HomeMy WebLinkAboutBuilding Permit #475-13 - 66 VEST WAY 12/19/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:c Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
L®CATtIOIVI (e�
^ ` ynot§� 1Q0.XI - 0Id structure yes,',
MAP�'NO PARCEL��� ZONING,DISJTsRICT`i� 1,., HrstoricaDstnct yest no,,
4 W MachmeiShop Villages yes; no..
TYPE OF IMPROVEMENT
PROPOSED USE
Resid tial
Non- Residential
❑ New Building
One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septie Welli
E'-Floodplam, ❑ 1Netlands,
❑Watershed Distr ct'=
❑ VVater/Sewe.r ,
;KIP I IUN Ur V11UK 1 v or- rcnrumvnw.
Identification Please Type or Print Clearly)
OWNER: Name: �C� � '�r�,��`n Phone:
Address LL fia��i..
one:SZ?3D-t604
Address:
r Z5
Supervlsol's Construction, License:S`- , __.y Exp$ 'D _ate
Home Improvement;L_icense_;° � � ��� _ Expo Date", _'d -� 3
ARCHITECT/ENGINEER Phone:
R)
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: $3 5i�-66 FEE: $
Check No.: � Receipt No.: �2
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
_ .Signaturexof contractor ,.7� . ._ m...,
Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
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 Tow -P. ]Engineer: Signa
Located 384 Os ood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at '124.Mam :Street:,
Fire Departmen #signature/date
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
B Notified for pickup - Date
i
Doc.Building Permit Revised 2010
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/Crossection/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
MOTE: 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: Doc.Building Permit Revised 2012
Location V
No. Date4i��
Check #�
26045
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
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Building Inspector
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Renewal. MA Home Improvement Contractor
byAndersen. License #170810 (Expires 12/23/2013)
Renewal bAdeeCoration Federal Tax ID #41-1918413
WINDOW REPLACEMENT an Andersen Company by nrsn orrp
104 Otis St., Northborough, MA 01532
(508) 351-2200 • Fax: (651) 351-4810
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
buyer(s) Name Date of Agreement
Buyer(s) Street Address, City, State, and Zip Code
E -Mail Address Home Telephone Number Work Telephone Number
Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen Corporation
("Contractor"), in accordance with the terms d conditions described on the front and the reverse of this agreement and on the attached
specification sheef(s) (collectively, this 'Agre "). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed
all work under this Agreement.
Total Job Amount�0 Amount Financed
Deposit Received (33%): 6 D
Estimated Starting Date:
/)/��� ' _ J�
/pc yJ}[
Method of Payment:
OCheck ❑Cash
DYso/MC ❑Discover
( ) �/(��./
Balance at Start of Job (33%): D
Balance on Substantial �.j
Completion of Job (33%): 1
Estimated Com letion ate:
p
Z�i7/y
inanced OAMEX
If credit card is selerted,.please
see Credit Card Payment Form.
Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that
there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation
from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby
acknowledges that Buyer(s). 1) has read this Agreement, understands the terms of this Agreement, and has received a
completed, signed, and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first
written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF
THERE ARE ANY BLANK SPACES.
Rene byAnde s afion Buyers)
By.
gnatur f Produ nager SigCature
Print Name of Product Manager Print Name
Buyer(s)
Signature
Print Name
YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD
BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS
FOR AN EXPLANATION OF THIS RIGHT. r
--------------- i< - - -- --
NOTICE OF CANCELLATION X
Date of Transaction— .You may cancel
this transaction; without y peva ty or obligation, within
three business days from the above date. If you cancel, any
property traded in, any payments made by you under the
Contract of Sale, and any negotiable instrument executed I
by you will be returned within 10 days following receipt
by the Contractor ("Seller") of your cancellation notice,
and any security interest arising out of the transaction will
be canceled. if you cancel, you must make available to the
Seller at your residence, in substantially as good condition
as when received, any goods delivered to you under
this Contract or Sale; or you may, if you wish, comply
with the instructions of the Seller regarding the return '
shipment of the goods at the Seller's expense and risk. I
Ifyou do make the goods available to the Seller and the
Seller does not pick them up within 20 days of the date
of your Notice of Cancellation, you may retain or dispose
of the goods without any further obligation. If you fail to
make the goods available to the Seller, or if you a ree
to return the goods to the Seller and fail to do so, then
you remain liable for performance of all obligations under
the Contract. To cancel this transaction, mail or deliver a I
signed and dated copy of this cancellation notice or any I
other written notice, or send a telegram to Contractor:
Renewal by Andersen Corporation, 104 Otis
Street, Northbo gh, MA 01532, BY NOT LATER THAN
MIDNIGHT OF -4 . (Date)
I HEREBY CANCEL THIS TRANSACTION.
