HomeMy WebLinkAboutBuilding Permit #114-2017 - 40 WILDWOOD CIRCLE 8/4/2016 i
BUILDING PERMITI� 1 4do
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^1}' r' TOWN OF NORTH ANDOVER `=a
APPLICATION FOR PLAN EXAMINATION ~ - _
Permit No#: 1 L � 1 Date Received eA �ySSqTH�SE���
Date Issued: O y � -
IMPORTANT:Applicant must complete all items on this page
LOCATION qD (/y«,k)�DOD
Print
PROPERTY OWNERzZ� 0 ti ��.�0e1'�
Print 100 Year Structure yes n
MAP 165 PARCEL:ZONING DISTRICT: XV_Historic District yes
Machine Shop Village yes cIMj
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement- ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
O Septic ❑1Nelli Floodplain -1, -1- fl Watershed District.
DESCRIPTION OF WORK TO BE PERFORMED:
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lilJJ t l 2 X 2'-j "VC z Gj"44T,j
Identification- lease Type or Print Clearly
OWNER: Name: Phone:
Address:Contractor Name:Name: Phone:
Email: _
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED N$925.00 PER S.F.
Total Project Cost: $k ;1! 4O FEE: $
Check No.: — Receipt No.: e:5c�
NOTE: Persons contracting with unre red contractors do not have access to the guaranty fund
oy- ---- - ---- --- —- ---- --- - ---
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I
f
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ TanningWassage/Sody Art ❑ Swimming pools
well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM �
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Z�1�
PLANNING C& DEVELOPMENT Reviewed On Signature_ I
COMMENTS
' CONSERVATION Reviewed on Si nature
j/. A nl, i
COMMENTS ad A�--
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WEALTH Reviewed on Si nature
z54,z,��l
COMMENTS s ��D ,�� �jhL \
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Cor-�ervation Decision: Comments
Water & Sewer Connection/s►gnature Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
IFIRE DEPARJTMEN7 -�Temp,�Dur�pster on;sitex {des x�'`;'`
.! � tir l.a'r "Z G.l1' 1, e 7• �7 a�'i�r. -1 ai:i.1?�4t +1 n� y
Lo+►a�t�etl of 124jMaini9eet " '}yt� ``y�r .� �: ;•�, ::h :,.• * r ;
rf '�'tJt x s� ria -a „ -• F ... , i.{�' � � � ��
FNij'ID partmentsi nature/date , r14 �,, �T• 4;�' ' A s �' � 11
n -� u ,.,,
V t 4, _ • i i ..r} !• ;`1� (,"-. .•��r.f.ter; -{. V..-,Nl
COMMENTS:`-
r.+�.. ,� ;.._ �.-, . -�. . ,C ,' ": ''�Y. g•', ,,Yaw's.,
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.$1oo-$1oo0 fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit 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
OTE: 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
OTE: 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
r Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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
Doe:Building Permit Revised 2014
Location 4,11 U)j-�.
No. 114 " DateI O#za/�
• TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $ r
Other Permit Fee $
TOTAL $M
1
Check#
f, r/ Building Inspector �'
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 11200.00 m
$ - $ 14.40
Plumbing Fee $ 1.80
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 1.80
Total fees collected $ 118.00
40 Wildwood
114-2017 on 8/4/2016
above grond pool
Plans Submifted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL �.
Public Sewer ❑ Tanning/Massage/SodyArt ❑ Swimming Pools
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. Permanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING M DEVELOPMENT Reviewed On�j � ��� Signature_
&(��A�.
COMMENTSICI �� 1� n 4 �)�r)
CONSERVATION Reviewed on Si nature
l. 15�'/
COMMENTS
WEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sevier ConnectioniSignature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPAR{TMENT Temp
��xr � f z � ��4�, Dun�ipsfer on;site,:, :yes_�._:,j.r •.,:. .�,�t� g�nq��` �?'-��... � ,�,�,�:-
Located at-124�MainStreet a } x• +,
FirejD00ment signature/date -. 4e mak` �� Y =s��-
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< -4 - • .7 , .st.f.j.•_. -t r,. ..ti -, .��,.+z. "i'•rz' s��:--••.�'•i"it
COMMENTS': , y-;• . - s, -,'. �;,; ��, �T t= � �` ;:
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No. 11 ( * _ ,�
soh ver, Mass,L AK O8 Q� ZO16
A_ coc«�c«ew�c«
7�A�RATEO
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT L D Septic System
THIS CERTIFIES THAT ✓ ..!... ....✓ . BUILDING INSPECTOR
has permission to erect buildings on ......T.... .... 1./� .. i .. Foundation
.......................... ... .
