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54 SUMMIT ST - BUILDING INSPECTION The Commonwealth of Massachusetts -� Board of Building Regulations and Standards FOR MUNICIPALITY Massachusetts State Building Code, 780 CR M USE (� Building Permit Application To Construct, Repair,Renovate 71 r fish a Revised Mar 2011 t/ll One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Appl' Aiding Official(Print Name) Signa re" Da[ SECTION 1: SITE INFORMATION. hl�royertrry`ArGss: / 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use _Lot Area(sq ft) , Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ m IB r ?r-� Qwn'er'ot,�2q�grA.lc]I ai c I 1 Kam.. O` l' L ae(Print) r I City,State,ZIP Ro.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': I SECTION 4: ESTI_MATED CONSTRUCTION COSTS Item Costs: Item Official Use Only (Labor and Materials) 1. Building f.%,/7T 1. Building Permit Fee: $ Indicate how fee is determined: h / ❑ Standard City/Town Application Fee , 2. Electrical $ ❑Total Project Cost'(Item 6)xmultiplier x 3. Plumbing /a 7]�/f 2. Other Fees: $ 4. Mechanical (BVAC) $ 1��•7� List: 5. Mechanical (Fire $ - Su ression Total All Fees: $ J /b/t aq�/ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ -/b ❑ Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES t. 5.1 Construction Supervisor License(CSL) CS 10ACK46 �p� 1 lJ � License Number Expi ion ate me of CS older 1 1 (B� ' y List CSL Type(see below) l.f NN—o and [� reeer t�J1 /V\JY Type Description D)y �l Y�� OX32. U Unrestricted2 Family (Buildings u el ing cu.ft. R Restricted 1&2 Famil Dwelling iL ty/7own, Late,Z M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances OLS 31 Jbuioe tl'1US ernh�,1 rY1m. I Insulation Tele hone Email a ress D Demolition .2 Re istered Home Improvement Contractor(HIC) HI Registration Nuintier E irati ate IC pa . e istr a e 6 o.an re Y1 y) �'• Y mail address t own,State,Zip Ill' Telephone 1 SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c..152.§ 25C(6)) 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 f the building permit. Signed Affidavit Attached? Yes .......... No........... ❑ 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 to act on my behalf,in all matters relative to work authorizedby this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNERS 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 applicati is true and accurate to t best of my know dge and under nding. Print can er s or [hori d Ag ['s Name(Electronic Siguature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at w-ww.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost' Detail L L�tI>iD C/�BYSE �t� � S �tS778Z Customers Last Name,First Namef Store No. Order No. ACRYLIC TUB/S'HOWER BASE_(check off all appmedi to iiems)_�-� ❑Bathtub ❑Replacement Bathtub XSShower Base ❑Replacement Shower Base Color of Material:PgWhite El Biscuit ❑Almond ❑Orchid El Gray ❑Sandbar ❑Mexican Sand [I Other ICGx� R Tub Width/Specs: ❑4h Ft. ;.5 Ft. ❑51Y.Ft. El Two-Wall Tub El Square Tub ❑Tub Edge Piece Cry. ❑End Cap Shower Base Specs: ❑Shower Base Liner(SBL) ❑Universal Shower Base(USE) ❑Universal Retrofit Shower Base(URSB) Size:aO X�. leg Model ❑1 Center❑2 Offset❑3 Diag.2"x2"❑Neo Angle❑Base w/Builf-in Seat❑Base w/Affermarket Seat Existing Tub: FGast Iron ❑Steel ElFiberglass El Left Hand ElRight Hand ElPainted Replacement Tub:TYPE %Acrylic ❑Steel El cast Iron El Fiberglass ❑Bathtub Overflow Cover and Drain SpudlShower Drain: Chrome ❑Other Standing Waste ❑Yes ❑No Drain Location: ❑Leff z❑�rr Center �Right Tub/Shower Base Bottom: ❑BathGard'"❑Striped SathGard" 19 No BathGard' Conversion: 54Tub to Shower Base ❑Shower Base to Tub ❑Tub to Tub ❑Shower ase to Shower Base �lA 'OQ� Tear-Out Existing: �Castlron ❑Steel ❑Fiberglass 2FOther¢�7!