----- �,<------------ --- -�
NOTICE OF CANCELLATION
Date of Transaction . You may cancel
this transaction, without any penalty or obligation, within
three business days from the above date. If you cancel, any
property traded in, any payments made by you under the
Contract of Sale, and any negotiable instrument executed
by you will be returned within 10 days following receipt
by the Contractor ("Seller") ofyour cancellation notice,
and any security interest arising out of the transaction will
be canceled. If you cancel, you must make available to the
Seller at your residence, in substantially as good condition
as when received, any goods delivered to you under this
Contract or Sale; or you may, if you wish, comply with the
instructions of the Seller regarding the return shipment of
the goods at the Seller's expense and risk. If you do make
the goods avoilable to the Seller and the Seller does not
pick them up within 20 days of the date of your Notice
of Cancellation, you may retain or dispose of the goods
without any further obligation. If you fail to make the
i
oodsavailable to the Seller, or if you agree to return the
oodsto the Seller and fail to do so, then yyou remain liable
ar performance of all obligations under the Contract.
To cancel this transaction, mail or deliver a signed and
dated copy of this cancellation notice or any otherwritten
notice, or send a telegram to Contractor:
Renewal by Andersen Corporation, _ 104 Chis Street,
North .�l,
�u�h�(MA 01532, BY NOT LATER THAN MIDNIGHT
OF I , l , _. (Date)
I HEREBY CANCEL THIS TRANSACTION.
Buyer's Signature Print Name Date I Buyer's Signature Print Name Date
RbA Copy - White Buver Conv - Yellow Buver Cort - Pink
Renewal meWal by Andersen Corporati( MA Home Improvement Contractor
byAndersen. 00104 Otis St., Northborough, MA 01532 _ License #170810 (Expires 12/23/2013)
WINDOW REPLACEMENT an Andersen Company
(508) 351-2200 • Fax: (651) 351-4810 Federal Tax ID #41-1918413
WINDOW SPECIFICATION SHEET
Date of
The Buyer(s) listed above hereby jointly and severally agree tb purchase the goods and/or services listed below, in accordance wi�the prices and terms
described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,
of which this Specification Sheet is a part.
1. Contractor will Install a total of .Y windows in Owner's home, using the following individual quantities:
Double Hung (DB) _ Equal sash _ Cottage sash (1/3 top, 2/3 bottom) _ Oriel sash (2/3 top. 1/3 bottom) _ Flat sill a f c)nss u3s)
Casement (CS) _ Hinge right _ Hinge left (as viewed from exterior)
Double Casement (CD)
2 Lite Gliding Window (GW)
Casement / Picture / Casement (CT) _ 1:1:1 or _ 1:2:1
Glider / Picture / Glider (GPW) _ 1:1:1 or _ 1:2:1
Picture Window Bay or Bow
Awning Window _ # Lights Soffit / Roof Shingle / Copper
Specialty Window Patio Doors (see separate door spec sheet) Seat to be Primed / Oak / Pine
2. Qty of Windows to be Custom Fit Replacement:
37:�L Qty of Windows to be Custom Fit FuII frame (INCLUDES NEW INTERIOR & EXTERIOR CASINGS)
Exterior casings: _ Pine Maintenance -free material _ Factory applied 908 Fibrex brickmold
4. Glazing to be: jol-HP Low- E-4 TM _ Tempered _ Other If other, please specify:
5. Exterior color to be: -1 White _ Sand _ Canvas _ Terratone _ Cocoa Bean _ Dark Bronze _ Forest Green _ Black
6. Interior color to be: White._ Sand _ Canvas _ Pine _ Maple — "Oak _ Same as Exterior Note: Wood interiors need to finished by Owner.
