HomeMy WebLinkAboutMiscellaneous - 88 PHEASANT BROOK ROAD 4/30/2018.,.
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Cunningham Lindsey U.S., Inc.
P.O. Box 703689
Dallas, TX 75370-3689
Telephone(888)738-8714
CLCAT@CL-NA.COM
March 20, 2015
Facsimile (214) 488-6766
TOWN OF NORTH ANDOVER BUILDING COMMISSIONER
NORTH ANDOVER TOWN HALL
120 Main Street
North Andover, MA 01845
Claim Number: A033547423
Policy Number: 53750400005
Company Name: Arbella Mutual Insurance Company
Date of Loss: 02/18/2015
Insured: SEAN MCGUIRE
Cunnin haVa
m
Lindsey
Property Location: 88 PHEASANT BROOK ROAD, NORTH ANDOVER, MA 01845
To Whom It May Concern:
Claim has been made involving loss, damage, or destruction of the above captioned property,
which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6,
to be applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer. Kindly include a reference to the captioned insured,
location, date of loss and claim number.
Date ... 2.-...zg �- o rs
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
v
This certifies that ... ,...........
. CC'l�02 S
� has permission to perform .......... ...........�.............:..`..��........,�!��? �:'.`9 ..
Ik wiring in the building of ....... � .......... .........................
�t.
PSE
s at ............ .................��l�ri�....�!C�F.��.:......�, North Andover, Mass.
so j$'33c
t Fee../S.......... Lic. No...............:1-.% r*
a ELECTRICAL INSPECTOR
Check # 009/ ((J
6891
Commonwealth of Massachusetts Official Use only
-- O
-- Department of Fire Services Permit No. to
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051' (lease blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All NNork to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.00
(PLEASE PRINT IN IrVI: OR TYPE ALL INFORM TIM[) Date:
City or Town of: � TR R Q "Z� < -i e e— To the Inspector of ' JlVires:
By this application the undersigned Rives notice of his or her intention t -form the electrical work described below.
Location (Street & Number) $ 6 P`c? r� <
Owner or Tenant
Owner's Address
1.1
Telephone No.o�-�s_�Cp%�
Is this permit in conjunction with a building permit? Yes ❑ No� (Check Appropriate Box)
Purpose of Building
Existing Service
New Service
Amps / Volts
Amps / Volts
Number of Feeders and Ampacity
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
Location and Nature of Proposed Electrical Work: Installation of Security System
No. of Meters
No. of Meters
Completion of the folloiving.table may be ivaived by the Inspector of bi ires
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above [:]In- E]
Swimming Pool rnd. grnd.
No. o mergency tg mg
Units
No. of Receptacle Outlets
No. of Oil Burners
-Battery
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiatin Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pump
Number
Tons
KW
No. of Self -Contained
Totals:
Detection/Alertin Devices
No. of Dishwashers
Space/Area Heating KW
Loc Municipal El Other
on
No. of Dryers
Heating Appliances KW
Security Systems:
es or Equivalent
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 kVires.
Estimated Value of Electrical Work: r CJ i (When required by municipal policy.)
Work to Start: X& A P Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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:)
1 certify, under the pains and penahies of perjury, that the inform�rtio zi ou this plication is true and complete.
FIRM NAME: ADT SecurityServices, Inc. � LIC. NO.: 1533 C
Licensee: Stephen Provenzano Signatu LIC. NO.: 2624D _
//fapplicable, enter 'exempt" in the license number line./ Bus. Tel. No.: 603-594-5900
Address: 18 CLINTON DRIVE HOLLIS N.H. 03049 Alt. Tel. No.: 603-594-5930
*Security System Contractor License required for this work; if applicable, enter the license number here: SSCCO01633
OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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- ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ `7
The Commonwealth of Massaehuse Permit :10. Office Use Only
Departmcni of Public Safety t ( 15?
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 Occupancy 6 Fee Checked
(leave elan
cked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetu Electrical Code. S27 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /0 /6 /q %
City or Town of MPA AAdovere To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described_ below.
Location (Stree
"er or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes [a`*" No ❑ (Check Appropriate Box)
Purpose of Building _/ -/o se- Utility Authorization NO.
Existing Service Amps / Volts Overhead Undgrd ❑ No. of Meters
Nev Service ^Amps loi0 / a40 Volts Overhead ❑ Undgrd No. of Meters_
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No.
of Lighting Outlets
30
No. of Hot Tubs
No. of Transformers Total
INA
No.
