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25C-019 (5) 186 NORTH ST BP-2020-0967 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-019 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0967 Proiect# JS-2020-001644 Est.Cost: $10475.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MELISSA FOWLER 114370 Lot Size(sg.ft.): 7100.28 Owner: NOW MARY zonine: URB(100)/ Applicant: MELISSA FOWLER AT. 186 NORTH ST Applicant Address: Phone: Insurance: 87 CHESTERFIELD RD (413) 977-0455 W(' LEEDSMA01053 ISSUED ON:3/9/2020 0:00.00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final• Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil• Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: FeeType: Date Paid: Amount: Building 3/9/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building.Commissioner .FE8 J Department use only -r City of Northamptontatusof rmit, Building DepartmentCurb Cuts riveway Permit 212 Main Street $� '/Se tic Availability Room 100Water/We I Avai ability Northam ton, MA 0106Q, p �T f Str ctural Plans - of nl_�m� phone 413-587-1240 Fax 413-5874irarT6N. ans Other peZ- APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: �{ This section to be completed by office 15Ip�D f O0( I1 J1 Map � � Lot 0l Unit Qddho, iJ I MA C IO6o Zone Overlay District I Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ` rnrn �0 Mo NOa <St• NUMvoornf Ua IM A ZName ' Current Mailing A dress:412 - s�� -�yssTelephone 2.2 Authorized ent: /; 'SSA A. rrit �,eP05 OwS-3 Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ,0,u1S (a)Building Permit Fee 2. Electrical "l (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee [/ 4. Mechanical (HVAC) (� 5. Fire Protection Tj 6. Total=(1 +2+3+4+5) IO Check Number f to (� This Section For Official Use Only Building Permit Number: 1-> �*�V / 7 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Mel',55(ti @ 100451`'"J be-IDN- COrrN EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[p] Brief Description of Proposed Work: 1k&VVWye 0Z6i►N(;V- 5µcl"LnL.E V-WF%ok/�Z-�uo(x w�ive4.�.) Alteration of existing bedroomYes—,�L No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement —Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing complete the following a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT propertyIv as Owner of the subject herebyauthorize ��•U,SSA VW1�-n— uNI+Mi CQouS �M to act on my h f, in all matters relative to work authorized b this building permit application. As S ,t a�.aD Signature bf wner Date CxsA A---rbwLE'L— , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. G1�so, I�. Print Name a.ac, as Signature of Owner gent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction pSupervisor: Not Applicable ❑ Name of License Holder: I l F j SSA /T (,(/(�1�( C:5 License Number 8 C�nEsTei 'iE[� I�p L 0aua3 Address � S t) o)053 Expiration ate Signature Telephone J 40, 5 � v4Ss 9. Re ist red Home IM rov ment Contractor: Not Applicable ❑ I MSU,5sp l� W Company Name Registration Number 60-tiv,;�p CdNs�cno� Se2��c.;�s a ,� a.�ai Addi Address Expiration D to V� �CS��F'l ��• -ewS MA Telephone 413 9�3 oyS SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts r� w DEPARTMENT OF BUILDING INSPECTIONS ? 212 Main Street • Municipal Building Northampton, MA 01060 Sj �7i10 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation,repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building c°ntaining at least one but not more than four dwelling units....or to structures which are adjacent to such residence or Wilding"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: d0 5�4►N �� 1 rJC2VY1 Pr►'1.� Est. Cost: _b 10,4 4�r Address of Work: 1$( 00"I �j�• �)0 npp/j VAA Q iQ bD Date of Permit Application: off• )(9, 01c> I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: a.aG.)'D HEOSSA I A.-fov)Im 10 Date Contract r Name HIC Registration No. OR: Notwithstanding the above notice,I here y apply for a building permit as the owner of the above prope Date Owner Name and Signature City of Northampton Massachusetts ' _ ��<< DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street *Municipal Building Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: `b(o �OM1rA ST. 6o/cA6rY) x) Ma 01060 (Please print house number and street name) Is to be disposed of at: IJdA�m Z N Pt (Please pfint name aW IoEatW of facility) Y J Or will be disposed of in a dumpster onsite rented or leased from: m K -ss �j2v f kCA P (Company Name and Address) j W,/ r�; / A_ ;Xab•a� Sig at a of Permit Appl cant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of IndustrialAccidents a I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.govldia A'I'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information /� Please Print Legibly Name(Business/Organization/Individual): eU35A /7•'1 OwL�. /��N(,t/h�? 0 L ledTC��1d/J T Address: F51 C�VMtJa12-O L e e D.S IMA- otos-3 Ci State/Zip: 1.EL' i l' 7A 01()&() Phone#: j3.933. L �r S Are you an employer?Check the appropriate box: Type of project(required): I.E]I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. [J Remodeling 3.F]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4. am a homeowner and will be hiring contractors to conduct all work on m 10❑Building addition ❑I y property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general no and I have hired the sub-contractors listed on the attached sheet. These sub contractors have employees and have workers'comp.insurance? 13.Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I arrr air employer that is providing workers'compen cation insurance for my employees. Below is the policy and job site information. I Insurance Company Name: I 1131:tl q` t Policy#or Self-ins.Lic.