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Home My WebLink AboutBuilding Permit #470-2017 - 93 MAIN STREET 11/3/2017A �� A,11A. h- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 7D " �O I Date Received !! ix0! Date Issued: /I- - Rao e, r V-�t�ao �a�NO IMPORTANT: Applicant must complete all items on this page Residential Non- Residential 0 New Building U One family 0 Addition %a r7 Industrial Alteration No. of units: 0 Commercial Repair, replacement 0 Assessory Bldg D Others: 0 Demolition 0 Other INx$'�: 9 �NI t J T'1 CylNetlands terlewer r ; , ,> ,,,y✓ Print �J��CEL', �ON1NG f315TRICT Histonc'Disri� yes no. Ma ch�n;Shop;Village fives no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building U One family 0 Addition , Two or more family r7 Industrial Alteration No. of units: 0 Commercial Repair, replacement 0 Assessory Bldg D Others: 0 Demolition 0 Other Sstcfi 1NlelIbodpl0� CylNetlands C Watersfied D►sfrct terlewer ; , ,> _ QC -*")'VV FL 19NIO (1.�.,Di•:9 �CT1'c-��y Gw i�y67s �9r�J/� Go�trvr�/1 S f2Cz_MdV F AWn &6,0�4C4 LA-rg-A-x-� S _ PAJ'NT IAJA. . M — I#- 0 Identification Please Type or Print Clearly) q79- SQD_ $oZgy OWNER: Name: t2 �.JOh�J /u�22fE , Phone: 977 685_4T$'OycW) Address: ARCH ITECT/ENGINEER /NONE, Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �,�, DDO FEE: $ .S 0 0 Check No.: qo,&� Receipt No.: 31/3/ NOTE: Persons contracting wit unr Bred contractors do not have access to the guaranty fund Signature ofi Age = natureb -contract1P or. BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received_ Date Issued: - IlWORTANT: Applicant must complete all items on this page E t. PR0PERTY��®1NNER nti^ 1DDYearStructure yes ,no r MAP PARCEL UP,- T, _u �Histonc®istnct .yes ,no .� Mac}iine:Slio Village" yes no - - I?�- 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 Septic T.0 Well ' ❑ Floodplain 0 Wetlands u VUaterShed Di4NG-t ❑.V1later/S:ewer,.� �. r 1.- OWNER: Name: AAA �.�. DESCRIP I IUN Ut- wUKK I U Mt t-1:MrUm'v'r-LJ: Identification - Please Type or Print Clearly - Phone: Contractor Name: Phone:. - - t Address: 'Su pervisor's,Constr,,uctibii License ;-. _ __ _�� _ ;Exp. •Date:+__ Home,liniprovemerit License: IL ". Date -- ARCH ITECT/ENGINEE Phone: Address: Reg. No., FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No,, NOTE: Persons contracting with unregistered contractors do not have: access to the guaranty fund r- --------- -- - -- - -- -- - -- _- S`ignature_of_Adent/Own& Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ •TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El 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 CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature. Reviewed on Signature Reviewed on Signature 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 Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Locaiea Jd4 usgood Street no i 1imension 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 Doe.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. I" . 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 40TE: 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 :t Doc: Building Permit Revised 2014 Location 3 S 7. No. 14'7 0 17 Check #.M?a Date /l"?,' ?0)7 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $500. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ R,w I. vBuilding Inspector Location 47 3` 9!;- M K l' IV S 1 No. '(? O - i -G i7 Check # v 31131 Date ll ` 3 — 7-0) ? TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $500. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ uilding Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 25'5,000.00 m $ - $ 300.00 Plumbing Fee $ 37.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.50 Total fees collected $ 475.00 93-95 Main Street 470-2017 on 11/3/2017 Kitchen Remodel, Replace Bathroom fixtures 0 cc 3.2 •Q L QMW d s = �o C. L � • 4+ _ • � s o tt: t gEtm Ir% 0.