,describe:_ Site ID: Energy Specialist: Reviewed by: Air Sealing: 10 hrs(936 x 1.25= 1170 sq.ft.);Attic Stair Cover Thermal Barrier with carpentry 3 Door Sweeps and 3 Weatherstrips 1. Vent bath fan to roof flapper: 2 ! 2. Propavent 2'or 4'(if necessary): 93 3. Damming: 52 k 4, Attic Floor Open Blow Cellulose 6": 936 sq.ft, i P 2 RL F 3 1 BF R ( 3 2X E s 1 3 BF 2XrL 2 RL i P I n For Office Use Only _._..._. -_- _----- Bushes Ladder Neighbor Proximity ( Pocket Doors Insert Radiators Fences} Existing Conditions X=Access ❑=Vents Note Inside Square R=Roof S=Soffit G=Gable RV=Ridge Vent C5=Continuous Sof'I CDE Continuous Drip Edge T=Triangle Install 0=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise j�=Vents Note if,,Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access Rev 1/14 Conner aY PRODUCTS SERVICE WORK Services Group This service is brought to you through support from your local utility This.Agreement'ts made by and among and Conseniation Services Group(CSG).. P>3krickLou><s.` Attn RCS;; 80 miridges Ln Nolfili Andave,MA O1.84S 2225 50;R'ashin gton Street,Suite 3000 estbolough MA Q15$1 W. .. Sitemll 500002288807 Reg No, .1734. 4 Project ID P00000295052 Federal ID Na.222457X70 Custontet TD::C00000298917 Cot1l1'actmD:.2015Q909'ASEAT ! @Tall comploted contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will petform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the toms of this Contract,including the attached recommendations/work order describing the worlt in detail(the"Work")which are incorporated herein by reference: Description Quantity Location Perform Air Sealing at Estimated 02.5 CFM60 Per Hour. 19 living Space $843.20. Attic_Stair Cover Thermal_Barrier with carpentry 1 Hallway .. . $260.23__ Door Sweep 3 NIA _. $69.54_ Exterior Door Weather Stripping ._... _.,. 3 NIA_ $62.77_ Sub Total: $1,255.74 Utility Incentive Share $1,255.74 Customer Contribution $0.00 i ,i I I For office use only Printed:91912015 Page 1 of 2 It. PAYMENT Customer agrees to pay Contractor for Ute Work,the Customer Share of the Contract Price as follows:Patnnent#1:$ y.oo as a Deposit payable to CSG upon signing the Contract(not to exceed 113 of the total retail costs).Mail cheek&contract to CSG,Attn:RCS,50 Washington St.,Ste, 3000,Westborough,NIA 01581.rural Payment$_ 0.00 as the final payment for the Work shall be payable to the Independent Installation Contractor("IIC")upon satisfactog completion of the Work,Customer understands that he/she will not be required to pay the Utility Incentive Share of the Conit'act.price in the aniotutt of$_f 7 S Se74 .Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Ill. DISPUTE RESOLUTION The TIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Coni act,the TIC may subnut such dispute to a private arbitration service which has been approved by the Office of Consumer Affaits and Business Regulation and Customer shallbe rcquired to subntit to such arbitration as provided in M.G.L.c 1421, You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day folio ing the signing of this agr�eemme�n�t. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. -Ll r( *Ct st er Signat Dat .- Indicate your selected IIC here,if applicable (OK) Initial her you want G rS S{e V di Pe c o t -the Progr<'m1 to assign a CS i ur Name of CSG Representative(Printed) Participating Contractor TERIMS AND CONDITIONS AI'IPEAR ON THE REVERSE. 