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HomeMy WebLinkAboutBuilding Permit #866-2014 - Great Pond Road 2/3/2016v�;LU�ly A4M Lr -- Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this paize r1ORTIM\ Q �4LED /6 O h'ti fin; _6 LOCATION 3% IYl rd t o� S� ��'{ 7 - Print PROPERTY OWNER k i✓y � �� ✓� f- y Print 100 Year Structure yes no MAP YDol PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes , no 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 g( Others: ❑ Demolition ❑ Other yr $,J t a a u �Septr ❑Well ,mss, ❑ Flootlplain Wetlantlsy.. ' ❑ Watershged. D'istnet , DESCRIPTION OF WORK TO BE PERFORMED: fq �d'Srgl;�y �'x�'rr/e� t,✓�/� . hSv/A�%or lirns� X o Identification - Please Type or Print Clearly OWNER: Name: %Y ✓,'n Phone: Address: 3 s h4a rel iJ S ? `r -r7- Contractor Name: I Phone: Email: Address.: - ;I- tA57- 577 /4 -15)--0 w Supervisor's Construction License: /0 a % 7 Exp. Date: Home Improvement License: 10)-;"x G Exp. Date: 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: $ 3,000. ©0 FEE: $ 5-fe Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f Public Sewer ❑ Taming/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ti Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit ..DPW Town Engineer: �i�nat,tirP• V Located 384 Osgood Street 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 ❑ Notified for pickup Call Email Date Time Contact Name, 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application � Certified Surveyed Plot Plan 46 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) Mass check Energy Compliance Report (if Applicable) Engineering Affidavits for Engineered products . TOTE: 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 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 i6 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 Doe: Building Permit Revised 2014 Location,41-66-,eow No. J(, Date2 %A TOWN OF NORTH ANDOVER Check #1 -1 \ I 3 5 Certificate of Occupancy $- Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector OWN = J W = LL aLLI O m r E + ac O Vaf Z o J > 00 O cc O W N Z m j a O W H Z u �i W ~ w LA Z H (a7 F W a o uj ix u. Y Y O LL >. N U O. N a 'O � LL 3 w >' U f9 ii w > O = (0 O LL t =3 O w u N N O LL s h0 p C' ` v i Z N cu ') Y O CN rA yV n b O E O v Z O � O AAI++ O U .E m m CL O R O �0 0 O CL CL CL a� Q o= a v J �CO d Z O CL vU) CL .y RISE Engineering MContractor R allorNo 8186 MA Registration Ito Im "RISE A division ofThWuh Engineering MUNEMNG 60 Shnunton, 021339-5 R 339.50Z.63iSCONTRACT Page 1 PRQGRAMCMA-HES CUSTOM L DATE CUMTO ,aoWeoR�l Kevin Carney (978)413-0303 09232015 421810 00003 SERVICE STVUWT anlarc STRUT 39 Harold Street nil o 39 Harold Street SERM siY.87ATE,ZO• SaIAiS CnY.STATE.ZO• North Andover, MA Ol 5r� North Andover, MA 01845 JOB DESCRIPTION AIR SEALING- Provide labor and materials to seal areas of your hose against wasteful, excess air leakage. This work will be performed in cosart with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include canllct, foams and othef products. Primary areas for sealing include air leakage to attics, basemex►ts, attached garages and other unheated areas (windows are not generally addressor.) This will require (2) working hours. A reduction in cubic feet per minute (Cfm) of air infiltration will occur, but the actual number of of n is not guaranteed. At the completion of the weatherhation work, and at no additional cost to the homeowaa, a final blower door and/or combustion safety analysis will be Conducted by the sub-contractor to ensure the safety ofthe indoor air quality. $170.00 AIR SEALING: Provide labor and materials to install Q40n weatherstripping and a doonsweep to (2) door(s) to restrict air leakaip. $150.00 WADS: Famish and install blown in Class I Cellulose to (1440) square Set of shingle and/or