HomeMy WebLinkAboutBuilding Permit #138-17 - Fernview 5-7 8/18/2010 BUILDING-PERMITF *1oRTN
o tt�Eo .6�ti
TOWN OF NORTH ANDOVER ,�� 4` �'' •6 0
APPLICATION FOR PLAN EXAMINATION -
Permit NO:
Date Received1.0
R �`
Date Issued: v
��SSACHUS����
IMPORTANT:Applicant must complete all items on
utt,s.:: . this page
dam!
N'�
[`rf 'tTF' .M
5 »•7'To � 7* n f z'f%�'t'a F s.ff-(i s �'--a k s� .a-. { S rxs,...- �� m*,
fi, ,F c I err n.syr v P fi g J Phil r ynL s r r tti s� !7 t ' v .
MIN
,[�.'3-�' 7 •aS i1';q"l' s�' ai4`cE.t '� - �,.'"'1 'ae{a'•
MIN � Ill i� a ., x: .E �'a ,+..R r'r`�
a -s �. -... - ns f. �^ `� ;'.if'�.3 -'
F^ •t,�c.� •Y.. ti..�T"4r�;,�•'}`gr.C"'[�'y't» ES F4c°"s`L•'`?'ee.�. � awe � s''yr�yy'.rn�M•c .> L:�rn.:..Y ,s..w,t,�a tt<� � t;t�r
[ c �g1F.��".Cd"� ) � Ft`.. \ � , �� ��lt Y� la.. � �i prRr Y �,� �.,.Z-ilJu.�.:,���•ti 5 C'r �� 4 -
r�u� �' _.,t .� rF r..'�`rz�]�1=a� t��, ,l,t .e `I�;'�,gy�e`p,,.+ 1.�+''•�5'f�iia4:'r:.uii�Yl�� F�.,�''Y"�f �%�� '�� � 'S' �'�'.}.+„•�fi`.^.M1� ��;
ml.i KR'Ovfy'1''t ;?" 3,s�-.� .. -� _�'r�y�y„r 0. r���±�� 2`�;.�z t u'�- '2 Ed�'4�T��r e��,+:' R••�i4 k :3,�`' �..�
T
.J„ � r '7a.;�7tiN '�atT- �, i �v^: 77' `.a.�Ti3?:r ��(;7�r Sr- .-4Sj..m "C sr.� •1 w.,;a•7�'�-., � ECut =s.���-.r T L iv rt_�.� ha.� t`�
.F- txy`Y.':�'n,a.�_ ,a.:di3�"J't_d r--r+e.;.:.is:.,`"'F,}.yJe.;;_i�-r,�.rria 3� �,xt�y r!w r3�.7z"�%'Tt�•,��.+�r 1+t v�`..1.. -a:��ri1kY��.s��� `�� I n a.�,'y �+�.i 7`.1-
-
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- Assessory Bldg Others:
Demolition Other
M1'3�1 om �� 1
" L
-6 s�r j'�' +F1�� � a.+.lP�E,.,'",r Y�'•rrr-r�(''s�- fJi-t j- i,.�.�'.4�§ r:r.�yr
...ac;'';�r��a+[7.f.+.�11#/'P.!ISi^`iFTstS'�r�L�_'t-'g+a`q'3;; r.�'�"'�`�+^��i'`�.��F�s� `e w:.t'�.-�i..a � �_ �, P tL� &'�y"��'�' 5'-.a-�` r�•-a`� .�'I�'rr� ��1`:.��
.�...�. ..- ..3 ?r<r.5'_u�s,�.t_eyi,..�� _•.!i.Jy1Y,h Y:x.kr�..',g,.,s�' ,-% ..,2��.,}, .�,}�•y' ��.���.a s.. t � 4� r1 r"L �a n -'+[.a
1 _,..r.v-n+c�c t..t-. J+'.:-gf� '4']>-•. xNF r-..j�{,-fF,a;:��r'prw:�Yr��� ..r,`h .S�
DESCRIPTION OF WORK TO BE PREFORMED:
r
Identification PIease Type or Print Clearly)
OWNER: Name:_ �'�+1��,�� f Phone
N a
�h [3.3.`zws ...1. !.:.i'-'.`b'i,u�0s<`'�"x:�"-.-.,.•'Tx4,�"'vs. *r�!�'kslr--tr °'�"kl.�"Fsti ti.o..�.�-�ce.. R:�?✓`7:.,€iaa.m°"$r..55�s rk'�
g rs'"7�'g''7''.r++.",'rfpss'-3.F�l?.u"`j`.'-`F' i�r'.S„'..-:.e7" �Y:._ !^'•"r ''+`y.y:1* �L�,}i�'aIY=:�I��F`'
r;�•�'-{u: '�rH
•rev-a �rr -� y + � -�Fy r,:[•ti. ^,r-,_���.,x .F yt` - � f`Y{-s' ?