#: WC a3 I 24 633Q 9 Expiration Date: lI ZyoZfa Job Site Address: I NO Ny(I„� ,St. City/State/Zip: 0 04 A) m1� O 10(p6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex ' ation date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. !doh reby cep ' r r r to �Ksa ena 'es ofperjury that the information provided above is true and correct. Signat re: Date: o� olV Phone �J13 Official use onlp. 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#: CERTIFICATE OF LIABILITY INSURANCE DA 2/oa/2o1�s 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 CO AC NAME, Cynthia Squires HUB INTERNATIONAL NEW ENGLAND LLC iALCN, xtl: (413)733-3131 A Ne: EA' Re -MAIL cynthia.squires@hublnternational.com 564 Center Street INSURERS AFFORDING COVERAGE NAIC4 Ludlow VIA 01056 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURERB: UNLIMITED CONSTRUCTION SERVICES INC INSURER C: INSURER D: _ 267 CADY ST INSURER E: LUDLOW MA 01056 INSURER F: COVERAGES CERTIFICATE NUMBER: 480003 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW I IAVE 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 TYPE OF INSURANCE ADDL SUBR POLPOLICYNUMBER MMIP�Y EFF P"DICDY EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ JCA AIMS-MADE u OCCUR PREMISES a occurrence $ MED EXP(Any one person) $ _ NIA PERSONALS ADV INJURY S GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY❑ T LOC PRODUCTS-COMP/OP AGG $ OTHER: S AUTOMOBILE LIABILITYCO BINED SINGLE LIMIT $ l£a accident — ANY AUTO BODILY INJURY(Per persm) S ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per a 1 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ [XCCSS UAB HCLAIMS-MADE NIA AGGREGATE S DED I I RETENTION$ $ WORKERS COMPENSATION X I �ATUTE ER AND EMPLOYERS'LIABILITY ST ANYPROPRIETORIPARTNERIEXECUTIVE YIN EX,EACH ACCIDENT i 1,000,000 A Of FICERIMEMBER EXCLUDED? I NJAI NIA NIA WC2318620633019 11/28/2019 11/2812020 (Mandatory In NH) E.L.DISEASE-EA EMPLO S 1.000,000 If yes,describe under j DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ 1,000,000 NIA DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be atUched if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search too!at www.mass.govAwdiworkers-compensatienfinvesUga6onsl. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Western Builders ACCORDANCE WITH THE POLICY PROVISIONS. 73 Pleasant Street AUTHORIZED REPRESENTATIVE Granby MA 01033 � Daniel M.Cro y,CPCU,Vice President—Residual Market -WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD -'� UNLICON-01 AODIORNE A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYY19YY) 9112/20 j 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 j REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. j IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 License#1780862 CONTACT Amy Odlome NAME: _ HUB International New England PHONE FAX 96 Shaker Rd. (AJC,No,Fd):(413)224-7712 (AK:,No): East Longmeadow,MA 01028 ao"bAREss:Amy.Odiome&ubintemational.com INSURERS)AFFORDING COVERAGE NAIL N INSURER A:Atlantic casuatty Insurance Company 42846 INSURED INSURER 0 Unlimited Construction Services IncINSURERC: 267 Cady St INs_uRERD. Ludlow,MA 01056 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 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-' TYPE OF INSURANCE ADDU:SUBR. POLICY NUMBER POLICY EFF POLICY EXP UMT'S A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 111 1,000,000 CLAIMS-MADE LX _UR X X 'L261002402-1 5/U2019 51U2020 PREMGETORENTuED� : 100,000 MED EXP one $ 5'000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X I POLICY F_— DEFT I 1 LOC PRODUCTS-COMPIOPAGG 2'000'OOO OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT— S ANY AUTO BODILY INJURY Per arson E AUTOSOWN ONLY AUp�TNOERULEEDp BODILY INJURY Per acciderd S AUTOS ONLY AUTOS OIrIYOPER�d MAGE f UMBRELLA LLAB OCCUR EACH OCCURRENCE i EXCESSLUU) CLAIMS-MADE AGGREGATE S DED RETENTIONS WORKERS COMPENSATION �R OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT RIS F15 EXCLUDE[ NIA an story in ) E.L DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is considered additional insured for completed and ongoing operations for commercial general liability when required in a contract. RE:Sage at Hudson—253 Washington St.Hudson,Ma.Western Builders,Inc.and(Owner)SHI-III Sage Hudson Owner,LLC c/o Sage Senior Living,LLC are named Additional Insureds with respect to General Liability,Business Automobile Liability and Excess Umbrella(following form)Liability Coverages.General Liability Additional Insured Endorsement including ongoing and completed operations is attached.Business Automobile Blanket Additional Insured Endorsement is attached.General Liability and Business Automobile Liability Policies are on a Primary and Non-Contributory basis-endorsements attached. Waiver of Subrogation in favor of Additional Insureds applies to all policies-General Liability,Business Automobile and Excess Umbrella Liability(as SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Western Builders ACCORDANCE WITH THE POLICY PROVISIONS. 73 Pleasant St Granby,MA 01033 ---- AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �ammonwealth of Massachusetts Division of Professional Licensure Board of Buildina Regulations and Standards istruc^tion'Sboe-visor �S-114370 Expires:01/30/2023 MELISSA A FOWLER,A 317 KENNEDY ROAD LEEDS MA 01053 m Commissioner ----�.�-�-ter.-�,-�---------- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 197490 12/17/2021 1000 Washington Street Suite 710 MELISSA FOWLER Boston,MA 02118 MELISSA A.FOWLER 87 CHESTERFIELD ROAD Gur c<<G 'zt LEEDS,MA 01053 Not valid without signature Undersecretary