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HomeMy WebLinkAboutMiscellaneous - 90 MAIN STREET 4/30/2018a .w Date,,/ .1../17... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that... ....................14r......... has permission to perform a2 ........................................................................................ plumbing in the buildings of .............................................................. at .... b.' 1. ... !/� r ..........,,..,................ ...............�:.1-�� ., North Andover, Mass. Fee�oZ.s .. Lic. Nod. �.OS �:.... _....................................... (J �jPL MBING�NSPECTOR Check # �Z U� � �Co� �.���v /f —'� MASSACHUSETTS UNIFORM APPLICATION FOR P RMIT O PERFORM PLUMBING WORK CITYA4M DATE PERMIT # OWNER'S NAMEMH ad JOBSITE ADDRESSy y� 1L�►/_ POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL [;K PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES F1 NO ❑ FIXTURES Z FLOORS BSM 1 2 3 .4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK -TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO ❑ IF YOU CHECKED YES, PLEASE INDICATVTHYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best ,f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp ianc with ine/pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4 (/ PLUMBER'S NAME Pite-L _ LICENSE # ( 6 73 SI NA/TURF MP ©- JP ❑ CORPORATION [ 1 :,? U,3q PARTNERSHIP ❑ # LLC ❑(1 # AW, LA'k -ADDRESS G i C 2_(/2_(/.- U `� �"'�-- COMPANY NAME V 0 a,� Vle CITY "','jSTATE IA't2_ ZIP 0 C r TEL / 7p CY -3 & �-S FAX 546FL 546F9F6 r CELL `I �� �, G r 4-(o3 EMAIL n or- Date ... 4.7.11j--- TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... 4A...................................................... has permission for gas installation .. inthe buildings of ...... ..... ........................................................................ at .... r�1J&A-) .......................................... . No 4Andover, Mass. Fee/ .0 ..... Lic. No.%3P3..q .... ?�. .. ............................ S PECTO Check 90 % z 15 6 -,, i U b CONVERSION BURNER COOK STOVE DIRF(:T V1FNT HFQTFR DRYER ----�-.-- - _ - FIREPLACE FRYOLATOR — — FURNACE GENERATOR GRILLE --- -- ---! -_ -- -- - INFRARED HEATER LABORATORY COCKS _MAKEUP AIR UNIT OVEN — POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST- --- --- ---- - - --7 - -- - - — -- - -- ---- -- -- - UNIT HEATER UNVENTED ROOM HEATER -- - - - WATER HEATER _ OTHER t. INSURANCE COVERAGE I have a current Ilebiiug� insu mace policy o�r ks substanfial a uivalent which meets the requirements of C�iGL. Ch. a42 VES ' I�® I IF YOU CHECKED VES, PLEASE INDICATE THE TYPE OF COV GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY B014D �IN4r!4 NII nnAngnc ullApfean. o--._-.- ... uan. �il{�woi eau UJI " 81OI0we 0'6f U1 flair vlm,���u�Bbu,�ehis General Laws, ano ¢nat my signature on mis permit application waives thus requirement. 1 SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWYNER AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the est of my knowledge pnd that all plumbing work and installations performed under the permit issued for this application will be in cpli ncwit a Pe" nt provision of the Aassachusetts State Plumbing Code and Chapter 142 of the General Laws. 'LUMBER-GASFITTER NAME LICENSE # 1 d C 73 SIGNATURE 11P ✓ MGF JP JGF LPGI CORPORATION `�# 3 0 3 Y PARTNERSHIP # LLC # ;OMPANY NAME: Q c A., v., 6�t.t� �C �, ADDRESS 7 C > ,, v-,, Y ;ITY L- aAm vez-c, STATE M t ZIP p 1 Fy 3 TEL % 7� (F-7 3 4- 3 AX 92Y( Sr 7 f ,/ t CELL 9?� �4 i I (,)TEMAIL z ru e. c. C i9- C_ o-. C" f ASSACIIUSETTS U111FORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY� r N � � AJ�o V q C PIIIA p•� DATE ,� � )/ I � PERMIT # - l l D'� - JOBSITE ADDRESS 9' M i N OINNER'S NAME ''✓I ((„ N � C �,` � ll �'r� (� GOWNER f f J ADDRESS TEL FAX TYPE OR PRINTw OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEAR.,'' NEW: RENOVATION: REPLACEMENT: V PLANS SUBMITTED: YES NO APPLIANCES Z BOILER FLOORS- fF 2 3 4 5 6 7 8 9 1tri7 19 l2 73 14 BOOSTER CONVERSION BURNER COOK STOVE DIRF(:T V1FNT HFQTFR DRYER ----�-.-- - _ - FIREPLACE FRYOLATOR — — FURNACE GENERATOR GRILLE --- -- ---! -_ -- -- - INFRARED HEATER LABORATORY COCKS _MAKEUP AIR UNIT OVEN — POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST- --- --- ---- - - --7 - -- - - — -- - -- ---- -- -- - UNIT HEATER UNVENTED ROOM HEATER -- - - - WATER HEATER _ OTHER t. INSURANCE COVERAGE I have a current Ilebiiug� insu mace policy o�r ks substanfial a uivalent which meets the requirements of C�iGL. Ch. a42 VES ' I�® I IF YOU CHECKED VES, PLEASE INDICATE THE TYPE OF COV GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY B014D �IN4r!4 NII nnAngnc ullApfean. o--._-.- ... uan. �il{�woi eau UJI " 81OI0we 0'6f U1 flair vlm,���u�Bbu,�ehis General Laws, ano ¢nat my signature on mis permit application waives thus requirement. 1 SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWYNER AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the est of my knowledge pnd that all plumbing work and installations performed under the permit issued for this application will be in cpli ncwit a Pe" nt provision of the Aassachusetts State Plumbing Code and Chapter 142 of the General Laws. 'LUMBER-GASFITTER NAME LICENSE # 1 d C 73 SIGNATURE 11P ✓ MGF JP JGF LPGI CORPORATION `�# 3 0 3 Y PARTNERSHIP # LLC # ;OMPANY NAME: Q c A., v., 6�t.t� �C �, ADDRESS 7 C > ,, v-,, Y ;ITY L- aAm vez-c, STATE M t ZIP p 1 Fy 3 TEL % 7� (F-7 3 4- 3 AX 92Y( Sr 7 f ,/ t CELL 9?� �4 i I (,)TEMAIL z ru e. c. C i9- C_ o-. C" W The Commonwealth of Massachusetts Department of Industrial Accidents r...-_4 „ Office of Investigations t . - Ml 600 Washington Street Boston, MA 02111 F K ti '4 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information// Please Print Legibly Name (Business/Organization/Individual): &) Q A� 1da� k m,� Address: G % C tvve-u J Yk x- o t S, YS Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ® I am a employer with 4. R I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 6. ❑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. [No workers' comp, insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t employees and have workers comp. insurances 5. R We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] 9. [] Building addition 10.0 Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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. tContractors 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./� p Insurance Company Name: A f s 4 , ' � Policy # or Self -ins. Lic. �D 0 !O 4 9 O 124 / Expiration Date: 4 aZ "Ar Job Site Address: City/State/Zip: 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. 4 I do hereby cert' un*r tthe pai%n en s of perjury that the information provided above is true and correct P 61r7 -136F3 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 #: L_ File No.: 1 Case No.: ,dover State: MA Lip: 01845 aw Enoland National Mort. Corp, Fo r o 1�w� 10. d' „N 14 1 + M Y 'w Date..3...�.Q....... ..3 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................................................... has permission to perform ...... �. �!. 'e- I2 � � (D r A A ' d '`-, ..(.... ................................................. wiring in the building of �<� t I R N ................................................................................... D— 9 a' w N S ............. .North Andover, Mass. at.......................................:...................... Fee... 5 ...... Lic. No. �.%�2 J.:. l d IA..�. .!u... . ........ ....... ELECTRICAL INSPECTOR Check # 9 S 4433 ThF09j M0AWFALTHOFAf4S►'S'4CffUSE77S Office Use only DEPARTMFV7'OFPUBLICS4FE7Y Permit No. 7- / /` VAPA BOARDOFMEPREVEM ONRWUTAHOAN527CMR12:(a0Occupancy &Fees Checked PLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat 7----7216�'3 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: YesE] No (Check Appropriate Box) Purpose of Building/`�. '`/ Utility Authorization No. .. Existing Service�'Amps / Volts Overhead [M- Underground a No. of Meters New Service . � Amps / Volts Overhead ® Underground No. of Meters vt i Number of Feeders and Ampacity _ gad _ e O _ 6 a_ G o — Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA and El around No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP • '� y�wpm sq�offl ltmla=Co�a� Laws