12D RUSSELL DR - BUILDING INSPECTION (3) y 7, --- I he C'onnnmt\reallh of ibt:usaehusetn .
I Board of Building Regulations and Standards CI'I'1'OF
\lassaehusctts State Building Cute, 730 CNIR S.\Lli,\I
Building Permit Application Ta C'unstruct. Repair. Renovate Or Demoli-
"� (Ale-or rwo4'unol. Dl ellm•%r
Phis Section For OI'fieiul Use Onl
Building Permit Number. Date Applied:
( 3 lZ
Building Otlicial(Print Nunel Signature Odle
SECTION I:SITE INFORMIFATION
1.1 Property Address: 1.3 Asstssors blap S Parcel Numbers
42/42 ✓fSY l//Ji r✓�C
I.In Is this an acce ted street?yes no \IuP Numher 1'urcel Numher
1•3 Zoning Information: 1.4 Property Dimensions:
/oning District 11roposcJ U:a Lnt Area(sq II) Frontage(11)
1.3 Building Setbacks(it)
Front Yard Side Yank Rear Yard
Required Provided Required Provided Required Provided
1.6 Woler Supply:(M.G.I.c. 40.§Sa) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Nublic❑ Pr1%ate Cl Zone: _ Outside Flood Zone? Municipal❑ On site disposal s)stem ❑
Check if ycsC3
SECTION2: PROPERTY OWNERSHIP'
2.1fOwneel of Orrd:
Name(Print) CigtSlata.ZlP ,.
{ ;L)) k✓ S Se ( ( fJr , ),.P y7,? 9`/ 22(,
No.and Street rclnphone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ E.xistitsg Building❑ Owner-Occupied Cl I Repoirs(s) (3 1 Alteratlon(s) ❑ I Addition ❑
Demolition ❑ AcctssoryBldg.❑ Numbero Uniq OtherASpecii) S irz.
Or' f Descriptn of Proposed Work"':
T
Gr e- C! i L Un/h /- �-
SECTION at ESTIMATED CONSTRUCTION C05TS
Item Estimated Costs: OMCIu1 Use Only
I Luhor;md..\laterialfl
I. DuilJing S DDD•O D 1. Building Permit Fee: S Indicate hosv let is determined:
Iilauieal S ❑Standard CityTown Application Fee
❑Total Project Cost'I Item 6)x mulliplier
1. PluniM°g S '• Other Fees: S_
1. \Icch.uniCA all\ t('1 S List:.—
.....i,,n fatal \iiFccs: S_.._------
Chcd \o. Check AmounC C,n,h \momw
r. 1'utal l'rnjeet Coo: i C _...__ . _ .
G�(7. ❑ P.tiJ in Full ❑Outstanding
11.11 Ilul•mce Due:
v l
SECTIONS: ('ON,S'I'MicrION.NF'.RVI('F.S
5,1 Construction Supers isur License 1(SLI Gtv�D �! / •ZO/ 2
. . YC�.S_. __ I iccosc i\umhc;1;
%pinitioo Rite
.. ---� —_.._—
\,unc of l'SI. I Ioldcr _
Intl'.SLI'�pc . __._
_28 _ n
Na .InJSlrcct - — -- -._......_..-_-- . .. _._..__--- I•)P�' ucser'Piton
II IIBuildings utt to 3.q.1mo Co. it.)
��q,(��y� , GDt� DC C �a-v ReslricleJ 1.'l•?F.Imil 1)llcllin
l'it. fawn,eI c,LIt' — -- ,%I Masonry
Ill' I Roolin Cowrin
...—. - N'S Window and Siding
SF Solid Fuel Iluming Appllallccs.
78/ y0,-2VYs I Insulation
I'elc hone Email adJress I D Dcnwliliun
..2 Registered Home Improvement Con rue or HIC)
c / , y 93 rf- 3a• /3
lie&^/itree /J fi HIV �:i D IIIC'Rcgi.lratiunNumber I:cpirutionDule
I Ill'C'om any Name or I�R,:disirol�ne
Z.9 /+:. v
No old Sy�et limuil address
Ci /Town, ate ZIP Tmlc hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.e. 152.1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atfldavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize 6'- Iq Ax S v -L,--- e-C
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Uwner's Mane(Elcc runic.lignuture) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application Is tru and accurate to the best of my knowledge and understanding.