clapboard exterior walls. The butt of the upper corse of your wood siding is art to drill holes into the wall sheathing behind The holes aro then plugged and the wood siding is reinsWW using stainless steel finish nails. Twuh-up painting, if needed, Will be the asst mWs tespertsrb➢lity. buvaicing Val oCCuf upon Completion of installation. Subsequent to your Mment as an added service RISE Engineering will return when weather permits to chock for any voids with an infrared scanner. Any major voids that maybe fond will be filled at no additional Cost. $2,664.00 RISE Engineering will apply all applicable, eligible incentives to this amtrad. You w0l only be bulled the Net amount Currently, for eligible measur s, Columbia On offers 7S% incentive, not to exeood $2,000 per calendar year, and an incentive of 100% for the Air Seating measures up to the first $680 and an additional $340 if savings ae justified by the auditor. For the safety and health of your home's indoor air quality, we will be Conducting a blower door diagnostic of the available air flow in Your home both before the wok is begun, and atter the wea&aizWw work is Complete. We will also conduct a full assessment of the combustion safety ofyour heating system and water heater. This has a value of $90 and is at no cost to you. Total allowable weatherization incentive is $3,110. $90.00 4 Fedeval ID# RISE Engineering R! Contractor Roffistrwon ��a� RISEA division otThfetse6 Ecgiaeering uacoT EMNEMING 60 Steak Canton, MA OM 339-5M197 FAX 339-5924345 CONTRACT Page 2 PROGRAM Ti09 UaoaURAcr m UaIUUaa®URUO UUEIMMU�I RUr� CMA HES U*►BWR�RMCAs DENWISEDBELOW CUSTOM PaCIE RATE CUBIT. womc«met Kevin Carney (978)413-0303 09232015 421810 Q0003 sEWJ= $TINET BUJAS SIRWI 39 Harold Street 39 Harold Street SEW4= WV. STAIF,aP anU.m CMY.Smw,zip North Andover, MA 01845 North Andover, ARA 01845 JOB DESCRIMION Total: $3,074.00 Program Incentive: $2,260.00 Customer Total: $814.00 WE MIME KMM TO.FUMM SERYWO-CORPLETE M A=RnWM W M1 ABOVE SPEWrATM& FOR T!RESUM OF ***Eight Hundred Fourteen 8M 001100 Dollars $814.00 tUPaRFUruv ANDAMMALST,®EBId7 iCUSTOMERAORM10aHOIAYOfWMEWFW-W1MWCFt%V"iMCtAMWU M10.YMAW n� AF�esoanrs.s��IBmEros�anuRo�ATaetmU auanAacea,amtnsaFa.:.Ue�.AemooMaacmRaeasmaTea� OO NOT SIGN 7M CONTRACT W WERE ARE ANY BLANK SPACES TURF-Rr>;FPal neme� C STV1 tAtMCWmt1CF IMMIMSCOMRACTMAYBETOOIQRAMBYUSUPIMSUgMVVfM DATEOFACC@mNCE 9/a J�OLD 30 • ACCEPTAMGFC MRACT-UMAWMMCMBPECMCATiOO=CONMWMAM DAYS.OAOYM�ttATYM OAU D AAU ME T000TMUEYAswc OWNER AUTHORIZATION FORM Nick Brings (Owners Name) owner of the property located at 39 Harold Street, North Andover, MA 01845 (Property Address) 39 Harold Street, North Andover, MA 01845 (Property Address) hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owners Signature Date The Commonwealth ofiWassachuseffs Department of-IndustrialAccidenfs I Congress S1ree4 Suite 100 Boston, M41 02114-2017 .mass_govIdic NVorkers' Compensation Insurance Affidavit: lauiilders/Contractors Elecnici2us/i>lumbers- TO BE i9LEID Wl ,i -HE P ERIl U3- iNG AUSORI X , Name (Business/Or-pnizatiowlndividual): �� �7 %%� ! 1 i � 'i ! j i , /� • !`i i l I' _ T i 1 Address: 611� e i/ City/Stateaip-__ Phone #: Ase yon nu cmployer? Cbl the appropriate boz-. mm a employer with iemployca (full and/r part-time)_o 2-01 am a sole proprietor or partnership and have no employers working far me in any capacity- (No work—'comp. insu sore zcguirecq 301 am a bommwaer doing alt work myself [No workers' comp_ insurancerequired-]t 4.❑ I am a homeowner and vnll be hiring coatractom to conduct all work on my property. I will ensure that all contactors either have workers' oompansation insurance or arc: sole praprictors with no r-coployces_ 5.0 I am a general contractor and I have bired tbv sub-wnazctors listed on tbc attached sbom 'ibcsc sub -contractors bavc anploycrs and have workers' cutup- insurance t 6•E] We arc a corporation and its ofireas bave mocised tbeir right of eteraption per MGL c- . 