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HomeMy WebLinkAboutBuilding Permit #212-14 - 99 EDGELAWN AVENUE 9/9/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:p�[ Date Received Date Issued: 7 IMPORTANT:Applicant must complete all items on this page LOCATION i - Print. PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: 4-b2LPkCEL:94_ZOAI� DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family 11Addition wo or more familyD 11 Industrial Alteration o. of units: [ICommercial Repair, replacement 11 Others: ❑ Demolition ❑ Other D Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 5Au&�wad wvrX bo- kn�- Identification Please Type or Print Clearly) OWNER: Name: r-- Phone: 7� -6� 3- �a Address: IT Jyctwh � - -7 Garr u-© 1 -831- 10� ' i) CONTRACTOR Name: ._ ! _. Phone: �j Address: r�ns Supervisor's Construction License: 7 _Exp. Date: 9L � Home Improvement License_ Exp. Date: � -2 y ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$100`0.00 OF THE TOTAL ESTIMATED OST BASED ON$125.00 PER S.F. Total Project Cost: $ 63,q T FEE: $ 5>UD Check No.: ab� q�° 34 6 by or Sw Receipt No NOTE: Persons contracting with urn .is ered contractors do not cc I Si nature of-Agent/Owner Si `nature,of contractor'ry a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location -::FA, I LM No. ' Date .� i' • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee n $ TOTAL $ Check# � 26817 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF:SEWERAGE.DiSPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑_ . Swimming Pools J ❑_• Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ ❑ Private(septic tank, etc. permanent Dumpster on Site THE FOLLOWING SECTIONS FOR.OFFICE�­USE ONLY . . INTERDEPARTMENTAL SIGN OFF,x U FORM. DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT` ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS I 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 Tovv:: Engineer: Signature: Located 384 Osgood Street FIRE DIEPARTMi--VT -Temp Dumpster on site yes no Located at 124 Mair., Street Fire Department signatureldate y 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 ® Notified for pickup - Date Doe.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 Li 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) Li 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all casts.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 NORTH own of t ndover 0 h ," ver, Mass, 01 13 COC MIC Nl WICM y1" �d A�RATEO S U BOARD OF HEALTH Food/Kitchen PERMIT -T LD Septic System THIS CERTIFIES THAT 6A.r1r.r.. BUILDING.. ........................................................................ INSPECTOR Foundation has permission to erect .......................... buildings on q.j...... .. ...I,C,.t.n>a.............�......... ...... Rough to be occupied as ..... .... ....... 0........Di)n. �............................. Q... .. ....... Chimney provided that the person a ceptin this 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 Wilding Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough Service ................. .. ..................................................... Final BUILDING INSPECTOR 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. SEE REVERSE SIDE INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INTSTORE COPD LOWE'S OF SALEM, NH, STORE#2382 STORE PHONE:E­'1111/ tOORP'4TI0 DOOR541 SOUTH BROADAY SALEM, NH 03079-0000 SALESPERSON:SALESPERSON Document Print D This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuan ment, including the specifically completed pages of this document, the Terms and Conditions included with this document the other addenda or attachments