Rough
to be occupied as ... ...ary#wp.... ................................ .......... Chimney
provided that the person accepting th 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 CONS TIO T Rough
Service
... .. .. .. . . ............ ........ ......
Final
BUIII NSPE OR
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.
., TOWN OF NORTH ANDOVER
OFFICE OF
_ BUILDING DEPARTMENT
1600 Osgood Street,Building 20, Suite 2035
+b North Andover,Massachusetts 01845
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please prin
DATE: 5F— q_l�
JOB LOCATION:
Number Street Address Map/Lot
HOMEOWNER ��y�,�y�v � ,. �'v 1'7 - go 3 `lfA
Name Home Phon Work Phone
PRESENT MAILING ADDRESS '
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner oceupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided
that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be, a one-or two-family dwelling,attached or detached structures accessory to such use and/or farm structures.A
person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR
Section I IO.R5.1.2)
The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable
codes,by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE if
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Exemption
I
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth of.lVMassachusetts
Department o.f Industrial Accidents
1 Congress Sheet,Suite 100
':d Boston,MA 02X14 2017
- �
- -` www mass gov/dia
,Y Workers'Compensation Insurance Afa-davit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A.p�plicant Information Please Print Legibly
Name(Business/Organization/Iudividual): 1070,Nw Dlu AeoC4A
Address: 4fb w,(Lo
City/State/Zip: /V, SCJ OdC.2 41J�/S Phone
Areyou an employer?Checkt&apliropriate box: Type of project(required):
1.❑I am a employerwith employees(full and/or part-time).* 7.• [(New co]istxuetion
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remo deag
any capacity.[No workers'comp.insurance required.]
- 9. ❑Demolition
3.LAI I am a homeowner doing all work myself[No workers'comp..i surance,required.]t
10 rJ Building addition
4.Q I am a homeowner and will be hiring contractors to conduct all work on my 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.Q Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. Roof repairs
These sub-contractorshade employees and have workers'comp.insurance.tYL
14.�fOther R o
6.Q We are a corporation and its officers have exercised their right ofexemption per MGL c.
152,§1(4),and we have no.,employees.[No workers'comp.insurance required.]
*Any applicant that checks box41 must alsofi11 out the section below showing their workers'compensation policy information.
T Homeowners who subriiit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must-atEacjned 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.
lain an employer that is pi�ovidingworkerrs'compensation insurance for my employees.' 8eloiv is thepolicy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lio.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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 Iuvestigations of the DIA for insurance
coverage verification.
I do hereby certify under thepains a -penalties ofperjury that the informationprovided above is Arue and correct
Signafore: d Date: 00
Phone#: a—
Official use only. Do not-write in this area,to be completed by city or town official
City or Town: Permit cense#
Issuing Authority(circle one): i
1.Board ofIfealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defft ed as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,ox any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who lias not pro duced acceptable evidence of compliance with the insurance coverage required?.'
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall.
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
PIease fill-out-the workers' compensation affidavit completely,by checking he boxes that apply to your situation and,if
necessary,supply sub-contractoi(s)name(s),address(es)and-phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. lie advised that this affidavit may be submitted to the Department of•Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidenis. Should you have any questions regarding the law or if you'are required to obtain a workers'
compensation,policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line. -'
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has,provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. # 617-•727-4900 ext.7406 or 1-877-AIASSAFE
Fax#617.727-7749
Revised 02-23-15 www.mass.gov/dia
North Andover MIMAP March 4, 2016
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— Horizontal Datum:MA Stateplane Coordinate System,Datum NADS3,
Meters Data Sources:The data for this map was produced by Merrimack
—SR MD�rM Valley Planning Commission(MVPC)using data provided by the Town of
Roads ®E .'so q d North Andover.Additional data provided by the Executive Office of
k7,Easements 3r'�. ����0� Environmental ANairs/MassGIS.The information depicted on this map is
O Parcels _ for planning purposes only.It may not be adequate for legal boundary
F definition regulatory Interpretation.THE TOWN NORTH ANDOVER
MAKES NOOWARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
# r< THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
Ir ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
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Store2l Print Screen
MEETING NOTICE-TOWN OF NORTH ANDOVER
Board/Committee Name: Conservation Commission
Date: June 22, 2016
Time of Meeting: 7:00 PM
Location: 566 Main Street (School Administration Building)
AGENDA
1. Call to Order: 7:00 PM
2. Pledge of Allegiance
3. Approval of Minutes - 5/25/16
4. Public Hearings: 7:03PM
Conservation Restriction
• Review of Leonhard Conservation Restriction
Small Project
• NACC #175, 108 Campion Road (Montopoli)
Request for Determination of Applicability
• 120 Campion Road(Sigman) (Sullivan Engineering Group, LLC)
• 58 Glenwood Street(Sinaci)
• 30 Gray Street (Barclay)
• 40 Wildwood Circle (Thompson)
Notice of Intent (NOI)
• 242-1681, 384 Osgood Street(DPW)(Linden Engineering Partners, LLC)(cont. from 6/8/16)
• 242-1682, 56 Candlestick Road (Martin) (Sullivan Engineering Group, LLC)
Abbreviated Notice of Resource Area Delineation
• 242- , 0 Osgood Street (Edgewood Retirement Community Company, Inc.)(MHF Design
Consultants, Inc.)(cont. from 6/8/16)
General Business
• 242-1603, COC Request, 315 South Bradford Street(Smolak Farms LLC/H. Michael Smolak,
Jr.) (ESS Engineering & Surveying Services)(cont. from 6/8/16)
• 242-236, PCOC Request, 325 Appleton St(Timothy P. Houten, Esq.)
