Loading...
HomeMy WebLinkAboutBuilding Permit #203-15 - 30 MILTON STREET 8/25/2014 BUILDING PERMIT o* %AORTHtUeID 06 "-%. 6 TOWN OF NORTH ANDOVER 0 0 APPLICATION FOR PLAN EXAMINATION *L 0 Permit No#: Date Received ED S US Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION An 4--vo not PROPERTY OWNER MAP PARCEL: -print _V 100 Year yes no ZONING DISTRICT: Historic District yes no 0 Machine Shop Village yes F(.no ) TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential 0 New Building PtDne family D Addition 0 Two or more family 11 Industrial 11 eration No. of units: El Commercial �f Repair, replacement El Assessory Bldg El Others: El Demolition 0 Other - El Septic 0 Well 1i Flobdpla-ih, 0 Wdtlands D ,Wqterahecl-District 0 Water/Sewer r DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: W'1U'CzYn L. TrOM8194 Phone: 97,f-o/87-A.)_V7 Address: 30 Mt' J +Q,,\ S4. At, "VtC ^A ol^',T Contractbr,N,ame:_�--*-W,,,'.q),\+---- Phone! Address:-3.5'0- etrr S-(., A- 4ndo m;q advS_ Supervisor's Construction License: C S 663_ 1 J Date: Home Improvement License: _Ex Pqfp- __Jp_ YL 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature ofAg.ent/OWnerSignature of contractor 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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 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 NOTE: 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 ❑ 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. 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 Doc:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ j Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 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/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp,Dumpster on site yes .- no _ --- Located at 124 Main Street Fire Department signature/date _ _ r _ - 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.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 Location No. Date r . - TOWN OF NORTH ANDOVER . Wx� ' Certificate of Occupancy $ Building/Frame Permit Fee $"C,/z ft Foundation Permit Fee $ Other Permit Fee $ •�Jo�aa�r����`�� TOTAL $ 27948 Building Inspector NORTH Town of s ndover No. h ver, Mass, 1 'QA COCHICMEWICK\,�' TED Pp�,�'�5 S U BOARD OF HEALTH Food/Kitchen PER IT TII Septic System THIS CERTIFIES THAT ..l.� .....T"� (0.4.. BUILDING INSPECTOR ........... .... ..! ...: ............... Foundation 4 has permission to erect .......................... buildings on ...... ......... . .. .I1. .. .p........... Rough to be occupied as ............ .. . ... .�.'......"every .. ...................................................... Chimney provided that the person accepting t permit shale nform 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 CONSTRUCTION S Rough Service ....................... .. .............................................. 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. NORTH own of t ndover 0 . . � No. h ver, Mass, 1 �Q cocmc.,WIcx "1' ADRATED ►•Pp,�'�y S BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ........ .. .�.�: .....Tr7PY"101.V. .. BUILDING INSPECTOR ..... . .......................................... Foundation has-permission to erect .......................... buildings on ...... ...... j.. ..... .... ..�........... � Rough tobe occupied as ............ .. . ... .. ....*..... ..................... ...................................................... Chimney provided that the person accepting t permit shall in every respe nform 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 CONSTRUCTIONS Rough Service ....................... .. .............................................. 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 IFIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Additional Wormation If you have general,questions or need additional i cfatmation about the Hone Improvement Contractor Law or other consumer rights,or ifyou wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: - Consumer information Hotline Office of Consmaer Affairs and Business Regulation 10 ParltPlaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visitthe OCABRwebsite at 1=://www.mass.gov/oeabr/ If you want to verify the registration of a contractor or if you have questions or:need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Of ace of Consumer Affairs and•Business Regulation 10 ParkPlaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the MC website atlitlp:/Iwww.tnass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: . ltttla://db.state.ma.lis/i.oineimyrovememit/licenseelis" For assistance with informal mediation of disputes or to regisi;er formal complaints against a business, call: Consumer Complaint Section Officp of the Attorney General 617-727-8400 .AND/OR . Better Business Bureau 508-652-4800,.508-755-2548 or 413-734-31.14 version 2.1•-11/22/2010 Contractor A rbitr�.tion The Home Impiovement Contractor Law provides homeowners with the right to initiate an arbitration action(as an 'alternative to court-ction)if they have a dispute with a contractor. The same right is nut automatically affordedto a contractor,however. The contractor would have to resolve any dispute lie/she has with a