K �' T� � �l'J,I�i � _ Y C.. � �' _ S. �l�•' - `t��..�'� �ex,,L_!�..r+' t �rs � `�'T '.'£��4 (I
-r1 =� �"�” r �_� �.. •tiz, may- � r-�� `;"�;i;i.s�, �,,�, s c"s' � ��',,.; .y,--c�
,,.. aS"".' � C'�7w"-f•�-.,�' - r?1.inrx,t;/a /�.�`�Sy'.;i." n��r�x�� i.ay;�3.-scum! �rr�1�r
. ������ �+ -r. �� v ;'=a^fl�'� Y ���-` ��� ,�,Y.n+4�.� �y-�� � .!?:z•'"�'��4�N�3it-.�c��'i.',.'i�t�''fes"Via'', ".��,. ,V°'tv ^�..ir
��� �. �,7�rv•.F _ .... +.1 � '1� �. 2Fi�� v r.�1'�-_ '[�.R,�:�YS ry ,x, y,�-r,[a 5��,`a ,rKf �rR ��,�ys�.�
�-
5F',`.4 L is;�i1's
X,1_, E .}x£ Sia v 9t.(!�7� LF `� ;r• .r,c.rr�z�.r r4 F � `t'c[-t '�->. �r `jz-r-y s3a-.,•"N"". Y°-��.,�ar. ti"Zr to r `�'e
rrq "bC4t �� , Stitt k�rYmy4 3tt +s1F � � 'i't2S Ii r yy 3 �
��•. 3�2icoy tit y n. '�4� .L-"�.�� �,
' ��d;�Jf,'r'� �Ai7�Jd'sUL�]Il-,L�ITu�.�� � � [ .,��t'..�.��..�- d y�''sE.�`f4���„,dd���.,�`�� ���, 'x,[���cr� y�” ,�?�,r�'F��s„ :����'•*�;�-+
e� "vrs. � �-...,�� / '� e����-•ts rs� ..� 'ae � .�'e eC ti, m� G
n.'-'rL•� Iy ..���:�" i"/![�.''.'Yi.o r�•.rr;�iryr,.�J.it4�p�,rr�+yF- hl�Y�'�1�!��R F� f��;gi'�a;.izsxh� ��+,;:>_:23s4' �`A`•,.:r...'St.."�gM1"�f a �,'c C .:�rw.,a. c•�i`i:�'F a
1 s'�,,.ta ���r-��.R5'.s.-'rli�`...._ r w..�.�',�C.,•`�,�„l.-(41h�i.N.y�'q L..!"�T4�Fi....��y...l !^mac�nS �r� hiF F�F,Y' .Yl.,� Lf.'��r'ti_•r��y�S �-” i LF.�'{lii.::",•i�'.1 ..t..Sy.,�
���i1^.'�?it:5 r a �a,'.f;�l ,-.1 '��,�.k'.-"w--'-'p� '� ,asi.G s�,�,,5 M>y._•rY � x�.ri rr[� �c r.!s;{S� '�.d�=s a'=�Y dr�k s -rrs',f2 �r'a
ar^,��`�'�rrc'�t�r3 �..5?vv'hiv?n 1•-'�7_l.3 4 �'i�' -*+s•�r 4r .7u.-rtS 1 r a-- � �- a••S.--rT.in �'�`A���'�- �•-r '.��Cft''�t��r s� s
q 'i �'rrla ,..- ,..=J62 •.�r - fix. '
13 �"'�9s11,,,�?T��"' �la��l���•'S��,:t.�..., , ,,_r,:t�a,'�.' -�': �,,.��, �",t;` ��r�s `Y�,�,�r✓ : ,,�.�r7?;�—,,
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ S7 3 °1
FEE:
Check No.: Receipt No.:
I
NOTE. Persons contrawith unregistered contractors do not ha access to he uaran f d
S� naEure rA gnf/O nuu er
.�_ .
gS� na rerofk n raea � r ..