• Enforcement Order-146/148 Main Street(Smith/Sutton Pond Condominium Trust) (cont. from
6/8/16)
Decisions
• 242-1680, 1-3 17 Massachusetts Avenue
• 242-1679, 1920 Great Pond Road (North Pump Station)
Adjournment
NOTIFICATI®N TO ABUTTERS
Under the Massachusetts Wetlands Protection Act
The North Andover Wetlands Protection Bylaw
In accordance with the Massachusetts General Laws, Chapter 131, Section 40, as amended,and
the North Andover Wetlands Protection Bylaw, (Chapter 178),you are hereby notified of the
following:
The name of the applicant is 'a���a...tJ _
The applicant has filed a94 g t)p_ 1� with the North Andover
—� (application)
Conservation Commission(NACC)for the purposes of i a.',T»-t
(project description)
at pto L;Lh") J ca_-4_A f tUf3/1- ! E -[7vilP1�
(site address)
The North Andover Conservation Commission will hold a public hearing on
WEDNESDAY, Z — �? 02 at 7:00 P.M. at the Town Hall, 120 Main
(date)
Street,2°d Floor Meeting Room,North Andover,MA 01845.
Copies of the ' R L � A may be examined or obtained for a fee from:
(application)
(check all boxes that apply):
❑ Applicant at
❑ Representative at
0_�Conservation Department, 1600.Osgood Street,North Andover,MA 01845 Monday
through Thursdays 8:00 a.in.to 4:30 p.in.Tuesday 8:00 a.in. to 6:00 p.in. Friday, 8:00
a.m.tol2:00 p.in. Please call the Conservation Department at 978.688.9530 beforehand
to verify arrangements. Copies may be available for a fee.
Further information regarding the hearing, or the Wetlands Protection Act,may be obtained from
the Conservation Department at 978.688.9530.
NOTE: Notice of the public hearing,including its date,time, and place will be published in the
Lawrence Eagle-Tribune at least five(5)business days in prior to the public hearing
date.
NOTE: Notice of the public hearing,including its date,time,and place will be posted
in Town Hall, 120 Main Street,North Andover,MA 01845 at least 48 hours prior to
the public hearing date.
NOTE: You may also contact the Conservation Department or the Northeast Regional
Department of Environmental Protection Office for more information about this
application or the MA Wetlands Protection Act.To contact the Northeast Regional
Department of Environmental Protection Office, call 978.694.3200.
CONSERVATION COMMISSION
PUBLIC HEARING
Pursuant to the authority of the Wetlands Protection Act, Massachusetts General Laws Chapter 131, Section 40,
as amended, and the North Andover Wetlands Protection Bylaw,the North Andover Conservation Commission
will hold a public hearing on:
WEDNESDAY,June 22,2016 at 7:00 PM in the School Administrative Building located at 566 Main Street,
North Andover,MA
For the filing of a Request for Determination of Applicability by(applicant)Raymond Thompson
To alter land at: 40 Wildwood Circle(Map 105D,Parcel 66)North Andover,MA
For the purpose of: install above ground pool with waiver request within the Buffer Zone to Bordering
Vegetated Wetland and a Potential Vernal Pool.
Plans are available at the Conservation Office, 1600 Osgood Street, Suite 2035
By: Louis Napoli, Chairman
N.A.C.C.
APPLICANT INFORMATION:
Run once in the Lawrence Eagle Tribune on Tuesday, June 14, 2016
DELIVER OR FAX THIS LEGAL NOTICE TO THE LAWRENCE EAGLE TRIBUNE BY:
Friday,June 10 2016 b noon
Y
Applicant(s) must bring proof of publication of this Legal Ad to the meeting
Tribune Fax#978-685-1588
Legal Ad Billing Info:
Raymond Thompson
40 Wildwood Circle
North Andover,MA 01845
Tel# 617.803.9192
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
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