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HomeMy WebLinkAboutMiscellaneous - 1090 TURNPIKE STREET 4/30/2018 (2)r N / ,tom �� �✓ 141, NORTH k 3�0`,,.o O�h0L a �o � •" � TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Senior .Center, 120R Main St.,.North Andover, MA on Tuesday the 14I' day of September 1999, at 7:30PM to all parties interested in the appeal of Marsha Telesetsky & Mark Fielder, 1090 Turnpike St., North Andover. Petitioner is requesting a Variance from the requirements of Section 7, Paragraph 7.3 of Table 2, for a side setback in order to construct a 3 -season sunroom and deck, with landing and stairs. Said premises affected is property with frontage on the North Side of Turnpike St., which is in the R-2 Zoning District. Plans are available for review at the office of the Building Dept., 27 Charles Street, North Andover, MA,Monday through Thursday from the hours of 9:OOAM to 1:OOPM. Published in the Eagle Tribune on 8/31/998: 9/7/99. MUlegalnotice/5 CD 535m:-=-� - a c:m. 'Zm w na..m s 'GD CD m.J 0 C=D 0 s 03 0 0 w.. <www �� ' W'QC - a .z m C �.� m � d. m Cn � 3..._ ; y � SO,0 CL Er W W j �` .� 0� DI. O N 0 m W y o-ia J��.. �0?w�.,==gym By order of the Board of Appeals, William I Sullivan, Chairman ' NORTN + OL O A SSACHUS�� TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Senior Center, 120R Main St., North Andover, MA on Tuesday the 14I' day of September 1999, at 7:30PM to all parties interested in the appeal of Marsha Telesetsky & Mark Fielder, 1090 Turnpike St., North Andover. Petitioner is requesting a Variance from the requirements of Section 7, Paragraph 7.3 of Table 2, for a side setback in order to construct a 3 -season sunroom and deck, with landing and stairs. Said premises affected is property with frontage on the North Side of Turnpike St., which is in the R-2 Zoning District. Plans are available for review at the office of the Building Dept., 27 Charles Street, North Andover, MA Monday through Thursday from the hours of 9:OOAM to 1:OOPM. By order of the Board of Appeals, William I Sullivan, Chairman Published in the Eagle Tribune on 8/31/99& 9/7/99. Ml/legalnotice/5 CT m ^��wc�gv wcmgSmn9c�cmEg c cooZpr Wva�°Ww�G�ZIDLNO�N7N�'v'�mNzovoo°.03 -i^^� �p D CL o� m�� -Z 22 w y a =r =rte v cmi w w W o m� W Ro -60 w Q °' a r °w �D. 7Do W O N. o �o D .w c��� ?c _m (n�N ami ?mho aN GNaZ Cn co�'Wm N.a3 �.m -morn-,oy�aciomOnpOr O vlc N D>> Coo3�Z T y w 3 0'0 �' o °' m �o SN w = .m o m�a�io m DQa=<m f. �D moos' v0o95'-M3 y - �<-i, , mz -'�L fD (O �p �.NNfD OC SaN��?NN-.-O tQ �N�%0O CCD Dpi CVO 6=r< (-)M N-C.Wn Oj�IV V ND)7mNN VO. ��Nmmm 1� v -_mow DN p� m N�mm a3ocoio- 6.ao -ID 0Dgwm-rN S• m3<ya KCLKE � o a w <om 35. o4Daim° 7(D5 a3?w9'mmmoR��o»'� 'vN M L a a ( rlcl�_� c� Cad . Vet � Received by Town Clerk: 0 r � �' Lle Ste%' NORTH ANoovE TOI��i OF NORTH ANTDOVER. MASSACHUS AUG -5 A 39 BOARD OF APPEALS APPLICATION FOR RELIEF FROM THE ZONITNG ORDDI NCE Lee Stephens/ American Profile (Agent) ApplicanMarsha Tel PsetskyMark Fielde�ddress 1090 Turnpike S .r t N Anrinyer,Mass Tel. No. 978-689-3774 1. Applicant is hereby made: a) For a variance from the requirements of Section 7 Paragraph 7. 