F
Location K4 4/�1
No. f Date
f
�aRT� TOWN OF NORTH ANDOVER
9
' Certificate of Occupancy $
4
b''•'° Building/Frame/Frame Permit Fee $
�ss�cwusf. 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
235 ;��
Building 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
C0MII 1EI I 10
i
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/ Driveway Permit
DPW Town Engineer: Signature:
ART'�11IBIN: Erx D r �pster� ite a e h, �` �ry ocated 3840 ood^Street.
s
4 d
LocafetlR� laln�tree#: t 1
���r:G ,e�tS1T [t'lElltsi '.T3d't'ifiire%Cj3te ' y - 'ES
s ] }
ryY - ...4
Y
�-
:�COMME'NTS
L
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)
't
I
❑ Notified for pickup - Date
Doc.Building Pemut Revised 2010
I
I
J
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/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ IVI
"'ass 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
1 -New Construction (Single and Two Family)
❑ Building Permit Application
❑ Ce ll ieu 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 Departmentrior to
p 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 Regis recording
must be submitted with the building application e ti 5'of Deeds. One copy and proof of recording
Doc:Building Permit Revised 2008
-T4 - — -
NORTH
TO
of
_ Andover
0
No. =_ _
l 3 p•r?o�t - - __
KU lover, Mass.,
Op COC LA
HICHEE
WICK
7,p ADRATED
S BOARD OF HEALTH
Food/Kitchen
PERM IT D Septic System
s BUILDING INSPECTOR
e/rr�t
THIS CERTIFIES THAT.............11C4................................. ............................ ..........................r......................................... Foundation
........ buildin s on ... .... ��i�
has permission to erect..... ........ . g .................. .. ............................. Rough
to be occupied as............ M........... �. ........ .................................................... hunn y
C e
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRU ON TART ELECTRICAL INSPECTOR
Rough
......... ......................................................................... ........ .. Service
. .. .. ..
BUILDING INSPECT
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
,l
SEE REVERSE S 1 DE Smoke Det.
f
u.cf i
DL
'. BO CQ ofBulldin k rtnrent c,j 1'uh�
nstruction S r,ulttion
License; Cg .ltr(!Vit.
Restricte 0p up�rvrsor License.tng Ir'l 1
to: 103272
LESLIE
9 p RDELL `�•, .
ME HEN Wp MAU0 9 %�
844 f
C'ununissi _
ager
EXpirat_
Ion
• 10/13/2013
Tom'
103272
09
�-\ �� i .t}il+ fn<zanlien�jrarrl.cs . :�
'-E�'�!nE,Ih�F�Fc3vEPtENT COi�T; �
ne7strat�en; X444670
Exrra�ron 1 /6/2010
� Tr# 276574
� r= TYpe =,-D3A.
s
Wj<GEuLv _ 1
9 P'Z}C AVE:.
h1E'rIUCN; IWA 01-84;q`
i -
Wordell's Home Solutions LLC Estimate
9 Park Ave
Methuen, MA 01844 Date Estimate#
x:naz x
(978)-397-5248
Lic.#144467 8/12/2010 1350
Name/Address
Catherine Hanley
{ 384 Lowell St.
Andover, MA 01810
Due Date
8/12/2010
Item Description Qty UM Total
Labor Remodel an existing bathroom using the same layout. Remoldel will consist of 1 2,400.00
removing only the vanity and the toilet in the bathroom. Stripping the half walls of tile
and sheetrock. Stripping the floor and repairing any sub-floor issues. Remove the
existing tub surround for replacement. Installing water resistant sheetrock on walls
where tile was removed. Installing 1/4"hardibacker over sub-floor. Laying out the floor
with new ceramic or equivalent tiles in a diagonal installation including a new
threshold. Installing a new tub surround and fixtures, a new vanity sink with fixtures,
new medicine cabinet and a new toilet. Installing any new towel bars etc as required.
