HomeMy WebLinkAboutBuilding Permit #342-19 - 211 COVENTRY LANE 10/10/2013 p
TOWN OF NORTH ANDOVER O� NORT11 q
APPLICATION FOR PLAN EXAMINATION +
r #
Permit NO: 1 Date Received *
SSACHUS�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
rint
PROPERTY OWNER 1—//Pr 4— �� /11e-
MAP NO.: ,,_PARCEL: 3 0 /?� Pri ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ j
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building One family
❑Addition ❑Two or more family ❑Industrial
❑A teration No. of units:
epair,replacement ❑Assessory Bldg ❑Commercial
❑Demolition
❑Moving relocation ❑Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
-16AZ4,t / t y.GG{�L — fti/ G 3/?r, ✓,Gayh iZ--f'Oe-5� , 4,nn)1417 41a
�IIdentification Please Type or Print Clearly)
OWNER: Name: //r?✓i +,4,,P a ti Phone:
Address: Z y -L�
CONTRACTOR Name:_ /A16-1Phone:
Address: ��>� j���m / D,(' a�-Y•( /y1f} O/�y j
y
Supervisor's Construction License: CzSD 8529%5-- Exp. Date: 10 /e//y
Home Improvement License: 4�1 Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg.No.
FEE SCHEDULE:B ULDING P=O 0 P 10 OF THE TOTAL ESTIMATED COST B D ON$125.00 PER S.F. .
Total Project Cost :$ x12.00=FEE:$ l &.,/� -/tt
Check No.: � J Receipt No.:
Page Iof4
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. TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION`.. . -
Print
PROPERTY OWNER
LL - Print 10 V;ar ola Structureu yes no
MAP NQ: ___ -PARCEL: _ ZONING DISTRICT _ _.. _. Historic District yes ;nog
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family El Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
E Septic ❑V11ell ❑ Flootlplain, E Wetlands ❑ Watershed'District
❑,Waterl;Sw,
eer
DESCRIPTION OF WORK TO BE PERFORMED:
it
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR 'Name:, Phone:
Address:
Sup`ervisor's Construction'L-icense:
Home'lmprovement+Lkense: Exp.. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
w
Check No.: Receipt No.:
NOTE: Persons contractingwith unregistered contractors do not have access to the guaranty fund
Signature of Agent/b' r': o
ne „ ;°-_ ,_ Sian'46re,of contractor .i _
[11 Pinne InInivar'I F1 Certified Plot Plan ❑ `Stamped Plans ❑
Location C� qO V4
No. IJ Date �0 0
. - TOWN OF NORTH ANDOVER
ED
• Certificate of Occupancy $
.--
Building/Frame Permit Fee $ %
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#CIO 6)
r r �� I:i
v U` u Building Inspector
Id( .
Plans`Subrnittedll PlansWaived-0 Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF,SEWERAOE:DISPOSAL
Public Sewer ❑ Tanning/Massage/Body-Art ❑. . .Swimming Pools ❑
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, DATEA_PPR.OVED
PLANNING & DEVELOPMENT- 0. ❑
COMMENTS
.CONSERVATION Reviewed on Si nature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes_..
�I
Planning Board Decision: Comments
Conservation Decision:
Comments
!Water& Seder Connection/Signature& Date Driveway Permit
DPW Tovv� Engineer: Signature:
tl �
Located 384 Osgood Street
FIRE D0ARTM-L-'NT 'IT Tem' p' Dum ster on site es
_ p p yes no
Located at 124 Main Street
-Fire'Departmerit sipnatu're/date
C0MM.ENTS .
TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑
F1 Tobacco
Art ❑
Public Sewer
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑ 11Permanent Dumpster on Site
Private(septic tank,etc. F] Electric Meter location to
project
NOTE: Persons contracting w'h Uxrx—aisZMgd contractors do not have access to the guaranty fund
Signature of Agent/Owner gnature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ to Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
Zoning Board of Appeals:Variance,Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
i
Conservation Decision: Comments
Water&Sewer connection/Snature&Date Driveway Permit
Temp Dumpster on site yes—no— Fire Department signature/date
k •
i
Dimension
Number
Number of Stories: Totals square feet of floor area based on Exterior q rior 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 - Date
i
Doe.Building Permit Revised 2010
`I
I
Building Department �.