hereto, shall be referred to herein as this "Contract." ce of a Lowe's receipt, upon which the entire agree- PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE "TERMS AND CONDITIONS " BEFORE SIGNING. applicable portions) of Lowe's receipt, and any Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56-0748358 Customer Name S BARBARA MOODY Customer Address Home Phone 99 EDGELAWN APT 3 978-373-9536 L city Other Phone NORTH ANDOVER State/Province 978-373-9536 Installation Address MA Zip/Postal Code T 99 EDGELAWN APT 3 01845 O Installation City NORTH ANDOVER Installation State/Province MA Installation Zip/Postal Code 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY r47385 OOD PRODUCT : STK : 1X3X10 RED OAK BOARD . 1X3X10 RED OAK BOARD - QTY 1 PD KEYLOCK#V615318 : SOS : SOS VYL THERMASTAR PATIO DR . PD KEYLOCK#V615318 : PE 94 3/4" X 79 112" : SOS : SOS VYL THERMASTAR PATIO DR : 94 3/4"X 79 1/2"/XO/PATIO"*THIS PR THERMASTAR BY PELLA(R) WINDOWS & PATIO DOORS - 8/28/13 TO 9/10/13 . PEL LLA VINYL PATIO DOORS EAST- ,,�, , ICE REFLECTS A 15% QTY 1 PD KEYLOCK #V615318 : SOS : SOS VYL THERMASTAR PATIO 13 : 9 KEYLOCK: EL 53 8Y PE TIO DOORS EAST-Q,°;F PROMOTION 94 3/4" X 79 112" : SOS : SOS VYL THERMASTAR PATIO DR : 94 3/4" X 79 1/2"/OwPATlO : PELLA VI W112A : STK : WHITE W&D SILICONE 19.8 OZ : 9.8 OZ WHITE SILICONE WINp LLA VINYL PATIO DOORS EAST- NYL PATIO DOORS EAST-QTY QTY 1 QTY 8 OW AND DOOR CAULK : MOMENTIVE PERFORMANCE MA- TERIAL A Store 2382 Project No. 389843180 for BARBARA MOODY P__ STORE COPY 130980 : 130980 : STK : 1 X4X8 TOP CHOICE EWP PREM S4S : 1 X4X8 TOP CHOICE EWP PREM S4S : IRVING FOREST PRODUCTS (MAINE) - QTY 4 130983 : 130983 : STK : 1 X4X10 TOP CHOICE EWP PREM S4S : 1 X4X10 TOP CHOICE EWP PREM S4S : IRVING FOREST PRODUCTS (MAINE) - QTY 2 238343 : 2826-8 : STK : 3/4X3.5X8 RF EMBOSD PVC TRM BOARD : 3/4X3.5X8 RF EMBOSD PVC TRM BOARD : ROYAL MOULDINGS LIMITED - QTY 2 366933 : LRF1024 : STK : 10IN X 24FT ROLL LEAD FLASHING : 10" X 24' LEAD FLASHING : UNION CORRUGATING COMPANY-CAN - QTY 1 Materials Price $ 1541.44 INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Patio Select Location : Back Door Select New Door : Sliding Number of Doors to Install : 2 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 48 Deliver Door : No Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : Extra Help Needed to handle door to deck Other Work Charge : Yes Comments : no comment Labor Charges E92. 0Detail Deduction E$Ei 0 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right. Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES 1-where applicable Store 2382 Project No. 389843180 for BARBARA MOODY Page 2 of 8 STORE COPY SUB-TOTAL $2898 9 l� TAX $ 0.0 DELIVERY $ 65.0 i ORDER TOTAL $2963.9 BALANCE DUE Work is to commence upon reaso a e avail blity of Contractor which is anticipated to be [fill in date]. Estimated completion date is [fill in date]. NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full COMPLETE THIS SE TION ONLY WHEN THE CONTRACT TOTAL EXCEEDS S1,000.00: [)(Customer to Pay in Full; OR [_J Customer to use the following payment schedule: (1) Deposit of $ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and (2) Payment of $ to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap- propriate box below): [_J Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_J Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. Store 2382 Project No. 389843180 for BARBARA MOODY Page 3 of 8 NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. C.142A STORE COPY LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, T AT LOWE'S MA UBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY O HE EXECUTIVE FFICE OF CONSUMER AFFAIRS AND SINESS EGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT U H ARBITRATI N AS PROVIDED IN M.G.L. c.142 / 1 By: Date: r Lo me Centers Inc. Owne y -L f /r :> Date: d7 / l ,3 By: Date: Co-owner or Witness THE SI NATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE WNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. WITNESS HAND(S) SEAL(S) BELO - HIS Ct, f DAY OF t - _ Lowe's a Centers, I c By- (Seal) P nt Name: Addres owner (Seal) City �`�li�f , 7 , StatJ/ rovince Zip/Postal Code o�.