-�' =; emu% Re-Bath Patented Thermal Expansion Sealant Installation Technology (Required for Manufacturer's Lifetime Warranty) , r" TUB SKIRT STYLE (check one❑Straight Skin ❑Ar dia �SautaRoaa ❑ ona ❑Biltmore Sierra Vista ❑Two-Wall Tub ❑Other ACRYLIC WALL SYSTEM ❑Tub Walls Shower Walls Numberof Walls 3 Return Walls 0 Color of Material:❑White ❑Biscuit ❑Almond ❑Sierra Granite ❑Taupe Granite ❑Ivory Marble A White Marble ❑Heron Marble ❑Umber ❑Mocha ❑Arctic Gray ❑Travertine ❑Crema Travertine ❑Rock Creek ❑Other ❑Standard ❑Mosiac Sim. ❑4-Sim. )K 6"Sim. ❑12"Sim. ❑Hampton ❑Newport ❑Subway ❑12"x 24" ❑Convessa (Flat) Tile Tile - Tile Tile Sim.Tile Sim.Tile Sim.Tile ❑12"Slate ❑Old World Tuscan ❑Bullnose ❑Classic Subway ❑Other Finish&Wall Height: Wainscot Wall System: Ceiling Panel: Gloss ❑Other: Top I Finish ^97E ❑3/4 Height .Floor to Ceiling Height Color: Height: Style. Wall Tear-out&Repair Damaged Areas: Style: Lin.Ft.: �c ❑ , ❑Yes No ❑PLB ❑SDW ❑End Bottom Color ❑Total Area M.R.Drywall(Greenboard) Color: Hei 1: _LJQ Tub/Shower Only � ding Build-out Above Existing Tile: ❑Yes❑No ❑Soffit Cc e Remove Existing Wall Surround:❑Yes❑No Style: Lin.FL: Re-Bath Patented Thermal Expansion Sealant Installation Technology (Required for Manufacturer's Lifetime Warranty) VALVE CHANGE OUT 1 PLUMBING TUB/SHOWER ENCLOSURE ' Yes ❑No IF&R Existing Fixtures) Model k Make: VQL 7/j Frame Style: Model: I / I VO ID Finish/Color: (;. •r-�7_/T—r^2-/'' Finish: IGs Glass Type: �S f„6rr Raise Shower Arm to from Floor Remove Existing Enclosure / Install Existing Enclosure r ❑Re-Bath ❑By Customer Discard ❑Re-Bath❑By Customer Removal and Reinstallation of Existing N Sink Naniry Polo❑Other ❑Save for Customer ❑SEE WARNING SYSTEM PRODUCTS Window Trim Kit: ❑Yes XNo Color ❑Sill El Caps ❑Soap Dish Color ❑Surface Mount ❑Recessed Cry. Security Bars/Towel Bars: ❑Shampoo Shelf Color ❑Surface Mount_❑Recessed Cry. ❑ "Size IS�_Ory. Corner Caddy Color Qty. ❑ Color Ory. �36"Shower Tawe �jJ/•/I Color .�Oty. ❑ "Size Color pry, 99"Shower Tower Color Cry. Shower Curtain Rod: nt�Existing ❑Hand Held Shower Make Model ` Finish ❑ ize Color ay. OTHER WORK TO BE PERFORMED uAL, 6A7I O/vt '7�i.1�2—OU 7. / t7o/1,C.7 -/':rr-4t ri VCo 4"E S Y ./U %L /Gf-aitlr GF�Z Oro R o*C OAm�/9/4z) ✓ CZ,-SC 5 i .s A'7 ✓, . /f//'094ts 1,55,*7C L 4x+aDlUaetlL '�/Jj-,✓ZlastA, ' (—�+9/'.t/i 'L3 - Clean-up and haul away all job related debris Accepta�nc d Auth i atio h f at t be represents the Bath System desi 2n�e forl or u: X C ..X/Y�r(1 YMYl' , 1 pY cuvmmersgnaWra � pate Home Depot U.S.A.Inc.,2455 Paces Ferry Road,N.W.,Bldg.6.3,Atlanta,Georgia 30339 aD-tss(iaivizl DISTRIBUTION:White—Home Depot Copy Yelbw—Customer Copy Pink—Installation Professional Copy (� sd `f1-f (U :1 Home Improvement Agreement:Tub&Shower Liners f 19(//D 2SN-ftG(� Customer's Last Name,First Name Store Order No. 5 / .57 ¢rued Address _ 0Fo--AnP-ol CRy State Zip -BillixtiMalling Address(It different Dom Service Address) 0 0 City State Zip Z-3 — Z 3— S7 t9�S Custom YS Daytimef /��' Co timers Evening Tel.No.CUSTOMER S INI LS: ' \ BY INRI ONG,YOU AGREES TWR BY YOUR SIGNAWRE BELOW,HOME DEPm,ITS AFFILIATES,OR AN AUTHORIZED REPRESENTATIVE MAY CONTACT YOU BY PHONE,FAX OR in LS THAT MAY BE OF INTEREST TO YOU.YOU MAY ALWAYS CHANGE YOUR MIND LATER;JUST LET US KNOW. Payment: $5 ._ Due immediately. Sales Tax: $/,pt�j— It applicable. ❑Financing Program lid Total Amount of Sale: $/ ,/o/ .� Includes all applicable discounts,rebates,and taxes.Excludes finance charges.` 'Any finance charges will be determined by your separate cardholder or loan agreement.Home Depot is NOT a parry to your cardholder or loan agreement.Please see the General Terms and Conditions following this page for more details regarding other charges which may apply. Antici ate�In Ilation Schedule Please note that neither Home Depot nor Installation Professional are responsible for start/finish delays resulting from events beyond their control including,but not limited to,acts of nature,governmental actions,manufacturing/delivery delays caused Start Date: ✓ ! /3/ /3 by third parties,damage to merchandise,labor strikes/unrest,Your financing,any incorrect information You provide,legal encumbrances on Your property,Your property's nonconformance with zoning