- 0 CL r� -O r- Z> � cc L =D> N� CD cc -0 •♦: *:its c 0 C Z a=te O O C" o H Q CL CD a�M .j 0•=_0rn Q L Adc=CL c �a = d H O N v m LUV1 `� cc L W = -0— O O li •2 to _ •Q. t O W 0 m Z3 CL N °'•>w c N M O H t . �oL) d u O LU Z Z W zCl) Z IL v� XLu O W IL Z M ZE v v ti i 00 L C L- 0 Q c a M = J � O Z U) rM-, cc o:cr O cc z uW J Wa O w Wa N Z Z Wa LL z a Z O Z Z V W CC D: H O u 5 CO W W C cu m J J N O O d W v N T T Z N a) v 4! "O 'a+ 0L0 C C C f0 j N m i <a j N w O O O- O O t c O c O w c O LL LL U LL d' LL d' N LL W LL m N N N 0 cc 3.2 •Q L QMW d s = �o C. L � • 4+ _ • � s o tt: t gEtm Ir% 0.- 0 CL r� -O r- Z> � cc L =D> N� CD cc -0 •♦: *:its c 0 C Z a=te O O C" o H Q CL CD a�M .j 0•=_0rn Q L Adc=CL c �a = d H O N v m LUV1 `� cc L W = -0— O O li •2 to _ •Q. t O W 0 m Z3 CL N °'•>w c N M O H t . �oL) d u O LU Z Z W zCl) Z IL v� XLu O W IL Z M ZE v v ti i 00 L C L- 0 Q c a M = J � O Z U) rM-, Genesis Builders LLC Thomas A. Gioseffi P.O. Box 1016 • Salem, NH 03079 Phone: (603) 231-5009 • Fax: (603) 894-5732 November 2, 2016 Dr. John Rizza 7 First Street No. Andover, Ma 01845 RE: Renovation of 2nd Floor Apartment Contract Dear John, Here is a proposal for the work at the above address. The following items represent the scope of work as I understand it to be; Included in this bid: I. Apartment Renovation: Scope of Work: Includes estimates for materials and labor for renovating this 4 - room apartment. This will include the following: • Remove existing kitchen and replace with new cabinets, new counters, paint and new flooring. • Remove existing bath fixtures and replace with new tub/shower combo, new toilet, new vanity, paint and new flooring. • Upgrade electrical and plumbing as needed. • Purchase and install new interior doors and knobs, a new fire code entrance door and other trim as needed. • Prime and paint all ceilings, walls and woodwork. • Install new appliances purchased by homeowner. II. Miscellaneous: • Cleaning: General cleanup of site daily to maintain a safe environment. • Rubbish removal: Genesis Builders LLC will provide daily rubbish removal with the use of an onsite dumpster. • Permits: Permit will be pulled by Genesis Builders LLC III. Not included in this bid: • Does not include any fire alarm or sprinkler work. Schedule: This project should be complete 45-60 days after start date. Time & Material Contract: This contract will be a cost-plus contract where invoices will be submitted as actual costs and a fee of 12.5% paid to Genesis Builders LLC. Any material purchased by the customer will be the responsibility of the customer and not warranted by Genesis Builders LLC. The estimated cost for the above work is $25,000.00 Deposit due at signing of contract will be $5,000.00 Invoices will be submitted every two weeks. If this contract meets with your approval, please sign below, returning an original and keeping a copy for your records. Thank you for giving us the opportunity to perform this work, and we look forward to working with you. Sincerel t 16 Thomas A. Gioseffi Date Genesis Builders LLC . John Rizza Dat Po" First Street Seven, Inc GENES4 OP ID: NB .a.C—v�#cu CERTIFICATE OF LIABILITY INSURANCE FDATE TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR 11 1021201 6Y) 11102/2016 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 Planright Insurance -Salem 224 Main Street Suite 2A Salem, NH James A Santonto CONTACT NAME: James A Santo PHONE Ic No Ext :6O3-890-6439 Alc No): 603-890-6521 AIDMDRE ss: Jamie santoinsurance.com INSURER(S) AFFORDING COVERAGE NAIC INSURERA:Tudor Insurance Company INSURED Genesis Builders LLC, GIO Realty LLC, GIO MO Properties 40 Lowell Road INSURER B: Peerless Insurance Company 24198 INSURER C: INSURER D: Salem, NH 03079 INSURER E PERSONAL & ADV INJURY $ 1,000,000 INSURER F r[ov101V17 NUIVIMMIC: 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR INSD WVD POLICY NUMBER NPP8274856 MMIDDNYYY 01/08/2016 MMIDDNYYY 01/08/2017 LIMITS EACH OCCURRENCE $ 1,000,000 REAPEU PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMPIOP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PRO TY -DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) It