The fol;,3wing is-a-list of the required.forms to be filled out for the ap prop riate.permit to be obtained. i
I
Roofing, Siding, Interior Rehabilitation Permits �
o Building Permit Application
o Workers Comp Affidavit
Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses j
o Copy of Contract
u Floor Plan Or Proposed Interior Work
u Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
I
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
u Copy Of Contract
u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
L3 Copy of Contract
o Mass check Energy Compliance Report
o' Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all casts if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
i
Doc: Doc.Bui?ding Permit Revised 2012
Enter construction cost for fee cal- North Andover Fee Cakulation
Construction Cost
$ 543045.00 m
$ - $ 648.54
Plumbing Fee $ 81.07
Gas Fee 10'0 comm. $ 100.00
Electrical Fee $ 81.07
Total fees collected $ 910.68
211 Coventry Lane
342-14 On 10/10/2013
Kitchen Remodel
tAORTH
Town of E � Andover
- 0
1 � Z
o h , ver, Mass,
A- COC NIC Nl WICK y1.
7a A�RIITED r'4�,�'�y
lS U
BOARD OF HEALTH
Food/Kitchen
PERMIT LD 7( .
Septic System
THIS CERTIFIES THAT . . . ... ...... ................... BUILDING INSPECTOR
..................... ... .. ........ ......... .... .. .............
has permission to erect buildings on ...Q�. .� .0 All . ..,,.., Foundation
Rough
tobe occupied as ...... ...4! r........ ......a.. .... ...... .,............................................................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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 ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO TA err Rough
Service
a
.................. .................................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display_ in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing ox Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
SEE REVERSE SIDE
NORTH
Town of t EAndover
No. _ * -
,� o h ver, Mass,-
CoCNICMl WICIt %-1. -
�d A4R�TED r'P�,`'�y
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ..................... ... ..Cir...l �.. ................. BUILDING INSPECTOR
........ ......... ...... ............. ...............
has permission to erectFoundation
p .......................... buildings on ...�. .�.....���!�!'.. ..... ......C41.1.14NEW..........
Rough
to be occupied as ...... ...4!�! ...........A. .. ... .............................................................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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 ELECTRICAL INSPECTOR
(,jrr'W UNLESS CONSTRUCTIO TA a Rough
Service
.................. .................................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
4
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
SEE REVERSE SIDE
NORTH
own of
? E ndover
0 0
- - I
No.
oh , ver, Mass,
COC HIC HI WICK
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ......................Kcoww.n ....., ........F............ ................................
Foundation BUILDING INSPECTOR
has permission to erect .......................... buildings on ...Q9. .�.....�O.V40�.. ..... ...... �..........
Rough
to be occupied asIt
4. . ...!R. .. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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 ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO TA ;'L� mamma% Rough
Service
t
.................. .................................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
SEE REVERSE SIDE
't•; ..:lli �"ii1 f. '.j• v' _1 ;l" �t(lt'+�
mt,l,t;ni�; tlrti k-O, per kitchen plan
J.L. WHITE WOODWORKING INC.
108 Killam Hill Rd.,Boxford,iMA 01921
978-887-9997 Fax 978-887-6704
October 5, 2013
;: to tioxv location for ooktop
Amy&Tim McManus lct� h:atcr
211 Coventry Lane + n�%% sink_ faucet, dishwasher, and garhsgc ,_'i +
North Andover, MA 01845
Kitchen Remodel
Remove existing kitehen cabinets amd disp6se. ' ' -,ut.
Install 1 x 6 tongue and groove pine ceiling in kitchen
Install new window casing M
Install ductwork, exterior wall cap for,new exhaust1o6d '►+
Install new kitchen cabinets per kitchen' Ian
Install end panels, fillers, fascia, moldings,toe kick per kitchen plan
Install customer supplied hardware'
Install appliances t . 1, 14111 YEN itch+nil.
