5 THOMAS CIRCLE - BUILDING INSPECTION I
IIII n -
lllh
UPC 10330
No. 153�
N.ASTINGS, MN
Commonwealth of Massachusetts
Board of Building Regulations and Standards
Manufactured Buildings Program
LABEL REQUEST FORM
This Section for State Use Only
Date Received C 6 e.X I Label Numbers Issued:
Fee Received $ .CLQ 0, . i! G j 0 ?2 1 -
Check Number 4f ,Z„� Date Issued: t, 1, C Issued by: �
This Section to be Completed by Manufacturer-PLEASE PRINT OR TYPE
SECTION 1 - MANUFACTURER INFORMATION BBRS\DPS I.D. # 0575-08
Manufacturer Name New England Homes, Inc. MC# 050
Street 270 Ocean Road
City/State/Zip Greenland,NH 03840
Manufacturer Telephone Number: (603) 436-8830 Fax Number: (603) 431-8540
Manufacturer-Plant Inspector Richard H. Farrar
Third Party Agency T.R. Arnold and Associates Inc. TPIA # 03
Number of Labels 4 Total Amount Attached $200.00
Manufacturer's Serial C-10547 Manufacturers Model Astoria Colonial -
Number Designation
SECTION 2- LOCATION OF BUILDING
Street 5 Thomas Circle
City/State/Zip Salem,MA. 01970
SECTION 3- BUILDER/DEALER/CERTIFIED INSTALLER INFORMATION
Builder/Dealer Anthony V. Tiro
Street 9 Gianna Drive
City/State/Zip Saugus, MA. 01906
Certified Installer Keeley Crane Service
Licensed Construction Anthony V. Tiro License Number: 069003
Supervisor 9 Gianna Drive
Expiration Date: current
Saugus. MA. 01906
This form shall be completed by the manufacturer when requesting manufactured building labels. All
information shall be clearly indicated. Incomplete forms will be returned to the manufacturer unprocessed.
This request shall be forwarded to the State Board of Building Regulations and Standards-CERC
Building,Paul A.Dever School-1380 Bay Street,Taunton,MA 02780
Bbn\Fomis2\mfgLabelRequest
June 15,2001
DEPT. OF PUBLIC SAFETY FP�s`us
P.O.BOX 1063,Hadley Bldg. yr y * ,g
167 2 Lyman Street
y 27 � `M"�' P68655705
Westboro,MA 01581-6063 4 1 4 0 5 00 . 420 OCT 10 08
5 958 vv_srsoeoucr:.MA 0 1 5 8 1
Thomas St. Pierre
' Inspector of Buildings
120 Washington Street
Salem, MA 01970
Z
3 I lilt 11 lilt 11 H Hill 1 11 MI ill i till I 1 I fill