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Building Permit #1059-16 - 80 MAYFLOWER DRIVE 4/11/2016
NoRYH BUILDING PERMIT oFstLCo b��o TOWN OF NORTH ANDOVER �� � ` tib APPLICATION FOR PLAN EXAMINATION . f__ Permit No#: l f/� Date Received ��°0 rEo. S SSACHUS� Date Issued: IMPORTANT:Applicant must complete all items on-this page LOCATION 78 ��o ►u��/F�s� enc, R�`V,� �& Print PROPERTY OWNER lea V/"e, 14 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: If IQ Historic.District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building ne family ❑Addition P*fwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑'Septic ❑rWell! 5IFlootlplan ®�Wetlantls. ❑ LWatershedD�stnctY _.QW .eewer �.__ _-_._._ _.__ __.z _�_ 3.3 DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name:_K45d,'m r, T*-c Phone: 1��183 3/GL3 Address: /o .c iVe- &o 14.44o0-ems a71.FgJ- S:�e T44,, , Q Contractor Name:_:9a12;j4m;i t C• CsG-om,0 Phone: So 8-3;L9 -X630 Email: K� • Address: &q tV44 /-.'LLar-.e, vee, (/n A- oigct� .I Supervisor's Construction License:-C S 0753 c :L— Exp. Date: ra. Iy//G I. Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 444- CoW0 C< Phone: 778`'i0A '©l�( 14wftftcc ©G-bei+ 'F1.5- Address: f�K�to11-e6e M 4. Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. d Total Project Cost: $ /z PUD FEE: $ /CV- Check No.: 74�5�5 Receipt No.: NOTE: PersoBecontractin wit u inter d co tractors do pMavelacc to a uarmy and -: — L . fdiri 4 w , n - - - J Flans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/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 PLANNING & DEVELOPMENT Reviewed On0rp Signature COMMENTS ? �; ` 'Sc CONSERVATION Reviewed on Co Signature COMMENTS HEALTH Reviewed on Signature • 9 I ' 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 Drivewav Permit DPW Town Engineer: Signature: +, Located 384 Osgood Street F�IREDEPAR+TME�ITT,ernp Dumpsfer an site;�..,yes �.,:,�� g;� �;��;�rt.►�'noi�' � ¢�� }� , i Located at�12W n Street, �.♦,y ��t T �f �4� r •, �yi � .. r }ira� 'S�N�� .e •.^sz `Wt�.n�-'�JLa17S ♦ if i � Fire Department si gnature/date.Za .s� ?:i►'�,'�t�.(.rr��Y.t�tti��, �-��L�;'$.�•`r T� .x�'�t-A.�.��� �. :.�} i�' i) i.}? ���"f''�'i���'*f'�1��(j��a��4'�`��t . .h-'� +Y.'^+'r- ^r.-,.m� -""'.,��".f.f� COMMEM1JTS '"�'; t :s..,�1 .,.rt - •�<.,. ; . •;,. ;, :6,�;.. i, rt�4ay} ' r M 4�.'f. 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 Permit Revised 2014 l 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 4- Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4, Copy of Contract 4. Floor Plan Or Proposed Interior Work 46 Engineering Affidavits for Engineered products ®TE: 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. P f-�C - Licenses 4. Copy Of Contract 4. 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 product s 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_P.lan l/ Photo of H.I.C. A�. icenses Workers Comp Affidavl Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products iNIOTE: 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 k - r No. r ; / _ Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $�_ Foundation Permit Fee $ /C Other Permit Fee $ y TOTAL $ Check# .r Building Inspector NORTH own oT _ ndover 0 . , h , ver, Mass, /©�1—/6 •p coc „tw.cK 'l. x.95 RA TE D U PERMIT T D BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ....... .... . ....,(;• ?�j, ;; ,Jc. BUILDING INSPECTOR has permission to erect .......................... buildings oncL/¢l. Foundation G Rough to be occupied as ...... .......... ..G.. .�`. •, /� ��,'/ ........ ,.......................... .............. •••• ••• ••• Chimney provided that the person accepting this permit shall in every respect conform to the terms of e appllcation 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 CONSTRUCTIO ARTS Rough Service BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Building • Rough i 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. The Commonwealth of Massachusetts f Department oflndustrialAccidents F d 1 Congress Street,Suite 100 Boston,AM 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED'WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Ledb Name(Business/Organizationadividduual): KeA L144n Address: /0 L4'�>°��� 4`v6_L $_ �j o V''p 1-n City/State/Zip: Phone -3 Are you an employer?Checktlie appropriate box: Type ofy' ject(required): LE]I am.a.employer with ! employees(full and/or part-time).* 7, ew conkruction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. [A Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3..❑I am a homeowner doing all work myself.[No workers'comp.Insurance required.]t 10 0 Building addition 4.F1I 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 rlam..a fetorcontractor s with no employees . 12..E]Plumbing repairs or additions 5. general contor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.# 13.Fj Roof repairs 6.Q We are a corporation and ifs of icers,have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit 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-attached 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. X am an employer that is pioviding workers'compensation insurance for my employees.'Below is'the policy and job site information. Insurance Company Name: C G—, eD" Policy#or Self-ins,Lic.#: CcS(v a V.g - 0Ga3(V A1 Expiration Date: iS / Job Site Address: City/State/Zip: /(p > Vim► 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 Investigations of the DIA for insurance coverage verification. Y do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature. '— Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 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 defined as"...every person in the service of another under any contract olhire, express or implied,oral or written." ` An employer is defined as"an individual,partnership,association,corporation or other legal entity,or 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 has not produced 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 Please fill-out the workers'compensation affidavit completely,by checking the'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. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•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 Accidents. 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"fob 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. A new 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 burn 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia NOTICEI NOTICE TO = 9 TO EMPLOYEES r EMPLOYEES Sq lb The Commonwealth ®f Massachusetts DEPARTMENT OF INDUSTRIAL, ACCIDENTS 1 Congress Street, Shite 100, Boston, Massachusetts 02114 — 2017 617-727-4900 — http://www.state.ma.us/dia As required by Massachusetts General Law,Chapter 152,Sections 21,22&30, this will give you notice that 1 (we) have provided for payment to our inured employees under the above mentioned chapter by insuring with: ACE GROUP NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDL KORO. MA 02344-1450 ADDRESS OF INSURANCE COMPANY (GS62US-OG23626-9-15) 08-15-15 TO OB-15-16 POLICY NUMBER EFFECTIVE DATES •�� M P ROBERTS INS AGENCY 1060 OSGOOD STREET W� NORTH ANDOVER MA 01845 NAME OF INSURANCE AGENT ADDRESS PHONE# _~ OLD SALEM VILLAGE OF NORTH HEPATICA DRIVE & �• ANDOVER CONDOMINIUIM TRUST; MAYFLOWER DRIVE NORTH ANDOVER MA 01845 EMPLOYER ADDRESS _ EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAI. TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the previsions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably •� _ connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 011918 W20PIG16 TO BE POSTED. BY EMPLOYER Massachusetts -Department of Public Safety Board:;f Building Deg WI and Standards �. _s__ n._.. .