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Home My WebLink AboutBuilding Permit #103 - 20 ENFIELD STREET 8/4/2011 I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 1WORTANT:Ap licant must Complete all items on this page, LOCATION a S � Print r PROPERTY OWNER ' Print MAP NO: 0,.2,3OPARCEL�D�� ZONING DISTRICT:- Historic District yes no Cpjt Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential ❑ New Building One familyNon- Residential � 0 Addition 0 Two or more family 0 Industrial 0 Alteration No, of units: ❑Commercial Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other S eeptic; ®W - � .�...�P�..� �t tlands� �®. •is s `_- _ --_ - We We rice- DESC�-iTION OF WORK TO DE PERUrORM�D; 1 * P pit (Identification Please Type or Print Clearly) OWNER: Name: " Address- -�- CONTRACTOR Name: ft (� p Phone: Address: k j e Supervisor's Construction License: (p`_1 q Exp. Date: J0 Home Improvement License: J(}aq S7- Exp. Date: =j ARCHITECT/ENGINEER Phone: t Address: Reg. No. FEE SCHEDULE:BULDING PERMIT-$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S F. Total Project Cost: $_ �� . '`a FEE: $ 0. 00 Check No.: 1133 os I q L(G,! Receipt No.: NOTE: Persons contracting with unregistered contractors do not have the arantyfund �- _- w.. ,m , Location No. Date NORT" TOWN OF NORTH ANDOVER E PowR f • + � . Certificate of Occupancy $ C' tfs�� 4 Building/Frame/Frame Permit Fee $ s�CMust 9 Foundation Permit Fee $ F Other Permit Fee $ TOTAL $ Check # 24 � EJ Building Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL ❑ ❑ Public Sewer Tanning/MassageBody Art ❑ Swimming Pools I. 'I 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 1 CONSERVATION Reviewed on Signature 1 COMMENTS 1! 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/si nature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTWNT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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.$10041000 fine NOTES and DATA— For department use I " I i ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi 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 i o 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 g NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Per 1 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 Cor Trace ❑ F=loor/Crossection/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Pern 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Perm In all cases if a variance or special permit was required the Town CIerks 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: Doc.Building Permit Revised 2008mi CONTRACT# r M U11 ftll A MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT INSTALLED SALES SPECIALIST NUMBER CUSTOMER ' &nMnia(i STORE NO._ STREET ADDRESS STREET ADDRESS 0q L (C7L)l/,J .� a CITY STATE ZIP CITY n _ _ , �, Atda,�rr STT .: a ?y TELEPHONEcoz DAT LOWE'S HOME CENTERS,INC.'S MA HIC NO.: 148688 CASH BANK LCC REG FEIN:56-0748358 a CARD � CHARGE This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment,the entire agreement,including the specifically completed pages of this document,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract." PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTAL TION STREET DR CI Y STA E ZIP m o�g e 91 T A � � 1 (i u oto au 12 Aer ,ac wvAe � 1 1 1 Contract Total Are permits required for this installation?: WYes [ ] No *applicable tax included NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Work is to commence upon reasonable availability of Contractor and/or