No.
of Lighting Fixtures
Above In -
Swimming Pool grnd. ❑ grnd. ❑
Generators INA
No.
of.Receptacle Outlets
(0d
No. of Oil BurnersNo.o
f Emergency Lighting
Units
No.
of Switch Outlets
No. of Gas Burners 1
FIRE ALARMS No. of Zones
No. of Detection and
Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local ❑ Municipal ❑Other
Connection
No. of Ranges
No. of Air Cond. Total
tonsInitiating
No. of Disposals ,
No. of Heat s Total Total
Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No.
of Water Heaters
KW
No, of No. oT
ns Ballasts
Signs
Low Voltage-
oltage•Si
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 Li bilit Insurance Policy including Completed Operations Coverage or i substantial
equivalent. YES ;, NOE] I have submitted valid proof of same to this office. YES W' NO 0
If you have ch cked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE OND ❑ OTHER ❑ '(Please Specify)
Estimated Value of Electrical Work $ 57000
Work to Start NOW Inspection Date Requested:
Signed under the penalties of perjury:
FIRM NAME Respwse C_ �ecietG Smut
xpiration ate
Rough �/l�6 C# it Final
dP_446SPOAlft �I
, _/ 4 LIC. NO.
Licensee Signature /Et ZI NO.
Address IS3 rna-Y S ,�A Bus - -re-). N I7 -39S -777s
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not havq the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE $ "10
Signature of Owner or Agent G�
i12 1218
iv
Date .....V.. �l..�s!..ei %
0,
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that �°�.. Q�!1..,5�............ = iedit.t SeR��(e 0C
has permission to perform ....%L%.1. � ' ....... .'! '.................
wiring in the building of ...........................................
n( �� ..
at ..�?�'..,� �'...�i.�.......t:'!I.'�.�..�.n�.�................ .North Andover, Mass.
Fee. 6kO.i.0
0. Lic.....................................E........................
ELECTRICAL INSPCTOR
10/20/97 12:85 280.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
14t TamH01iIUEtt4 d :fflunt4miettB
} 0eparttttcut of Jlublic eafct0
{c; 3
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit No. /6 916 6 �j S "
Occupancy ,& Fee Checked
MO (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMpt 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date `I Cl- 7
City or Town of NORTH ANDOVER To the I Spector of Wires:
The udersigned applies for a
Location (Street & Num
Owner or Tenant
Owner's Address
emit to perform the electri
1.4
Is this permit in conjunction with q building permit:
Purpose of Building
Existing Service Amps —J Volts
New Service 100 Amps<2!9_! 'fG Volts
Number of Feeders and Ampacity
Location and Nature of Proposed I
described bK�*k
AJC✓l 4*X/Z,_
(-C'( I U A.
Yes (Check Appropriate Box)
Utility Authorization No. -7c) S %�
Overhead ❑ Undgrnd ❑ No. of Meters
Overhead ❑ Undgrnd No. ofPeters
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
❑ ❑
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 Detection and
No. of Ranges
No. of Air Cond. Total
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
LocalMunicipal ElOther
❑
No. of Dryers
Heating Devices KW
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 Mas'sAd6usetts general Laws
I have a current Liability Ins ce Policy including ComplsJs60perations Coverage or its substantial equivalent. YES NO ❑ I
have submitted valid p of same to the Office. YES NO ❑ If you have checked YES, please indicate the type of coverage by
checking the appr We box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electric �� $
Work to Start J Inspection Date Requested: Rough ��/% / �G [�_ Final
Signed under th P alties of perjury: / %���' �
FIRM NAME �� 6r/ G LIC. NO. � r . - d
Licensee 10 J f — Signature `SCj NO. >
1/4
L 1/i��i aP Jr / f� ll y(. Bus. Tel. No. 6
Address /J Ir(�_ ly✓7r� Alt. Tel: No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owr�ef Agent
(Please check one) 1 f`�'��` . \
Telephone No. PERMIT FEE $ (f
(Signature of Owner or Agent) �1Z ft CGt 4 7 . x-6565
Date..........
f NORTH 1
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............................................ ..........
has permission to perform ............... .J.. ('Q
...... 13
� � f ti
wiring in the building of ....... `
at ` �.�i:.................... , North Andover, Mass. o
Fee.. �.. .:.�U... Lic. Noj�..1..!. ............ .
ELECTRICALINSPECTOR
C jr %/7
WHITE: Applicant CANARY: Building Dept.
PINK: Treasurer
Location Q / 17 -56,/
No. y t Date
f '
�oRTM
TOWN OF NORTH ANDOVER
.
Certificate of Occupancy $
Permit
}
Building/Frame Fee $
s�CHust
Foundation Permit Fee $
Other Permit Fee $ T
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
/r�
/ /
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Building Inspector
_
Div. Public Works
Location'
No. Z 1� ,J
Date
NORTIt
TOWN OF NORTH ANDOVER
�No /•,�O0AL
O?O:
a
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r
Certificate of Occupancy $
Building/Frame Permit Fee $'
sausE
CH.,
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $ J
Water Connection Fee $ "
TOTAL $
Building Inspector
Div. Public Works
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'Town of North Andover , NORTN.