�w Z �� s--./ F - / Z
Prim )i%ner'i or AutuvireJ Abent'i Nano;I Flk:rook Signature) Dale
Nam:
1. .\n Owner who obtains a building permit to do his her own work,or an owner who hires an unregistered cuntractor
([lot registered in the Hume Improvement Contractor I HIC) Program),will no have access to the arbitration
program or guaranty fund under M.G.L. c. 142A.Othcr important inturnlalion on the HIC Program can be Bound at
ww.s I Information on the Construction Supervisor License can be found at It li„ Ill.],; -Ip.
hen substantial uvurk is planned, provide the information below:
rota) flour area(iy. 11.1 _ ____,._1 including garage, finished basement attics.Jerks or rvNlU
Grois liv ing.Irea I sq. 11,1 Habitable roust cutmt
\lumber of Iircplaces \'umher of bedrooms
\tlnlher kit'bathrooms — -- \unlberol'I;dl'halhs
I 1 I/e o1 I1e.11ing i),leol \Illllticr oI Jecki. porcles i
I\pC I Q`UIIIIl' i%itclll I'llclo,eJ OIte11
t "Intl,lll'nlictittithlllrl` hc.IIhi111111UI1Uf"IoLIIi'rOjeetl'tlsl'• '
, i, o® CERTIFICATE OF LIABILITY INSURANCE �°'�`"�°3/9
3 9 1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NDT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT., If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements).
PRODUCER NAME; T Paul T Mu h
628 BroadwayAG.
Paul T. Murphy Insurance Agenc PHONE 781 321-9700 FAX N ; <791) 324-4253
+uaL
Malden, MA 02148 ADDfREss: aul@ tminsurance.com
INSURE S AFFORDING COVERAGE NAIC#
e14URED
NSURERA:First Financial Ins Company
INSURER B:Safety
Advanced Energy Solutions LLC INSURER C:Chartis
28 Hamilton St
INSURER D:
Peabody, MA 01960 INSURER E.
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDTIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPEOFINSURANCE ADD LI EFF POLICY IXP
1 POUC/NUNIBER n MN)DdYYYY I Lmrr$
A GENERAL LIABILITY CPS1366798 5/7/12 5/7/13 EACH OCCURRENCE s 1 000 000
X COWAERCIAL GENE PAL LIABILITYPREMIS DAMAGETORENTED E 50.000
CIAMMADE a]OCCURMEDEXP(A ore Peso,) S 5,00
PERSONALBADVIWURY $ 2,000,00
GENERAL AGGREGATE $ 2,000,000
GEN'LAGGREGATE LIMIT APPLES PE R PRODUCTS•COW1OP AGG $ 21000,000
POLICY PRO- LOC S
B AUTONIOBILEUABIUTY 6217181 3/19/12 3/19/13 aaSINED- G I II E 1,000,000
ANYAUTO BODILY INJURY(Per{arson) E
ALL OWNED SCHEDULED
AUTOS X AUTOS BODILY INJURY(Per=Went) S
X HIRED AUTOS X AUTOS
WNED PROPERTY DAMAGE $
e[PE tleM
$
FEM
EULALUIB OCCUR EACH OCCURRENCE $
SS LUIB CLAIMS-IMOE AGGREGATE $
RETENTIONS
coNPEtsAT1oN WC005690446 5/1a/1z 5/14/13 wcsrAru• DnR- E
ANYOYERS'IJABILITY VIN XARTNE
PR EReER EXCLUD D?ECUTVE 7 NIA EL.EACH ACCIDENT $ 1 00O 000
talory e NH) E.L.DI$EASE-EAEMPLOVE 100O 000
ibe wWerION OF OPERATIONS b — E.L.DISEASE-POLICY LIMIT E 1,000,000
17 1
DESCRIPTION OF OPERATIONS I LOCATIONS RVEHICLES (Attach ACORDT(i.Additlmal ReRRMe Stlre .Nmoreslatetoregdre )
Insulation-GLAC Inc, Community Teamwork Inc, NGRID Corporate Services LLC, DBA National Grid
D13A Boston Gas Co DBA Colonial Gas Cc DBA Essex Gas Cc and Action Inc on GL per form BG-G-305
Construction Contracts. Coverage is subject to policy terms conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
Community Teamwork Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Larry Bevere ACCORDANCE WITH THE POLICY PROVISpI
Energy Programs
45 Kirk St, 2nd Flr AUTHORED S�ATFVE
Lowell, MA 01852 //
01988.2010 A96RD CORPORATION. All rights reserved
ACORD 26(2010105) The ACORD name and Togo are registered marks of ACO
Phone: Fax: E-Mail:
CITY OE S.l(.E.�t, NLUSACHUSET-rS
t3l'mmc; DEP.1Rl mir
110 WAiHNGTON SrXW, Jw FLOOR
'� TL?s. i97� 74l.9S9!