Building Permit T ; Al
' �• j;'J. tl h<jr''• �1 It-3i I�f ilhr+-... t...+y�n`t. Ott 11 .
Plumbing
Rough gas line to new location for cooktop
Install additional kickspace heater
Labor and material to connect new sink, faucet, dishwasher, and garbage disposal
Connect,cooktop
Plumbing permit
Electrical
Conform existing wiring to new kitchen cabinet layout.
Wire outlets to code.
Provide GFI protection as necessary.
Provide power for electric oven, gas cooktop, fridge, dishwasher, hood fan, and disposal.
Install cords on dishwasher and disposal.
Install (2) duplex receptacles on island.
Install (9) 5" recessed lights with white baffles and BR30 LED bulbs in homeowner approve
pattern on existing main kitchen light switching. /
Install (1) 5" recessed light with white baffle and BR30 LED bulb above sink on newfswitch:
Install Diode LED Blaze lighting under all upper cabinets by range and sink on switch.
Provide power for forced hot water toe kick heater.
Pull permit and obtain necessary inspections.
$19,161.80
O
' � YS
1� Massachusetts -Department of Public Safety
-' Board of Building Regulations and Standards
Construction Supenisor
C:
License: CS-082995
HT f 1 I! JEFFREY L WHIG '
10,+ v, l i I Lt.14 0 108 i ULLAM HILL RD, s
1814POird 11.'. 0921 Boxford MA 01911 '.
��.G,,, Expiration
f
Z 0/18=2014 Com10/18/2014 missioner
O i I l, Consumer A t i"i r-: Office of Consumer Affairs and Business Regulation
10 Park 11I. 1 0 10 Park Plaza - Suite 5170
Bosun, Boston, Massach efts 02116
Impro\ ,-•. racto1 Home Improvement C�for Registration
Registration: 118096
J Type: DBA
Z Expiration: 1/30/2015 Tr# 235460
J.L. WHITE WOODWORKING INC. u
JEFFREY WHITE
108 KILLAM RD a w
BOXFORD, MA 01921
Update Address and return card.Mark reason for change.
SCA 1 w 20M-05/11 Address Renewal Employment Lost Card
r WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
Associated Industries of Massachusetts Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803
(800)876-2765 . NCCI NO 26158
I
POLICY N0. AWC 7024045012012
PRIOR NO. I AWC 7024045012011
ITEM
1. The insured J L White Woodworking Inc
Mail Address: 108 Killam Hill Road Boxford MA 01921
I
Street No. Town or City County State Zip Code
FEIN x)o=9707
❑Individual [j Partnership ®Corporation ❑Joint Venture []Association. []Other
Other workplaces not shown above:
2. The policy period is from 12/12/2012 to 12/12/2013 12:01 a.m.standard time at the insured's mailing address.
3." A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here;
MA
B. Employers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A.
The limits of our liability under Part Two are: ' Bodily Injury by Accident$ 100.000 each accident
Bodily Injury by Disease $ 500.000 policy limit
Bodily Injury by Disease $ 100.000 each employee
C. Other States Insurance:Coverage Replaced By Endorsement WC 20 03 06A
D. This policy includes these endorsements and schedules:SEE SCHEDULE
I
4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
INTRA 039177
SEE E(TENSION OF INFORMATIC N PAGE
Minimum premium$ 48.3.00 Total Estimated Annual Premium $ 1,416.00
As indicated interim adjustments of premium shall be made: Deposit Premium $ 1,461.00
® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly
MA Assessment Chg. -
$1,072.00 x 4.2000% $45.00
This policy,including all endorsements,is hereby countersigned by 11/21/2012
Authorized Signature Date
GOV GOV KIND PLACING CLAIM NAME SAFETY Circle Business Ins Agency Inc
STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP 247 Newbury Street
MA 5437 2 705 Danvers,MA 01923
WC 00 00 01 A(7-11)
Includes copyrighted material of the.National Council on Compensation Insurance,
used with its permission.