any special order or c stomer made Good(s)which is anticipated to be [fille in date].Estimated completion date is_ [fill in date]. Said estimated substantial completion date i's not of the essence. A statement of any contingencies hat would materially change said estimated substantial completion date is as follows: (if applicable,insert-a statment of such contingencies). IF THE ONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMP ETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [ ustomer to Pay in Full; . OR [ ]Customer to use the following payment schedule: (1)Deposit $ to be paid upon siging contract. Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or . [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142 LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT t_c1wF'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- SSZR130A LOWE'S COMPANIES, INC. PAGE: 1 SLH 2382 PROJECT ESTIMATE BOW WINDOWS (COPY) CONTACT: GIAMMARINO, NICHOLAS SALESMAN: KARRIE DONOHUE CUST #: 86507244 SALESMAN #: 1505102 PROJECT NUMBER: 59544 DATE ESTIMATED: 08/04/11 QTY ITEM # ITEM DESCRIPTION VEND PART # 1 266251 REPLACEMENT 700 BOW 149 UI REPLACEMENT 700 BOW 1 60301 BASIC LABOR BASIC LABOR 1 235636 REMOVAL & DISPOSAL REMOVAL & DISPOSAL 1 105451 CUSTOM SOFFIT WORK CUSTOM SOFFIT WORK 4 3263 PNE BASE 713 3 1/4 X 9/16 12' 71312PINE 2 98458 PVC BRK MLD WHITE 8FT 07526 1 12192 15/32"X4X8 3 PLY SHTG 32/16 8 6550 5/8" J-CHANNEL WHITE 306-WH 329063 4 6307 WHITE SOLID SOFIT TRI 4"X12' 424214 3 6308 WHITE VENTED SOFIT TRI 4"X12 ' 423590 DETAIL FEE CREDIT 35.00- TOTAL FOR ITEMS 2, 573.78 FREIGHT CHARGES 0.00 DELIVERY CHARGES 0.00 TAX AMOUNT 0.00 TOTAL ESTIMATE $2, 573.78 THIS ESTIMATE IS VALID UNTIL 08/11/11 MANAGER SIGNATURE DATE THIS ESTIMATE IS NOT VALID WITHOUT MANAGER"S SIGNATURE. THIS IS AN ESTIMATE ONLY. DELIVERY OF ALL MATERIALS CONTAINED IN THIS ESTIMATE ARE SUBJECT TO AVAILABILITY FROM THE MANUFACTURER OR SUPPLIER. QUANTITY, EXTENSION, OR ADDITION ERRORS SUBJECT TO CORRECTION. CREDIT TERMS SUBJECT TO APPROVAL BY LOWES CREDIT DEPARTMENT. LOWES IS A SUPPLIER OF MATERIALS ONLY. LOWES DOES NOT ENGAGE IN THE PRACTICE OF ENGINEERING, ARCHITECTURE, OR GENERAL CONTRACTING. LOWES DOES NOT ASSUME ANY RESPONSIBILITY FOR DESIGN, ENGINEERING, OR CONSTRUCTION; FOR THE SELECTION OR CHOICE OF MATERIALS FOR A GENERAL OR SPECIFIC USE; FOR QUANTITIES OR SIZING OF MATERIALS; FOR THE USE OR INSTALLATION OF MATERIALS; OR FOR COMPLIANCE WITH ANY BUILDING CODE OR STANDARD OF WORKMANSHIP. NORTH 0VVn Of 0 No. J;`MM _ dover, Mass.,g` • Y o +;� LAKE 1 CO CHIC MEWICK ORATED p,Q ,�S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... ..I..G....... ................ a•• •• ! ►•• •�• Foundation ..A............................. has permission to erect........................................ buildings on .. .�......... r4... . !!' r. ........��.............. Rough . tobe occupied as............. .... ..... I. .v. ........................................................................................... Chimney provided that the person acceptin this permit shall in every respect conform to the terms of the application on file in Finat this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 't Buildings in the Town of North Andover. PLUMBING INSPECTOR t j VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 M ELECTRICAL INSPECTOR UNLESS CONSTRtJC Rough ..................... ....................................................................... ....... Service BUILDING INSPEC Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE-DEPARTMENT. Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i =mill= rEIRTIFICATIE CERTIFICATE IS 188UED AS A MATTER OF INFOJ�MATION ONLY AND CONFERS NO RIGHTS UPON THE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED E POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN SSUING INSURER 8 AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. MPORTANT, If the Certificate holder lean ADDITIONAL INSURED,the policy(in)must be endorsed, If SUBROGATION s WAIVED,subleet to the terms and conditiona cf the policy,certain policies may require and endorsement A atatement this certificate does not confer rights to the certlf ate holder in Iieu of such endorsement PRODUCER Now England Heritage Ins Agency 335 Mein St Stoneham,MA 02180 COMPANIES AFFORDING INSURANCE INSURED COMPANYA GRANITE(STATE INSURANCE COMPANY Green*Instauntlon Cc Inc 185 BowStraat Everett,MA 02149.OMO TFA818 TO CERTIFY THAT THE PVUCIE8 OF INSURANCE?LJ81 ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITH$ANDING ANY RMUIREMINT,TERM OR CONWION OF ANY CONTRACT OR OTHER WCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN I8 SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND COPIDMONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVZ BEEN REDUCED BY PAID CLAIMS, go LTR YTreorsuirumce PaLMNIUMER PouLI0 OVEFFEaMIDA,e FafWaATi0 n" 01MMARS L"1LrrY E PROPRETow LEMITS PARTNCUTIVE OFFICER#Anti; WCL C EXCL Q 7424458 3M4/2011, 3/0412012tATRYLIMn 9THM w-Cowrap�AF01into MA Opwdc n/Orty. CIDENT S OOL1,POLICYLIMIT $ X500,00SAC O OPE H IJIL TrF.UB CERTIFICATE HOLDER CANCELLATION LOVVM HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DISM1969 POLICIES BE CANCELLED BEFORE THE AM,RICHARD EXPIRATION DATE THEREOF.NOTICEW&L 16 DELM90 IN ACCORDANCE 151 COMMERCE WAY WIMTETHE POLICY PROVIOIONG. WOBURN,MA01801 AUTHORISED REPRESENTATIVE 00 £/Z d S8112S Pal1124SUI- << �9� 51£5L81 S11e4SUL OZ�50 £0-80-6�OZ i From:6 05/09/2011 10:35 #913 P.001/001 AC R " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYrn ___ [ 05/09/2011 THIS CERTIf KATE 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 QOVERAQE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TKII ISSUING INSURER(S),AUTHORIZED ACPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTBJyT; It tho Cortl Kate holder Is on ADDITIONAL INSURED,the pelicypQalmuat be endorsed. 1151.18ROGATION IS WAIV£D,EUb)w 10 the terms Ond GondhlDna of the policy,renaln Pnlldeo may require an ondora+meet, b atelement on this WINIKate does not cIXlfof rights to the cerlHlcale holder in DaU Of Such endoragmant(e), PRODUCCA CUNIACT Now England Heritage Insurance Agency Group, Xnt. NAlaaf 335 Main Street Arc 741.438.5000 .781.438.$02$ Stoneham, MA 02]80 ADDPRO QI',El �+�--+�,..r ,�—�.. ..___. ___._ 4!45 R R8 AFPORMCCOVJ"Gg NAIC>M INCUkQA� bISt1Rl:RA: Safety Insuranr;eC Greene Installation Co. Inc, oIlyany 39454 165 Bow Street 1NSUMIRD: Safety Indemnity Ins. Co. 33618 INeUReRC: ,,• - ------ EVerQtt, MA 02149 INOURERO; . COVERAGESRK: CERTIFICATE NUMBER:Master 11-12 RgviSed REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAKO ABOVEE FOR THE POLICY PERIOD INDICATED. N07WITHSTANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THi3 05RTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMIT$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS, IN R LT YYPa QP IN'3URAN00 ADD INS poucy NUOIDER UMIY$ 51<NaRAI 6tAQILRY l3MA000857 06/0812011 0510812072 EACH OCCURRENCE S 1,000 000 X COMMERCIAL GENERAL LWpILr1Y --—- rV__1S 100,000 __ C4AIM&MAOE L;.,:.J OCCUR A MEp axP iAnN«,.a+.o�1 p 10 000 — PKRSON►A4 6 AOV INJURY i 1 000 000 -' -- GENdAk AGGAECATE S 2,000.000 4EN'L ACCREGATe LIMMAPPI,IrS Pap., POLICY PACT' LOC PRODUCTS-00 I PAGO S 21000.000 AUTOMODILC LIADILITY I 6208932 01!301 oii 0713012012 OOIWOI ENGENGLE L4M-it s ANY AUTO IFA Coddontt LOW. ALL OWNED AVTOg BODILY INJURY(Par pwSon) S B X SCNEOULED AUTOS i BODILY INJURY(pre sol) X HIRED AUTOS PROPERTYDAMkOg S {P.t,.wrumty X NON.OwNgD AUTO& "{ S UMBRaLLA LIAO S occuR 00000080 07190/2011 01130/2072 eACW Ot cuRRENCe s 1 000 00 A Bxcesa LIAR CLArM9-MAOg AOGRRGATC S _ OEOUCTOILP X RETENTION S 10,00 S 1 000 000 YIDRKCR S COMPCN�ATIQN S AND OQSPLOYa1tS,LAAMILITY SEPARATE CERTIFICA'r ANY PROPA.ETOR/PARTNHR1CXCCUTIVEt YIN TO BE ?l20VIDE ILL EiAGHACpOCNT s OFF10EcWMEMBERExCt,URt?fIv NIA 1fg 4$ IL( (r,NN) BY CARRIE (!.L 01WAX.CA EMPLOYEE 5 If u doRIXlbe finder 0 RCVIl F v RAT N Lolpv t?.L,DISFA6E•POuCY LIMB G DESCRIPTION OF OPERATIONS)LOCATIONS I VCHICUS(Mach AC0R0101,Addlt1on111 Rmirn>t SeMdur�,It mom space h requited) nStallation of doors and windows. Subject to the terns, c0nditions, endorsement$, and exclusions of the policies. CERTIFICATE HOLDER CANCELLATION FAX: 7$1.537.3464 ..— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEJ_L40 BEFORE THE EXPIRATION DATE THEREOF, NOTICE VK1. DE DELIVERED IN EAd+fIrS HOME IMPROVEMENT ACCORDANCE WITH THE POLICY PROVISIONS. ATTIC: R=HAIRIa AUTNORMO0kRPReaeNTATrVa 1S COMMERCE WAY URN. 11A 01801 William Kell JAL ACORD 2$(2008108 m 18$8,2009 ACORD CORPORATION. All Eights reserved. The ACORD name and logo are reglstillMd marks of ACORD £/£ d SGIeS PaI MSIL1I- << �9h51MU 02:90 £0-90-LLOE The Commonwealth of Massaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Oraanization/Individual): ( � 'n v,-P Address: 2y-ft' Q e+ ity/State/Zip: oo)y Phone #: l - Are you an employer?Check the appropriate box: Type of project(required): 1.XI am a employer with �j 4• ❑ i am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance.+ 9. ❑ Building addition com [No workers' comp. insurance P. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] c. 152, §](4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policv information. ' Homeowners who submit this affidavit indicating thev are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Uecg) n A 4er 1 in� ��S �Cl O VA C Q Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 0/1 �-A A S ice iP7 " City/State/Zip:v,, x t)A- G1�` Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure cover g s required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 an or ' -year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 00 a day ag 'n t the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigatio o e DIA fo insurance coverage verification. I do hereby ce der th p 'ns toad penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: — Official use only. Do not write in this area, to be completed by cit)'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#: �. I,.Itll�, iI, �1' p.11 Wit 111 '01 I'i{IiIt( �,tII I, �� •..•.,. X1719 —. ,. To l c . 1G RONALD A GREENE 10 RITA DRIVE MEDFORD, MA 0215JL 5 Expiration: 10127/2011 t ,.uunr.�i,�uar Tr---. 6717 / �.. /'•yI�I 0fricr a /r�(_`onrumrrr, Ai airx Sfu�inc4x ttCrutation HOME IMPROVEMENT CONTRACTOR Registration: 102957 TYpet Expiration! 713/2012 Private Corporatior GRSENE INSTALLATION CO„INC. Ronald Greene 155 Bow Streety, � Evorett,MA 02149 Undersecretay £/L d SGIeS P811124suI- << �9�SZMSL 02:50 £0-90-L40Z /