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HomeMy WebLinkAboutBuilding Permit #709-2017 - 535 CHICKERING ROAD 1/11/2017BUILDING PERMIT 0 O'tr",���,,o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:7o7— 17 Date Received I'll I Date Issued: EWPORTANT: Applicant must coi - N Print" 0,,RZ,-@g FOR, L1R,!4_T._NYY,? COR VN E On;:i [PUR, mKIN DISTRIC all items on this i4it-0i dt, NPS -1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family El Addition El Two or more family 0 Industrial 0 Nteration No. of units: [?'Commercial ffRepair, replacement El Assessory Bldg 0 Others: El Demolition 0 Other E,=ep ft , EFloodplain Q WEe ands 1 Stz W f DESCRIPTION OF WORK TO BE PERFORMED: �ri���Prol� /yam/� Identification - Please Type or Print Clearly' OWNER: Name: Chicklpiel ez AoA"i!9 L, &(f - Phonel/,Vm_W�7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDINGPERMIT: $IZOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. ___1rotaI Project Cost: $ FEE: 7 Check No.: Receipt No.: 3 NOTE: Persons contracting with unregistered contractors do not have: access to the g" fund tyfi fund contract - S_ignatu�e_of Agent/Owner _Signature of con'habt Location No. Date Check #3—Y V TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Plans Submitted ❑ I Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ -TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/MassageBody 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 v 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 a . • Planning Board Decision: Comments ' Conservation Decision: Comments Wates" & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locarea Jb4 usgooa Street FIRE DEPARTMENT - Temp Dumpster on site yes no Locaied.at 124,Main Streetr . Fire. bepartinent, signature/date. ,.: COMMENT .r -)imensioh 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 rnin.sl 00-si 000 fine 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 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.1. 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 VOTE: 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 H J uLU uj v L7J Q W S N N N V LL Z Z Z d Q Q Z Z U Z a W LU0 O F- c O J W LL N N m O d W Y T O N m cu \ N U -O L C L L _ _ to U C O Q O 7 E to 7 7 > h=0 f0 C:O N O O t C O O N O c 7 LL Ln LL W U LL cr LL d' V) LL w LL m 0 _ Q . r+ 0 V da c o N1 v Q L y E a� o = c„i L �• y C 3 as � CL J m a) r : > _ • M d i O O y 0.-0 � y d now.F+ V1E C O Z �r� y O C y = I c O 10 �• �s 0 o c = CL •� I— y N v m co AW W C 'a_ O O LL 'y LU0.O :5 :E.2 W •E c� L V a� 0-0 mom, CL �, . cn y .0 � 0 I=- s w a.0U J O 9 E � O O Z y I � 0 � N •E m m CL s_ O ^ CD 0 0 0 `—ao� 0 0 c � Q v J � 0-0 Z W 0 v CL CL N B O Z 41 41 cu v 0 N Y O E Ln Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy 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 Contractor Information Nam �i[�Ceri era ut. C Company Name e(+SSS !. Street Address (do not UNA Post Office Box address) S3S C 4d Contr ct r/ Sal person/ Owner e e ,d L c City/Town State' Zip Code Al Business Address (must include a treet address) l�� � �✓ r Psf 1`� alb Daytime Phone Evening Phone 97k-'79 - v9g7 City/fown State Zip Code 9 Z�K Mailing Address at different from above) Business Phone Federal Employer ID or S.S. Number I ­1that thiomosthome improvement coat.,,.. have a validid .gist.aon number Home Improvement Conbactor Reg.Number Eapuation date 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.) j4r�lp f eL°r-OQI �gr1_7 Required Permits - The following building permits are required Proposed 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 r ! excluded from the Guaranty Fund provisions of A4 A! (Date when contractor will begin contracted work MGL chapter 142A.) ,X` 7, Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule 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: $ 10 upon sighing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $ �. by _/ / or upon completion of $ ®' by _/_/_ or upon completion of $41336) dpon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(') Including all finance charges(") Law requires that any depositor down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. rr��� Express warranty - Is an express warranty being Provided by the contractor? 11 No t_ <v; (all terms of the warranty must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law. requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract most be completed and signed. One copy should go to the ho caner. The other co o be ke y the contractor. I � Homeowner's S gnature Co or's Signature Date Date ACORO® �. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/11/2017 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 CONTACT NAME: Elizabeth Chavez FAX PHONNo,E WC_, (978)688-4474 No): DEGNAN INSURANCE AGENCY, INC. E-MAIL 9 ADDRESS: echavez de naninsurance.com @ INSURERS AFFORDING COVERAGE NAIC # 85 SALEM ST. INSURERA: AIM MUTUAL INS CO 33758 LAWRENCE MA 01843 INSURED INSURER B INSURER C: JAMES DEBRECINI INSURER D: FAMILY ROOFING & PAINTING INSURER E: 2 TANAGER WAY INSURER F: LONDONDERRY NH 03053 COVERAGES CERTIFICATE NUMBER: 117488 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER EFF MMIDDIYYYY MPOLICY EXP MI DY/Y YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE FIOCCUR DAMAGE TO (Ea occur ence $ -PREMISES MED EXP (Any one person) $ PERSONAL & ADV INJURY $ N/A GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO - POLICY ❑ POLICY F—]LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS UMBRELLALIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR N/A DED RETENTION $ $ A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICE R/MEMBEREXCLUDFO? N/A (Mandatory : . NH) NIA N/A AWC40070259002016A 05/11/2016 05/11/2017 STATUTE ETH E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification Search tool at www.mass.gov/lwd/workers-c6mpensation/investigations/. Sole proprietor has not elected coverage. GtK I RIGA It MULUtK GANGtLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 120 MAIN STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845 Daniel M. Cro Bey, CPCU, Vice President— Residual Market— WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1 ACOROe CERTIFICATE OF LIABILITY INSURANCE TE (MM/DDNYYY) 703/3112016 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 Phone: 978-688-4474 Fax 978-327-6558 DEGNAN INSURANCE AGENCY 85 SALEM STREET LAWRENCE MA 01843 CONNA,TACT DEGNAN INSURANCE AGENCY PHONE FAX Arc a Exl : 978-688-4474 C No): 978-327-6558 E ILSS: cdegnan@degnaninsurance.com INSURER(S) AFFORDING COVERAGE NAIC # 03/05/16 INSURER : NORTHLAND INSURANCE COMPANY INSURED DEBRECENI, JAMES D/B/A FAMILY ROOFING AND PAINTING INSURER B INSURER 2 TANAGER WAY LONDONDERRY NH 03053 INSURER D: INSURER E PRODUCTS - COMP/OP AGG $ 2,000,000 INSURER F • PnvP 7Af:FC CFR-iIFICA7F NIIMFIFFL YhIIIY KCVIJIUN NUIVI6GK: 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 INSU13ANCE AFFORDED EY THE POUCIES 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 ADD'L SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A GENERAL LIABILITY GENERAL LIABILITY CLAIMS -MADE Il OCCUR WS274266 03/05/16 03/05/17 EACH OCCURRENCE $ 1,000,000 AMAGE TOCOMMERCIAL PREMISES Ea occurence) $ 100,000 MED. EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PELT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea aoddenl) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (per accident) $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ QED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YrN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? F (Mandatory In NH) JJ If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- 0TH TORY LIMITS ER $ E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) fine COr?Monwealth ofHassachusetts _ .Department of Indr9tiial.Accidents r I Conn -cess Sheet, Suite 100 Boston, AIA o2114-2017 ass ov/dza www m .g b�M �1V oi�cnslplmexs E -P Workers' Cmpensation scdaa TOu�SH OA��OtlX.. Please print J Namo (Busi wsfOiga:t�izaiionllndivi6'4:. S�- Address: Phone #: Are you an employer? CJ?ecktIie appropriatebox: qmployees (W and/or pari bate).* 1.LgIamaemp oy 2.E]Iamasoleproprietororparinmhip - 1e° quiro�]°3'eesvaorkmg formein any oaparity [Noworkers' p• insurance3.E] I am ahomeowner doing all workmysel£ [goworkers' comp. insurance required-] 4.oIamahomeowmrandwillbehiring,,,,tractorstoconductailworkonmyproperi'Y- Iwill ensure all coutrac to=s eitlherhave workers' compensation insorauce or aro sole proprietors wsih.n9 eumgioyees. 5_� I am a general contractor and Ihave hiredthesnb-contractors listed onthe attached sheet These sub -contractors have mployees mdhaveworkers comp. insurance. e - of exe tion per MGL C. 6.Q We are a corporation.and :ifs, officersh aye o w encs equired ] ' h ' no employe [N Type of project (x'eq&0c1) 7. ❑ Ivei'do`nstriiciion 8. E(1; .emodeluig 9. ❑ Demolition 10 ❑ Building addition ILL] Electrical repairs or additions �. MPI mbing repairs or additions 13•,�oiifxepairs 14.M Other andwe ave d - Gtionbelow iheirworkers' compensation po&cyiofoanation: *Any applicantthai chgclrs boil #1 dust els° o e doing all work and �enhue outside contractors must submit a mw affidavrt mdzcahng such i Homeowners who'sAluft this affidavit indicating Y thename of the sub -contractors and state whether or notthose enfiiies have tConiractorsthatch0ck#h bogmust attached'anaddtions o a°ov ff workers'comp.policymurtber employees. ifthesub-couhaetorshaveemployees, ey P� to ees Lelowist/iepolicymzdjohgte X am an employer' fiat is providing workers, corrlpensation insuFance for• my erne y information. Jusmance CompanyName; 1-r r I 7 1 - i1 n �� 7Q j Seo LxpirationDate• / / Policy # or Self -iris• Lic. #: —AKWI, CA) C r, 11�d • City/state/zip: Alrkc� Rl- Job Site Address: eclaration ag e showioag the policy number and expiration date). Attach a copy of the wox'kers' co-mtpensa�on cydP 500.00 Failure to secure coverage as required under MGL o-152, §25A is a criminal violationpunishable by afire up to and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER a3�d a fine offp too t $250.00 a day against the violator. A copy of this statement may be forwarded to the Of(tce of Investigations of the DIA for insurance coverage vexftration. X do Iter•ehy eeitify aax i� rmdpenalties of perjury that the infonneon provided above ZY frue and correct: 1 Official use only. Do zotw1ite in tlzis area, to he corr�pleted by city or to7vrc official~ • PermuitlLicense # City or Toimzz D'SidngA-athority (circle one): 1. Board of ff ealth. 2. Duilding D epart nent 3. City/Tovn Clerk 4. Electrical fmspector 5. Plumbing Znspector 6. Other Phone #:, Contact Person* 4 ,s� ��e Cpoaavraao�uoecildi o�C/�i��a�,raaef�d. ` Office of Consumer Affairs & Business Regulation jr -= HOME IMPROVEMENT CONTRACTOR , Registration:122385 Type: , Expiration w $/2672018 DBA j+ FAMILY ROOFING &PAINTING ='_`4 JAMES DEBRECEN'-' i 30 RIVER ST. ,� V.... METHUEN, MA 01844 �- Undersecretary ' Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099685 Construction Supervisor Specialty JAMES J DEBRECENI , 2 TANAGER WAY LONDONDERRY- NH 03053 �-•^� Expiration: i Commissioner 12/06/2017 1