I1rveao ftLiabkyhstr=PbbcynxkdWCanpiwopwabomCova,Wcrtsstiuiatalegiraint YES NO I1mesthnftdvalidpot£of=ne1othe0ffim YES NO ff} uhmcduiWYESpkmemk*thetAxcfomWbydixi the Wpq Il�SiJ1ZA1 BONDl ffiZ- R ftweSpa* 1~,rirV1t;,., r`kAm WctkioSlatt htspactimDateRagtte d Signed undasPa>ahies FIRMNAME 3 Rwgh Fnal OWNER'S INSURANCE WAIVER; IarnawarethattheLi=w"ra anddrtmysigtatr onftp=*appfimfimWMesthis requffemal (Please check one) Owner Agent AIL TeLNa hts� (mal Laws Telephone No. PERMIT FEE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation. Insurance Affidavit Name Please Print Name: Location: city Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one werking in any capacity I am an employer providing workers' compensation for my employees working on this job. Companv name: Address C Phone #- Insurance. Co. Policy # Company name: , Address cibc Phone # FaPhue to secure coverage as required. under Section 25A or MGL 152 can lead to the Imposition of cximinat penalties of.a line up to $1.500.00 and/or one years' impnsornxmt-as welLas-mW-penaKie m-Molimm4AMDpyy K -O a*e-dA$1A0M-ailWagWuWjme. I understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for emwage verification ! do hereby certify under Me pains and penalties ofpegwy that the information provided above is bye and corxect. Signature Date Print name pbone# Official use only do not write in this area to be completed by city or town officiar City or Town PerfrA44marmirn DI. OCheck Y immediate response is requked Building Dept p Licensing Board p Contact person: Phone Selectman's Office #. E] Health Department I] Other Location !A No. Date_'�� A a TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ y� s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y 0 Check # & e YV 15 9 U 1 - ,41W (C/-'`-- Building Inspector fj TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING In" Secfim for H u ai USe 010 BUILDING PERMIT NUMBER: DATE ISSUED: py 3 SIGNATURE: (&---- Buildin Commissioner/Inspector for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomution: Public ❑ Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Retold L41—) of - Name (P Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Lice CnonstructionnSu sort_ Licensed,gonstruction Supervi^�'',, ll sor: do _ , . , n �•C G�/�-tC Address t(W d Signature Telephone Not Applicable ❑ (� Sd 7S� License Number Da C' Z Expiretio--n Date Home ImproveRent Contractor 3.2 Re764),AildPG')t} 6 tNOtu Not Applicable ❑ Company Name C4 A-Aw & dlAc %` ( Registration Number Address Expiration Date Signature Telephone T rn X ic Z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) g Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work (check all a©olienble ) New Construction ❑ I Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑Demolition ❑ I Other ❑ Specify I Brief Description of Proposed Work: '� / ( Aa I) t-1, C&t'4 I SECTION 6 - ESTIMATF,D CONSTRUCTION Cnc%Tc I Item Estimated Cost (Dollar) to be feted by permit applicant OFFICIAL USE ONLY 1. Building 0 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b)� 4 Mechanical (HVAC)�- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number z�Et i1Vw is VWiNEKAUH10K1ZAHON 1V HE COMPLETED WHEN OWNERS/AVfENT OR CONTR kCTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize CEpid(J(i(�'J /— to act on My be al in all ma er�i 1 tive to work ed by this building permit application. Sin re o Owner �� Date / SECTION 7b OWN R/ THORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS IIEIGFIT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHHRvvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �' `" •� : Zia Commt�trtvea fi orN�racfutsatts Q?amrr. a`1r�iaC�2rcirferr�s �; �.imvstiga�ions 600 wasfrittg= 3'treet ft=r, WA Q2TY1 • Ttiorker's' CampcasadanlnsttrmoeAmnavit Location. City; an work myself. Nesse?