3 and Table 2 of the Zoning Bylaws. b) For a Special Permit under Section Paragraph of the Zoning B -,-laws C) As a Party Acgrieved. for review of a decision made by the Building Inspector or other authority. 2. a) Premises affected are land and building(s) numbered 1090 Turnpike Street Street. b) Premises a5ected area property with frontage on the North (X) South O East( ) Nest ( ) side of Turnpike Street Street. C) Premises of ected are in Zoning District R2 and the premises aFected have an area of 46,172 square feet and frontage of 1 no fee 1. 3. Ownership: a) Name and address of owner (if joint ownership, give all names): Marsha Telesetskt/ & Mart- H ' c�1 der Date of Purchase 1 9Ag" Previous Ownerna,1e b) 1. If applicant is not owner. check his/her interest in premises: Prospective Purchaser Lessee _xOther Agent/Contractor 2. Letter of authorization for Variance/Special Permit required ofg Received by Town Clerk: TON, OF NORTH A INDOVER. yL-�SSACnSETTS M,63 BOARD OF APPEALS APPLICATION FOR RELIEF FRO'�\-I THE ZONING ORDN:--",TC- Q$ L•ee Stephens/.American Profile (Agent) 411 address 1 090 Turnpike St r_�t Applicant r sit Tei pset•sk �'- Mark Pi a1 t3a Tel. No. g7R-689-3-7-74— T � 1. Applicant is hereby made: a) For a variance from the requirements of Section 7 Paraaraph7.3 _and Table 2 of the Zoning Bylaws. b) For a Special Permit under Section Paragraph________ of the Zorung B,-la,,vs C) As a parte Aggrieved, for review of a decision made by the BuildL - Inspector or other autho rite. a) Pre mises affected arc land and buildin�(s) Street. numbered 1090 Turnpike b) Premises aiTected area property with frontage on the North (X) South () East Strut. side of Turnpike Street C) Premises affected are in Zonin<z District and the premises a6ected have an feet. area o i 46-,172 _square feet and frontage of 1 50 ;. Ownership: a Name and address of owner (if joint owiriership, Q,ve all names): Marsha Telesetsk & ;4 t' "I Date of Purchase Previous O'Wnernnne b) I. If applicant is not owner, check his'her interest in premises: Prosoective Purchaser Lessee —_Other Agent/contractor 2. Letter of authorization for Variance/Special Permit required � of 3 4. Site ofproposedbuilding: Rear right sidefront; 14 -wide 10' 4 feetdeepp: of home �Z�X lei P T-,��CK IJ(G�x6f /P,4e fJ�Q"'r Height 10' stories: 1 feet. a) Appro\imate date of erection A. S. A. P. b) Occurancy or use of each floor: 3 seasonnsun room and 12'x14' P.T. deck 6'x6' landing & stair: C) Type of construction Prefab & P _ T Woad Has there been a previous appeal, under zoning, on these premises'? NO When 6. Description of reliefsouQht on this petition Relief from side yard set baric requirement leaving 23' were '3p, i s requi rari %. Deed recorded in the Re«istry of Deeds in Boot: No. 2933 PaLle 195 Land Court Certificate No. Book Page The principal points upon xhich I base my application are as follows: (must be stated in detail) The shape of the lot and the topography of the area create this hardship. It is reasonable to expect to have casual living space in a home. Other homes in the area have enclosed porches, decks etc. I agree to pay the ng fee. advertising in newspaper, and incidental expenses'` idi Sianature of Petitioner (s) 6 of 8 WORE' SHEET DESCRIPTION OF V ARI42NCE REQUESTED ZONING DISTRICT: Required Setback Existing Setback Relief or Area or area Requested Lot Dimension Area 43,560 sq' 46,172 sq' Street Frontace 150' 150' Front Setback (s) Side Setback (s) Rear Setback (s) Special Pernit Request: 7 of 1)1 136' J-A-�3-99 TUE 10:03 P.03 jit` ^9 `i �' �1R ; i : !i i CAN PROF :LF.� : x�,. � U, 003 Uri UTU—) 1'�- r 's -VOWN OF NOR7M ANDOVER USY (3E i?ARTIES OF INTiEST: PAG>!;„_.�—, sUBJECT, PRv17 PTY A41�EiE/5S MAP PAR # NAME 07 D mm ar3�fQ c .1 y 1076 2! o/' ` 7- -- .�- rlo ?//� 141 i_ t 151 � !�,_.�--.-= -• — .17 —�- i ETl-li5 LISP OF NAMES & ADGRESSi-a 01< PARTIE-50 F THIS CERTIF'ES 0 4LY THAT O 1 AS iP. TH PP' CANT FROM THE RECORDS ar THE ASSESSORS OFFICE.fNTEtiES T WPR E ASSESSQRS OFFICE I AFFIDAVIT I, the undersigned, the owner of the property at 10Y -i'z'ee ' Hereby verily that I have authorized Lee Stephens/American Profiles to apply to the Building g ne parlment of the City of Alcr (� �'�� 6�� ', l'��- I Cily State to act as agent oblaining building permit 111(1, or any zoning requirements needed to oblain permits. -� Signalure oi'Owner Address ol'Owner 16P IwA-o'zf Date, 4/16/99 14:48 rcFnF comm 0000 Co m CR Eq `'saa rrr -ai ^ai y 000 2 2 2 tm A A 000 w-�iy Rf tq p n NCA m 1 O m A W.4 I 1 0 'O '9 TEMO, Inc DAVID CENTORBI (ext 219) ->LEE 2/2 O Iv O 9l/S Z 9l/S Z 2 5/16 2 5/16 Q I O i /,0, X/Y , �V l few . zi I h. ats � 14 r, f i� ll L.vr� GYM �j �I rZ\/4T1r)N1 6 rr 5/4 x 6" cap 2" x 2" trim, 2^ x 4" mil 2" x 2" pickets (max 4" opening 36" 4^ x 4" rail post (max S' o.c_) Exterior wall t. ,e- 2" x 4" rail 1 " x ;" trim 514 x 6" decking Flashing i a y t5c, JUL-1,3-99 TUE 10:04 � m C o a ti x ; co o co r f N V1 '� > • � O 1 � �x rn O CO m a 5o N n �Q 8 i f P. 05 atiou 1$;uj `4. 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JUL-13-99 TUE 10:04 I■ 1 P. 04 a corporation duly established under the laws of Massachusetts and having its usual place of business at 124 Grove Streets--`�ank.lin, Norfolk r , of County,'-1Ylashrzse:§;�`7i tonsiieration of Thirty Six Thousand and No/100 (36,000.00) Dollars "r ; grants to Marsha Telesetsky of 99 Willow. Street, No. 7, Chelsea, MA with quttrininf. rournantii ih&,&V� C;. A lot of land situated on the northerly side of Turnpike Street (Route 1114) in the Town of North Andover, Essex County, CommonweAlth of Massachusetts, and being shown as Lot No. 5 on a plan entitled: "Plan of Land in NORTH ANDOVER, MA, Prepared For FORBES REALTY TRUST, dated April 3, 1986, drawn by Christiansen Engineering, Inc., and recorded with the Essex North District Registry of Deeds as Plan No. 10242. For Grantors title see deed dated April 28, 1989 and recorded in Essex North District Registry of Deeds at Book 2933 Page 195 This sale is not a sale of all or substantially all of the assets of the Grantor. 3ln 3Uittten 3Vbrrrnf the said First Parkway Corporation has caused its corporate seal to be hereto afRxed and these presents to be signed, acknowledged and delivered in its name and behalf by Kate McDermott its President hereto duly authorized, this 16th day of tfarch in the year one thousand nine hundred and ninety three --z CA CA.: Signed and in presence of First Parkway Corporation by�& r— 9 7/1 . �Lit!•C �B1i 11 D t P Re s id en t y C ss. %- 19 Then personally appeared the above named Kate McDermott as iir6i/she is PresideuL. of Fa.rst Parkway Corporation and acknowledged the foregoing instrument to be the free act and deed of the First Parkway Corporation a�!R. tl �Lfi 01Lu j - i Donal C.. Mc Lr, ublic U ^•.., •- •� `-'r :� L_i / -eek. c� afWfice of the Peace � •�. `,•:i' may' ',. -. My commission crpire9-,. ��,.�,.•;'•�+ ` � � 19 t� z 4/16/99 15:01 TEMO, Inc DAVID CENTORBI (ext 219) 4LEE 1/1 m r r 21 R z D Z b b G O o w-nw- APROALE o �) 0 at a? N N J ', m m Ln Ln � P, w w D r A C m r > Cr] O N 4 fel Nz m m x x x 1 � 9 Ca � d N F o O m r O V > V V D L D o o O O . 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L' U •� O I�\`{ ,� Z x x C A ll n n �F, C, v x f oA N u x a x m T. x ri UI v O D D D D D a N o N 0 r N z Q n n e c m S x' m A O .Z_1 O O? D D D D � r� x ` o y xI D F 0 M> _ ,y �Dr �r �r �r (�r p n 'X o N ~ z i ? 4 Co y m0 O Z \ A y - o v v rA E 2 < _ 2 ~❑ z �` D A u u9i O Co u E n e rn to t- m N pN C (mil m D (q D 1 m g r m ❑ L I ° O z r a N G7 i4 m y Uo N r D D r U1 � CD Z Z D D Z Z D D Z z D D m r r 21 R z D Z b b G O o APROALE o �) = y $ '3 V m Z_ �^ c D A z m r > Cr] O N 4 fel Nz m m Dzm N o � 9 Ca � d Ca m o "0 Co _ A a O ^ O _ < m Q O m z7 O Cd m r r 21 R z D Z b b G O o X 0 a i X y X V Z_ LA O Dzm C o o � m � d m o Co _ A a O ^ O _ < m m O m z7 O � N z 2 H � O D o O [� m r r 21 R z D Z b b G O o X 0 2 X O X V LA Dzm C o o � m -PAxl m o ❑ ^ _ < m m O m z7 O z y H � O D D < O D - _ I " rl p ,� o n M x m z Z 0 u y I Z7 1 m y unAi m M• r< z° C1i D { • v O n x� rl m Im a f • m� >�Ai O = O O V 7C A z z I N N Z O m0 Co m I 2 � m Gom �o z c a� z y p< �1 4/16/99 15:00 TEMO, Inc DAVID CENTORBI (ext 219)-i LEE 1/1 FILENAME: 99W3900 04/16/99 APROFILE =x z D N�f'41 yyx0 G% 0 LD rT' F rar-L3 r�0 1NAZ maNru O CLI EN T/PROJ. FIELDER CUSTOMER SIGNATURE: DRAWN BY: DAVID CENTORBI DATE: PH. ( ) 0 C: z 1n3 i rn �r> x8A r D N m x �N3p 3 O O rn0 SCALE: NONE ATE I REVISIONS V" II III m x z —I 0 v m — n z _ P °o, + CLI EN T/PROJ. FIELDER CUSTOMER SIGNATURE: DRAWN BY: DAVID CENTORBI DATE: PH. ( ) 0 C: z 1n3 i rn �r> x8A r D N m x �N3p 3 O O rn0 SCALE: NONE ATE I REVISIONS 4/16/99 14:58 z_ x Z D m Z Z 1 m n D n D m m m 0 L3 r - W O 0 Q � om m m m rn X . Co CD D v m z 0 0 m m U ti i �D�� OcAO_ rn yrnDN zArn� O Ju D f4 0 OA�< Z°o 3 z z O Tn C: tlD a 0 1-9� m 0 m Q 1Dom�mm �r4 =r m 01n hh c Z r0LAo n Z -<n m 0 Cn 0- D Z 3 D Z r M m e m D r 0 x C -)Z i m Q i ? O O Z I _ ZQ� Dm o 0z m 1 0 TEMO, Inc DAVID CENTORBI (ext 219) -+ LEE 1/1 0 i 0 D '1735 MOCVIM .S '1735 WdNIM .G uT 0 x � X o — � O_ Z I u 3 z B' IHINDOVt SEDT. W KNOOK SEDT. D CLIENT/PROJ_ ( PH. ( ) FIELDER CUSTOMER SIGNATURE: DRAM BY: DAVID CENTORBI DATE: SCALE: 1/4"=1 zm x 1 tP Oz m� n �� ?r N� I rn a� m N m x A z DATE I REVISIONS z` 4/16/99 14:51 TEMO, Inc DAVID CENTORBI (ext 219) -*LEE 1/1 cn=vz DZmD D Zr 2p m N D r N C r o m M>snD I 02 00 nfr- Ln C4 n0Z y DVI (A D y r Z O> Z N EA CO m U Z) 2(Ao �m00 0>mCA Ll rl rnCC-00Z X�m� m D XM C3 m0 CLIENT/PROJ. FIELDER CUSTOMER SIGNATURE: DRAWN BY: DAVID CENTORBI DATE: PH. ( ) I SCALE: NONE DATE I REVISIONS Commonwealth of Mass c't usettsFOccupancy Oficial Use Department of Fire S ices d Fee CheckedBOARD OF FIRE PREVENTION R GULATIONS leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 9MR 12.00 (PLEASE PRINT 1NINK OR , A FO ATION) Date: pS a City or Town of ) To the Inspector of Wires: By this application the,undersignedQgives notice of his or her intention to perform the electrical work -described, below. Location (Sttes X Nu/mber)-%61 / � .� �`c• � .%/ �' ` c a r y y��� Owner or Tenant Owner's Address Telephone No.IZ7Y-6V -� �\[� Is this permit in conjunction with a building permit? Yes [vr No ❑ (Check Appropriate Box) Purpose of Building�,, , n r Utility Authorization No. Existing Service SLU Amps it 9/ 11ji volts OverheadIN Undgrd New Service Amps t I j/ d tk.�olts Overhead ❑ Undgrd Number of Feeders and Ampacity / jnPr Location and Nature of Proposed Electrical Worl-' 't O k No. of Meters No. of Meters 1� Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. s Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of LightinggrmFixtures Above In- Swimming Fool d. ❑d. o. o Emergency tg mg ❑ jDattery Units No. of Receptacle Outlets 0 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches�y t+� No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers HeaTPo�. Number Tons KW No. of Self -Contained IDetectionfAlertingDevices Space/Area Healing KW Loral ❑ Municip Connectial [I Other on , Heating Appliances KWSecurity Systems: No. of Devices or Equivalent KW No. of No. of Data Wiring: Suns Ballasts No. of Devices or Equivalent Bathtubs No. of Motors Total HP _ Telecommunications Wiring: No. of Devices or Enuivalent 6 Auack additional detail if desired or as required by the Inspedor of Wires. COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless oovides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The xtifies that such cois in force, and has exhibited proof of same to the pier tiitt issuing office. INSURANCE 7OND ❑ OTHER ❑ (SI�fy-JILI,lIt T 1.&Hvw- bs (Expiratio Date) z ofEledtical Work .1!- (When required by municipal policy.) a - 0 S Inspections to be requested in accordance with MEC Rule 10, and upon completion. rthepains and etralties oJperj ,that the information on this appliegtion is true and completr~ Ca `L LIC. NO.: 9/IIfi�ii/�111I)WIAUADSlb Li(' -NO-: Aal� 0 wj �s Date. �/ ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSE� l _ This certifies that .,WZ ................................. ............ has permission to perform .....1...eAwj/ !,L wiring in the building of ..".... k/Z!............................................. �r..1+.�.. , North Andover., Mass. Fee. a..... Lic. No` #.� X ........ Y�'f_ ...F�, f1 1.,!'� ..... ELECTRICAL INSPECTOR Check # 562`i Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATI? APPLICATION FOR PERMIT TO All work to be performed in accordance with the M; (PLEASE PRINT WINK OR City or Town of: ; By this application the undersip Location (Street & Owner or Tenant Owner's Address s or her 5('t f? FOficial Use O9go d Fee Checked leave blank rORM ELECTRICAL WORK :tis Elcctriwl Cock (MEQ, 527 9MR 12.00 Date: �S Q _ To the Inspector of Wires: to perform the electrical work described below Telephone No. Is this permit in conjunction with a buildin permit? Yes [p No ❑ (Check Appropriate Box) Purpose or Building , ` L Utility Authorization No. Existing Service ' 7(7 Amps It 91 12-0volts OverheadIs Undgrd 9 No. of Meters s' New Service (i Amps a AaoltsOverhead ❑ Undgrd No. of Meters 1_ Number of Feeders and Ampacity / )o t Q 1'n 6 Lc i Location and Nature of Proposed Electrical Work' W t r•.,..k.,lotinn nfthe fallnwinr table may be waived by the InsDeclor of Wires. Attack additional detail rydetkred. or as regkured by the Inspector of Wtrts. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the Iicenseeprovides; proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cois in force, and has exhibited proof of same to the permit issuing office. / cHEF- cK oNINSURANCE V BOND ❑ OTHER ❑ (specify.) i 'i 1 t 7 bs (Expiratio Date) Estimated Value of EIectrical Work (When rtsquired by municipal policy.) Work to Start: — a 0 3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cert, under thepains and enulties off. peg ,a FIRM t the information on this application u true and complete FIRM NAME: �(U LIC. NO'.:]h /�3 t- - LIC NO-: Licensee: /b Signa ,v4- _ D� (Ijapplicable. ent "'exempt"'tr li a 1' �pj Bus. Tel No.- ff Addr$ss- t; ' !7 `D Alt. Tel. No._ OWNER'S lkqSURANCE WAIVER: I am aware thit the icensee does not ave the liability insurance coverage normally requira►d b_y law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent- Owner/Agent I PERMIT FEE. $ , Sianafirr» Telephone No. of Total No. of Recessed Fixtures No. of CeiL-Susp. (Paddle) Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures AboveIn- Swimming Pool d ❑ d. ❑ o. o mergency Lighting Battea Units No. of Receptacle Outlets 0 No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches p No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump: Number Tons KW No. of Self -Contained No. of Waste Disposers Detection/Alerting Devices No. of Dishwashers ace]Area Heating KW Sp g Local ❑ Municipal ❑ Other Connection , N&tif Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Sians Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attack additional detail rydetkred. or as regkured by the Inspector of Wtrts. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the Iicenseeprovides; proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cois in force, and has exhibited proof of same to the permit issuing office. / cHEF- cK oNINSURANCE V BOND ❑ OTHER ❑ (specify.) i 'i 1 t 7 bs (Expiratio Date) Estimated Value of EIectrical Work (When rtsquired by municipal policy.) Work to Start: — a 0 3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cert, under thepains and enulties off. peg ,a FIRM t the information on this application u true and complete FIRM NAME: �(U LIC. NO'.:]h /�3 t- - LIC NO-: Licensee: /b Signa ,v4- _ D� (Ijapplicable. ent "'exempt"'tr li a 1' �pj Bus. Tel No.- ff Addr$ss- t; ' !7 `D Alt. Tel. No._ OWNER'S lkqSURANCE WAIVER: I am aware thit the icensee does not ave the liability insurance coverage normally requira►d b_y law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent- Owner/Agent I PERMIT FEE. $ , Sianafirr» Telephone No. ro rxiO cn z ril z i H H z o ro H � n o C z H 9 r z rro O PO o O � H H .D C1 ry E x i