P,kx(973) 740-44
K1313P I PY OUXOE.L
MAYOA I}Mcmm ST.PMA"
D1R=C1t OP PL 3UC P4ovEtiTY13v mD Vc COSL%nSstoN Ex
Construction Debris Dlspasal AtfIdavit
(required for all demolition and renovation work)
fn accordance with the sixth edition ofthe State Building Code, 730 CMR section 111.J
Debris, and the provisions of MCL a 40, S 54;
Building Permit AI is issued with the condition that the debris resulting from
This work shall be disposed of in a properly licemed waste disposal facility as defined by&ICE c
I If. S IJOA.
The debris will be transported by:
(fi4M or' autar)
The debris wi 11 be disposed of in
(namra o!lamliiY) / /
fiddratorrt.diiy)
utn�mra ol;ermit rppliunt
A
r<� ,
'ACTION, INC
47 Washington Street
Gloucester, MA 01930
Agency: NSCAP NGR[D Application#:
PROGRAM: DOE/12 0
JOB NUMBER: 0
DOE Wdrk Order#F. 0' E.S.C.performed? No
Work Order Date:1 r, 05/08/12 x
ax PnmaryContractor .'r_i Advanced Energy Solutions[' . _
Contractor. NA #Bulbs installed 0
» :
s Cost of Bulbs
Client Gina Ragonese; µlnspt,$175.00 Max, - $0 00`
Street 12D Russell Drive a - .e Other In Kind $0.00
City;State,Zip: Salem Ma 01970 Electrical Work $0,00
:Telephone: 978-944-6226."` $Amount KeySpan $0.00
' $Amount National Grid $0.00
Blower Door Test: Yes Other Utility $u On
' Inspect Knob&Tube No -
t� Date'Job Completed Estimated Repair Total $152.06
° Actual Repair Total` `$0.00-
Weatherization Estimated Actual Cost. Est Cost Act Cost
Door kit $45.50
Regular door swee
Automatic door sweep
Air,sealing 2-part foam(per hour) $75.00 -
Attic air sealing 2-part to=(par hour)
$75.00 I s,
Weatherstri window(per side) - $6.00 r -
Seal ducts-mastic .$65.00
Seal duct returns-mastic 1.5 $65.00 .$97.50 -
W/S&insulate attic hatch R30 I - $33-.50 -
$0.00
$0.00
$0.00
Weatherization Totals .' ' $131.00 - $0.00, .
Insulation -Estimated_ Actual Cost Est Cost Act Cost
R38 restr.Rtgarag6 overhead 98 $2.10 $205.80
Attic flatR30open $L37
Attic tlat/slo a R30 restricted . $148 -
Thermodome - - $I80.00
Attic kneewalRll FG $1.31
Attic kneewall R12 cellulose wlmembrane $1 73
Attic kneewall floor R30 restricted $1.48
Insulate attic stairs-&.walls- $135.00 -
Sidewalls-vin IRI5DP ..$1.79
Blow FB ( KW -' 36 c .$1.82
1"rigid FB Pt Crawls ace walls 167 $2.04 $340.68
1"rigid FB @ Crawlspace overhead 241 $3.30 $795.30
1"rigid FB r Attic kw 204 $2.04 $416.16
Steam pipe insul,to:F.25"R5 - $5.51 ..
DH W p pipe insuation R5 = $2.63
Insulate door- V rigid board R7.;' ,1. $51.00 $51.00
Si11 2-part-foam w/FG batt R 19" $2.20
Insulation Total: $1,874.46 $0.00
✓� V ..
DOE. -
Other Measures Estimated Acutal Cost Est Cost Act Cost-
Roof vent-small " $80.00 v.
Gable vent-rectangular $92.00. -
Recessed can cover - - $30.00, -
Cut/finishattic/kneewallaccess $105.00
Test drill sidewalls,-4 sides - $60.00 r,
Blower door test $45.00-Vinyl re Iacement wiindow-161 ui,-
Faucet aerator $15.00
Low flow showerhead $25.00 1fi10t, Y - -
Htn
$0.00 P
Otlfer'Totali. .y':., p $0.00� ,'...$0.00�'
Energy Conservation '.:r Est Cost Act Cost
Total:(Max$10,000.00) F 1 $2,005.46 V)00 - -
47
Repairs ?. Estimated Actual Cost Est Cost- 'Act Cost
Re air/refitdoor r ! 1 $52.00 $52.00
Adjust door striker: late" _ $20.00 z.
Door entry lockset $73.00
Re air"door hin'e - $25.00.
