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HomeMy WebLinkAboutMiscellaneous - 150 LACONIA CIRCLE 4/30/2018 150 LACONIA CIRCLE 210/105.D-0163-0000.0 ` t 1 1 II } As 0 X5'0 ®` ((tt�� �j� �.} i a f 04C TommunlUl:# If fflusar4uuttOffly.s Permit N (® i3epartment of Public —*afetq Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) -25- 7-S ( TON) Date s RTH ANDOVER . City or Town of N() A () To the Inspector of Wires. The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 50 LA-ColVIA* Cie. Owner or Tenantg1 A\,(/,O A2/ hM(0S Owner's Address SA al AS .4'82V-C Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building 'Baser>7"u f FlNI's 6,) Utility Authorizatioonn, No. Existing Service 200 . Amps /2-0 / _Volts Overhead ❑ Undgrnd lYJ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work TO CHIP--K' 0(,t-F Q,0--ne/c, C WO2Af- oAJ E 0wh41�:,e o F l M No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures /_ Swimming Pool AboveE, In- �J grnd. grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal ❑ ❑Other Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to the Office. YES NO C If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAJE LIC. NO. r Licensee �QP F- "RI146PAML U71'— Signature / LIC. NO. 2 z G Address 192-1 SAL-Cm ST 40. AyapVfeg2 BA t. Tel. No. SOA-) 6 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, a d that my signature on this permit application waives this requirement. Owner Agent =k e k one) � 2 Telephone NoX908 PERMIT FEE $ (Signature of O er or Agent) x-6565 � :R Date... ... . ... .. .. NORTH o?°e' TOWN OF NORTH ANDOVER '° PERMIT FOR WIRING IQ+, .�•" ,SSACHUSES This certifies that .... .... ... :. � .! t ..... f :. ..... : . has permission to perform ........................................... 19 wiring in the building of......�..�..f� .... ................................................. - .........:v.:. ` .............. ,North Andover,Mass. 8 Fee.tea,}:.....-T:... Lic.No, ............ ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CGOLD: File ANARY: Building Dept. PINK:Treasurer COMPLAINT NUMBER DATE: #4 JANUARY 24, 1995 COMPLAINTANT:DAVE TIMPE CLOSE DATE: ADDRESS: 150 LACONIA PHONE: 688-2908 OWNER:LISA BRESNAHAN PHONE #: ADDRESS:851 FOREST STREET INSPECTION DATE: ORDER L DATE: COMPLAINT: APPROXIMATELY 4 MONTHS AGO THERE WAS AN OIL SPILL IN THE BASEMENT OF 851 FOREST ST. AND ALL WAS CLEAR WITH EPI. AT THE PRESENT TIME THEIR BASEMENT FILLS UP WITH WATER AND THEY HAVE ACTION: TWO PUMPS PUSHING THE WATER OUT INTO THE PROPERTY AT 150 LACONIA. MR. TIMPE REQUESTED THAT THEY DIRECT THE PIPE ELSEWHERE BUT THEY WILL NOT. THE WATER FROM 851 FOREST STREET IS BEING PUMPED INTO 150 LACONIA BACK YARD DIRECTLY ON TOP OF THEIR LEACHING FIELD. THEY ARE VERY CONCERNED ABOUT THEIR LEACHING FIELD AND IF THE BOARD OF HEALTH COULD INTERVENE. r �- ♦ Lt)uu p, z) fa� IN �. .. W .. ... �. ;. .. .Y �t d'•`+'�ad��`ti� � �a4`x k>;e �d. ♦ r.���, .l��l.i� i.,,7iw�.4 .t�u.•';. NORFOLK ENVIRONMENTAL Andrew T. Donoghue Environmental Scientist 378 Page Street-Bldg.