7. Hardware: White _ Stone _ Canvas _ Estate Hardware: Style:
S. Install Lifts with Double Hung Windows
9. Screens: windows to have: _ Half or _b41I screens Screens to be: Fiberglass _ Aluminum _ TruScene
GRILLE DETAILS
Owner approved (initials)
ADDITIONAL WORK DETAILS
11. Qty of— Sills FJ-_ Sill noses to be replaced by Contractor
12.Contractor will remove metal frames of window&
13. Contractor will install new — paint -ready or stain -ready Interior '-4-Exterior casings in _ Pine _�intenance-free material
14 ontractor will install new _ paint -ready or _ stain -ready _ Interior _ Exterior stops in _ Pine _ Maintenance -free material
tit) ) Intls Owner is aware that Contractor does not do any painting.
16. Contractor will wrap exterior casings with coil stock of color.
Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing.
17. Contractor will insulate, caulk and seal windows with 3 -Point system to prevent water and air infiltration. Removal and disposal of all job related
debris, windows, storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued.
is.ID4-Yes ❑ No Building Permit -Contractor will secure any and all necessary permits. The fee for the permit(s)
J _included in the Contract Price and a separate check is required at the time of sale for this fee. Ck # $
It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the
terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both
the Buyer(s) and ContrA) Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet.
Renewal by nd n Co do Bu er(s)
By. ,
f
tgn r of Pr du nager- Sitgiiature
r
Print Name of Product Manager Print Name
Buyer (s)
Signature
Print Name
: The C mtt�ea1th of M�Sra�ach� '
Dqw-axe cr.of raiiratHd Acini . ta'
Office of fm►'es*f`io&
600 %Yasiracgtari Sirtet
' . •Base hrA Q�rzr .
- ivwmmasa go l is
Workers' Compensation InMance A$UIsvit: Bmlders/Contr=tDrs/glectricisnr/l°.Igmbers
A Iicsnt Lafera►slian Please Prat Lea
-Nmne (sysmms/oigemizei3,c udidividoei)._ r n p u G& Y) a tt('�ed'C rN
Addrrsc: b L-(' s �T
Sd g ' S 1- ,-9p() -)
Are yon emplo , check ffe apprnpaaft'b=
1 I am a e�ploper with C� 4. ❑ I em a g=m%l camtcacbs emd I
ea>plopeea (furl andla�rpatt-time),«
have hired the sab-oa
i
2. EDI am a eolc propuetor c�pe¢taa-
hated on the attar�ed shut
na emplay
ship and have e� �
7� cents have
waddn fx me m � ��,
�' m znsta8a
5. ❑ We an a caepa=atiam and its
[No ��, �•
oft>om have theme
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3. ❑ I am a hameov= doing eIl Wcdc
rj& of cxcmp� pm Mme'
in� yNo wad=' -gyp,
cc,, 1-52, § 1('41),, rzd we b m no
1nHOt�nCe d-] t
esnpiopeex� [NO Wa3mm
camp. h=mm mquim&)
Type of prn}ect (required):
6, ❑ NVW ccroshvctioa
7.. [�odaliag
9. [Q Bn� addition .
1D,❑mwbical M*m or additions
1nPain cc edditians
12.❑ Rod
13.❑ Ddm
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wacln= 000�7' 4uftm �nm.
t S W==5 wim vd=dt thin affidavit mduthey Wt doing an wod; and fhm hue amide =Ut eo6mit axe affdav$ and C6g 9--%-
� 't6m this hoz ffiat dtaahed mm amts &rowing the== oft= -d thea wcdo�m' =* PAY
I an axplvyer t%t a provirii. WO;bVs' �awa>ion &uurmm for my mpk'= Below is the policy and jah arse
�� C� � �• • � e ���. � c Vie, s , .CCa
•Iusnz$atx Co�mpeay Natne;_ � � � �; , (3 — 'i ; -1 � .
Policy # or self -ins, I -it.
Sob lss
Or Ad: e a�{
Attach s copy of the wad mm' p ' deciss Page (showing file paRq Mmlbw lad eRrstwn tlalie),
Fei}nre'ta VW= � e as mdw $wfm 25A ofIER, c. 152 can lead to the iPasit am of c�mia d pmnlfies of e
fine •up to $ 1,500.00 an&c r cine --pear hDPIitut, as Wr1 ea civil peaeltiex is the fa= of a SM? WORK ORDER- and a fm
of m' to 5250.00 a day phle the violator. Be advised .69a copy of'rtbis ctahm led map be fnrwafdnd,to the Office of
ins of the DIA frn• msarancx coveaaega v�ian. '
.I do 7rereby.� P ofpe jm�+ that the yTforriora prnvuTid above a gree =dmtrta't
4:a_o 1,.,.
