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HomeMy WebLinkAboutMiscellaneous - 1060 TURNPIKE STREET 4/30/2018 (3)Location- -No. ocation No. Date fg Z.cl C - t TOWN OF NORTH A NDOVEri,, a-mmWIALp Certificate of Occupancy $ ♦ • �*� / Building/Frame Permit Fee $ J J E � st �+c►+us ACHU Foundation Permit $ it F C � Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ • TOTAL $ i 1 /Building In4ector g ',- 10284 1,,- Div. Public Works r Location /a 6 r (,( k!j Date Rlze-19 ` f N TOWN OF NORTH ANDOVER Certificate of Occupancy $ Sy Building/Frame Permit Fee $ Foundation Permit Fee $ C) OL i Other Permit Fee $ r Sewer Connection Fee $ r Water ,Connection Fee $ j TOTAL $ �- /Building Inspector � (� c�}� pp 5 m �V Ge (i Div. Public Works r Location 1060 ti Jfr oDate ` ofd oT .,� TOWN OF NORTH ANDOVER _ p Certificate!of`Occupancy $ Building/Frame Permit Fee $ VIC CMustt� Foundation Permit Fee $ Other Permit Fee $ ` Sewer Connection Fee `$ �- 4"43P-water .Connection Fee $ 077,50. TOTAL TOTAL _ $ !l Jai V-4,lot 4131 TO P A 01 "v 9� NO V d� 1 W N F W ¢ Z F 0 a o � z y W C ► W W = O z u 0 t m Z`: a W 4 1 z I U � x o J J LU V \\ 1 WP o�V at V x N N � � 1 c" W z W L m = 0 ML o�; W <W w o 0a, d > 0 0 o U 0 n U 0 0 � W d d L W N d 0 Z 0 = LL0 0 m U 0 Z ►- u LL 00 < M 0 0 _0 �i p N< z F = LL 0 s W W F W W N 0 x a F �fl Q � W 0 z a a W z Z 0 C LL .A Z`: 0 } Z a LL i O u 'la N J lit W L L a LL 0 O K t m 4 1 I o J J LU V \\ 1 WP o�V at V x 0 c" W z W L m = 0 ML o�; W <W W< a 0a, d 0 0 o U 0 n U 0 0 � W d d L Z < 3 m J < m m m U W 30 00 < M W W W �i 0 } Z a LL i O u 'la N J lit W L L a LL 0 O K t m 104 AAA N 2 0 � H 0 < u J W 0 L W Z N z W 0 Z G Z 0 J LL J F f' m F Z j 0 0 m W Ir < WQ 0 m Z H F Ir W _N N 0 0 0 m M Z LL d _ Z 0 0 < 0 N fllW Q Z Z m Z 0 0 F j < F o W W F N W Ca J_ f F C 0 U. p N > > W < m Q f p 0 0 F < z N J J F 0 N W C G 0 J J F ,6 LL u W _J 0 0 N Ku m LF F- m W W < W W 13 0 < < J J < 0 W W W d d W < 'd O Iq :L G I J J LU V \\ 1 WP o�V at V x 104 AAA N 2 0 � H 0 < u J W 0 L W Z N z W 0 Z G Z 0 J LL J F f' m F Z j 0 0 m W Ir < WQ 0 m Z H F Ir W _N N 0 0 0 m M Z LL d _ Z 0 0 < 0 N fllW Q Z Z m Z 0 0 F j < F o W W F N W Ca J_ f F C 0 U. p N > > W < m Q f p 0 0 F < z N J J F 0 N W C G 0 J J F ,6 LL u W _J 0 0 N Ku m LF F- m W W < W W 13 0 < < J J < 0 W W W d d W < 'd O Iq :L G ' 14 S m mm 3 O Qf r D N� n D N O� � O O D D ° i 3 ow O O n w w O o c o<> D* O n c A m o 0 0 D T A m rl0 Z� • D m W D T m m n n Z n O N D; N D BIZ i Or O O r mO2y� OD Z ZnQAnn7mSOT nn yD p m v, N7Cnn p�_� -, naw A O' pG° 00 OD n N'"1 x mm _M OOOZ OOON A Z O 0-1No 110D O o S p O;= c mm A� m m m Tm Z TN; N _ N 'i N Z S .pZZ �y T n ZZ �„ a Z N Z Z N O ol N ti W 0 zDy N; 3 (J N 0 m4^ m n 70 Zm �i r GlZ N GI p 0 pD D N ZDDT30�2�0 0 3 N D D Z Z £ N ^� O Z 7l C Z << o a 101 or) O > ; m N S� 2 D t 0 T m 0 Z m 0 A Z m O r T y 0 N N O { { N y z < Z 10 " _ N O 0 _1111 ��� IST iIIIIII�IIi ItiIIIIIIIIIIII_� Z^'O0cm Om-DZDpOmOv x.Nma + : .=�0D0-+DDOy -t3oz7C *,m DC OT mm D --+i �Dn2 ENODDO vin n �Z t0 �,,,,,, 0 zz CoT2�- TA <NzZ D C ON TO y�"N�O mmar r T n<., 2 y 0 D A _ n O pm m A D m Z �Z O C; < -r O N N O D T Z N C Z O Jo -1 W D O y S -� S m A Z T r D ti; m Z` r Jo N N yn S O A Q o0 O O T S; OO m_ m N-< 3 T I m n N rZo m m ]C m n O Z y T � C) N O Q 0 ~ D CO T Z p y c G Z p 0 O N x C I C C r n N A m 0 Z Z< D P T 0 Z D m y c \Ir1 I Ia A "0 zm0 N x a0g >o p VIII IS IIIJN 0 0 C D z Jn 1 ;a r -i +. D02, 0, w DO yZz '°c �XN D� To, -i U) p3m mx x (A tAO� �z� mN3 HOZ m m�0 NCz o0 m Or �Zr ANO z?z v =v m �> nz =nl mm D0 3 O z N W z 0 0 0 W N s ' Z J0 m 0 W 0IL a ¢ d w mo N 0 0 Z 0 m m 0 r Z 1 W H m m m0 0J LL LL 0 w N N N Z < y i ``C, N J J LL< 0 N 0 z W F 0 0 u u S Qj � OM1 � `z 0 + V i 0 0 0 z > 0 `^ 0 m z o ° (n - s C3 -A r Vth W W