•__ _ - ,.I171J1.1LllLIUll JUl)l'1�1I.1V1 i License: CS-075302 BENJAMIN C OSOOD, ' 69 Old Village Lade y North Andover NFA 0845 Expiration Commissioner 12/041201E it t Irr � I I .' I i ® t ' 1 j i i , _ ®® -. ® ® ® ® ® ® ® ® J ®® } ®® u� ........... ....................... .............. .... ................................... ........................................ I ----- ...................................... ................... i : ............---------------------------------------------:...........---------------------------------------------.----------------------------- ------ ....................................... House ,j 16--15 Front E/e vo tion 3/16"= 1'-0- DmWng dote: Colonial Drafting March 25, 2016 978-902-0131 Scale applle$/or 11 x 17 droving E-mc/% o%nQCdroRing.com r t t I 1 1 f r... r.......... ...J............................t Left Elevation Rlaht Elevation 1 1 ........................................... .........................----............................................................................... .....--....: House f 76-15 Colonial Drafting D-1,V data: Back Elevation Mooch 25, 2016 978-902-0131 stole opals ro,nxn d-119 £-mot• dlonfcdrolllnp.com 751-6.1 20'-10" 5-6" "-0" 10'-4" Precast re LAJ 00mote----J I Bulkhead.............................. . . . ........ ........................................................4. . ....................................................... .... • ... .. .... ... ..................................... ........................................................... . ....r.Install...m..Posolve—........- . ............ .. • r ——— — • I S RodonMlIIptlon Radon 111001 } s te m j S)Stem 5--0- W-O" -0. 5'-0" --1---r3)-2x12- ------------------ ----------------7 5-oo-T ---------- ------ 3 112 d1c. It: Lolly Column m 'd q (m/n.)concrete Slab with opprowd wpor T border beneoth-,, .o. ............... . ................. ...... r W�-,�P' p border bnaath� ....... .......... r4 0. 7T . 7 .............. 3t/2"d/a. 4'-9 S' ...................... o. ............................... ---------------- m Beam Pocket LollyColumn x 6'dp x 9*101/ ................... ...... 2, L-- ------------ =j . . ...................................... -12'�1 ?.x 1-0 dp.ft g. ............................ 4 reqd rdqd 2'-8" 7 12'-6" L 4'- 10'Cone.Fan, 20"W. .10.dp. 't . ............. .................. .............................................. 1 ............... 32'-0' Duplex A 16-15 Foundation Plan DrowIng date.- Colonial Drafting March 25, 2016 978-902-0131 Scale applies for 11 m 17 draw/ng E-mail; clandcdruffInq-com 75'-6" 2Y_gy," 20'-1194" 10'-4Y." 5'-0" 10' " 5'-10" 5'-10" 10'-1 6'-0" 7-5- 8,-0• 2._,,0.y A._D. i I I Dining i Kitchen Kitchen i Dining Offd� rr�I�O Goroga F/n/sh Gorage F/n/sh A --AcW1.4m.t/Dyoct Y Y A0.1 roGnef byouf 5/8 Type-X 5sum )peboard y wr 0 00 .-Y-Y Gypsum Wallboard G o yp on Garage side\ I on Corage side I 1 1 a I I Ot5 Garage 3'-10" T-6" 2Y." 3'-6" 5'-101'." 5'-101x" 3'-6" 2Y." 7'- S-10" p 0 Garo9e N N pcst ----------------------- ------------------- .—.— .—.._.—.--- ...................... GEnt° ase ©Os En try N En try Q© o Cu age/House 70 m/nute Arlo.) n I ' Entry Door p te 8m roting -- --o a I 70 8m mlnuratinlmin.) Closet Closet O N N O 16'x 8'Coroge Door �, 8'x 8'Goroge Coon w/th Transom window with Transom window m 'a L ng Li wing 6'-3" 22•_0.. q•_6'• b 4'-6" 12'_6'. c 0 I I a o is D• J.