I
I
1
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
6� Please Print
Name:
Location:
City Phone
F7am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
r1am an employer providing workers'compensation for my employees working on this job.
Company name: J . L A.,//^i
�� f /
Address /ell �J ' � /lam ry
City. Phone#:
Insurance Co. 141,1y?"fril� ��'� ` ��� Policv#
Company name:
Address
City: Phone#:
Insurance Co. Policy#
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00
and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date
Print name Z— A/4 /fes Phone# 92:5- 31
Official use only do not write in this area to be completed by city or town official' ❑ Building Dept
❑Check if immediate response is required Building Dept ❑ Licensing Board
❑ Selectman's Office
Contact person: Phone#: ❑ Health Department
❑ Other
FORM WORKMAN'S COMPENSATION
{
Massachusetts Home ImIlrovement Contract
This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard
v co
language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a PY of"A
Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information -=__ — s _ - =Contractor Information
-
NameCompany!4e
47 �of
Street Address(do not use a Post Office Box address) - - Contractor/Salesperson/Owner Name
9-1��el 0
City/Town State Zip Code Business Address(must' clude a street address)
1,44 '01M-71.1 -
Daytime Phone Evening Phone City/rown State Zip Code
Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number 9S/-307
Home Improvement Contractor Reg.Number Expiration date
I""quit"that molt home
as valid regWntton number
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.)
Required Permits-The following building permitsr are r6quh'ed' PropoWd'Start'and Completion Schedule-The following schedule will
and will be secured by the contractor as the homeowner's agent: be.adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be w
I excluded from the Guaranty Fund provisions of' &M-'11S )late when contractor will begin contracted work.
MGL chapter 142A.)
Ak Date when contracted work will be substantially completed.
Total Contract Price and.Payment Schedule q
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum Of:
Payments will be made according to the following schedule: r
s&3670" upon signing contract(not to exceed 1/3 of the total contract price 2Lthe cost of
special order items,whichever is greater)
or unon.comulekiolt �'0 I1f_�T /��v�!/t✓�7y Cl��'��
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/%me/]f8 Brookhaven 1 frameless cabinets
YOU/COm
p ry in all plywood construction
" p Use period has ended. with maple dovetailed full ext.&soft-close drawers
Complete Thank you
for us%ng Door style:Colony Solid wood full-overlay
Finish:On cabinets against walls Nordic White paint.
PDF Complete. On cabinets in island Cherry wood in Natural finish.
Finished sides=FB.
Ceiling height:approximately 94 3/4"when finshed.
Top height of tall cabinets:90"
Hanging height of wall cabinets:54"A.F.F.
Top molding:MTT 806 and then MCR8114 applied
on top to meet ceiling.
Included in price:Scribe molding,fillers,MSU 805
(3-8'lengths in Nordic White and 3 in cherry natural).
one QHCK touch-up kit.
Hardware: 17 of F13 bin pulls on slab drawers&top of
B12134 door rail for trash&bottom drawer of 1341318,
A27 knobs on all doors and drawers elsewhere,and
A98 knobs on small wooden drawers(10).
BOF,WOF and TOF are overlay fillers to be applied on site.
Counters:Granite probably,to be selected later.
27 "
168
24" aaI Av, 13
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8
a�Y 16w
C> WOF0336
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ala 2 ODIs 21"deep 2
for below gas cooktop
two ODIs and OCD Two knobs on BIRD
and recessed toe right BAU0634ED OESPR 81133034 OESPR W3036 W362213
FB left B Eight
4" 30"--436"
4" 30"--4-36" 18"--�-24"
172"
BAU06 to have 5 ODS.
All dimensions-size designations 2020
J7 This is an original design and must Designed:8/28/2013
given are subject to verification on TECHNOLOGIESD not be released or copied unless Printed:9/9/2013
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
I
mcmanusbrookbaven2 All Drawing M 1No Scale.
I �