=- Le?fbly IS Telephone n: t� / 3 `/ D I am a homeowner periormin� D 1 am sole proprietor and have no one working in my capacity D I am an employer providing worker' coma ensatiou for my employees working on this job Company Na=c: Address: Ciry: Telephone Oh. insurance Company; Policy ": D I am (eircle one) sole proprie , general coatracr or homeowner and have hired the contractors listed below who have the follovrina. workers' compensation policies: Coropany Name: Address: /� Ciry: ✓ vY I Lt !i— Teiephoae'r: V `� �� Insurdace Compaxr�, %2 UJL tee WS Policy r: P•�b 9 C/ Company Name Address: City: Teiaphone �: Issuance Company: Policy' Attach additional sheet if necessary Failure to secures coverage as required under 5eotion ^5A of MGL 155 can lead to the imposition of criminal penalties of z nne tip to '1,�D 0.00 and/or one years' imprisonment as well as civil penalties in the form of a STD? WOPM DRDER and a fine of 5100.00 a day against m.. I understand that .a copy of this statement may be forwarded to the OMI of Investigations of the DIA for coverage verincation. I do hereby ae }} under the p s nd penalties of perjury that the information above is true and correct simature: / Date: 2/3�/� Fain_ Name: A- G W Phony T Ozneial TJ s >_ pI�LY •- D o not write in this arez o Buildino Demartm eni City or Town: Permlt/Licenss r: o Licensing Board ❑ Selectmen's O i=E o Health Deparimenl M Check If immediate response is required o Other IY1assachusetts General Laws chapter 152 section. 25 requires all employers to provide workers' compensauon for their employees. As quoted from the "law" an `employee is defined as every Berson in the'service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, par ncrship, association,. corporation or. other legal entity, or any two or more of the foregoing engagedin a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or tae occupant of thetwelling house of another who employs persons to do maintenance, construction or repair workon such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer. MGL chapter 152 section 25 also. states that every state or local licensing agency shalt withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of -public work until acceptable evidence of compliance with -the insurance requirements of this chapter have. beetyresented fo.the contracting authority. A plicants Please fill in the workers' compensation affidavit completely, by checking the.box that applies to your situation and supplying company names, -address and phone numbers as all affidavits maybe submitted to the . Department of Industrial Accidents for.confu ation of insurance coverage. Also be sure TO sign and.date the affidavit. The afridavit should.be returned tothe city.ortown that the application for the permit or license is . being requested, not the Department ofindustrial Accidents. Should you have any questions regarding the "law".or if you are required to. obtain a workers' compensation policy, please r, IlE, e Department at the number listed below. Cir�v or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you, regarding the applicant..please.be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be rete -Med to the Deparmzent by mail or FAX- unless other arrangements have been made. The Office of investigations would Iike.to thank you in. advance for your cooperation and should you, ave any questions, please do not hesitate to give us a call. The Depart7nent',s address, telephone andf= number: 'Che Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington. Street Boston, IYL4 02111 Fax T (617) 727-7749 Telephone (617) 727-4900 -ext. 406, 409, or 375 4 I� _ �1ce �oomrma�uueal�/, a�✓�iaaacic/%uaelta BOARD OF BUILDING REGULATIONS License:. ONSTRUCTION SUPERVISOR Number'G$ 075384 i . Blrthiii't j10L07Jj,00 02 Tr. no: 75384 iTo: 00 ,, - - - - - -� ,-:ani;•-... RONALD P GAGNON I I 75 COCHRANE CIRCLE: METHUEN; MA 01844 Administrator A 1 xCOO w A o o a o z z Q o C -0W w° n°' U co w cd w w (n U W c�° V) �, w x 0 a t � w z w a G� G w� ° cin v !� o cn c c m c o C N O C vV .�� '•mac CZ O W := O �• c O O � Q CD O v o a N O m . o O c� .r N CD� is C,* _ c c 9 N O N fl•v m ow y m CD co� fl 1: •- N mL. f m C7 N O of �; c o`• O c Q V ca m 0 •O = m C - O !�I m t W O ��m_ �.. LL m+" C�. O C3, CJ N O W E C.2 m` O m c ie - CIO CL m� O� _ � •=CD !® 4- CL, - a Rl O 42 v CD O CD L O Q Z co CL O CO) � C a I CCp y u) O �E m m CD C3 CD CL 1- ♦=.+ CD O �CO C O CD L- O d a �a y C o � � ev ev �0. O ♦D C Z O 0 CL U y O C C C d CO)