W m O W W o < z a W z Z F < Z 0 < N Z O r 0 0 H m u W rn m w u a www z u z z 0 a N <_ F N J 0 0< m o N m W Z u x N N i N � o > W W O r Z � o i t7 Z t7 = D Z U 0 r LL 0 0 0 0 LL = 0 m 0 w w V - m N < x to F 0ro v W � t7 a < m 0 m LL �I 0 �I Z < LL i 0 r u < N J W a a a LL 0 O m < 0 m z 0 F (� 0 W z w W IL 0 it a N z 0 F u D N z 0 z W W L u t W 0 N M U) Z Z t 0 0 s u u W W N N t m > > i 0 0 0 m J J 1= LL LL { 0 N { m W W w 13 U { N a a { w N Ft 0 J J ul LU V W 3 o § o U 0 u u S 0 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out -this section***************** 5-0,q 37d -Er fd APPLICANT: Phone a02 760a LOCATION: Assessor's Map Number /0 ?-C Subdivision Street l Parcel 7 Lots) 3 _4r_( ()Go St. Number ************************Official Use Only***************** ****** RECOMMENDATIO S OF T WN GENTS: Conservation Administrator Comments Y2 1 I &� Town Planner Comments Food Inspectoorr-Health /vim Septic Inspector -Health Comments Date. Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - r-�water connections / 4 ll YS X§ - driveway permit (S; ve q". 35S l': ,. .) I Fire Department Received by Building Inspector Date r , / � 2 / � � � •. k k 3 % � I Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) �� G 7 S fie" 5 &)/SV x!"91;11 'e 5t Lot 3 Map and Parcel : Purpose of Application (check below) Phone Number of�p�licant: X Single Family _ Two Family 37k-y7gY o8) I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in Texist ce as of the effective date of this by-law, provided that no additional residential unit is created. he lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application isfor dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and./or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a, lot which is ready for building permits,(i.e. all other permits from all other boards and commissicns have.bepn received- and- tha project is -in corvpliance with those,permits), avid ihe_Demrelopment-Schedule does nct ac,.=r,--,)date issuing a building p rmit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates icauinq i 0;;r�4; permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate informatio , or the checking off of an above item which does not comply, whether done to my know) ot, is gr unds for refusal by the Building Department to issue a Building Permit. /� �� Si tu/r o Owner or Authoriz d Agent who signed the Attached Building Permit ate This farm must be attached to the Building Permit upon application for such permit. GUNYA CORP. 9 Travers Street Haverhill, Mass. 01830 508 374-4784 August 14. 1996 Budding Inspector Attention: Denny Town Hall Amex 120 Main Street North Andover, Mass. 0184 Dear Kenny: Pursuant to our conversation today.. this letter Nvill ser%�e as an addendum to plans submitted to your office. This specifically relates to building pennit applications for lot 2. 1024 Turnpike Street, and lot 3. 1060 Turnpike Sheet. As there is a setback of 30' from the property lane on lot 2, and a conservation setback on lot 3, the decks shown on the rear of the buildings are hereby deleted. Each plan Nvill be amended to have a landing and steps pursuant to the NNIassachusetts State Building Code. Prior to construction. I Nvill have Merrimack Enaineerine Services. Inc. verify lot comers and setbacks. they will do this again upon completion of as -built foundation drawings which will be submitted to your office for approval. Thank you for your assistance. upon review and approval could you kindly call me at the above number and leave a message as to the amount due for each pennit. and Nvhen I might pick them Lip. Sincerely. 19 ��\9\ u4 CN �I cz �I EO �-' z O d � : � -pp LE v u L d c� � z z Q C� O "C C LE •L :3 GLS T C L U C z w z z � 'L -C.