HomeMy WebLinkAboutBuilding Permit #499-2017 - 36 LANCASTER ROAD 11/10/2016tJ.�WpJ BUILDING PERMIT
4TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: 4&9 ` 2--o 1 7
Date Issued: ll - 10 - on -C! 6
IMPORTANT:
Date Received //-/0 - t;LP / 6
must complete all items on this
LOCATION c3 L /-/+4 Gl-n t �/2 ZJt
n,
PROPERTY OWNER M
Print 100 Year Structure
MAP PARCEL:!07 � ZONING DISTRICT: Historic District
Machine Shop Vi
O�-1t`ED ib .ryO\
*6
0 z A
PROPOSED USE
e1
yes no
yes no
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other_
El Septic El Well
❑ Floodplain iiWetlands
T❑Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERI- K ti.:
Identification - Please Type or Print Clearly
OWNER: Name:✓ /1 I 0 ter' 0"A 0'I'T Phone:
Address: .�✓� CGI ��
Contractor Name: T&,`'^ �A-� 'C— Phone
Email: TcAv\ L �,4 -S7 1 6- � /.)L -X as . � ��✓1
Address: JII Z� 7--tOtfc /2/s
Supervisor's Construction License: Exp. Date:
Home Improvement License -
or
f
ARCHITECT/ENGINEER Phone:
Address:
Reg. No
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.0 ER S.F.
Total Project Cost: $ °I- S��"'' " 0 FEE: $ dpi 3
Check No.: GO 3 d Receipt No.: 3 �I
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contracto
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 ❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature.
CONSERVATION Reviewed on Signature
COMMENTS
f
HEALTH Reviewed on Si nature
COMMENTS
Z6ning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
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
COMMENTS.
z
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
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NO
t e%T— w
Doc.Building Pennit Revised 2014
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
Location 5 � WNC S ClZ
Check # (-
Date //—
,j' 0/6
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 31
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Cj� Building Inspector
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Proposal To: Mark & Terry Reiumont
Street: 36 Lancaster Rd.
N. Andover , MA
Roof proposal
Certainteed Landmark
1. Extra caution will be taken to protect house
exterior deck, pool area and landscaping as best as
possible. (tarps etc.) Magnets run at final clean up,
2. Remove all metal panels and asphalt shingles
from entire house.
3. Inspect and re -nail any loose or lifted plywood or
roof boards. Any compromised plywood will be
replaced at an additional cost of $60.00 per sheet
of 1/2" cdx fir.
4. Install heavy gauge 8" white aluminum drip edge
to all eaves and rakes.
5. Install 6' of WR Grace ice and water shield along
all eaves and top to bottom in all valleys.
6. Install Certainteed Diamond Deck synthetic
underlayment to remaining sheathing up to ridge.
7. Install all new pipe boots.
8. Install Certainteed Swift Start starter shingles to
all eaves.
9. Install Certainteed Landmark Limited Lifetime
architectural shingles to entire roof and shed.
10 year material MFG. warranty. (See extended
warranty) All shingles will be installed and
fastened to mfg. specs.
10. Counter flash chimney lead and all wall
connections with ice and water shield, tie into new
shingles and seal. Inspect original lead flashing
after it is exposed. Re -use if not compromised.
Quote additional cost at that time if original
lead is compromised.
1. Install new GAF Cobra ridge vent capped with
color matched Certainteed Sha w ridge
shingles.
A
Date 9/1/2016
m.reiumont@comcast.net
12. Removal of all work related debris. Planks will be
placed under dumpster to prevent any damage to
driveway.
13. Building permit included.
14.Contractor workmanship warranty: 10 der
normal wind and rain conditions.
Total roof cost: 19,000.00
Gutter removal: $500.00
Skylight option: Install (1) new Velux manual
venting skylight and flashing kit. With solar powered
light block in stock colored blinds.
$1,600.00 additional cost. Or, install (1) new Velux
S06 solar powered venting skylight and flashing kit
with solar powered light block in stock colored blinds.
$2,650.00 additional cost. Note: There will be up to
a $800.00 tax rebate available to you when you file
taxes if you choose the solar powered venting
skylight. Note: Some minor cosmetic interior finish
work may be needed after skylight installation. Can be
quoted by Jim Testa if needed.