3111 PRODUCTS SERVICE WORK Consel- aM Services Group This service is brought to you through support from your local utility This Agreementz made by and among and `. Ctjnservation Services Group(CSG) l'atr5ek X,oals.: ACi t� RCS 80 Bridges Ln North Andover,MA.01845 2225 50 Waslultgton Street,State 3000 Westborotigh,MA 01581 Srte IA 540002288807 Reg eta 173484< < Pro�ectTU P00000295052 Customer ID.;✓00000298917 Federal IIINo.222457170. ContiactID.2U150909:WORK (ice completed contract to address above) 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be perforated lite following work on these"Premises"in a professional manner and m accordance with the terms of this Contract,including the attached recormnendationsAvork order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantity Location Vent hath fan to roof flapper. ... __... ._.._. _. __... _.? Attic. Attic ........ _.. _ . ..... _ $356.19 _ 52. ..__ NIA $113.86 Attic Floor Open Blow Cellulose 6" 936 Living Space X1,375,92 Sub Total: $2,104.41 Utility Incentive Share $1,578.31 Customer Contribution $526.10 ®frC7 For office use only Printed:9/9!2015 Page 2 of 2 11. PAYMENT 7 Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment til:$ 1-7,5-3 7 as a Deposit payable to CSG upon signing the Contract(not to exceed 1, of the total retail costs).Mail check&contract to CSG,Attu:RCS,50 Washington St..,Ste. 3000,Westborougty MA 0158E 11na1 Payment:$ j Sd. � as the final payment for the Work shall be payable to the Independent Installation Contractor("IIC")upon satisfactory co letion of the Work.C istomer understands that ltolshe will not be required to pay the Utility Incentive Share.of the Contract,price in tate amount of$ �57 :M Changes to individual line items and/or previous incentives may increase or decrease the size of the Utilihy incentive Share. III.DISPUTE RESOLUTION The IIC and Customer hereby mutually agree In advance that hi the event that the HC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service wlrich has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 1421A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day followirig the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. st mer Signature Date hldicate your selectee C here,if applicable (OR) Int sere if you want it <- •e Ve CCC` v/_the Program to assign a CS r D to I Name of CSG Representative(Printed) Participating Contractor "�il✓r TERMS AND C®NbMONIS APPEAR ON TIM REVERSE. 3/14 A ®®_ttwwitsstt--ggNmass save < CMITRACTOK PERMIT AUTHORIZATION FORM I PATRICK LOUIS owner of the property located at. (Owner's Name,printed) 80 Bridges Ln NORTH ANDOVER (Property Street Address) (City) hereby authorize the Mass Save Horne Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. x t b-)IrJ C�uko owner'�Si store Date FOR CSG OFFICE 135E ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date R tl6 For 'mice Usc oRry Rev. 12132011 The Commonwealth of,llassachnsetts Department of Industriatl Accidents Office of Intxestigafions I Congress.Street,Sitite 100 Boston,,WA 02114-2017 Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ibly Name W-\t't r ky- wU ms`s ..... _ Address: 00 J30X 344 — C'itylState/Zi \1)i l 171y(?iit 0' 34' 3 Areyou an einployer'Check the appropriate box: 1°ype of project fregnirecll I am a general contractor and l I. t stn a cmplo}•er with � � C;, ?ac.� ttsnstnrctssn employccs(rust and or part-titrse).* have hired the stab cemtractors Z.a I aux a uric proprietor or partner- listed.on the attache sheet. ?. Remodeling ship and have no employees Chess sub-contractors have , ( Demolition working for nic in an ca acit r. e`mployc�c�and have workers' q- building Y ' p addition [N, o workcrs'comp,insurance comp.insurance.. required.] 