yes, describe under NIAV STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) re: 93-95 Main St, North Andover, MA ('COTICIr ATC Unl nee _. Town of North Andover 120 Main Street North Andover, MA 01845 ACORD 25 (2014/01) 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 O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, HA 02114-2017 www mass.gov/dia Compensation Insurance Affidavit: BnUderes/ContxactorslE,lectrxczans/ lumbers. TO BE FMED WITH THE PERK n -MG AUT]IORITY. Name(BusiroesslOxgabization/individual):. Address: P City/State/Zip:_ Are you an employer? A ecktlie appropriate box: IhfQS 1 L � W4,03 -V79 Phone #: 603 - 1.I am a employer with employees (full and/or pari time).* 0. 2. I am a sole proprietor or partnership and have no employees Working forme in any capaciiy. [No workers' comp. insurance required.] 3.E] I am a homeowner doing all work myself [No workers' comp. insurance required] t 4.❑I am '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 proprietors with no employees. 5. L]I am a general contractor and I have hired the sub -contractors listed on the attached sheet: These sub -contractors have employees and have workers' comp. insurance.* 6. Q We area corporation and itsofficers have exercised their right of exemption per MGL c. 152, §1(4), and we have no em , ployees. [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 outside contractors must submit a new affidavit indicating such (Contractors that check this box must attached' n additional sheet showing the name of the sub -contractors and siate whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. compensation insaaran ce fop my employees. Below is til e policy orad j obi site X am an employes' that is providing worke?s Type of project (>recluixed.): 7. ❑ NdVd6nstriiciion g. Remodel.Ig 9. ❑ Demolition 10 C7 Building addition I LE] Elecf dcal repairs or additions I-zj -Plumbing repairs or additions 13•. 0 Rb6f repairs 14.[] Other information. Insurance Company Policy # or Self -ins. Lie. #: Expiration Date City/State/Zip: Job Site Address: Attach a copy of the workers' compepsation policy declaration page (showing the policy number and expivatrio�o 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. X do hereby certify ul#er thepains andperya ties ofpe�iyY tlaat the information provided above is true and correct r .,/ -S I '— Official use only. Do not write in this area, to be completed by city or town offzcial. City or Town: Permit/Liceme ## Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. CitylTown 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 of hire, 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 enferpri-se, 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 xequhred." 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=contractor(s) name(s), address(es) and phone number(s) along with their certificates) 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 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 -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 "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. 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 e i i Massachusetts Department of Public Safety �v Board of Building Regulations and Standards License: CS -077258 Construction Supervisor THOMAS A GIOSEFFI P.O. BOX # 1016 SALEM NH 03079 �/(�--�.n Expiration: `ommissioner 03/13/2018 Office of Consumer Affairs -ii .BusFness Regulation OM;E IMPRgVENT CONTRACTOR` i ration,r 4640 TY.. e: P. Expiration �za Q.1 Individual j i THOMAS A G1 SE 1`E=( SALENj;: NH 03079 �`-y ClndersecfeNary 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) PICKUP - Doc.Building Permit Revised 2012 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 COMENTS DATE REJECTED DATE APPROVED ❑ ❑ CONSERVATION ■ ■ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decisio Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street ' FIREtDEPARTMENT Temp ,D.umpster on. site Located at 124'Ma1n St,eet _ „ Fire Departmentsignture/date r ,4 .,q COMMENTS'