Certainteed 4Star extended direct MFG warran
tv%
A fully transferable 100coverage against
material defects for a fully non pro rated period of
50 years. Please refer to pamphlet left in estimate
folder. Offered to our referred homeowners and
included in this proposal at no additional cost.
Balance due upon completion
References available upon request
Hiehly rated member of the accredited BBB and
4n—Lie's List
Thantglk u! Jn ' �
ALL UNORMW
Q;q
ONE ROOF
Chimneys
Residential & Commercial Roofing
Siding
CHIMNEYS POINTED -REBUILT -CAPPED
All Types Of
Mass Toll Free
1 -800 -WAIT -4 -US
I * Roof Leaks Experts
Loca//y Owned &Operated Since./ 9�
Expert Masonry Work
Licensed & Insured
(924-8487)
m ti ;••••.•=
IKO G3aBB �
Vzoew o� olsis �
#e
WLicense
Work Year ar Round
Proposal To: Mark & Terry Reiumont
Street: 36 Lancaster Rd.
N. Andover , MA
Roof proposal
Certainteed Landmark
1. Extra caution will be taken to protect house
exterior deck, pool area and landscaping as best as
possible. (tarps etc.) Magnets run at final clean up,
2. Remove all metal panels and asphalt shingles
from entire house.
3. Inspect and re -nail any loose or lifted plywood or
roof boards. Any compromised plywood will be
replaced at an additional cost of $60.00 per sheet
of 1/2" cdx fir.
4. Install heavy gauge 8" white aluminum drip edge
to all eaves and rakes.
5. Install 6' of WR Grace ice and water shield along
all eaves and top to bottom in all valleys.
6. Install Certainteed Diamond Deck synthetic
underlayment to remaining sheathing up to ridge.
7. Install all new pipe boots.
8. Install Certainteed Swift Start starter shingles to
all eaves.
9. Install Certainteed Landmark Limited Lifetime
architectural shingles to entire roof and shed.
10 year material MFG. warranty. (See extended
warranty) All shingles will be installed and
fastened to mfg. specs.
10. Counter flash chimney lead and all wall
connections with ice and water shield, tie into new
shingles and seal. Inspect original lead flashing
after it is exposed. Re -use if not compromised.
Quote additional cost at that time if original
lead is compromised.
1. Install new GAF Cobra ridge vent capped with
color matched Certainteed Sha w ridge
shingles.
A
Date 9/1/2016
m.reiumont@comcast.net
12. Removal of all work related debris. Planks will be
placed under dumpster to prevent any damage to
driveway.
13. Building permit included.
14.Contractor workmanship warranty: 10 der
normal wind and rain conditions.
Total roof cost: 19,000.00
Gutter removal: $500.00
Skylight option: Install (1) new Velux manual
venting skylight and flashing kit. With solar powered
light block in stock colored blinds.
$1,600.00 additional cost. Or, install (1) new Velux
S06 solar powered venting skylight and flashing kit
with solar powered light block in stock colored blinds.
$2,650.00 additional cost. Note: There will be up to
a $800.00 tax rebate available to you when you file
taxes if you choose the solar powered venting
skylight. Note: Some minor cosmetic interior finish
work may be needed after skylight installation. Can be
quoted by Jim Testa if needed.
Certainteed 4Star extended direct MFG warran
tv%
A fully transferable 100coverage against
material defects for a fully non pro rated period of
50 years. Please refer to pamphlet left in estimate
folder. Offered to our referred homeowners and
included in this proposal at no additional cost.
Balance due upon completion
References available upon request
Hiehly rated member of the accredited BBB and
4n—Lie's List
Thantglk u! Jn ' �
U
r i The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
` Boston, MA 02111
www.mass.gov/dia
Builders/Contractors/Electricians/plumbers
Compensation Insurance AffidavitPaePr ebl
Name (Business/Organization/Individual): �- � 4 eA Q'_
Address:
City/State/Zip: 1
Are you an employer? Check the appropriate
4,
box:
Q m a gene ral`coritractor and I
1. ❑ I am a employer with
have hired;the:sub-contractors
employees (full and/or part-time).*
listed on the attached sheet.
2. ❑ I am a sole proprietor or partner-
These sub -contractors -have ,
ship and have no employees
employees and have workers'.
working for me in any capacity.