--i :1 C4 G tc O w z v W -C m � v C tx. cy, w z C7 z f� C Ll.. O z w Q v W O L Co y O U) uml z C C .O C ,C O C ` Q O C O O QJ y C 4T ct O � :.._. A 'o O m � E Co • m m c H CIO Q a om C3s O �o mc E N R mm N O N • m 3 = Ca Vl _ m U :� N •� m CD o C rn :ac�� m N m ' :LL O Q1 W d C L •O F-� rn C CL �-- m H mC •C = m m G N d H 0 N m r0+ ~ L Cn tv L m � N B m R C O f" _N =.B Z E c,� � N o CJ C3 m O.O C N CL .O. 0:5 2 cv o yO F— L CL M a M U O CD O O v Z CD CL O y CO D � I Com_ caCD p 'v COO O �O •g m m CD ate_ .00 O .� O i O O i cC3v o Q CL as Q y � O_- O O R V .G. O � CA Zco O C. V i CC .0 C CC y ir 1 Oki • A I ILYA V-11 NINE LMAUFU V= 123 ft North Andover MIMAP October 3, 2016 .:..._.. • : >.-s•.. ��.:.:',::" �.,�: �-'•.. Wit,. I _ c_....ia.M( I, =:_ � •� �altr � ;107�C=00.9.9" 107JC 0094 ✓,p a�t� lU7, C d� 1241TUCKERIF�ARNiRD .0020 '::-i _ .;107 C 0106 -......_• _:.::::_ d;. ..._: •iP �J)i€ t .:;._. -: -_- . _ _ 1 03'TUCKERjFAR �C�d^ M�Rp` _ 10;1,4, TURNPIKE;fiST ` :. .. •yp •,3dt� :••:�llr.: ••. ��� eft . S... \1024 4TURNPIKE�ST l%15 TUCKERiFA. RM; RD;: -•--_ .. 1 -101.0:6097 C ..... ;ltt.: 127TUCKEROARM)RCI 107.0-0119X ..... -7 \� ' �� MW -•c• ._.. t1�060 TURNPIKE�ST'� ... f, ._ :::• ... 1, :c:__ .. .I, :-:... 107.0-0120 , ...,• '`_;_: ::••ci:": _. __.:? _:? :�tr ,` 6SS >SJ,cr : �4ltt �( •� �_ � kV.tr��:==-..._ 107X'-0.0081, ulte 1049 TURNPIKE ST \ �� ..:::::c ..._. 107.0-0017 114 :_:.:.:_. ....... 1, • • :_:_. ::.....I, • :. •:r �t1 :� alit,..::;: u1.tr.:� •. �1.✓ .:�s. _:`' ..•=_�� of, vU�r :' �•Sa1u ',..: ••�atu •�� `�, : ,air:.::... .. ,t, : a'<li.:: ,. � •'� -- .... ... iii •:_.: :.:__ .�. _ _ 1•yr7,;0-.0,009; - t, 309U TURNPIKE&, 107.G0016 107C'-0107 1101 TURNPIKE ST,-- ._ ,' 1'07.:C=0108; os © MVPC Bo Zoning Overlay Zoning 0 Municipal Boundary © Adult Entertainment Dlstric V Busine 0 Machine Shop Village Ove 11Busine s 1 District s 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, — Rail Line ® Watershed Protection Dist U Busine Interstates © Historic Mill Area O Busine — 1 © Medical Marijuana 0 Gener, — SR 13 Downtown Overlay District fl Planne 0 Historic Distdct ! s 3 District s 4 District Business DistrictOt Commercial Dev Dist NORTH T�gp , 'Oh, ? e�+ • •S OQ Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental AffaimIMassGIS. The information depicted on this map is Coria Roads U Osgood Smart Growth (40 C Comd t r Easements C Hydrographic Features O Comd Development Development Dist Development Dist ,; ( O —• "' to for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING ❑ Parcels Industri Streams i7 Industri I 1 District 2 District �, i ,^, THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Wetlands !f Indust' 3 District o�q >>� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF a Industri 0 Exempt Lands - Reside C Reside S District ce 1 Distrix ce 2 District _ THIS INFORMATION C Roeide ce 3 District U$E de 1" = 123 ft •�=de ce 4 District ce 6 Distric de ce 6 District „e a esidential District CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number Aj, p,,3 9 0.43�</�99 THIS CERTIFIES THAT THE BUILDING LOCATED ON J19 9 0 mt% 1 lee, MAY BE OCCUPIED AS 5NFAMIlyE11; IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. of "' ; CERTIFICATE ISSUED TO604) A O r' .. oc ADDRESS I D O TO rAJA8 k, 64% _. c doop 43ACHUS Building Inspector _v y C � o � CO) n 10 0 CD n Z CO) CD ar 0 � � o CL �• y > to O CD Q� ...� CD CD O CD Ica ca 3 CD y' y �• O CQ CD CD � v C O $Z CD o CD CDO i �� pGp �a . 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J�1bwN 0/N �CM�f Cpn,iv�.viTy P.�.vGt '250098 paog e 4A7Z jo -,/al93 s 2 3 ZaT I`3 ti 0 Z FEB - 6 fP V rl k J� 6-;t" Op _ Y � J V Rz O T /N . �O. �.✓o o v�,t�� /%,.o SS /^ ,o,e.4jIV -AOMC C:� vac i Y,4 �d P /917 �/E�•triw�t' E'.vrer�E•rwr` ,rE,rrrcEs .�.voorcc, ,y-is,,c�cvvse-�rs oiaio T�/ o aj I .e i J •f Date INP 3778 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACHUS� This certifies that--�,.�.,..... ........................ I has permission to perfor . .. ............... .......... plumbing in the buildings / at er, Mass. ,North Ando ... FeZC95 ..... Lic. No.. . . . ............................ PLUMBING INSPECTOR 08/05/98 08:58 195-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1 q03 - - MASSACHUSETT UNIFORM APPLICATI OR PERMIT TO DO PLUMBING .ype or print) NORTH. duilding Loca -.-5�no �e FO� r�A New P Renovation Replacement Date Permit # d� Amount �' ►� r Plans Submitted n 1i tA Owner's Name (Print or type) Installing Company Name Check one: Certificate Li Corp. MPartner. nuwJ k 1 Business Telephone t '— I(J Firm/Co. ii Name of Licensed Plumber: Insurance Coverage: Indicate the type of insura ce coverage by checking the appropriate box: Liability insurance policy r7l Other type of indemnity a Bond ❑ Insurance Waiver: I, the undersigned, have been mdde aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus to PI b' o e Chapter 142 of the General Laws. By: Signature of Licenmum e ,71 2 ypee f Plumbing License Title !tC City/Town rcen mer Master Journeyman APPROVED (OFFICE USE ONLY i' Now MONO MMOMMM mom (Print or type) Installing Company Name Check one: Certificate Li Corp. MPartner. nuwJ k 1 Business Telephone t '— I(J Firm/Co. ii Name of Licensed Plumber: Insurance Coverage: Indicate the type of insura ce coverage by checking the appropriate box: Liability insurance policy r7l Other type of indemnity a Bond ❑ Insurance Waiver: I, the undersigned, have been mdde aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus to PI b' o e Chapter 142 of the General Laws. By: Signature of Licenmum e ,71 2 ypee f Plumbing License Title !tC City/Town rcen mer Master Journeyman APPROVED (OFFICE USE ONLY t This certifies that has permission to Date ....... 4 ....... 6 .... ......... k ...... TOWN OF NORTH ANDOVER wiring in the buildidgy of iW at Fee. ..X4�1 .. ......... Lic. No - Check # )7/ 5676 PERMIT FOR WIRING ............ 4v........ d ... 4.-,) .... ;. !.. �... .North Andover, Mass/ 0 ELECTRICAL I INSPECTOR Commonwealth of Massachusetts Official Department of {=ire Servicepermit No. t Occupancy and Fee Checked 0 BOARD OF FIRE PREVENTION REGU TIONS [Rev. 11/99] leave,blank APPLICATION FOR PERNtDate: M'ELECTRICAL WORK All work to be performed in accordanclectrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR T E ALL �y� j City or Town of. To the Inspector of Wires: By this application the undersign give notice o his orM intention to perform the elect work described below. Location (Street & NZZZ7�'rl,Wl )_ Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. - b_ Yes.. ❑ No. W (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the following table may be waived by the Insoector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool grnd. ❑ grnd. ❑ No. ot Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o Detection and o. Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting in Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained . Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kms, Security Systems: No. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: f �((When required by municipal policy.) Work to Start: —4-0,,Vspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thepains andpenalties of perjury, that the information on this application is true and complete. FIRM NAME:Security ces LIC. NO.: 15 _I �jr Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid,9hsee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ ownf T',zngPnt. Owner/Agent Signature Telephone No. PERMIT FEE: $ ,5, L10