HomeMy WebLinkAboutMiscellaneous - Exception (247)ALPER AUDI, INC.
STRUCTURAL ENGINEERS
February 21, 2001
Bob Nicetca
Town of North Andover
27 Charles Street
North Andover, MA 01845
Re: Sweetheart Cup Company 351 HO d f q
Mezzanine Acceptance
:•R
I hereby certify that I am the structural engineer of record for the above referenced project. We
designed the framing, bearing walls and foundations and prepared the structural plans and
specifications for the mezzanine addition now being constructed within the existing Sweetheart
Cup facility. Based upon our review of submitted material's test reports, shop drawings and
intermittent site visits by an independent testing lab, we can state that to the best of our
knowledge and belief the mezzanine is being constructed to be in conformance with the plans,
specifications and the applicable sections of the Massachusetts State Building Code, -6th edition,
and meets the accepted standard of quality and care of the construction industry.
Respectfully,
Marc H. Alper, .E.
MHA;esm
A01002 MHA Sweetheart Cup Mezzanine Accept. 2-21-01
0 E
BUILDING DEPT.
1804 Borman Circle Drive • St. Louis, Missouri 63146 • 314/432-8600 • Fax: 314/432-8630
E-mail: aai@alperaudi.com • Website: www.alperaudi.com
FEB -12-01 4ON 5:08 PM PIERCE ARCHITECTS FAt, NO. 9787453376 P, 2
t
ARCHITECT'S FIELD REPORT
Date: 25 January 2001 Architect's Project No.:
Project: SELECTIVE DEMOLITION Field Report No.:
Sweetheart Cup Company
351 Holt Road North Andover, Massachusetts
Contractor: Mr. Gregg Ernst; Pfoject Manager
CLAYCO CONSTRUCTION COMPANY
2199 Innerb�lt Business Center Drive
Saint Louis,'Missouri 63114
Weather: Sunny, 25° F
Present at Site: Bob O'Dell, superintendent and workmen, Clayco Cotlstruction Company
0015,1
I visited the site on Thursday, January 25th at approximately 11:30 A.M. to review progress and
quality of the selective demolition work and to determine if the work is being completed in
accordance with the requirements of the Contract Documents dated 01 December 2000. The
following observations were noted:
Work in Progress
I . Loading of demolition debris from staging areas into dumpsters.
2. Removal of abandoned mechanical ductwork, piping, electrical conduit and miscellaneous
equipment.
3. Removal of CMU walls and framed partitions.
ra
Observations
L Non=structural selective demolition work is progressing well and appears to be approximately
40 .to 50% complete at this time.
2. -The selective demolition work as observed has generally been completed in accordance with
the Contract Documents.
Items to Verify
No items require verification at this time.
FEB 1 32001
BUILDING DEPT.
FEB -12-01 MON 5:09 PPS PIERCE ARCHITECTS FAX NO. 9787453376 P. 3
Architect's Field Report
25 January 2001 Page 2 of 2
Information of Action Required
1. Pierce Architects has yet to receive the Submittals and copies of the Insurance Certificates as
required by _the -Contract Documents. Clayco shall provide copies of all sub -contractors'
Insurance Certificates as well as Clayco's Insurance Certificates with the Submittals as indicated
in Specifications Section 02071 -Selective Demolition,
Report Prepared By:
Daniel H. Pierce, AIA
Sigq
Copies: Gregg Ernst, Clayco Construction Company Fax (314) 429-3137
Bob O'Dell, Clayco Construction Company Fax (978) 738-9866
Ed Moll, Structures North Consulting Engineers Fax (978) 745-6067
FEB -12-01 BION 5:09 Pik PIERCE ARCHITECTS FAX NO. 9787453376 P. 4
ARCHITECT'S FIELD REPORT
Date: 09 February 2001
Architect's Project No.:
Project: SELECTIVE DEMOLITION Field Report No.:
Sweetheart Cup Company
351 Holt Road North Andover, Massachusetts
Contractor: Mr. Gregg Ernst, Project Manager
CLAYCO CONSTRUCTION COMPANY
2199 Inner -belt Business Center Drive
Saint Louis, Missouri 63114
Weather: Rain, 35° F
Pre -sent at Site- Bob O'Dell, superintendent and workmen, Clayco
Ed Moll, Structures North Consulting Engineers, Inc.
0015.1
3
I visited the site on Friday, February 9th. at approximately 8:30 A.M. to review progress and quality
of the .selective demolition work and to determine if the work is being completed in accordance with
the requirements of the Contract Documents dated 01 December 2000. The following observations
were noted:
Work in Progress
1. Removal of demolition debris.
2. Removal of abandoned MEP piping, ductwork; conduit and miscellaneous equipment.
3.. Removal of sections of concrete slabs on.grade.
Observations
1. The majority of selective demolition work has been completed in all areas of the building
including removal of the tilt -up concrete panels, CMU walls, framed partitions, and
mezzanines as indicated.
2. The concrete floor slab has been removed inthe general area between column grid lines G - N
and between 6A - 13.
3. The following. steel column locations were observed to have been damaged during.tbe
demolition of tilt -up concrete panels:
• Column grid line L-2 , L-4, and possibly L-5 as well.
4. The following steel column locations were observed to have been damaged by construction
equipment during general demolition operations:
• Column line G-13.
a i�
FEB -12-01 MOTs 5:10 PM PIERCE ARCHITECTS FAX NO. 9787453376 P. 5
Architect's Yield Report Page 2 of 3
9 February 2001
Clayco indicated that Sweetheart Cup authorized the removal of the following additional
sections of tilt -up concrete panels:
• Column grid-line T between -grid lines 5 - 6.
• Column grid line 8A between grid lines T1 and U.
6. Some exterior wall panels have been damaged by demolition operations in the area along
column grid line 1 between grid lines K and M.
7. Some concrete tilt -up panels located along column grid dine 8A have large holes broken out
of the center of the panels: Clayco indicated that the --subcontractor started to remove these
panels in error, when Clayco halted the demolition opgrations in this area.
8. In the former Boiler Room located between column grid lines K=L and 15-17, the flue piping
(breaching) has collapsed through the roof, damaging a large section of the roof and roof
decking.
9- The -bus duct located -on column line O between column grid lines 15 -and 17 has been
temporarily supported with unistrut framing and, hanging rods. Where the bus duct penetrates
the CMU wall along column grid line 15.5, the concrete block abovethe'opening have fallen
down onto the bus duct. It appears no steel lintels were installed in this opening when the
original construction was completed.
11. With the exception of the above noted items, the selective demolition work as observed has
generally been completed in accordance with the Contract Documents.
FEB -12-01 MON 5:11 PM PIERCE ARCHITECTS FAX NO. 9787453376 P. 6
w
Architect's Field Report Page 3 of 3
9 February 2001
Items to Verify
1. Clayco to provide Pierce Architects with a copy of the report identifying the scope of roof
replacement work required or recommended. Pierce and Structures North w,1ll review said
report, review the existing construction details and conditions at locations -where tilt -up concrete
panels have been removed, and advise the Clayco of the remedial repair YVork required to
properly support the roof expansion joints. Refer to attached Field Report dated 9 February
2001 prepared by Structures North Consulting Engineers for additional information.
Information of Action Required
1. Refer to attached -Field Report dated 9 February 2001 prepared by -Structures North Consulting
Engineers for additional information and action required relative to the observations identified
above.
2. Prior to determining the means and methods of repairing the damaged exterior wall panels as
identified in Observation item -6 above, Clayco-shall confirm that the siding-lnaterial is free of
any hazardous materials (asbestos), and advise the Owner if additional measures wit] be required
to remove, repair and/or replace any damaged materials.
3. Repair the damaged sections of concrete tilt -up panels as identified in Observation item 7 above,
with new Gunite concreting methods as directed by Structures North.
4. Provide protective barricades in the former Boiler Room in the area of collapsed breaching as
indicated in Observation item 8 above.
Report Prepared By:
Daniel H. Pierce, AIA
/- - -), ftA, V�
ig-
Copies: Gr g Ernst, Clayco Construction Company F�x (314) 429-3137
-Bob O'Dell, Clayco Construction Company Tax (978) 738-9866
Ed Moll, Structures North Consulting Engineers Fax (978) 745-6067
FEB -12-01
MOIL 5:12
PM
PIERCE ARCHITECTS
FAX NO.
9787453376
P. 7
FROM :
STRUCTURES
NORTH
FAX NO.
: 9707451x067
Feb. 09 2001 03:57PM
P3
Structures (Porth Consult. Engrs.
60 Washington Street, P,O,_ Box 8560.. .
SALEM, MASSACHUSETTS 01971
*78) 745-6817
TO Pierce Architects
Attn: Mr. Dan Pierce
214 Derby Street
Salem, MA 01970
I visited the site in order to measure open web bar joists supporting the foot. These joists were measured and sketches were
generated in order to analyze joists in areas affected by the proposed installation ofprocess- piping.
The areas turvoyed included column line6 F to JJ, from 3A to iy, curing this time selective demolition was underway
DATE 22 January 2001 JOB N0, 60111
PROJECT Sweetheard Cup Company
Selective Demolition
LOCATI N N. Andover. Massachusetts
CONTRACTOR 0 ER
Clayco Constr. Co. Cappet;i Enterprises
WEATHER
TEMP.
PRESENT A S!T£
O'Deti; Workmen
I
The completeq work and the work in progress that f observed was generally in compliance with the contract documents.
End of Report
COPIES TO: FIELD REPORT
slcrlEo _.r
Cap �e�te G • t.'{' . �—
FEB -12-01
MON 5:13
PM
PIERCE
ARCHITECTS
FAX
NO.
9787453376
P.
8
FROM :
STRUCTURES
NORTH
FAX NO.
: 9707456067
Feb. 09 2001 03:56PM
P2
Structures North Consult. Engrs.
60 Washington street, P.O. Box 8560.
SALEM, MASSACHUSETTS 01971
(978) 745.6817
TO Pierce Architects. .
Ann: Mr. Dan Pierce
214 Derby Street
Salem, MA 019713
g February 2001 JOB NA 00111
iCT Sweetheard Cup Company
Selective Demolition
IOtJ N. Andover Massachusetts
I visited the site in order to assess progress of selective demolition for demolition contract document drawings D-1 to D-3, S-1
and 672 dated 1 December 2000. At the time of the visit, the majority of walls to be removed, including tilt -up conaete panels
and CMU and metal stud walls had been complete. Ongoing work includes removal of abandoned idlEP equipment, and
concrete slab demolition. In the following discussion, we have italicized the information that requires follow-up. Where
Clayco is referred to in the comments. we request written direction as to either the time frame for completing the corrective or
supplementary work, or direction as to how Structures North should proceed in providing remedial structural detailing.
We noted that there was damage to the steel columns on column grid line L where tilt up panels were removed Detween
a
L
L
V
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a
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�;d NAPYAU
ARCHITECT'S FIELD REPORT
FEB 2 6Ul
8�--LDIN� DEPT
4"(0Date: �p Architect's Project No.:
Project: SELECTIVE DEMOLITION Field Report No.:
Sweetheart Cup Company
351 Holt Road North Andover, Massachusetts
Contractor: CLAYCO CONSTRUCTION COMPANY
2199 Innerbelt Business Center Drive
Saint Louis, Missouri 63114
Weather: �G�1/,o �✓
Present at Site:
. AAA / .IL.
0015.1
I visited the site on Monday, February 26th at approximately 12:30 P.M. to review progress and
quality of the selective demolition work and to determine if the work is being completed in
accordance with the requirements of the Contract Documents dated 01 December 2000. The
following observations were noted:
Work in Progress
/.
Observations
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Architect's Field Report
Observations
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Page2ef
Items to Verify
Information of Action Required
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Report Prepared By:
Daniel H. Pierce, AIA
Signed
Copies: G gg Ernst, Clayco Construction Company Fax (314) 429-3137
Bob O'Dell, Clayco Construction Company Fax (978) 738-0789
Ed Moll, Structures North Consulting Engineers Fax (978) 745-6067
--The Commonwealth of Massachusetts
Division of Professional Licensure
239 Causeway Street, Boston, MA 02114
Board of Registration of Professional Engineers
e°
& Land Surveyors
www.state.ma.us/reaoards/en
617-727-9957
November 22,2000
Paul T. Merrill
9357 Sonora
St.Louis, MO 63144
RE: APPL. NO: 51.050 TEMPORARYPERMIT2000-142 PE"
Dear Mr.Merrill
In accordance with Section 81R -c of Chapter 112, of the General Laws, you
are hereby granted permission to practice PROFESSIONAL ENGINEERING
in the Commonwealth of Massachusetts for a period of thirty days from
November 15,2000
or until such time as Board need for final action on your application for registration in the
Commonwealth of Massachusetts. The procedure for using your.
MISSOURI SEAL
on a plan or document in Massachusetts under this permit is to letter or write under the
seal the following:
TEMPORARY PERMIT MASSACHUSETTS 2000-142 PE"
Very truly yours,
H. William Flood, PE
Chairman
a
,�-54.
Commonwealth of Massachusetts
ARGEO PAUL CELLUCCI
Division of Registration
239 Causeway Street s Boston, Massachusetts 02114
JANE GOVERNOR
SWIFT
LIEUTENANT GOVERNOR
JENNIFER DAVIS CAREY
OFFICE OF CONSUMER AFFAIRS
WILLIAM G. WOOD
DIRECTOR
January 12, 2001
RE: Certification of Registration
LIC: AR 10868
Michael J. Benz
To Whom It May Concern:
This is to certify that the above referenced person is licensed in the Commonwealth
of Massachusetts by reciprocity as a Registered Architect. The license was issued on
January 12, 2001 will expire on Aumt 31., 2002, unless renewed before then. The
license is found to be in good standing at this time, having no past or present disciplinary
actions against him/her.
If you have any questions, please contact the Board at 617-727-3072.
This document is certified by authorization of the COMMONWEALTH OF
MASSACHUSETTS, BOARD OF REGISTRATION OF ARCHITECTS,
certified by Tammy R. Tyndall, Administrative Assistant.
Signature.
Date:
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or lando er from compliance with any applicable requirements.
✓♦/TT1T T/� A l7*T 4 � . _ "� / � / 'n'LT/IATf!
ASSESSORS MAP NUMBER
/0 LOT NUMBER
-Z—
Z -SUBDIVISION
SUBDIVISION
LOT NUMBER
STREET f/4= l
P�� STREET NUMBER
.■.....■■......■■r.........................................................■
OFFICIAL USE ONLY
RECONEVIENDATIONS OF TOWN AGENTS
DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
CONOAENTS
DATE APPROVED
~
TOWNPLANNER
DATE REJECTED
l
CONO&NTS
1
.
DATE APPROVED
FOOD INSPECTOR -'HEALTH
DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
CONOAENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
!/
D DATE APPROVED
FIRE DEPAR
DATE REJECTED
CONOAENTS
RECEIVED BY BUILDING INSPECTOR
DATA
Town of North Andover
Office of the Building Department
Community Development and Services Division
William J. Scott, Division Director
27 Charles Street
North Andover, Massachusetts 01845
D. Robert Nicetta
Building Commissioner
January 22, 2001
Mr. Larry Gumb
Project Director
Sweetheart Cup Company, Ine.
30 Innetbelt Road
Somerville, Ma 02143
Dear Mr. GWW.
Telephone (978) 688-9545
Fax (978) 688-9542
Thank you for meeting with me concetnbag your anticipated move to the old Bowden Plant located at 351
Holt Road, North Andover. Pursuant to our conversation it is Sweetheart Cup Company's intention, in the
first phase, renovatee existing
the buildin building understand and
toSomerville, t that the
nd
operations into the existing buddingplans dW were shown
renovations would not tequine additions to the building or site.
In response to your inquiry I am of the opinion that this portion of the prc jest would not be subject to
Section 8.3 — Site Plan Review of the Zoning By-law, as there will not be:
1. A change of use in the existing stnuxure.
2. Any addition to the existing structure.
3. Any additional parking required
The second phase of your project will be building and paving additions at the site. This phase will be
subject to a Site Plan Review by the Planning Board- Please call if you require fiurther assistance at the
number listed above.
The Town of North Andover welcomes Sweetheart Cup Company
Yours truly,
1)
D.Robert Nicetta
Building Commissioner
CC. William Scott, CD&S
Heidi Grim, Town Planner
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 BEALTH 688-9540 PLANNING 688-9535
GENERAL _NOTES st'"e
I. These drawings are for renovations to the existing building
at 351 Holt Road, North Andover, which is to be in compliance
with the following codes:
Massachusetts State Building Code (MSBG) 780 GMR
Massachusetts Architectural Access Board (MAAB) 521 CMR
Massachusetts Electrical Code 527 GMR, 12.00
Massachusetts State Fire Prevention Regulations (5276MR)
NFPA 70-Iggq National Electrical Code w/ state amendments
Massachusetts State,. Fuel, Gas, and Plumbing Code 248 CMR
NFPA 231-lgg5 - Standard for General Storage
NFPA 2310 -Igg5 - Standard for Rack Storage of Materials
Use Group:
Main Use Group: F -I, Moderate Hazard Factory 780 CMR (306.1)
5-I, Moderate Hazard Storage 780 CMR (311.2)
B, Business 780 CMR (304.0)
Building Area:
Proposed:
Occupant
Load:
Warehouse Area
(93,135 51.
(/ 300)
= 210
Factory/industrial Area
I7q,000 s.f.
(/ 100)
= I,-7qO
Off ice Area
6,3(95 5.f.
(/ 100)
= 64
Building Footprint:
Allowed Building Area:
Building Height:
Construction Type:
248,500 s.f. 2,064 Total Occupants
Unlimited per 780 CMR (507.0)
Warehouse - I story / 85'-O"
2C Unprotected Noncombustible 750 GMR ((003.1)
Building is fully sprinklered. 750 CMR (g06.0)
Fireresistance Rating of Structural Elements 780 CMR (table 602)
Hours
Fire Walls and Party Walls 2
Fire Enclosures of Exits (interior stairway enclosures) 2
Shafts other than exits 2
Fire Separation Assemblies (fire partitions) I
Exit Access Corridors 0
Non -Load Bearing Partitions 0
Interior Load Bearing Partitions, Columns,
Girders, Framing $ Trusses (other than roof trusses)
Supporting more than one floor 0
Supporting only one floor 0
Structural Members Supporting Wall 0
Floor Construction Including Beams 0
Roof Construction Including Beams, Trusses, Framing, Arches
$ Roof Deck (20' or more in height to the lowest member) 0
Egress Width Per Occupant 750 CMR (Sect. 1011.3 a 1017.3)
Min. Corridor Width: 44" Req.'d
Calculation: Occupancy Load x 0.15 = inches of Egress
Use
Calculation
Rea.'d Min.
Width Provided
Warehouse
(210 x 0.15) = 31.5
32" Req.'d
252" 0 doors)
Industrial
(I3g0 x 0.15) = 265.5
270" Req.'d
288" (5 doors)
Off ice
(64 x 0.15) = gb
10" Req,.'d
108" (3 doors)
Building Area
Existing Area
248,500 sf
Proposed Area
No Change
No Change
Allowable
Continuation of
Same Use Group
Unlimited Areas
780 GMR Sect.
Length of Exit Access Travel 780 CMR (table 1006.5)
Use Group
F -I Moderate Hazard Factory
and Industrial
5-1 Moderate Hazard Storage
3404.0
507.1
250 ft with Sprinkler System
250 ft with Sprinkler System
2. Work shall conform to all state and local applicable building codes,
regulations and ordinances having jurisdiction.
3. Building ground floor slab elevation is existingt. The construction
documents are based on 100'-0" Finished Floor Elevation.
4. See sheet AG -I for partition types and typical partition notes.
5. See sheet A4 -I for typical mounting locations and heights of devices.
Mechanical and Electrical Sub-Gontroctors to schedule a pre -rough -in
meeting with the Architect to coordinate aesthetic location of outlet,
switch, data, thermostat, panel, etc. rough -ins.
6. Contractor shall verify all conditions and dimensions, and shall
coordinate with trades in the layout of his work. The alignment in
coordination of his work and other adjacent work is of primary
importance and shall take precedence over dimensions. Contractor
shall layout and verify his work to ensure proper alignment and fit.
Contractor shall report immediately any discrepancies to his
superintendent and the Architect before proceeding or proceed
at Contractor's own risk.
Contractor shall work from established points and lines, establish and
maintain markers for lines and levels of work. Do not scale drawings,
calculate dimensions and measure for layout of work.
Contractor shall report immediately any discrepancies to his
superintendent and the Architect before proceeding or proceed
at Contractor's own risk.
�. General Contractor is responsible for protecting all construction and
the repair of any damages incurred during construction.
8. Contractor shall obtain all required permits and similar releases for
required for construction and occupancy.
Cl. Contractor shall obtain ail required inspections of the work and
update the Architect and Owner on status and schedule of inspections.
10. Contractor shall coordinate work with applicable utility providers.
11. Contractor is solely responsible for the means, methods and sequences
of construction.
12. Contractor shall maintain a set of Record Drawings on site at all times.
13. Contractor shall remove and dispose of properly all construction debris.
14. Sub -Contractors are responsible for examining all substrate conditions
where their work is to be applied. Substrate shall be free from
defects, smooth and shall conform to the requirements of the
finished material manufacturer's recommendation.
15. Drawings (or portions of drawings) shall not be reproduced for
submittals. Submittals produced in this manner will be rejected
and returned to Contractor.
16. Typical dimensions are to column center line, or to new construction.
I-7. The word 'align' as in these documents shall supersede any
dimensional information shown. If a discrepancy occurs, notify the
superintendent and Architect immediately.
18. All angles are 45 deg., q0 deg., or 135 deg. unless indicated
otherwise.
Iq. Refer to spot grade elevations) for exact grade elevation.
Contours are approximate.
20. Refer to structural drawings and soils report for all Joints in
f loor slab.
21. All footings and foundations -in excavated area to bear on and/or be
be formed by clean undisturbed, virgin -subsoil or approved
engineered fill which is certified by a CEOTEGH engineer.
22. Provide clean concrete fill per structural drawings for all
building entrances to prevent frost heave.
23. Provide a non-metallic separator between all dissimilar metals.
24. Provide 1/2" pre -molded expansion material along foundation wall
where sidewalks occur, unless otherwise noted.
25. All interior wood blocking is to be fire-resistant.
26. All control .joints in gypsum board and plaster ceilings if not specifically
shown, at a minimum shall be located as required by U.S. Gypsum for
all interior and exterior locations.
2-7. Wall shall extend to structure when separating a room with
exposed structure from a room with a ceiling.
28. All penetrations thru rated partitions to be filled with safing insulation
and fire rated sealant.
2q. General Contractor shall coordinate the installation of access panels
in partitions and ceilings which are required by MEP and FP
Contractors. Contractors shall provide C.G. required access panels.
NORTq
O P
ACMUS� /
This certifies that /-/ l ��. r. LA
has permission to perform
plumbing in the buildings of.........t ..l!.. . .
at ...3 . l.. /..�. Z... J ......... I... ,,North Andover, Mass.
Fee,lt,.�l..... Lie. No.//..7. ? �':. ..... ....) .1...... .
Y PLUMBING INSPECTOR
Check #
Date .'T. �< 1: G. ?
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
5i69
100
MASSACHUUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
��U 1
Mass. Type of occupancy-CQMMERCIAL RESIDENTIAL ❑
Owners Name owners Address
Building Location �Yj % gni,+ p Date
—3/ Y/0-21
New �Q Renovation ❑ Replacement ❑ Plans Submitta0—
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Installing Company Name one: Certificate
Address
Corp. �5-+qo
Cit 0 w4m State Zip Code�"5j� Partner
Business Telephone:- Firm/Co.
Name of Licensed Plumber or Gasfitter
INS COVERA r: check
I have a curr�t liability insurance policy or its substantial equivalent. Yes
If you have ch ease indicate the type coverage by dx=ki 9' the a� gate box.
tY Other type of unity Bond
0it'S ID1St04N= FAIVFR: I am aware that the licensee does not have the insurmce coverage required by
Cbapter 142 of the Mass_ Cemni Laws, and that my signiture on this permit appli-catian waives this
Zf�tl1 TQi�lt
Check 0m:
Oraier. rl argent
Signature of 0..enar's Agent
I texecy certify that all of tho details and infamntim I have sain{tted tar entered) in abase app is ti&� are true and
accurate to the best of M lanalad and that all pludbing work and installatians perfvrnmed order. the mr= t is*ux-�d for
this awliotim will be in ampliance with all pertinent prwisians of the massac n. efts State Cos and r-laptns '142 of the
Type of License: _
Title Si of �Li u+rber
c'ty/'ibYm �] �� a.taumi:er I f
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