�'� ° Print Name Co-owner or Witness (Seal) Print Name Store 2382 Project No. 389843180 for BARBARA MOODY Page 4of8 a B'�€�i�;t e'c u,attor,s and Stan�sar�s ,€"�3 T�t���tif?n Saiaca-or+sir c =se' CS474572 C CARREIItO 3848A r a 4`�a3ts �tet E�9f02t2�14 :: F"T y kkT ce of Canstmer Affu & A rss Regnlaho� �� � nA�1�ifP1�UENtEN'�'Cf3�t� CTUR°r s � � •�'...¢�t� s tea"£• '�'�.-�`'` r - Rightfax N2-1 9/6/2013 6: 34 : 41 AM PAGE 2/003 Fax Server `` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYYI TML%CE'RTIFICATE 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 0 0 CER AND THE CERTIFICATE OLDE IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: MICHAIA.S I)OI_OLAS PHONE 168 PLAISTOW RD (,AIC,No,Exq: JFAX AJC,NO): RTI: 12 PLATSTOW.NH 03865 E-MAIL ADDRESS: 76JB[ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: HARTFORD UNDEKWRII'EKSINSURANCE COMPANY j CARRETRO-i EVTN NIERRl'DBA K C CONS"fRUCf1ON INSURER B: INSURER C: INSURER D: ' 2 SINIS ROAD - INSURER E: I K1N(i51 ON-NH [13418 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MWDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE ❑OCCUR. REMISES(Ea occurrence) MED EXP(Anyone person) $ GENTAGGREGATE LIMIT APPLIES PER PERSONAL 8 ADV INJURY $ GENF.RAI.AGGREGATE $ POLICY 0 PROJEC 1 0 LOC PRODUCTS-COMP!OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB 8 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND (WcslAluloRv ;OTHER EMPLOYER'S LIABILITY YM UB-513561643.13 08/18/2013 08118/2014 1 LIMITS ANY PROPERITORIPARTNERIEXECUTIVE OFFICE P./MEMBER EXCLUDED" N/A E.L.EACH ACCIDENT, $ 100,000 (Mandatory in NH) El DISEASE-EA EMPLOYEE $ 100,000 II yes describe under DFSCRIPTION OF OPFRATIONS helow E L DISFASF POI.ICY I IMIT $ 500.000 DESCRIPTION OF OPERATIONS/LGCATIONSIVEHICLESJRESTRICTIONSISPECIAL ITEMS 1'111,RI;PLACLS ANI`PRIOR CLR.I LFIC'ATL 1SSL LD V)111L CER11F1CAfL,11OLDLR,1 FLC1LN(;WURKLR.S COMP C'OVLRAGL•. TETE TNSi TtFD'S\f A WORKFRS(;()T\4F'F.NSATTpN POT.IC Y ANT)ITS C.IMTTFD OTHER ST.ATFS FNTXIRSFMFNT ATITHORT7E.S THF PAYNIFNT OF FIFNFFTTS FOR C'T..A1MS M.ADF BY THE TNSTTR FD:S MA FMPT.c)IFF,IN STATES OTT-TFR THAN MA. NO AI rFW(IRT7.ATIQN TS c.iIVFN TC)PAY i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 UT Boston, MA 02114-2017 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auulicant Information /1 Please Print Legibly Name (Business/Organization/Individual): Kevin ccyrelr0 Address: � c511�1Q5 RA. City/State/Zi : 03t$ 0 Phone#:_ ��-�31-lD�a2 Ar you an employer? Click the appropriate box: Type of project(required): 1. I am a employer with_2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.$ 9. E]Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑Other 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. $Contractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �+ Insurance Company Name: 6(41 Ty UJ&W17 413• Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: Gq LAIZf2 1((4,wk) 4:1-3 City/State/Zip: 9 I& � Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi e an penalties of perjury that the information provided above is true and correct. Signature: rtDate: 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#•