-e.�A.-8. �.^ � .D. J._9.c A'-D• 1. 2'-8" 2'-9V." 2'-9V4" 2'-8" 5'-0" 2'-B" 2'-9" 15'-109;+" Duo/ex 16-15 first Floor P/on Drowing date: Colonic/ Drafting J116'- 1'-0" Morch 25, 2016 978-902-0131 Sco/e applies/or 11 x 17 drawing f—olk o1onftdra/8ng.com 32'-,OW' 3Vi" 11'-110" 18'-Th" 2'-8" 2'-8" 18'-2Vx" 11'-11`✓n, 2•-6" 4._6" V-2W 4'-6" 4'-6" 9.-214 4,_6" 2'-6.. 9'-5Y." a-H8 A'-B.' V.--11B', x T-5' Botho Both M Bedrm 1 M Bedrm 1 0d 4'-2"3_8 T 4,-2„ F3'-2V4" 5'-31" o Computer °ath Bath Q °O 0 0 Z-10' 3-10"2' 2 M 0 oN II 1 72 6'-11" s-10" 2'_94,, 2,_3" Bedrm 2 Bedrm 2 2'-3° 2'-B'/" 5'-,0" 6•-,Y." 1iW 5'-0W' 5' -OV." o O O o c U 1 Fr- 8V," 2'-8" 2'-8" 8'n" 3'-6* 9'-0" 3'-4+4" 3'-41 9'-0" 3'-6" 15'-,ON" 3W 15'-tOv" 32'_0" /1 l/oioniai Duo%x1� 6-15 ® Drafting First Floor Plan Alo Carroll Drow/ng dote: March 25, 2016 978-902-0131 Scale opplies/or 11 x 17 drowing cam. olonvcdroflnp.com Ridge Board T,B COO,Tie®4'-0'c.0. Slope Cut(6)- ITd Nags 12 Roof From/ng-T x!0 (tee Frominq Plana for spot/np) Pryde No!/B ,.ppafar 12'ac.ofn/fold fin/ah/loot Atfk Frominp-T x 10 (Sae from! 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Stair Base Detail mn Loy 0du &nb. „emmmm,m= � Coxrote Skb �7 d'-0" 41 11'-g' ©rww+e-rw.w m+nv..vd m,••+ DyRlex # 16-1 D—ft dot,: Colonia/ Drafting March 25, 2016 978-902-0131 Main Building Section !/4"-r-o' Scale oppll.,(1107 d-11 f-moll, obnCcdmfU".com 7 771 r 1 I I 1i 1'11 -�` ' , ' 1 I t I I i 1 I t J 1 : i t f : I 1 I.l ..,, �.. -il ',' ,� ! :'.., li:. I.l i.. ..: !I , ', �t�_' , 1 l ��l rl.l•I1''. ,�I �I t ' _ ®®® '" mu ir ........... .............. ---------- ............ ........... ........................................................................ ----------------------- ...................... ............ ...... .......... .................. ....................................................................:..........:.......................................................................................... House ,f 16-15 Front E/e vo tion &vwing done: Colonial Drafting March 25, 2016 978-902-0131 Scoie applies for f1 x 17 droning f—moll' olonecdm{Nng.eom Leff E/evation Right Bevotion ...................... ................................................................................................................................................................................. : House j 16-15 - D-1,9 dole: Colonia/ Drafting Back Elevation r/e•a r'-o• March 25, 2016 978-902-0131 Sw/e opd/es/or 11,17 d—Mg E- O.- o/on9kdroll/nD•rom 21'_2" 20'-10" Y_0• 20'_10" 11'_6• 5'-0' S'-6" 5'-6" Precast Concrete U P Bulkhead U p a-0- ... �_. ......................... ........................................................ ..................................... r•/natal/Pa— .,............... ............. ... 1' /natal/Pons/w I i IRadon Mltlgotlon Radon M/t/potlon I �� S}e=em '^ 5'-0" p_g"�3^� '3 a 4'-g" 5,_0�� 5•_0" 5'-0" 1 5' 0" 19 4� ', ' S � ' ' �' �---, �••-� ��� - -�'J)-2x12;• - '� � "' o , 11 O �; ; � ' ; (tom •, N i i p ul4� R / Y 1/2"d1a. J Golly Column . ,-�• • ; (4 mold I o .I Up ©�• 4" Concrete Slob O Q •� °0 with lfh approved approved wh- $ C .. 6 border beneath---,, ;e ' Sm° , , _ 4'-8 _ __ 5'-0 4_g" 3•: .3" 4•_g" 5'-0" " --- ,a 3 1/2'dla.Cally Column b• Beom Pocket -- --------------- &-p _:.:.....:._.----__: ........................................................ .... w/2'-B'eq x 1'-0"dP• g• 'i, 4 ro d ( q' J 4 e (f0 req'd) 'i n •_5 2'_8" 16'_6" iv , 4-6" 12'_6•• 4'-6" 6� to*Conc.Fdn '0 20"w. x 10 dP•Ft y. 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