Prime and seal any new walls as required from installation. Finish paint the bathroom
walls and ceiling. All plumbing to be completed by a licensed and insured plumber and
electrical by the same.
Materials Tub Surround 1 Budget 135.00
Materials Bathtub Fixtures 1 Budget 210.00
Materials Vanity and Top i Budget 337.00
Materials Lavatory Fixtures 1 Budget 230.00
Materials Water closet (toilet) 1 Budget 245.00
Materials Floor Tiles 12 x 12 40 Budget 90.00
Materials Grout for all tiled surfaces 1 Budget 15.00
Materials 1/2"water resistant sheetrock for wall tile installation, 1/4"hardibacker for floors, joint Estimate 300.00
cement, tape, threshold for doorway, paints
Permit Costs Construction Permit Costs (plumbing/electrical extra) 1 75.00
J Phone# E-mail Web Site Total
? (978)-397-5248 les@wordellshomesohttions.com wordellshomesolutions.com
.- Page 1
Home Owner Sig: g>
Contractors Si
i
Wordell s Home Solutions LLC
Estimate
9 Park Ave
Methuen, MA 01844 Date Estimate#
z.mxY (978)-397-5248
Lic.#144467 8/12/2010 1350
Name/Address
Catherine Hanley
384 Lowell St.
Andover, MA 01810
Due Date
8/12/2010
Item Description Qty UM Total
Miscellaneous Miscellaneous Installation Materials for above mentioned materials 75.00
Disposal Costs Disposal Costs for Project (no dumpster on site will dispose of daily, dumpster will be a 225.00
higher amount)
Sub work Subcontracting Charges Electrician Estimate 600.00
Only
Sub work Subcontracting Charges Plumber Estimate 800.00
Only
NOTE: Costs for materials will be actual costs itemized on invoice unless purchased
by home owner. The labor cost listed is based on straight lay tile on both the floor,
diagonal will add and extra $80.00 to project estimate. Project may take up to 7 days
to complete due to drying times and inspections. Please see terms and Conditions to
determine the required payment plan. Items or changes not listed would be in addition
or subtraction from the original quote. A signed copy of this quote will be required at
the start of project and can either be mailed or handed over before the start of the
project .
Terms and Conditions
Phone# E-mail Web Site Total
(978)-397-5248 les@wordellshomesolutions.com wordellshomesolutions.com
Page 2 rq
Home Owner Sig: Contractors Sig; ;
i
i
" Wordell's Home Solutions LLC Estimate
n' 9 Park Ave
Methuen, MA 01844 Date Estimate#
y:[Y1AlT
(978)-397-5248
Lic.#144467 8/12/2010 1350
Name/Address
Catherine Hanley
384 Lowell St.
Andover, MA 01810
Due Date
8/12/2010
Item Description Qty UM Total
1)Scope of Work; Contractor agrees to furnish all labor, services, materials,
installation, supplies, insurance, equipment, tools and other facilities required for
prompt and efficient execution of the work described herein in a professional and
workmanlike manner
2) Quote Amount; Owner agrees to pay Contractor for the strict performance of his
work, the sum as indicated above subject to additions and deductions for changes in
the scope of work as may be subsequently agreed upon.
3) Payment Schedule; Owner agrees to pay Contractor in progress payments as
follows:
Payment#1 $1434.00 Upon Signed Contract
Payment#2 $1434.00 Upon Completion of demolition and ruff
plumbing/electrical
Payment#3 $1434.00 Upon completion of tile
Final Payment#4 Full Balance of Invoice Upon 100% completion and inspections
4)Work Schedule; Contractor shall complete the work as required by agreement with
the home owner. Contractor is agreed to be no more than 7 days late to start or finish
per agreed schedule. Work schedule may be amended based on additional work
inclusions and deductions and by agreement between Owner and Contractor. Not
subject to delays caused by other contractors or their agents.