— OFFICE OF �� o
COMMUNITY DEVELOPMENT AND SERVICES . 0
x
27 Charles Street
North Andover, Massachusetts 01845
WILLIAM J. SCOTT 9SSACHusEt�
Director
(978) 688-9531 Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE U v- -;��
JOB _LOCATION U8 P1161SA) 9161 —1 OUT G�y
Number Street address Section of town
"HONIEOWNER" %.vr .. 17B � 75- 5)
Name _ - -- Home phone D Work phone
PRESENT M�/,
AILING ADDRESS 1,�kU54_ Ag�K AD �.
V0121: q �l Ays
City/Town _ State Zip code
The current exemption for "homeowners" -was extended to include owner -occupied dwellings
of six units or less and to allow such -homeowners to engage an individual for hire who does
not,possess a license, provided that they owner acts as supervisor. (State Building Code Sec-
tion 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he!she resides or intends to reside, on which
there is, or is intended to be, a one to six family dwelling, attached or detached structures ac-
cessory to such use and/or farm structures A person who constructs more than one home in a
two-year period shall not be considered a homeowner Such "homeowner" shall submit to
the Building Official, on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned "homeowner assumes responsibility for compliance with the State Building
Code and other applicable codes,. by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICL-�L
Note: Three family dwellings 30,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0, Construction Control.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 683-9535
�.. _"14,� as,
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 or requirements.
******APPLICANT FILLS OUT THIS SECTION"""" I
APPLICANT % fio/�/�/� �%lONIQ�e Cl now/U
LOCATION: Assessors Map Number 106,8
SUBDIVISION (51)P -RSP reed
STREET P edSd/t
1q 9'07'x- 3 J y y
PHONEV'-1 & m 9-625-17-A100 / x as I
PARC' as 3
LOT (S) _
ST. NUMBER 88
�* OFFICIAL USE
RECOMMENDATIONS OF TOWN AGENTS: 23A.5
CON ERVATION ADMINISTRATOR
/V/A
COMMENTS
T,Ot N PLANNER
�V A
C MMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING iNSPECTOR
Revised 9197 jm
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FOUNDATION LOCA TION PLAN
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LOCATION:LOT 3A " MVREE GJTA l E
NORTH ANDOYERPAIA.
SCALE: I `=80' DATE:9/5/97
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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 oo�P operty fo Permit
rmit ( el
�j rr�� '
C hF� r_�✓E 10, JL 6IVi- r-,Yc, �� �laCsGe� li�Cn /mss e
Map and Parcel : Purpose of Application (check below) '
Phone Number of Applicant: I/ Single Family _ Two Family
sno%
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
existence as of the effective date of this by-law, provided that no additional residential unit is created.
The 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 is for 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
commissions have been received and the project is in compliance with those permits), and the Development Schedule
does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building 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 is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply, whether done to my
knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit.
Signature of Owner or Authorized Agent wlfo signed the Attached Building Permit Date
This form .must be attached to the Building Permit upon application for such permit.
iV
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CERTIFICATE OF USE & OCCUPANCYM.
Town of North Andoverr:t
Building Permit Number "
oate�
THIS CERTIFIES THAT
THE BUILDING LOCATED ON CR 'P .4
MAY BE OCCUPIED AS hf i IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
MORIN F
CERTIFICATE, ISSUED TO
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ADDRESS, /"'
:JACNUs��
Building nMector
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Location
No. Date
c r
a
vLORT1q - TOWN OF -NORTH ANDOVER
A-&�mgjsft Certificate of Occupancy $
+ ; , Building/Frame Permit Fee $
" Foundation Permit Fee $ C�
Other Permit Fee
Sewer Connection Fee
Water Connection Fee
TOTAL
qo-?
10971
Building Inspector
Div. Public Works
`&Location r< `
s No. Date Z
"j
MTOWN SOF NORTH ANDOVEP
ORTIS 1
a Certificate of Occupancy $
+ Building/Frame Permit Fee $
Foundation Permit Fee $
SSC USe .
Other Permit Fee $
Sewer Connection Fee
Water Connection Fee $
as
TOTAL $
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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*****************
APPLICANT: G rG=e9 T i �u p c< Phone s Py
LOCATION: Assessor's Map Number Parcel
Subdivision c Lot(s) 5
Street�ti�-� N ,- �pG� / St. Number
************************Official Use Only************************
RECO ATIONS OF T WN AGENTS:
Date Approved �o
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Date.Rejected
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Town Planner
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Food Inspectoorr-Health
JSeptic Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved
Date` Rejected
Date Approved ,:La 7Q
Date Rejected
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