152, § I (4)� and we have no cmpkyccs- (No wotkas' comp_ ins--ce"quircd.] Type of project (required)! 7- Fl. New construction 8. Remodeling 9_ Danolition 10 rl Building addition 11-[] Electrical repairs or additions 12. Fl Plumbing rzpai s or additions 13.n -Roof repairs 14. tether -Any applicant tbai cheeks box 9l must also fill out the section below showing their workers' coaq=Moo policy infonnatiot, t Homeowoas wbo submit this affidavit indicating they arcdoine all work and tbm biro outside contractors must submit a new nfSdavit indicating such tCootraaors that check this box mast artecbe i an nddkiot a sbect sbawing the name of Ibc sub-contracuws and state wbctbc or not tbose entrries have employees_ If the sub -contractors have as loyecs, they must provide their workers' comp_ policy number- ! amu erre empioyer that is providing workers' compensation insaranceJor rely employees. Bdow is the policy amdjob safe I -formation. t a Insurance Company Name: j C Policy # or Self -ins. Lic_ Expiration ]date. lob Site Address:- 3 %� J o (� �1 r CityiState2ip: yJ �J r 0(0 ver i .&ttach a Copy of the workers' compensation poUcy declaration page (showing Che policy number Ptd espirmfion date). Failure to secure coverage as required tender MGL c- 152, §25P is a criminal violation punishable by a fine up to $I500_00 ind/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 lay against the violator- A copy of this statement may he forwarded to the Office of investigations ofthe Dew for :nv cc overage verification_ da hereby certify under thegrains and penalizes oppe7jFury thatrise informer on provided above is &ue artd correct zignature: •' �,,� -` 'y - Date: - r 'hone #: Gil - '-', —7 f O- jjw, ad use on&. Do not write in then area; to be completed ley city or tame OJkIZOL City or "!Town_ Permit/License # Issuing Authority (circle one): 1_ Board of Health 2 Budging artaiaeaat 3_ City/Town Clerk 4. EIetirical Inspectos 5- I'lumibing Inspector 6- Other COnt2cf Person. Phone #:_ 1/4/2016 Preview: Certificates of Insurance ACCORV -CERTIFiC-ATE OF LIABILITY INSURANCE DAT) �. 11042016 01/04!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 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 CONTACT HAME: Automatic Data Processing Insurance Agency, Inc. PHONE % (A;C. No. Extl: talc. No, t. ADDRESS: I Adp Boulevard INSURERS) AFFORDING COVERAGE NAICa Roseland, NJ 07068 INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC PO BOX 958 INSURER C: Andover, MA 01810 INSURER o: INSURER E: INSURER F : 6CL'•Il}`It:JI I:'t :I �,<px:afr; 5 COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER: THIS !S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO.a HAVE BEEN ISSUED TO THE INSURED NA&IED ABOVE FOR THE POLICY PERIOD INDICATED. NOT :ITHSTANDING ANY REOUIREU.ENT. TERL' OR CONDITION OF .ANY CONTRACT OR OTHER DOCUIaENT 1'iiTH RESPECT TO ::HiCH THIS CEP.TIF;CATE MAY BE ISSUED OR LlAY FERTAiN. THE ;NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN :S SUBJECT TO ALL THE TERLIS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN I:'AY HAVE SEEN REDUCED BY PAID CLA!M.S W5RP LTR TYPE OF INSURANCE IVSD SND POUCYNUGIBER LI'Y F (MIXOD.YYYY) POLICY P 1 LIGHTS tI.7L1•DO:YYYYi COMMERCIAL GENERAL LIABILITY =LAIGM1I.I:,I:t I II'�(.11� (e:,C1- � `J::L9;HEhCE I'I:t1.1iv.t�lt.'. J: _'IC�_•li-_•: S CtI;L AGGEECnAit LILIII A°FLIES PEE: PULIC`" FIU: C J 'tl �t ❑ LE7:ElivL:,GL;IaI:,I E YfSC lti t:l_ _r:t•11 =CI• •:CIL > AUTOLSOBILELIABILITYIf.tL'JII;LL -.. PoJIC, LL L':N. BL° b'-FEDLLEO ::CIC= 611•aU i.Ll CS 1 ;:t. CW.IatAL LI;.111 ta: ul: 6CL'•Il}`It:JI I:'t :I �,<px:afr; 5 SCL'IL'!II:JLIi� d'v ;a:[r-.rN; 5 I'I::i1't •1 U•+(.LICt f= UL:BRELLALIAB EXCESS UAB 1 CLAII.1_d.U',C•E ( ( I EAD, :=CCCI&itr:Lt L:,CGIihG;.lE DEO ICt.