; .
comp. insurance.,
[No workers' comp. insurance 5
We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] t
employees. [No workers'
comm. insurance required.]_
Type of project (required):
6. ❑ New construction
7. Remodeling
g. [] Demolition
9. Building addition
10.0 Electrical repairs or additions
11.[] plumbing repairs or additions
12.❑ Roof repairs
13.Other �?6 `�
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t submit a new
t Homeowners who submit box must
attached an additional sheeg showing the name of the -sub-contractors all work and then hire outside rand stas mus te whether or not those entities have such.
$Contractors that cheek thisp, policy number.
employees. If the sub -contractors have employees, they must provide their workers' tom p Y
insurance for my employees
I am an employer that is providing workers' compensation. Below is the policy and job site
information.
Insurance Company Name:
Expiration Date:
Policy # or Self -ins. Lic. #:
City/State/Zip: kA
Job Site Address: xpiration
Attach a copy of the workers' compensation policySA of MGL la ation o 1g52(can lead t showing htheoimpolicy stio not criminal penaltiesofa
Failure to secure coverage as required under Sec
fine up to $1,500.00 and/or one-year imprisonm dvised that nt, as well a copy of this statement civil penalties in the form
y be forwarded to he office f a a me
of up to $250.00 a day against the violator. B
e aInvestigations of the DIA for insurance coverage verification.
I do hereby certify under the p ' sand/�enalties ofperjury that the information provided above is true and correct.
7j,�J �/j� � Date: 1
Signature:
p ` "
Phone #:
7Fieonly. Do not write in this area, to be completed by city or town official,
Permit/License #
n:hority (circle one):
Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Phone #:
rson:
acoR" CERTIFICATE OF LIABILITY INSURANCE
�.
YYYY)
DA,,,TE/06,208/20, 6
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(les) 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 02051-001
NONTACT Branch 2051-1
Perry Insurance Agency LLC
622 Chickering Rd
North Andover, MA 01845
Eac: (978) 685-7690 - ANo.: (978) 687-0149
E>;MiC.' 1P�fo.
ADOREss:
INSURERS) AFFORDI11,0 COVER
s R - A.I.M. Mutual Insurance Company
MED EXP (Any one person) $
INSURED
All Under One Roof
INSURER B:
ffGEN -AGGREGATE LIMIT APPLIES PER:
LICYOC
PRODUCTS - COMP/OP AGG S
INSURERC•
INSURER D
C/O John Lanzafame
30 Temple Drive
Methuen, MA 01844-0000
INSURER E:
CnVFRAnFA CFRTIPICATF NIIMRFR! RFVISIIIN NUMRFR_
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 REDUCEDB�YpPAID
ILTRR
TYPE OF INSURANCE
/NSR
VWBD
POLICY NUMBER
MM/DDM(YF
pCLAIMS.
MM/ODY/YI'YY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F--] OCCUR
EACH OCCURRENCE S
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL 8 ADV INJURY S
GENERAL AGGREGATE $
ffGEN -AGGREGATE LIMIT APPLIES PER:
LICYOC
PRODUCTS - COMP/OP AGG S
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
OS AUTOS
H RTD AUTOS NON -OWNED
AUTOS
COMBINED SINGLE LIMIT$
accident
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) S
PROPERTY DAMAGE $
d
S
UMBRELLALIAB
EXCESS LIAO
OCCUR
CLAIMS MADE
EACH OCCURRENCE S
AGGREGATE g
DED I I RETENTION $
$
/\
p�'IN�yfiP�Rf���p�����os��/C�gR,ilNgEfiRf�EXX
OFFICEWMEMBER EXCLUDE07 ECUTIVE Y
(Mandatory IInNH)
( ��,
D�gUIVIN �F bPERATIONS bek.
NIA
AWC-400-7009464-2016A
1119/2016
11/912017.