D,�tciml tt�e only. Do mer write in tOFriaATA tv be compmftd ;by city or MMlo,fj'usal .
City nr Taw=
se>ing �4 tt�nrit�{cicr cie.e>ne�: ecmr S. ?k mab* '
I Board of Sema 1. Stag D c>Qt .3. CkylTerorn Cis 4; B3eetricmi bag
Pham
_�®�I CERTIFICATE OF LIABILITY INSURANCE25/2 012
THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THII
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE:
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT:. If the certificate holder Is an ADDITIONAL INSURED, the PollcY(ies) must be endorsed. N SUBROGATION IS WAIVED, subject Ic
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(al.
PRODUCER 1-612-333-3323 CONTACT
Hays Companies Jonelle Hargrove or Eric Johnson
PHONE Eid)m FAX x:612-373-7270
80 South 8th Street dlAti
Suite 700 AD
PRODDER
Minneapolis, MN 55402 CUSTOMER W a--
wsuREO INSURER(S) AFFORDING COVERAGE NAIC 0
Renewal By Andersen Co INSURER A: OLD REMLIC IHS CO 24147
Corporation INSURERS: NATIONAL UNION FIRE INS CO OF PITTS 19445
104 Otis Street INSURER C:
Northborough, MA 01532 INSURER O:
COVERAGES 1o19oAaa
..�.wwn nvmo�R:
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
OF INSURANCE
ADDTYPE
L SU POLICY NUMBER POLICY EFF PSD EXP
Lam
A
GENERAL LIABILITY .
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
MAZY 59828
10/01/1
10/01/13
EACH OCCURRENCE S 1,000,000
DAMAGE O500, 000
PREMISES oxurrence i
MED EXP one person)' S 10, 000
PERSONAL R ADV INJURY S 1, 000, 000
GENERAL AGGREGATE S4 000,000
GEML AGGREGATE LIMIT APPLIES PER:
R POLICY PRO LOC
PRODUCTS - COMP/OP AGG f 3, 0 00, 000
s
A
AUTOMOBILE
LIABILITY
ANY AUTO
MNTB 21700
20/01/1.'d
10 O1 13
COMBINED SINGLE LIMIT
(Ea s -WW) $ 3,000,000
X
BODILY INJURY (Per person) f
ALL OWNED AUTOS
BODILY INJURY (Per aoddwd) _
SCHEDULED AUTOS
DAMAGE
(Per accident) f
XPROPERTY
X
HIRED AUTOS ,
NON -OWNED AUTOS
$
f
8
X
UMBREL"UAS
EXCESS LMB
X
OCCUR
CLAIMS -MADE
13273355
10/01/1
10/01/13
EACH OCCURRENCE $ 25,000,000
AGGREGATE' = 25,000,000
DEDUCTIBLE
X1 RETENTION S 25,000
ANDEMPLOLIABNJTY YIN
ANY PROPRIETORIPARTNEROMCUTIVE
OFFICER44EMBER EXCLUDED? a
(Mandatscribe )
III Yes, describe under
A
NIA
MMIC 117948 00
10/Ol/1
10/01/13
$
S
WCSTATLI -
X OTH
EL. EACH ACCIDENT $ 1,000,000
EL.DISEASE -EAEMPLO f 1,000,000
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT I = 1, 000 , 000
DESCRIPTION
OF OPERATIONS / LOCATIONS / VEHICLES
fAtlaeb
ACORD
fol_ Addaren.r R—d,.
Evidence of Insurance.
Evidence of Iseurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORD= REPRESENTATIVE
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supen icor
License: CS -095707
BRIAN D DENNIS.6N
7 LAMBS POND CIRC s
Chariton MA 01507 t
Expiration
Commissioner
09/08/2014
71. Coamxmo�uuea z a�,/�iaaeac�ivaetta
Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: ,170810 Type:
Expiration: -2723!2013 Corporation
R WAL BY ANERS�EiV�CCiRPORATION
„x
BRIAN DENNIS01�1s
104 OTIS ST.
NORTHBOROUGH, MA 015,32 Undersecretary
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