Phone# E-mail Web Site Total
(978)-397-5248 les@wordellshomesolutions.com wordellshomesolutions.com
01
y Page 3 `
Home Owner Sig: Contractors Sig; Wrp�
Wordell's Home Solutions LLC E
F �o� stimate
9 Park Ave
Methuen, MA 01844 Date Estimate#
" (978)-397-5248
H}LIUZ
Lic.#144467 8/12/2010 1350
Name/Address
Catherine Hanley
384 Lowell St.
Andover, MA 01810
Due Date
8/12/2010
Item Description Qty UM Total
The parties hereto have executed this Agreement for themselves, their heirs,
executors, successors, administrators, and assignees on the day and year written
below.
i
Phone# E-mail 7_ Web Site Total $5,737.00
(978)-397-5248 les@wordellshomesolutions.com wordellshomesolutions.com
3
Home Owner Sig: Page 4 Contractors Sig;
�
-aw' Hca e0 P'- ,. �r m'-GF",....'ey
08/18/2010 09:22 9786831381 READER INS PAGE 01—
............
DATE(MMIDDNY)
8/18/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY ND CONFERS NO RIGHTS UPON THE E
READER INSURANCE AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTENDCERTIFICATOR
690 Haverhill St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Lawrence, MA 01e47. COMPANIES AFFORDING COVERAGE
Tel 978 663-5603 COMPANY
FX,x 979 833-1,31,21 A U � Liability COMT)anv
INSURED '-Tordell '-q Home Solutions COMPANY Granite State Insurance ComDariv
B .
9 -Park Avenue COMPANY
14ethuen, MA 01844 C
COMPANY
D
'10
kl-�O�0M
R
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE Br=r=N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED 09 MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBERTION POLICY EFFECTIVE POILIOVEXPIRALIMITS
�Tlotj
LTA I DATE(MM/Doffy) DATE(MMRID�NY
GENERAL LIABILITY GENERAL AOCIhEGATS
A SI COMMERCIAL GENERAL LIABILITY PRODUCT3,-CQMP/OP AGG
CLAIMS MADE E OCCUR CLI166414 10/18/09 10/18/10 PERSONAL&ADV INJURY S 300 00()
OWNER'S&CONTRACTOR'S PROT FACH CCCURnFNCF —3 3.0-0,-,-0-0-0—
r-IRE DAMAGE An one fire) 5 50 - 000
MED EXP(A,y S 5 , n o o
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5
ANY AUTO
F7ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS I (Per Peraorl)
HIRED AUTOS
BODILY INJURY S
(Psis accidnnt)
NON-OWNE!C,AUTOS
PROPEFITY DAMAGE S
GARAGE LIABILITY AUTO ONLY-rA ACCIDENT IS
ANY AUTO I OTHER THAN AUTO ONLY:
EACH ACCIDENT I S
AGGREGATE I S
EXCESS LIABILITY EACH OCCURRENCE -S
UMBRELLA FORM FAGGRFGATE is
OTHER THAN UMBRELLA FORM I I I $
'.STATU-
WORKPRr.COMPENSATION AND L ORY tIMIT5 I
OT14.
F M PLOVERS'LIABILITY
EL EACH ACCIDENT 5
THE PROPRIETOn/ i WC0000770433 3/4/10 3/4/11
INCL FL DISEASE-POLICY LIPAT S
PARTNERS/EXECUTIVE
OFFICERS ARE! RXCL EL DISEASE-EA EMPLOYEE -s
OTHER
DESCRIPTION OF OPERATIONSILOCATIONCN2HICLES/1,;Pr-CIAL ITEMS
This certificate is subject to policy terms and conditions
Car,)entry Painting Wallpaper
.-M
gi
111"1011;11,�, 110113t7 b
aa
141-111
JJR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THR
Town of North. Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Inspectional Services 10 -DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
1600 Osgood St BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
No Andover , Ma 01845 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESEN IV
Fax- 978 688 954.2
MR P-N!
�Mr,R 4;�IM4
MEMEMEMMMm all �g: I Off.
- - -ON
w
�i