#10 one Stoughton, MA 02072-1141 PhFax (617)297-5200 - Fax(617)297-7050 F W� ;V, -•-rte .,,� i COMPLAINT NUMBER DATE: #4 JANUARY 24, 1995 COMPLAINTANT:DAVE TIMPE CLOSE DATE: ADDRESS: 150 LACONIA PHONE: 688-2908 OWNER:LISA BRESNAHAN PHONE #: ADDRESS:851 FOREST STREET INSPECTION DATE: ORDER L DATE: COMPLAINT: APPROXIMATELY 4 MONTHS AGO THERE WAS AN OIL SPILL IN THE BASEMENT OF 851 FOREST ST. AND ALL WAS CLEAR WITH EPI. AT THE PRESENT TIME THEIR BASEMENT FILLS UP WITH WATER AND THEY HAVE ACTION: TWO PUMPS PUSHING THE WATER OUT INTO THE PROPERTY AT 150 LACONIA. MR. TIMPE REQUESTED THAT THEY DIRECT THE PIPE ELSEWHERE BUT THEY WILL NOT. THE WATER FROM 851 FOREST STREET IS BEING PUMPED INTO 150 LACONIA BACK YARD DIRECTLY ON TOP OF THEIR LEACHING FIELD. THEY ARE VERY CONCERNED ABOUT THEIR LEACHING FIELD AND IF THE BOARD OF HEALTH COULD INTERVENE. I CPHONE CALL) FOR ��) DATE TIME M OF PHONED jj PHONE Y(1UR CALL AREA CODE NUMBER EXTENSION PLEASE CALL MESSAGE WALL CALL AGAIN i p v� CAME TD . cJ�(rvl/ SE£YCJU. WANTS TO 5EE YOU' SIGNED TOPS FORM 4003 FO DATE TIME/S M PHONED' OF RETURNED PHONE YOUR CALL ' AREA CODE NUMBER EXTENSION MESSAGE PLEASECAlL WILL CALL. AGAIN CAME TO; -SEE YOU. ' WANTS TO SEE YOU SIGNED TOPS FORM 4003 ofNom.i� DoT Gl-C C./Jcrsiy!/J C c*J T (mP�! - 6 .... )vpPU �bWnl ❑ WEU- AP oycDlYJT'C - Sti 11 G SY S i�M 1VE51<� APR0UPJ6 Aul-tiol?ITy PEA&) De516/1 C- r' �v �� - , � �A kzz6�" DI-sAPPPUVEp - Co,lip���o�5. " 12 -;W45S E] F:A R�4SoNS = h D�-� Sc�--c c SY5TEN1 1�SQA t.t.QT►o�.J rioA-) PIPE FI OA-\ 1-1006 'FO T/J 0 t� Ll Pry S5 `Q F/OJL NS%/flr.LG(i � � k'tcO DI �P��vv�D D,arC I��/j5o rvs , FVvgL /dPPI?DvAL DACE -ZZ- C/ APP) 16 6u-,Hog, i-�j cls b , M s 4 � rti 6h 10, 1 — ?t q �1 ' Ilk � e y f�`v�-0 1�;•%. 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GG � -¢983 � � � �'9�° v °a�� l DESiG,U DATA = TYPE OF BU/LLt/,414: 3 6 -R- .DL. o r ,t QArtAGE f CE'G1�4,� PCuM8lAl4 F-•!C/L/T/ES : /•�`'r� , !t� , 1� �� c� � � SEu/.1 G E FLOW EST/.yfA TE: �fd'G G P•I3 SEPT/C r4AII< : /- ,00 C,,e9/. \ `%t q• �° �� � y .4BSGi�OT/GN .I REA /OOo S•F• �g E„'� /�•4 E / 2 Mrd 7L100 ECE✓Ar/O,-J ' B07-Tt7M 464ev-4 rA::D" �it .,..,., �\. �.. �°• � ��' / � //0 14Z Y DROP M�•ti All iC.KaLA rR-477 © TEST P/rS / �Z •3 TOP 64EJKA7-/ 'AOR 4. fo/ 7 ANo sqvdy W A rc.4 rA B L E t/LOCA r7a Al k „�,,.. '' � � ! � / / � ���" ' X53' E43•� o � � / i \o �,� BO rrotit ELEV4r1,0 TESTS CGwD/j(:rEACi BY .TOSEFN r 64R,3ABA000 , R S \o J,ob / e r(i•/�'1 Ica .6 E a 7�._/,,k'/ �� W1 rVE.SSED dY YIZ-4,v 4 D,6S16.' Ge/rE,e/A cSHEEr / of a so�,o Pvc. P/PF 411 P,4ZLFAI 7-j f ,../ • a J C2�1 o cAPPEp c ENDS '� oe E uiv P/PE Q ALENr) G. 1/,4L BES E p E T/D IV . LE �p" D.. (FOe SPEC/F/CA TiO,VS -- _ r► 1 SEE sECTlOA./ QT - I " CAST I,PDAJ, s . , h /.Sd O 94L. CDit/ _l GQETE SEPT/G TANK -OhV t5 .sctiya• prc. I --LLT V To 1SC.46E -17,0 _/07 '- o $ -ION jV • c'S'R -r�3 Svc. �3'ELEC7- - v e _ A1C �!L '� � .,^,- . . .n► _Jay Ole � � •• •, � - � �O�j„S -/b� '' s - -� •• = � �ces '�B" wAsf/Eo �' �� -�/g .. u H�-v STONE •. /. . CD 7-0 /" IVi4SyED it d CA:>41IEDwT � MEET RSNE'�ZVf. -v PEC T .�. _40. s'�/• w• q� - Q Ow i . •- v tG T/pit/ toe4123 T/O NS - �HEE T 2 411 2 f ' �..�.......�...�.........e�....+.. ..,�.:..w_.......�...rs«uw.�u-.. :a......i.aew..�>w...anwaU:,:` -� .,wuw...w....a.......