TORY LIMITS OER
E.L. EACH ACCIDENT $ 1,000,000,
E.L. DISEASE - EA EMPLOYEE 5 1-000,00 00
E.L. DISEASE - POLICY LIMIT S 1,000,000.00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
The workers compensation policy does not provide coverage for John Lanzafame
CERTIFICATE HOLDER CANCELLATION
Town of North Andover
120 Main Street
North Andover, MA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
RUVIKU 25 (ZUiU/ub) The ACORD name and logo are registered marks of ACORD
i
Froa:Universal Insurance To:19789750481 07/15/2018 14:45 #1715 P12/002
CERTIFICATE OF LIABILITY INSURANCE OATS( N,00nmrYJ
THIS CERTIFICATE 19 ISSUED A>t A MATTER OF INFORMATION ONLY AND CONRER3 NO RIGHT8 UPON THE CERnFIC07 0016
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ATE HO
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 6Y THE
BELOW. THIS CERTIFICATIM OF IN3URANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE
REPRESENTATIVE OR PRODUCER, AND THE
ER. THIS
POUCUeS
OLICIED
CERTIFICATE HOLDER. 48), A
: 1 to older Is an ADDITIONAL INSURED, tiro
the t&nnS a ionsceffiof poUey(Iss) must o endorsed. If SUBROGATION 13 WAIVED
the tfirms end eenn Is... of the Pelh% certain Policies may require an endorsement. A atetemeM on this SUBR G door not
certificate holder to lieu of suds endorseman s
subJeet to
. confer
FRosuGER
hta to the
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UNIVERSAL INSURANCE AGENCY lLeandro 011MA sea
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508 732.8333
374 BELMONT ST. A11111111 bandronwwargalIL"Den .com
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CERTIFICATE NUMBER; 80
0377
THIS 1S TO CERTIFY THAT THE POUCIE3 OF INSURANCE U8TFA BELOW HAVE BEBd ISBUED TO THE INSUR DENAMFA ABOVE t-'EORR•
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR
THE POL
CONDITION OF ANY CONTRACT OR OTHER DO(X/MpJVT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
„ RESPECT TO
EXCLUSIONS AND CONDI770NS OF SUCH POUCIES,
PERIOD
H THIS
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UMR8 SHOWN MAY WIVE BEEN REDUCED BY PAID CLAIMS.
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DESCIUPTIONOFOPERA"ONSILWATIC"I SHIDLae(ACO"'C"AN'tle"dRmmftSpD*dW%NOW b• E�D�M4
Workers' Compensation benefits wlti be paid to Massachusetts employyees
derma for benefits to employees in atstee other than Massachusetts Mthe insured M� ns a10 Endo d 20 OS 08 B, no authorization IS 0411to paY
This certificate of Iruurance shows the c ployess outside of Massa Its.
tsiva date of this certificate or insurance), i (" fore* On she date that this eartifioats was Issued (unhm the eviration date on the above PdiCy es the
Search tod at www.mass gov&gdANOrke�v* SWIUN Of Ot1Me coverage
o patlonecan be Mwd*ad daffy by sooeselrp the Proof of Cov"s - Coverage Ve cetion
SWULD ANY OF THE ABOVE M$Clt*ZD POLICIES BE CAN
THE ANArEpamuBEALL UNDER ONE ROOF ACCORDANCII POCyPROVIo
80 TEMPLE DR
AUTI OREft RSFRsaLO1TATNL
METHUEN
MA 01844 ODI slam
CPCU, Vice President.- Residual Marke
ACORD 21 (2014101) The ACORD 1181119 and logo are ragfetarad marks of ACORD
oRO CORPORATION, All
BEFORE
Item It
Massachussatts - Dat:artmwit of °uJtsc sanity,
Board of Building Rogulationa an* S:arar.
Condructlun Super bur
License: C840120
,%%..1 i 1% 40
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MRTHURNMA Maw. �
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10
�amm:asiot�a� 04/03/Z017
Office of Consumer Affairs and Business Re
10 Park Plaza - Suite 5170 gelation
Boston, Massachusetts 02116
Home improvement C*actor Registration
Registration: 137057
t: 7YPe: DBA
ALL UNDER ONE ROOF Expiration: 1o=o18 TN 291333
1 6 q NZAFAME
ERRIMACK ST `
METHEUN
MA 01844
Update Address and return card. Ma '
sCA 1 q 20M -05M C]Address C1 Renewal Employment (] rk reason for change.
P oyment [I Lost Card
r"��iP �hJrrllrANrl+rY7lf�
Opir/r+llrlJJrt�initlrl
ce orCoasanterAfl'airs & Busl ens Regulation Re
HOME IMPROVEMENT CO gisttion d valid for Individual nse only before the
NTRACTOR ez
Regis;tratiogs expiration date. If found return to:
137057 Type: Office of Consumer Affairs and Business Regulation
I1-pi
Expiration: ror 2olt3 OSA 10 Park Plaza . Suite 5170
ALL UNDER ONE ROOF Boston, MA 02116
JOHN LANZAFAME
166 A MERRiMACK ST
METHEUN, MA oleo
dersecretary Not valid without s
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