homeowner.in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby inutiaally agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office.of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as-provided To Massaehwetts General Laws, chapte 142A.. Homeowner's Signatme ��`" -ontractor`s ignattixte NOTICE,-The signatures of the parties above apply only-to the agreement of the patties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alterative dispute resolution even where this . section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 14.2A)and other consumer protection laws (i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners may be exohi.ded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor•Law. The contractor is responsible for completing the work as described,in a timely and worlmanlike manner..Homeowners maybe entitled to other specific legal rights if the contractor guarantees or provides an express warranty;for workmanship or materials. In addition to guaxantees or warranties provided by the contractor, all goods sold•in.Massachusetts easy an implied warranty of merchantability anal fitness for a particular purpose. An emuneration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. Hyou have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). (Execution of Contract The contract must be executed in clunlicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document tivaffi all blank sections have been filled in or marked as void,deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the.original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fally executed copy of the contract, anal the three day rescission period has expired.. Accelerated Payments A contractor may not demand payments in advance oaf the dates specified on the•payment schedule in cases where the homeowner deems him/herselfto be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a j oint escrow account as a preregLdsite to continuing the contracted work. Withdrawal of Rands from said-account would require the __ Q;O- ';I'ITNP.Q r)drl-Infill•nn•rHF-Q — Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen•isor , License: GS-102663 SCOTT W WRIGII 350 BE ST ©; NORTH ANDOVER MA,.01849 �,,f:,,, JJ/5�c• " 't' Expiration Commissioner 08112/2015 . �ie�pnostiriaonurea���a�Vl�Gad6acfucaef.�d. Office of Consumer Affairs&Busi Iss Regulation ME IMPROVEMENT CONTRACTOR egistration: 138569 �TYpe. xpiration: _4/14/2015_ DBA E I WRIGHT GUTTERS`1r - '4 SCOTT WRIGHT 'x 350 BERRY ST. #` = NO.ANDOVER,MA 01845 Undersecretary �-, WRIGSC2 OP ID: KN DATE(MM/DD/YYYY) ACORO" CERTIFICATE OF LIABILITY INSURANCE 1 08/25/2014 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: T.A.Sullivan Agency,Inc. PHONE FAX o 135 Merrimack St A/c No Ext 978-683-4700 Methuen,MA 0184401843 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Agency Intermediaries INSURED Scott Wright INSURER B: Wright Gutters and Home INSURER C: Improvement 350 Berry St INSURER D: N.Andover, MA 01845 INSURER E: 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 POLICY NUMBER MM LICY EFF POLICY EXP LTR /DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADEOCCUR L117001598 12/01/2013 12101/2014 DAMAGE TO RENTEIT_PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 50,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY J PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 � OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Commercial Applica L117001598 12/01/2013 12/01/2014 A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Installation of gutters , siding and some roofing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BLDINSPECTOR 1600 OSGOOD ST BLD 20 ST 2035 AUTHORIZED REPRESENTATIVE NORTH, MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD JIM Co mn wonveafth o,fAfassac a. sett , - - .be,��Yt.�nent o,ft'.�cFr�st�rrclAcczcFents • . fayO.fiUTle o,fXnvesiPao= . 600 Washington,S'txeet �1. Roston,MA 111 wi mass govIdia workexc,g'compensation)rusux�ance.Affidadt:BuifderigICo)atrac oro/EIect-delansl�'XYim�.bex A Ream Worcnaation Please.Vx W LmMky 'Nama(Brtsiness(Organization/Pndz`vzcivat}: w t �� ly 11 2 5 Ad&ess: 3 SO Sf- - Cztyt tafet p: v�M A- © l8Y Phone: �. ❑I am a general contractor and .ir�ta e)onployer?Cf.eckthe appropriate-box: Type of project(required): F 1. ernplop with. .�� 6. �Now cbnsfruction employe � orpart rime)T havelikedthe aub-contract rs 7• �Remodeling 2.[l I am.a sole proprietor or Partner- -M artner listed on the attached sheet: ship and`havena•employees These mb-contractorshave S. El Demolition working for me in.auy capacity. workers'comp.insurance. 9. Building addition [Nb work-.03v comp.�nsuxance S. ❑We are a corporation and its 10.E(Electrical repairs or additions xegtured.] officers have exercised ' right of exemption or MOL 11..[(Plumbing,repairs or additions 3.Q X am.a horn eowaor doing all work g p p myself PTO workers'comp. c.152,§1(4),andwehaveno 12.Q aofxepairs filsuxancerevired.1 i employees.