«_...�.«.o._..._......_..s..� adir coy H ..� . .V .. �.��. .r7.... .,.. '� L4 COW &Ae� ~ ' e r Y i 4 1, Z o 7L 9'c J „ErA � r Q fes, i I K..�..,.....,..nrvs�e..Hexa«rwo.«er..im;.w..w...,n..'�a.ew�ww�.,.a.wasn�aa�•rrnri..,wn.�.ewex:ur.M.,s,<«.rn.�........,.u��«...,�w�.....;<.........�....aw.«,..y,rcv.«..�v...,,.,...`.�,,...,.rz,.,M.,,_ ' � l r r• •i1, ,I. RECEIVED ,�•1•,'!,I�,•�,,�: ���� ��l°�' 1 r.9�°!c�r;,�•�,fm,� ��;c$�.�:,R e,c o"r d • ,�..•,!.,•i•'. �,«1,,�;��•;�}�',I;yil;.�..'�4;Y1�'�; TOWN OFNORTH ANDOVER oeP,hei piovlded Wo loth for Ivo �,�, !De . 0 vi Soar HEALTH DEPARTMENT Illod Io lily IOCrI � c+ of ^ua •.. • ClI7 i • ,. 0 1�.�1.0 •In A, Facility In(orm. (Uon c r'.Inollry ..x,74,•,!;:� , -'� ••r '�� �,, 611 ntr'm';7; I u�,'i; 'lY�'t•; '� �' !• �•.'!,c•.1•l .•„ : 'r.,'. , " $1111 71 �'�.•SYS�. •I 2 ,,.. -------� �, ,. , .,lddlr�, (114Vfrrlrnlrlwr7`,, •' � ^ I i l r 9npn, n.m01� r F •;,, A 118'RaCord ' . - ;��� �:;I{,.I.. . ,jl�,.,''7•-,�.1�'-'� "-Osie o! Pumpin9 , 'Typo 91 +y31om, r-� •'�,: •l;' ... 1 i':.. g7001(y) $9D(!C lan, rl Ter. ( esc(ib9�;' .E m l�van.l Too Flllo(:Pl.v„aonrl [' Yoy No• ,,•':,)`,'''r,,�J''TIl'•''; I !'�`+,;,,�y(I,,r,•. � :';, '�,� ��''. � ,I ���„'a)'' :f•'.'I, IJ , , �. �eanao7 Yes /•, r'�l„ d. It 'I' Sr � � C-0f1{1 h'�.T•rl if on.Wh 0r)lonU:ye/e dl�poseo: • .. . ;; �d� /tel/'+r �' /1181J I, ' � , .... . �; ,eDD/9YeJailblorms,n�mai.�s�eC1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD - DATE I GP ` SYSTEM OWNER&ADDRESS SYSTEM LOCATION kl,g ND 011,VD6 ve-k IWO . DATE OF PUMPING QUANTITY PUMPED /2W CESSPOOL NOYES SEPTIC T - ANK NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES Rf LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY Q COMMENTS: i CONTENTS TRANSFERRED TO s. �� TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) 17'1 r 'I '�fir)pie- m r I 1 1 Ala- DATE ATE OF PUMPING: I QUANTITY PUMPEDMDQ U GALLONS CESSPOOL: NO ✓ YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS —� FLOODED _ SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: 0- r-44,6 COMMENTS: CONTENTS TRANSFERRED TO: 4 ���0VeK ® MAPFRE The Commerce Insurance Company-Im Citation Insurance CompanySm Commerce " Gore Road,Webster,Massachusetts 01570 INSURANCE- 508.949.15001 www.commerceinsurance.com April 23, 2015 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MAO1845 RE: Our Insured: DAVID A TIMPE/DARIA A TIMPE Property Address: 150 LACONIA CIRCLE Policy#: BDKTNX Date of Loss: 02/16/2015 File#: JYJX81-HPXPCI Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. AMANDA MILLETT Telephone: (508)949-1500 Ext: 11492 CLAIM REP SR, CASUALTY Toll Free: 1-800-221-1605, Ext:11492 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. April 23, 2015 Ice dams caused water leak/damage to bedroom,kitchen,and living room CIC 254 (Rev.4/95) MAIL I69 \-'-�c'"..,«.. Location + 1�Ac No. 2l Date p r- HORTIy TOWN OF NORTH ANDOVER .,,�00 ... p Certificate of Occupancy $ Q * = ' Bultding/Frame Permit Fee $ ,,• , ITS Foundation Permit Fee $ cHus Other Permit Fe � l $ Z,^e Sewer Connection Fee $ _ Water Connection Fee $ _ TOTAL $ � ` Building Inspector TQ - 3 © Div. Public Works PER11IT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP i-40. I LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZION E SUB DIV. LOT NO. I — LOCATION 1,6 I /� „Qy 1;A C i^ PURPOSE OF BUILDING OWNER'S N1 ���Tr C- V�Nj`� b�^�•_ NO. OF STORIES \/SIZE OWNER'S ADD`��SSA / �rrr����..