5. 0 We are a corporation and its I o,a L"lecnical repairs or additions officers,have exercised their I L Plumbing re airs or additions 3. 1 am a homeowner doing all.work p myself:LNo workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t e_152' 54,§1(4),andwe have net employees, No workers' 11C)Other comp.insurance rquired.] 'Airy applicant that checks t>x 41 niwt alsj fill out thr rtoion Wc�f s shoe viog iso#r u•orkcfr'eonlprttcati yfs pi tuzy inforol3tion. T Nomcaw tors who,�uhmit this ATidati`it iiJicati�q-tiny aro dots e all www arsf+,en hiri ctasi&conmOms must submit a new affidavit indicating such. 1Cot3ts c iri tttat chock this box trust atwhM an aasttiom l h:ct sh winv tt_c;;amt of th—,wb-corn.sato>ts a<si state ulief/:-r at trot thctsa critities haw employees. If the sutt-contractors hatic emptoy=s'L'try Tnustprutidz 016; vroulker"cutoff.policy tsuantxa. I ant an employer that is providing%,orkers'compensation insurance for mt,employees. Below is the policy t=and jab site information. insuraiace Coinpaiiy Name:_ _(.lists_ 4'1 aJ t" t { Policy#or Sell ins,l c.t#: !4"t._l A. ." --__ — Expirattion Crane:-A_3� 3 {its lx Y a �1 lab Site A ddress. t� Ci istate Zi a� -. J Attach a copy of the workers'compensation policy declaration page(shoeing the policy number and expiration date). Failure to secure coverage as required under Section 75,E of MGL c. 152 can lead to the;imposition of criminal penalties of a line up to 61,500,00 and/or one-year imps g)um:nt,as well as civil pcnalties in the form of a S41-OP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded tea the Oce of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains critic penrxtties of perjury that the informatiott provided above is trate and correct. Signature: s 1 �"^' `.. Date: t , (7ffciatl use ontr. Do not svrite in this area,to be completed by city or town official. City or Town: --, Permit/Licensee Issuing Authority(circle one): 1.Hoard of health 2.Building Department 3.cityrrown Clerk 4.Electrical Inspector S.Plumbing Inspector ti,Other Contact Phone AC"RIY CERTIFICATE OF LIA131LITY INSURANCE THIS CERTIFICATE IS ISSAJED ASA MATTER Of-).-.%FOPeATIONO,'�L't AND CONFERS NO J`UGHTS U---N rHECeRTIFFTOATE 14OLDER,THIS CERTIFICATE DOES NOT AfFIAMATWELY CA,NtaA71VELY AMPND,5XTFNC,OR ALTER THE COVEP.AGE AP't:CROE0 5Y THE PCLICTES BROW.THIS CERTIFICATE Of INSURANCE DOZ�5;NOT CON5TMITE A CONTRACT&ETWEEN 1e,&-I$SUIN5 INSURER(S),AUTHORIZED REPRESENTATTVE Ok PRO EA,AN6 THE CERTIFICATE-HOLDER, IMPURTANT:It the r*rfifite a-;1501TIORAL INSURED,t4*po!4ws)must tee e dCrsest.if S-UKOGAITON 15 WAVED,Sub)--a to the tikkrms and mn&tip s of ffie Policy,cewta4r,W4cies may mqu"an Cr,(f6rs4mervt,A statement on tnis ceotjfkattt does not confer rights to the mblivnte Wder ki lieu of t(xh Clayton Martin J in&Agency tne -7,pj,M, ieri7ay Mig;:;a Risk Servkei 'T, -8118 1649 Northmpton St PO Box 589 (NO) t866) 5 Holyoke MA 01041 ,jLS&, "uthkr Insulation Ift PO Box 344 IPswich,MA 01938 Z—OWPAW CERTIFICATE W)USEW. ONION NUMUR: rWK-M-To—cERTt,-y TI-AT Th--POUCIE$OF WSUVAN-nE USTED KI-mv klwt-EE04 ISSUED 7C.T'H-r-F*ZSURED D ASOVS FM THE MUICY VNIOD tNOICATEM KITWITHSTMVZi$.ANY RE0UIRE#vrEWr,TEA-MORC0,WMuN OC ANY CONTRACT QR O7kERDOCUV.ENT43."H RESPE�T TOVj*KjC"TH5 CERTIMAIE MAY BE MSLED CA mAY P-SATAwTHE!NSVRAF,PuA-9FQRDFD BY THE MMIES DESCRIaEO HEREIN IS SUWECT TO At I fE TERIAS, EM Um ANIn cmicirrKms ck-sucm PPwcrp-S.LmaTs�i<AvN vAy RA,,,E SSErq REDUCED By rA10 0-AWS, 0*3 ,0 11 GEwv Ar4-AE,14N Lw—Ftp-s L-R: w C�mwj MOW_ FVKK:Em� L" LJ ANv AvID E) Aa-z;S tWWkWA LM [3 0=* El 11 EXOM Lva _j oao LJ;w-nKrbw S WORXM cr AJM MITPY7171; qI_ sq AW v E A-I"Ak 1C,t)0"t MAARPX021 lacX1,201$ 10" El E) AA CERTIFICATEUL 0 SHOVLD ANT OF!HE A,&)'.t DESCRIBED PU-LjC?Es ME CANCELI.LD KFORE cleamult THE E"IRdIkTeAaATE i0TI1,F 1,V41 BE CE1,%TPM N Contractor Svcs ACCCArlKWE%VJw THE PDX 50 Washington Street Westborough,MA 01601 Signature: A 25(20101/05) 8PAC 3139 YYYY ,a�" CERTIFICATE OF LIABILITY INSURANCE DA7171DD/15 7/7/2015 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), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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). CONTACT PRODUCER NAME: Nancy Usher 536-0804 FAX (413)534-7874 413 Martin J Clayton Insurance Agency, Inc. PHONE Arc No E. (413)536-0804 _. ) 1649 Northampton Street E-MAIL ADDRESS: P. 0. BOX 989 INSURERS)AFFORDING COVERAGE _ NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO_ INSURED INSURERB:Allied World Natl_ Assurance Co Gauthier Insulation NSURERC: 44 ESSEX ROAD INSURER Di — INSURER E: _.-_- IPSWICH MA 01938 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 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. -- I_R - ADDL SUB - - POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM DD YYY MM DD YY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _1,000,000 DAtv1A6ETORENTED 50,000 A CLAIMS-MADE CX j OCCUR PREMISES(Ea occurrence) _ $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) 5,000 PERSONAL&ADV INJURY �$ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000,000 r PRODUCTS-COMP/OPAGG $ 2,000,000 ,X POLICY JECT El LOC �._ - _._ __. OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS PROPERTY DAMAGE HIRED DSAUTOS AUTOS NON-OWNED Per accidents _. $ X UMBRELLA LIAR OCCUR _EACH OCCURRENCE _$ 1,000,000 _ B EXCESS LIAB CLAIMS-MADE AGGREGATE _ _ $ _ 1,000,000 DED RETENTION 1 �BE020792125-194985 10/18/2014 10/18/2015 PER 0TH- _ $ WORKERS COMPENSATION _ STATUTE _ ER AND EMPLOYERS'LIABILITY YIN E LEACH ANY PROPRIETOR/PARTNER/EXECUTIVE _ __ _ OFFICER/MEMBER EXCLUDED? L�N/A -__ _ (Mandatory in NH) -" E.L.DISEASEEMPLOYE $ If yes,describe underE.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSUREDS) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 195 FRANCIS AVENUE CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG p ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MMMMbd with pdfFactory trial version www.pdffactorV.com Y Office of Consumer affairs and Business Regulation 10 Park PIaza- Suite 5170 Boston,Massachusetts 02116 Horne Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 1011/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER ._.._ P.O. 8©X 344 ___ _. .._.. .. . ..... .._...._.._. .......... IPSWICH, NIA 01938 ............. ----___.__ .... ... __ Update Address and return card.Mask reason for change. Address ,-'..] Renewal Employment '"' Lost Card GCA 1 0 �6M-05'17 .....-. -� ......, - .- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ; before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation �tegistration: 173410 Type: g , ' Expiration: 101112016 Individual I0 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RR ,,, r IPSWICH,MA 01938 Undersecretary 4- ot valid wi out signature h husetts-De BoardOf�u8ira e �p,rfmerrt of pct#aiic Safetyg rave and St wdardc s bra�r;.3�xr�aaaa�.�sxaYa�^r's s.nar�9.a3va:Lt3.F[F License.CUL-lo?"2 KURT R GAUTH" P'CL Box, J*w1ch SMA 01,9 ��..� 4 �r�YaX"4•b irtr+rprrzd &t�tr r 0602"17 17