regulations or building code requirements, (� hidden/unforeseen physical/hazardous conditions(including,but not limited to,environmental hazards such as mold,asbestos Finish Date: IZ 1 / �3 and lead paint)at Your service address,Your noncompliance with this Agreement,or Change Orders.Home Depot reserves the right to terminate this Agreement and/or require Installer to discontinue Installation given any of the foregoing conditions. Definitions:"You"P'Your"means the customer identified above."Installation"means the installation services specified in this Agreement."Installation Professional"or"Professional"means an independent contractor authorized by Home Depot(licensed and insured as required by Home Depot and applicable law)and the contractor's employees,agents and subcontractors."Agreement"means this Special Services/Home Improvement Agreement between You and Home Depot U.S.A.,Inc.(interchangeably referred to as"Home Depot"),which includes this page,the GeneralTerms and Conditions following this page,the State Supplement,the Invoice or Specifications and any other documents expressly made a part of this Agreement.Please see this Agreement's General Terms and Conditions for additional definitions. Acceptance and Authorization:By signing below,You authorize Home Depot to(a)arrange for Installation Professional to perform Installation and/ or(b)order and arrange for the delivery of special order merchandise,including special order merchandise that may be custom made,as specified in this Agreement.You understand this Agreement constitutes the entire understanding between You and Home Depot and may only be amended by a Change Order signed by Home Depot(or by Installation Professional or its authorized representative on Home Depot's behalf)and You.This Agreement expressly supersedes all prior written or verbal agreements or representations made by Home Depot,Installation Professional,You,or anyone else.Except as set forth in this Agreement,You agree there are no oral or written representations or inducements,express or implied,in any way conditioning this Agreement,and You expressly disclaim their existence.Do not sign if blank or incomplete.(Installation Professional'sl permitting information may need to be provided toYou later,)By signing,You acknowledge that have read,understand,and accept this Agreement in its entirety.You further acknowledge receiving a complete copy.Keep it to protect Your legal rights. V v ?' Plore�,arEFwa,sneGvrFadBNBme,AaaEssamG�prworNG�.�aa�le: _BV ITIALING,YOU AIITHORIZEDELIVERYOFMERCHANDISE SS P DEDABOVEWITHOUTDELIVERY AGENTS O INDEMNIFY ANo HOLD HOME DEPOT HARMLESS FROM ANY RESULTING CLAIMS. Pmfsessio Id se . w 571-7 Pkli bea�vc d p,esa J m a epl'a�� Pam — A ns M 3 - PRINTYourSalespersons� aAApplMade GOTOHOMEDEPOT.COMNGENSENUMBERSFORALOMPLETELISi OF DCEN ENBMBERS. BUYERS RtGHTTO CANCEL:SEE GENERALTERMSICONOmONS Home Depot:U.S.A.Inc.,2455 Paces Ferry Road,N.W:;Bldg.B.3,Atlanta,Georgia 30339 HD 165 ITvr v1 zl DISTRIBUTION:While—Home Depot Copy Yellow—Customer Copy Pink—Installation Professional Copy ® DATE(MMIDDIYYYV) , AC b CERTIFICATE OF LIABILITY INSURANCE y 11/19/2012 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 NOT 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(ies)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:NTA Eastern Insurance Group LLC-Main RHO"o - 5 -7 0 Pat.No: 8- - 233 West Central Street E-MAIL Natick MA 01760 ADDRESS:$eI twor asterninsur nc .com INSURERS AFFORDING COVERAGE NAIC# INSURER A: t Ve Insurance 19259 INSURED 29660 INSURER B:P m uth Rock Assurance Co. 54 New England Bath, Inc. INSURER C:Teghnology Insurance 'I Bay State Re-Bath INSURERD: 55 B Corporate Park Drive Pembroke MA 02359-1966 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:399719680 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER MWDD MM/DD/YYYf A GENERAL LIABILITY Y Y S 1959417 1212l2012 2/2/2013 EACH OCCURRENCE 81,000,000l X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence 8100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY X PRO- X LOC $ JECT kn OMOBILE LIABILITY Y PRC00001001800 10/15/20112 0/15/2013 Ea accitlent $1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Peracudenp $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS I Peraccidenl AB X OCCUR S 1959417 12/2/2012 Q212 01013 EACH OCCURRENCE $1,000,000 } ICLPtMS-MADE AGGREGATE $1,000,000 ETENTION$10,000 $ KERS COMPENSATION C336785 12/2/2012 2/2/2013 X WCSTATU- OTH- ORV L AND EMPLOYERS'LIABILITY YIN , ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED9 N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under D ES CRIPTION OF OPERATIONS below El.DISEASE-POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) TILE,STONE, MARBLE, MOSAIC OR TERRAZZO WORK,PLUMBING RESIDENTIAL OR DOMESTIC. Master Plumber: Dennis J. Russo. Home Depot U.S.A., Inc.,its parent,affiliates,and subsidiaries are additional insured on the General Liability policy where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Home Depot U.S.A., Inc. ACCORDANCE WITH THE POLICY PROVISIONS. c/o LexisNexis 1100 Alderman Drive AUTHORIZED REPRESENTATIVE Alpharetta GA 30005 , p I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS Ts LICENSED AS A JOURNEYMAN PLUMBER,, ISSUES THE ABOVE LICENSE TO. DENNIS J RUSSO 8 ALDEN TER PLYMOUTH MA 02360-4518 Y 20719 05/01/14 145885 COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THE.ABOVE LICENSE TO: DENNIS J RUSSOs 8, ALDEN TER PLYMOUTH MA 02360-4518 11265 05/01/14 145886 a • COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS REGISTERED A A A PLUMBING CORA ISSUES THE ABOVE LICENSE TO. DENNIS J RUSSO NEW ENGLAND BATH INC 8 ALDEN TERRACE ( " PLYMOUTH MA 02360-45181� 3477 05/01/14 240389 . ',v Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 uw�� www.mass.gov/dia Workers' Compensation [nsurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /I Please Print Legibly Name(Business/Organization/Individual): 6u �h 06 A Oa 5 f a fe Pe b �ki Address: S3-8 C_ 0!42 r�, fe PAr fC or, Ve City/State/Zip: Pembroke MA Oa35-17 Phone#: %re you an employer?Check the appropriate box: Type of project(required): . I am a employer with U0 0 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors .❑ 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. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.- required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions .❑ I am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp. insurance required.] my applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. enactors that check this box most attached an additional sheet showing the name of the subcontractors and state whether or not those entities have hployees. If the subcontractors have employees,they most provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name: r�L�t l70�rX/t1 Sn�cri'anGe (£�y r� rr7 �tr-'"-n Ge� Aicy#or Self-ins. Lic(.#: T-W 3.3� -7 8 �S_ Expiration Date: / 2 �-2 � C / 3 rb Site Address:_l`�I.L City/State/Zip: .ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby cer fy under the pains and perrrthies ofperjury that the information provided above is true and correct i ature: t �/ Date: hone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ��rusEtts=® ISM r 5�5392tl$ d d { WIN ti C " r W 19 Massachusetts- Department of Public Safet} Board of Building„ Reg,ulations and Standards NW Construction Supervisor License License: CS 103995 Restricted to: CO JENNIFER BYLO 688 UNION ST ' DUXBURY, MA 02332 mil �1'f Expiration: 11/12/2013 t'onuvisiuner Tr#: 103995 Office fAJE—e �.. B¢�si e¢ss honln HOME IMPROVEMENT CONTRACTOR Registration ,,Ag06g1 Type: Expiration _jlki242013 Private Corporatior N NGLAND BRA YSTATE RE-BATH ' M. JENNIFER BYLO 55 B CORPORATE 2A m•YE,- g a PEMBROKE, MA 021$9. -= Undersecretary ➢i , t 7 Ag COWIPAOM EAL'4H OF MASSACHUSE€TTS PLUMBERS AND GASFITTERS� LICENSED AS A MASTER PLUMBER isSuEsTHrE t�VEupr,Irs�x r QfIJt115 '-:l I?ussc_,: � -1+.LDEPT TER m� FLYR4QtJFFf MA 02 A 18 IN 11265 0510111�i K � � g��, _ 9