� LI E14 IFr ' A WORKERS COMPENSATION ANDEGIPLOYERS'LIABILITYS1+UL(E YiH nl tl Ei t t`.Is� E Fit'C c ELuu:t � (t:,andalory in NH) 1'-1� ;1 ,s. c=s^,b .. _,.• L•tSClill'11rt: L:F CI"=li,:l li:I:S :1:: �:- .IIA N POWC772258 01,01:2016 I 01!01'2017 X EIS tL E:.0 :,cLticzt.I s 1000,000 E L. DI_cd5t- EA EI:11'L13YkE S 1,000,000 t.L.l I tA�(: 1•;;U�� L'LIII 1.000.000 1 DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES tACORO 101. Additional Remaks Sch'.dule. may be atoehed it more space is required) Theilsch Engineering, Inc. 195 Frances Ave Cranston. RI 02910 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE AG 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD POLABEA-01 JONEILL CERTIFICATE OF LIABILITY INSURANCE D1/6NVDDIYYYY) 1/6/2016 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 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 CONTACT NAME: _. Durso & Jankowski Insurance Agency PHONE - - -- FAX 11 Saunders Street arc, Na Ext)_(978) 688-7000 _ _(A/c, No : (978 688-7001 North Andover, MA 01845 E-MAIL — wnnoacc- INSURED Polar Bear Insulation Co. Inc. Peter Leblanc & Steven Leblanc P O Box 958 Andover, MA 01810 INSURER(S)AFFORDINGC_O_VERAGE NAIC# _ INSURER A:Nautilus Insurance Co. _ 17370 INSURER B: Safety Insurance Company _ 33618 — INSURER C INSURER D: -INSURER-E. COVERAGES fnFRTIFICOTF NIIMRFR- RFVICInfd NIIMRFR- 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. 195 Francis Ave --- - - - INSR — '—BR�- --- - - LTR I TYPE OF INSURANCE i POLICY NUMBER I INSD WVD, POLICY -EFF^ MM/DD I JMMIDDMM! LIMITS A i X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 CLAIMS MADE OCCUR {�NN538691 03/24/2015 03/2412016DAMAGETO�ENTEO - PREMISES (Ea occuTence) $ - -- - " 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY IS 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER 1 I !..GENERAL AGGREGATE 1 $ 2,000,000 � POLICY (—I JEC " I T LOC I i _ PRODUCTS -COMP/OP AGG $ 1,000,000 OTHER- THERAUTOMOBILE B AUTOMOBILELIABILITY _ COMBINED SINGLE LIMIT '�r`E-a accident__.- _ 1 S_ 1,000,000 ;ANY AUTO 1 !2100926 X SCHEDULED i 01/04/2016 ; 01/04/2017 �' .ODILY INJURY(Perperson) $ ;BODILY INJURY (Per accident) $ - - AUTOALL S AO - NONOSWNED I X ` HIRED AUTOS X i PROPERTY DAMAGE �- AUTOS (Per acc deny $ UMBRELLA UAB I X I OCCUR EACH OCCURRENCE S 11000,000 AEXCESS LIAB CLAIMS -MADE; AN019284 �— 03/24/2015 03/24/2016 AGGREGATE I $ — -- - DED i RETENTION $ l -- - WORKERS COMPENSATION ' i ' I 1 PER ` - ' E ER.- LABILIT ANDEMPLOYERSYIN �( ANY PROPRIETORIPARTNERIEXECUTIVE + _OTH $ OFFICER/MEMBER EXCLUDED? IN rA (Mandatory in NH) I -J ! ; EL EACH ACCIDENT — E.L. DISEASE - EA EMPLOYEE $ If yes, descriW_ under DESCRIPTION OF OPERATIONS below r E -L DISEASE - POLICY LIMIT j $ i i I DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Insulation Work - Mineral Insulation Work - Mineral- Additional insured for general liability per blanket additional insured endorsement with respects to work performed on their behalf by the above insured is Thielsch Engineering �yaY1171Fr1\�a:LUA�Ja: . �rN�a�.�rr.�a f14000 nn7 A A f%f10I1 ^ r n^n AT1f161 All --..-. --A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thielsch Engineering Columbia Gas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 Francis Ave ACCORDANCE WITH THE POLICY PROVISIONS. Cranston, RI 02910 AUTHORIZED REPRESENTATIVE f14000 nn7 A A f%f10I1 ^ r n^n AT1f161 All --..-. --A O?Owrli S' fir II(LVmU*a&I* RegdWion office of Consu�°`er Aff�s �,.d � 510 - 10 P Pi S _ 02116 2�1�` 1°;�6 Bos�n� CIltr-? 0r lug opn cn ifl2726oYeme�lReg ,OIle 29M BEAR INS�1-p`TtON O ipO Vul(snt LeBlanc P.O. BOX 958 �1$,l0 _ ��- , Dcaia p�DOVM upa�Aaatmw � 1° `t �p12i6 ppg.GAt �s Sill 21ASTPMSTRUT jej,&wii7 NK M69 _