Slide bolt $20.00 +
Sash lock $9.50
Steelpre-hung doorw/life $640.50
Solid core doorw/hardware $367.50
Glass.replacement-to 64 ui - $44.00
Site-built interior bulkhead dr w/jambe" $435.75
Clean tters( er h000ur) $60.00
Buildin "'ermitfee 1 $100.00
Health& Safety ;_w - - _-.• , ,
Vent clothes' er to exterior-, $89.00
Vent bath exhaust fan to exterior ' $89.00
Replacement window lead-safe practices $20,Qp ,.
Repair/H&S Total:(Max$2500 00) : -a * �$152.00
Work Order Sub Total: $2,157.46 $0.00
i -
Measures 'S +• - �'. :•Estimated ' Actual s: Cost I Est Cost Act Cost
Other $0.00 .
Other $0.00
"Heating System Repair'" $0.00 .-_ -- $0.00
Action approval only; - - - -
w
Estimated Job Total: $2,157.46
Job camiotexceed$10,000 00"
Job minimum=$560.00 Job Grand Total: $0.00
AUDITOR: Brandon Dorrington
h
or
NSCAP
98 Main Street r
Peabody, MA 01960
Tax Exempt#: 042-385-280
h.
- Agency: NSCAP . 4 r
PROGRAM: National Grid/2012r� a,.. ,, •.
Job Number: 0 1 NGR1D Application#: .= 0 --
+ e- Work Orde# 0, -
Work Order Date: 05108112 '., '+• _. '+ Job Limit:
Primary Contractor: Advanced Energy Solutio '` Per Unit $4500 00 _
Other Contractor: NA
Client: Gina Ragonese ° K+T Yes=1. No=O
- - - Street: 12D Russell Drive K&T: 0 -
• ;
.„; ',,e;. ' -City;State;Zip: Salem,Ma. -
-- Telephone: 978-944.6226, Stand Alone:, No `
' ; `, ;.. • Fee. s
- - Code: 0
Blower Y Door Test: es :, • Stand Alone Yes=1 No=O -
t
Inspect Knob&Tube: No Elec.Contractor: -
Attic Insulation Estimated Actual 4 Cost Est Cost Act Cost
Attic flat R49 open(elec`heat only) $1.61
Attic flat R38 open "- - $1.47
Attic flat R30 open - $1:37 .
Attic flat R20 open 137 $1.29 $176.73 `
Attic flat RIO open _ $1.21
Attic tlat/slo a R30 restricted $1.48
Attic flat/slo a R20 restricted $1.42
Attic flat/slope R10 restricted - - $1.30
Attic kneewall R13 ' . $1.31
Attic kneewall floor P30 restricted $1.48
Attic/kneewall floor transition DP - $2.52 - -
Finishedatticaccess '' ", - - 't ..: - . , .$105.00
Te4orray attic access.,• $78.75
Crawls ace R 19 wl oly va or bamer 12.53
Garage ceilin floor R30 188 - $2.10 $394.80
Thermadome - $180.00 -
Roof vent-'small - $80.00 -
Roofvent-lar a $95.00
Pro pa vent $4.00
Gable vent all sizes --- $92.00
Soffit vent . $27.00 -
Attic sloe R30 cellulose w/membrane $1.95
Attic slope R20 cellulose w/membrane $1.75
Attic kneewall RI 5 cellulose w/membrane ' $1.73
Attic air sealing 2-part foam . _ 2 $75.00 $150.00
Ventdryer/bath exhaust fan - 1 -" $89.00 $89.00
yy
°t
Page 2 National Grid/2012
Estimated Actual Cost, - Est Cost . Act Cost'.-
Walllnsulation
Single nailed asbestos/asphalt RI5 DP $1.21
Double wiled asties lodaluminum R15 DP 15 DP - ..$2.31 - ^
k/stucco RI5 DP $2.89 -
Interior wall blow laster R15 DP 2I0 $1.90 $399.00"'
Clapbowd/woodshingle/vinyl RI5DP' '-� ' ` ^,1 $1.79 - •i "
Test drill 4 sides - ., • r -_^`:.:.$60.00 .i
Silt 2-part foam w/FG htt,R19 32' .:'': * ',:` $2.20 $70.40
Sill.insulation'R19 faced_,G,' rN"^ $1:58
Penme[er wra "RS $1 91
of
Door kn •.;� - .• +. .f _:1 $45.50 545.50
Regular door sweep . -° t ' '' $15.75 $15.75
Automatic door sweep t $23.00 > $23.00 Air sealing 2-part foam,.. .2 .;- $75.00 $I50.00 Sash lock $9.50 -
Glass replacement $44.00
i
Blower Door Setup - 't r:' $45.00 - I 545.00
Total Air Sealing Cost: -
Heating System Measures - - • -
Duct insulation&seal seams(sq.ft.) 96- $3.10 $297.66
H dronic pipeinsulation to 1"R5 $3.41 +k
H dronic pipeinsulation1.25"+R5 - $3.68'
Steam pipe insulation to 1.25"R5 $5.51
Steam pipe insulation-1.5 -2".RS ., $6.35 -
Boiler/famace replacement $0.00
Program repit �..' 1 '$0.00
Actual Total does not includd$175.00 K 8:T'charge. " "` < $t,856.78 Est Total.