[Nb workers' comp.xnsurancermquired.] Any applicantthat oheeks box#1 must also tilt outtheseutlon belowshow71g1he1r workers'compensattonpaoy information. "i gemeownerswha submifthisafddavitindxcatingfhey2redpingallworkandthenhireoutside contractors must'submitanowaffidavitiudicafingsi A howngthe nmeofthe sub_eouracfcrs and rorkes comp.policy xContracforsthat cheekthisbox Must attached nadditienalsheets -'am an e�nprayeN t/tat is providing l�or'A'eTS'co�nperas�atior�ir�sr�rarace fo�•r�y er�royees MOW a��lzie�olicy aYzr�jo�r site i�z,foxrnatio�2. •y-- . 112SUTanCe CompanY Mame:. 541 I U cL h SLCr a n C e- Rolicy#or�e1c Ins.tic.#: VU�C..�-3 I S'3�'���7'O 13 E�iratzon Date• 3� �/• . lob Site A.ddxeso: 3© m d h h S'E. City/State/zip: 14 Pi ch qr,44d 0/0'9,S-; .A.ttach a copy of teworkers'corapensatiozxTolicy declaration page(showing-tile policy number and expiration slate). Failure,to secure coverage as requiredunder Section 25A,ofMGL o.152 can.lead to the imposid0n,of criminal is enalties of a j fine up to$1,500.00 andlox one-year hnprisq ent,as well as civil penalties in the form of a STOP WORK ORDER and a tine ! ofup to$250.00 a day against the violator: Be advised that a copy of this statementmay be foxwardedto the OfCxce flf' h,.vestigations of:the DIA.for ibsurance coverage ver%ftcation. d do liereby ler uride tiiepainv artdpenaway of e u-Mat the ire oxrnaiiox2,pxoVid�b a 5 e9cla love is true and co xeez; - Si afore• 7 Date: / Phone# 799-697-)LAV offieial nese ogy. .Do not write Al AM area,to be convIeted by city or town official: City or Town: PermiMcense# I'ssuintg.Antbtority(circle one): Z.Board of Health 2.Building)Departm.ent 3.C 13ffoym Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other - - Information and Instructions Massachusetts General Laws chapter X52 xeq*es all employers to provide workers'compensation for their employees. Parsuantto this statate,an eraployeeis defined as",..everyperson iri.the service of another under any contract ofbite; • express orimplied,oral orwxitten:' An evTfoyq is defined as"ali individual,partnership,association,corporation or otherlegal entity,or any two oxmoxe. oftheForegoingengaged inajointenterprise,and lucludingthe,legal representativesofadeceasedemplp ex,.orthe receiver o tnistee of an individual,partnership,association or other legal entity,employing employees. ZMWevex tb.'e owner of a dWelling house having notm0re thast three apartments anal who resides therein,ox the occupant ofthe dwelling liouse of another who employs persons to do maintenance,construction or repair work ou such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152,§25C(6)also states that"every state or to cal Iic�nsing agency sham(withhold the issuances or renewal of a Incense or permit to operate a business or to construct buildings iu the commonwealth fon'any applicant who has:tot produeed.acceptable evidence of compliance with the insurance coverage required" Additionally;-MuL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance xequirements oz this chapterhave beenpxesented to the contracting authority." Applicants Please fa out the workers'comp ensailon affidavit completely,by chocking the boxes that apply to your situation and,if iiecessaxy,supply sub-conixaetor(s)name(s),addresses)andphonenumber(s)alongwith.their certificates)of insiwanae. LimitedUabilityCompanies(LLC)orLimitedLiabilityPartnerships(LM)withno employees otherthattthe members orpartaers,atenotrequfradto carryworkers'compensatiouiusurance, Xf anLLG orLLF dpesbave employees,apolicyis xequired. Be advisedthatthis affxdavitrnaybe,submittedto theDepar6nentof Industrial Accidents for confirmation of insurance coverage. Also be sure to sip and date the afdavi: lRe afridavit should be xetumc(f to the city or towu that the application for thepermit or license is being requested,not the Depattment of 7ndusttial Accidents. Shouldyou have any questions regarding the law or if you are rewired to Atain,a* rkers' com.Vensatlonpolfqy,please calt the Department at the number listedbolow. Selfin=edcom pages shouldenter their self insurance license number on the appropriate line. City or Tom Officials Pleasebasuxetbattheafzdavitiscompleteandpxintedlegibly. TkoDepartmenthasprovidedaspaceatthebottom of the affidavit fox you to fin out in the event the Office of 1•nvestigations has to contact you xegarding the applicant. Please be-sure to iM in.the parn3jyl1cense number whichwUl be used as a reference number, In addition,an applicant thatm-ust submitmultiple permit/license applications in any givenyear,need only submit one affidavit indicating current policy information(ifnecessary)and under".Tab Site Address"the applicant shouldwrite"all locations in (city towzt)"A copy ofthe affidavit that has been officially stamor ped or by the city ortownmay beprovided to the applicant aspxoofthatavalidaffidavit•is'onfllei'orf'uturepennitsorlicensa . Anewa%fidavitmustbefilledout each year.Where a home owner or citizen is obtaining a license ox p ermit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc.)said p exson is NOT xequixed to complete this affidavit. The Office of Xuvesggations would like to thank you int advance For your cooperation and should you have any questions, please do ztot hesitate to give us a call. The Deput encs address,telephone an-d fax number: Thc.tcmollm-althiofy-owsaeAv._ '- (Mce QUA--VONROVO)n 60GWas IVcaStwqt Devised 5 26-05 FaX#617-727-7749 e