�Lp111��1•n �,�� t/ BASEMENT OR SLAB ^ �� d`�•'J JC ARCHITECT'S NAME �j SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME C \\ SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION ` LAND COST OQ 6 SEE BOTH SIDES �� �-[\-- EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 ��'_ \ EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR °DATE FILED MUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED`AGENT F E E k U'l� OWNER TEL.# PERMIT GRANTED ( CONTR.TEL.# J 19 ^ CONTR.LIC.# H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S�OkIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY VJALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 1/7 1/1 FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH __ ASPHALT SIDING HARDVJ'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK .. SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROIL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st -1-3rd I NO HEATING NORTH Town of Andover No. 215 4; dower, Mass., 19`x' " COCMICMEwICK 7�ADRATED �� H BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT � -">AZAA..711.p*........................................................................................ Foundation has permission to e,w..AQ%Mrl ................... buildings on A.'0....A!;� N.....OA!Z................................... Rough to be occupied as�. imn y t-u��.....�Rpzer! .... .�� ��o.. .... . � ..�I�tI... Ch' e provided that the person accepting this permit shall In every respect c nform to the erms of the application on file in Final 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 E %. 6MONTHS UNLESS CON T ELECTRICAL INSPECTOR Rough ...... ............. .... . ... Service B DI S CTOR • Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT TOWN of NORTH ANDOVER AFFIDAVIT Hie mart ardzwtor lay awlaanit bo Femit PpliLtim J. M�c. 142 A mqnivs that the ' alteration, re nmatim, repair, I Uation, mma:s im, inprmm r,t, remol, dablitim, or omEt nrtim of an aciiitim to any pre- edstirg aaier-ooapned btrild- u g cmtairmg at least one but wt mxe than far dAe1l9 g unts...or to sU rtes 4dd1 are adjacent to soh residffm or hAldug"be dom by registered axdz tccs, inth own eceptRus, slag xuth other reci dramnts. Type of Work: Est. Cost Address of Work C� f�6(-C),,J Owner Name: Date of Permit Application: - I hereby certify that: Registration is not required for the following reason(s): Rr offine Use Only Work excluded by law Famit ND. Job under $1,000 Date BuiIding not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WTIH UNREGISTERED CONTRACTORS_- FOR APPL.ICABIE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Sided urrkr penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above r ty: �- Date Owner -Name i i l i I I 1 I , f r r,f t v i 49A i .......... \:7 - .tom•.-�� .�� 1� �_/ � /\ Y\,ti��� ���� ' /\ /' -� _/ l \ t- 1 �� ���_��-_/' _/ -. \ � � .L�� �1� _,^.�../r�.