I 50.00 I lAct Total `.
", r . ,r -,• AUDITOR: Brandon Dorrington - -
ary OF S:ti,.Ums NWSACHUSETTS
13LILDING DEP.\RT'\tF_NT
120 C(/.1SHLNGTON STREET, ]'a FLOOR
TEL (978) 745A595
F.Lt(978) 7)O.9844
Kj.%ll3E.RLEY DRISCOLL
�L�Yo.7 I�iostAs ST.P1F_RA8 DIRECTOR OF PULIC PROPERTY/tlt:R.DING CO\LC1153IO."ER
Workers' Compensation Insurance Aff1davit: Builders/Contractors/Electricians/Plumbers
li : illeant Information V19asit Print Le libl
Vc1lnalnaLn.+sUrgamntiominJividu•tll; se/ ��irL,?G � .�=�--; �a�?70y�
Address: 78 /err/ram.%yDlR �i1> %
CilyiStatc/Zip: !w Phonb N: 7//- V L 47 sc
Are you an employer:'CJ1gck the appropriate box: Type of project(required):
I.All am a employer with J 4. Q 1,Lars a general cuntraclot and I
r� . have hired the sub-contractors 6. �]Now construction
2.❑ en:pinyeels pro and/or tit artime). 7. 0 Remodeling
I Lars a sale proprietor ar partner• listed on the auachcd.rheet. :
.hip Land have no employees These sub-contractors have 8. Q Demolition
working for me in any capacity. workers'comp.insurance. g. 0 Building addition
[No workers'.comp.insurance J. ❑ We are a correlation and its
required.) officers have exercised their
MCI Electrical repairs or additions
).❑ 1 mn a homeowner doing all work right of exemption per MGL I I.Q Plumbing repairs or additions
myself.(\o workers'camp. C. 152, )I(4),and we have no 12.❑ Roof repairs
insuraneerequired.) t employees. (No workers' 13.0 Other
camp,insurance required.)
•.hny ipplkari that chats boa all must also all out the wutioa below showing their""too'camp.nu tun puuuy inmrmuaon.
'I Lveemam"who.ul+mil this arndavis Ind leading iher ore doing all work and then hire"isida contmom m1Ya nthmil arm arrlJavil indiering suck
:r,mrrnulon that chalk this box mail armched an addinunal.hat rhuwing the Maine of the rutiruNruture and shalt wortsre'wmp,put icy Inrormatloo.
lain an employer that is praYldhig rvorkers'cumpraradon inauruneoJar my emplayorx Below/a the policy and Job silo
hijarsnaslom y
Imurarce Company Name: 0,sor�,�e.a. G -
Policy 4 ur Salr-its. Liu. 4: 9 /0 /Y� Expiration Date: MS-•f Y- 1
tub Site Address: _.1Z P JSS GLC /✓�''""� Cityislute/Zip: r�Y 4 !ter -4 72)
,UtacIs a copy of I h a workers'compernallaa policy declaralton page(showing the policy number and expiration data).
h dluru to secure yuveraget as required under.Section 2JA of MGL c. 152 an Icad to the imposition of criminal penalties of a
tire up to SI.S00.00 und/ur one-year impri.ennment,as wall as civil penalties in the torn of a STOP WORK ORDER and a line
,!(up to S230110 a Jay against the violator. Ile advised that a copy of this,latement may be(urwardcd to ilia Oliica of
Inve,tigatiaus ni the fy lA tar in.tunnca coverage vest licutiun.
l du/rrreby cerriJy tinder Jto pains mid penaAlrr a/perjury shut she luJurorutlmr prop iJeJ above it out surd currrce
Dow:
IJllis'iul rue only. ib)nor wrist in this area,a Se runryltled by city ur lawn qII,juf
City nr l'utrn:.____ _. PcrmiriLlceme i
I++uiny.\ulhurily (stole nnelt —._. ....__
I. Ilourd ul Ileallh !. Iluildlm-Duparmtunl I. ( ityi fours Clerk i, hYcetrical Ingtcasur i. I'huohing ioepeenlr
4. Other
L'ndldd i'erinn; t'hnnC a: