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HomeMy WebLinkAboutBLD-19-001113 Elliott, Ken From: Cipro, Linda Sent Thursday,August 23, 2018 1:17 PM To: Hall, Lee; Elliott, Ken; Murphy, Bruce; Renaud, Philip; Inkley, Brad; Huck, Kevin;Sawyer, Jon;Simonian, Philip;Smith, Scott Subject: final for C/O 938 Route 6A Good Afternoon all, The Building Department is scheduled to conduct a final for occupancy inspection at 938 Route 6A—Canna Care Docs— on Monday 8/27/18 and would like for you to attend. The contact person is Stephanie and she can be reached at 508- 212-9364. Please notify me with your inspection results. Thank you, Linda ihs- ( era vet akir y4 wi a� Naoe rsy wonaz aintarz © CLL U O( 7- UT a,--ematte to ifet frwees AkE (45 (Q-615 €4E12- rucr Mor eokez a( ttl � 1 of•Y'1@ TOWN OF YARMOUTH Building Department CERTIFICATE OF Ar Z: , . (508) 398-2231 ext.1261 OCCUPANCY � ' O 4, PERMIT NO BLD-19-001113 M*n clei s 'T Q ,* 1•,, N/� STEPHANIE GLUCHACKI ; ADDRESS: 938 ROUTE 6A,YARMOUTH PORT, MA 02675 ZONING DISTRICT Bldg.Type:ICommercial SUBDIVISION MAP BLOCK LOT 143.88 BUILDING IS TO REMARKS USE&OCCUPANCY—CANNA CARE DOCS—OCCUP= Y SUBJEC -• ALL FINAL INSPECTIONS. (508-212-9364) it,/ • / / /or CERTIFICATE OF INSPECTI / DATE: BUILDING OFFICIAL: i M. DALE ORMON BUILDING DEPT BY 960 RO YARMOUTHUTE P6AORT, MA i PHONE 1I5 PERMIT CONVEYS NO RIGHT TO OCCUPOY ANY STREET, ALLEY—OR—SIDEWALK OR AFIT PART THEREOF, EITHER TEMPORARILY OR ERMANENTLY.ENCROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JRISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF JBLIC WORKS. CERTIFICATE OF OCCUPANCY BUILDING INSPECTIONS APPROVALS FIRE: OTHER DATE: ` G I.• DATE: INSPECTOR: / fi A/AO' INSPECTOR: ELECTRICAL BOARD OF HEALTH DATE: C? ( l (,(8 /DATE: -/ d r `8 ra INSPECTOR: INSPECTOR: 6441 PLUMBING/GAS / FINAL BUILDING / DATE: 71 M DATE: Z._ / / -Las INSPECTOR: 4-kti INSPE O- : /`7--"'/8 COMMUNITY DEVELOPMENT: DATE NAME Hall, Lee From: Cipro, Linda Sent Thursday,August 23,2018 1:17 PM To: Hall, Lee; Elliott, Ken; Murphy, Bruce; Renaud, Philip; Inkley, Brad; Huck, Kevin;Sawyer, Jon; Simonian, Philip;Smith, Scott Subject: final for C/O 938 Route 6A Good Afternoon all, The Building Department;s scheduled to conduct a final for occupancy inspection at 938 Route 6A Canna Care Docs—f on wlondy8/27/18 andyould like for you to attend. The contact person isstephanie"and she'can reached at 508- 212-9364. Please notify me with your inspection results. • Thank you, Linda toy - 11 4-d 11-0T / 1 • 1 ` BUILDING PERMIT APPLICATION ,'� item,* o • A R �O APPUCATiON TO CONSTRUCT REPAIR RENOVATE,CHANGE THE USE,OCCUPANCY OF, C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. to,' Toms ofYanttouth Building Deportment 1146 Route 28 • Yarmouth. MA 02664-492 Tel: , 50&398.2231 ext.1261 Fax 508-398-0836 mai Use Only // 2 Planning Board tmomWion Assessor*Department mdormaeort PermitNECJS'/91 0V Dat _ Plan Type Map for Permit Fee $ 0Endorsement Date /` i/ Recording Data Deposit Recd. $6 d Date„_,,,,,, plan No, 1.4 Property Olmensionc Nee Net Due _„$ ? / Other' LM Ara(0) Frontage(tt) Lot Covera This Section for 0111a Use Ory . Building Permit Number. Date Issued • Slgnaturo2,,,- :Z3 7 b' Cettillcats Occupancy Oficial l Dame is M t m reauvur.d , Seectiioon�I -Site Intormatton] !/n in . . . - -9:881.1 P 1 Property Ame(sp g-" IVin &A 1.2 Zoning Mtamatbn: - - • kin rrnoo441pnr1 m 03(6)5 Zoning District Proposed Use 1.3 tiny Setbseke(n) • I Front Yard Side Yards Rear Yard- ` :- Required _ Provided Required Provided Required. . Provided 1.4 Minter Supply(MAL„a.44!54) IS Food Zone trbrrnadann Comrnerac Public Private Zon BFE . Section 2• PrOwrrip/Autt orixed A9errt 2.1 OwnerRecoade . . M.i OrzH D1) goo 11414 Si ye ycgr N '� (grinj ) Melling Address: "��f. ,08- 362-6662—. Signature Telephone Telephone Email Address: 22 — Agent• r. Agent ) 1SORivtoAl. UdrVERS.eOPYcr4S:Aar Sk pha-ni2 I i )c.4iar.IC.I ?) kt,9w t I*--ett fail 124k', titAcrOt Mailing Addres(V► ) XrkintIr _ , c4 Signature Telephone - - - .. Fax - - Email Address: j Section 3•Construction Services &ktphau. n@.cax.nra.cw.e./ ..es:earn • S.1 Maned Casstnaetion 51ryeMsess Not Applicable (� ( License Number V r Address Expiration Oats . ! Signatue•. Telephone Email Address: - . ' t 4 - - - OVER Floor LS (g.7--4 COMMERCIAL ONLY—BUILDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: CI 58 m -to A \frArrnoottor-I-,r00 Oa 05 Scope of Proposed Work: RECEIVED ! Date: 8.15.18 Aifi, 3219. ( i BUILDING DEPART [ Based on the scope of work described above,the applicant is required to obtain app ?: 0 361 sign-offs from the follong departments as checked-off below: JNITIA ?tilt A A} /Health Dept—508-398-2231 ext.1241 6D150,--,10-vr- Conservation Comm.—508-398-2231 ext. 1288 Water Dept— 99 Buck Island Rd.phone no.508-771-7921 Old Kings Hwy.Hist Comm—508-398-2231 ext. 1292 Engineering Dept.—508.398-2231 ext. 1250 /Fire Dep .—Kevin Hue -tunes Armstrong,96 Old Main St.SY A. v. eszi- le ' Note: Please • ent for an appointme Other Appropriate plans and/or application shall be provided to each of the departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept • • - Thank you for cooperation. Receipt Acknowledgement: C.A1201c1A , La."(-Lit/ 9.1 Applicant's Signature Date Section B- Description of Proposed Work(check en applicable) ' ' New Construction 0 (tis mumpte tamiy only) No.of Bedrooms (fa munpe family only) No.of Bathrooms . : Existing Bldg. Q Repalr(s) 0 Alterations Q Addition Q Accessory Bldg. Q Type Demolition Other Specify:. .. Brief Description of Proposed Work: ' . 7H a a.iva4'n44zp with /f/c4cic Pra s cnor - Section 7-Use Group and Construction Type BuNdng Use Group(Check as appfkapable) Construction Type • A ASSEMBLY p' - A.1 p A4 p Aa Q IA ❑ / A4 Q A-s ❑ ' 1e Q 8 BUSINESS E71 - - E -EDUCATIONAL Q - 28 "Q - F FACTORY Q Ft Q - F-2 Q 2C Q .. H- HIGH NA2AFO Q - , 3A Q I INSTITUTIONAL Q - 41 Q 1.3 Q - - Id Q - 38 Q M MERCHANTILE Q 4 Q R RESIDENTIAL, Q 11.1 Q - Ra Q - R-3 Q " SA Q $" $1OFlAGE Q $$I Q S-2 Q EB Q • SPECIFY:' M MIXED USE-- Q . snort S SPECIAL USE Q - SP1YF!• - - - - I Complete this section if existing building undergoing renovations;additions and/or change in use. Existing Use Group: - Proposed Use Grggx - Existing Hazard Index 780 OMR 34 ' Proposed Hazard Index 780 OAR 34 Section 8 Building Height and Area " • - - Bulling Area edging tit applicable) Proposed Numba a noon or stories - induce basemen riot - Floor Area per Floor 45 - Total Area All Floors(sfl Total Height(ft) Section 9-STRUCTURAL PEER REVIEW(780CMR 11011) Independent Structural Engineering Structural Peer Review Required Yea SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING P -" I, f9• i t_ dfil.(oA �,��,{,t � ,as Owner of object property, hereby authorize '"_r " " to act on my behalf, in all matt tine to rk authorized by this building permit application. S.gnrllure of Owner Date I OVER i. w 3.2 Registered Home Improvement Contractor.j "- 4 Company Mama Not Amicable.CI • •' ••• - � - - ' Rem Wether Address - . . Eepa8on Date , Section -Workers'Compensation Insurance Affidavit(M-G.L.c.152 S 250(6)) • Workers a•mpensation Insurance affidavit must be completed and submitted with this application. Failure to provide t is affidavit will result in the denial of the issuance of the building permit. Signed A , -vit Attached Yes - No Section 5- Prot- ionat Design and Construction Services-for Buildings and Structures Subject to Construction • 'I Pursuant to 780 CMR 116(containing more than 35.000 c.f.of enclosed space) Section 5.1 R=• _• • - itecC NaAooecaae Q , Nam*(Registrant): - --- _ ReQstraaon Nurhar - _ Arliiress _ - Expiration Dale - - - Signature Telephone Section 5.2 Registered Profess • Engineer(s)I ' Ana d Rnpuehab Address . - - - RegalraUon raerhre Signa ture Teieplone E m neon error MN a Repot ay Address Registralon Number Signature Telephone Expense DW Nanta - Ana a RewatNOWtr - . Address - - ^IVuethar Signature Telephone - Eeptraoon Dae Area d Rapont istr . . �dr/N Resor Norther -, Signature Telephone Dau Section 5.3 General Contractor Company Mem • Person Responsible lot Construction Address Signal - - - . Telephone • • The Commonwealth of Massachusetts v_e.=_, • Department of Industrial Accidents =_ •'= Office of Investigations • `"�— 600 Washington Street _l'i_ 7 Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print Legibly Name(Burin storgaaimtion/tndividualy N OCTec4nndu es OSA I Nc. DBA Ccnno le �oc& y Address: glili 01140114t. -A Ci /State/Zi.: Orrnoty4haori- MA 0a05 Phone#: '181-3Sa- 8053 Arree you an employer?Check the appropriate box: 1.t i I am a employer with 4 4. 0 I am a general contractor and I Type of project(required): _ employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2. I am a sole proprietor or partner. listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. Building addition required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions _ 3.0 I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL insurance required.)t c. 152, §1(4),and we have no 12.0 Roof repairs 3a.D I am a homeowner acting as a employees.[No workers' 13.12brier flet, rEInCnr4i t7/J general contractor(refer to#4) comp.insurance required.). *Any applicant that abet box Ml must also 811 out the section below showing their wafters'compeaxtio8j»licy hdoomCon. Homeowners who submit this affidavit indicating they are doing all work and then hire outside cootracton must submit a new affidavit indicating such. tContracton that check this box roust attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. If the sob-contractors have employees,they must provide their workers'comp.policy number. I ern an ployer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. n Insurance Company Name: N � fro PP apAlpervI t east/0-41 Policy#or Self-ins.Lic.#: W OR A qq a,a 3a_ Expiration Date: 7I I 1 f 93 S rob Site Address: mR to-A yarmoulhpori- City/State/Zip: ma o ,15' 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 ertify under the pains and penalties of perjury that the information provided above is true and Correct Signature: icvvt ' L Lx.o t.; Date: 6•IC' I Phone#: I-101 colo() ciSq 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#: SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION j . I, Sk—Onn e GIVCIICAC_k I as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate,to the best of,my knowledge and belief. Signed under the pains and penalties of perjury. r;P Gi�1ac<<It Print t 9_IpPet 8:15,11 Oarur/AQMt Dat. - section 11 -ESTIMATED CONSTRUCTION COSTS Item - ' Estimated Cost paws)to so mrtpleted by pemst applicant 1,Building z Elacltieal - 3.Plumbing/Gu - - - d.MeoMNUI(MVACI - • - .. . STd Pto1+2. 6. 344.5) 7.Total Sporn Ft.*tam masa man Check Below• ' CI Conservation-Commission Filing (II applicable) 0 Old Kings Highway&Historical Convldssion approval (if applioabw) • • 4 Of 4 - MGL AND FIRE ��►���,� TOWN OF YARMOUTH a „, REVIEWED FOR CODE COMPLIANCE. :RRORS OR OMMISSIONS DO NOT RELIEVE . � 1 i HE APPLICANT FROM THE RESPONSIBILITY OF"AS BUILT"COMPLIANCE. DATENei �p. go Cly INSPECTOR YARMOUTH FIRE PREVENTION New Business Transmittal Project Name: Canna Care Docs Address: 938 Route 6A Contact Name: Stephanie Gluchacki Phone: 781-382-8053 Y N NA Subject Regulation ES 0 X Building Numbers MGL Chapter 148;sec 59 X Fire Lanes 527 CMR 1;22.3 X Extinguishers 527 CMR l; 13.6,Chapter 148;sec 28 X Maintence of any equipment,system relating to 527CMR1 1.1.4 Fire Protection. X *Hazardous Materials Storage 527 CMR I;60.1 X Emergency Plan Required 527CMR1 10.9.1 X Commercial cooking,Hood systems 527CMR1 50.2.1.1 X Commercial Cooking Hood Systems Cleaning 527CMR1 50.5.4 X *Commercial Cooking Extinguishment System 527CMR1 50.4.3 X *Candles,open flames,and portable cooking 527CMR1 17.3.2,20.1.1.1 X Blocking electrical panel 527CMR1 10.19.5.1 X Blocking exits 527CMR1 14.4.1 Extension cords shall not be used as a 527CMRl 11.1.7.6, 11.1.7.1 X substitute to permanent wiring X Limit storage heights to 24 inches below 527CMR1 ceiling without sprinklers 18 inches with X Maintain Aisle width of 36 Inch's(3 Feet) 780CMR 1101.1 X Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.1.2,34.1.1 X The right to inspect MGL Chapter 148 Sec.4 X *Upholstery 527 CMR I;20.6.2.5 X *Trash Containers 527 CMR 1; 19.1.1, 1.12 X Any Hazard to the Public Chapter 148;sec 28 X *Curtains, Draperies,Blinds 527 CMR 1; 12.6.2 Description of planned project/other requirements: The YFD support the application, subject to applicable submissions,permits and inspections. * YFD permit required-depending on occupancy and submittal Plan Reviewed By: Captain Kevin Huck Date: 08-21-2018 Copy for Applicant C Copy to Building Department I I Copy to Fire Prevention Entered in Firehouse I—I Final Inspection . ' ot �k TOWN OF YARMOUTH HEALTH DEPARTMENT ' •% PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: n Norm Building Site Location: CI 3 �`(l A-- LQ A `I Gtr M ou Mn pork- t mPr o a( -1 Propo7 re Improveent: eti f244 ,'. ,._fes iS —`ri Applicant: Stph0.f 1 t Ca U dna cg.l Tel.No.: U I 1 SOS 70 n Address: 9k&,r-ha.Q I , Sk-re-t-fr �AJI Rive It. oval Date Filed: 9j/24I 1 ••Ifyou would like e-mail notification ofsign off please provide e-mail address: & n i'Q @ Ca.nnaca rtdocS-teem Owner Name: M . &t-Q, Or Yrl o'1 Owner Address: 1017 m0•.tfl ant+ "J&Ybnou , PhfT Owner Tel. No.: % /.22.1.00192- . RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings,water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: ririr DATE:&l) ' /(8 PLEASE NOTE COMMENTS/CONDITIONS: n CD 12 CSC SMC D Consult Office Providers office AUG 212018 0 \ . ern inCil HEALTH DEPT. Bathroom re— / \ /...0(-tit,/ c✓t '\, C 01 a g n easy 2ultleMro 33410O d n _• o \ v n m ---. / o 0 o H N TOWN OF YARMOUTH / REVIE'. ED FOR BUILDING AND ZONING CODE COMPU- ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT' c ( A^y COMPLIANCE. G� . -: DATE: S _ 4 BUILDING OFFICIAL - TE • A CERTIFICATE OF LIABILITY INSURANCE DA E29/201 18 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 poliey(les)must have ADDITIONAL INSURED provisions or 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: Erin Miller NFP Property&Casualty Services, Inc. PHONE FAX 3915 National Drive,Suite 400 WC No.sett 301-6284113 lac,Nal:301428-4001 Burtonsville MD 20866-1126 NDORIEss: erin.miller@nfp.com INSURER(S)AFFORDING COVERAGE NAIC Si INSURER A:Hanover Insurance Company 22292 INSURED CANNA-1 INSURER B:Hanover American 36064 MVC Technologies USA, Inc. INSURER C: DBA Canna Care Docs 495 Central Ave INSURER D: Seekonk MA 02771 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:376032978 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. INSR ADDL'SUBR POUCYEFF POLICY EXP LTR TYPE OF INSURANCE INCE),WVD POLICY NUMBER (MM/DDIYYYY) IMMIDONYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY Y ZDRD092997 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE I OCCUR DAMAGETO RENTED PREMISEjEe occurrence) $100,000 _ X Businessowners MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY S 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 52,000,000 _ POLICY u JE; LOC PRODUCTS-COMP/OP 52,000,000 _ OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ (Ee accident) _ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILYINJURY(Per sadden() $ AUTOS ONLY AUTOS ) HIRED NON-OWNED PROPERTY DAMAGE 3 AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA UAB — OCCUR EACH OCCURRENCE_ 3 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS 3 A WORKERS COMPENSATION WDRA9S2932 7/12018 7/1/2019 X STATUTE ETH- AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNERIEXECUTIVE El EL EACH ACCIDENT $1,000,000 OFFICERrt,IEMBER EXCLUDED/ NIA (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $1,000,000 N es,descnb,under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 B Property Section ZDR0092997 7/12018 7/12019 Contents Various Business Income 12 Months ALS DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Addflonel Remarks Schedule,may be attached If more space Is required) RE:82 Hartwell Street,Fall River,MA 02771 4M 6 Resnik,LLC Is additional insured with respect to general liability,if required by written contract,with respect to the above referenced location. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4M 6 Resnik LLC 11 Aldrin Road Plymouth MA 02360 AUTHORaEREPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD