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Building Permit #535 - 247 CHICKERING ROAD 2/15/2006
NORTIM O 9 .. ,SSAC HUSKS TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:� Date Issued: r-9-&E-0—IL Date Received:,�q,)6-106 I IMPORTANT: Annlicant must comnlete all items on this naue LOCATION Q `- e r; r.A- Q 0 A acAoy—. f.. M!A �4,rint_ PROPERTY OWNER 3,1 c&.!' 40`� M,,J Print MAP NO.: 46 PARCEL: UGo ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential J New Building D Addition - Iteration IF One family E Two or more family No. of units: Industrial LARepair, replacement U Demolition Assessory Bldg I '' Commercial C Moving (relocation) Other L, Others: Ji Foundation only DESCRIPTION OF WORK TO BE PREFORMEDSlea1e_ \n V a4 OWNER: Nam<, Address:�� CONTRACTOR Address: ease Type or Print Clearly) �j7$^682^�gOS Phone Supervisor's Construction License: 13 %GJfo "7 Exp. Date:17l 06 Home Improvement License: ARCI-IITECT; F.NGINEE Address: Exp. Date: Name: Phone: Reg. No. FEE SCHEDULE. BULDING PERMIT. 510.00 PER $1000.00 OF THE TOTAL EST1,41ATED COST BASED ON .$125.00 PER S. F. Ov Total Project Cost :$ Q,!J 3.5, n x10.00 -FEE:$ Check No.: Receipt No.: /�9�� -j r Location No. d7 C) Date NORT►� ,� TOWN OF NORTH ANDOVER OF o1 i 07 O � s D i * ; y . Certificate of Occupancy $ s E<� s^GNUS Buildin /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee $�- TOTAL $ �� r Check # r) f� r ✓ Building Inspector { r j Date ..................... NORTH TOWN OF NORTH AND&ER OF 1 Y e. Q e� a OL PERMIT FOR GAS INSTALLATION I D a tl 1 �9SS4CNUSEt 2• - - '993 i This certifies that ........................................... has permission for gas installation ........................... in the buildings of .......................................... at .................................... North Andover, Mass. Fee......... Lic. No........... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Ddpt. PINK: Treasurer GOLD: File a Date..................... t w L ,MORTH • - TOWN OF NORTH ANDOVER 'py t�.ao ,e'1goL . p PERMIT FOR GAS INSTALLATION OCT� 8 "sy 1993 This certifies that ...�.. _ . , , .. , , , , ... { has permission for gas installation ................... . i in the buildings of .. - _ .�.! t. ...: r ........ .. ... . at ....... .: ��. ; .... l:r.. #..�.... , North Andover, Mass. Fee.. ?.1 . Lic. No:..;... ! L-! :'. ......................... l } GAS INSPECTOR WHITE: Applicant CANAR'Y'tuilding Dept. PINK: Treasurer GOLD: File Date / �q TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Nz� 1-? This certifies that.. ... ... 1'(�.61 . ............. has permission to per or m �? ........ 4� ............ 0 plumbing in the buildings o at. . North Andover, Mass. Fee. 7 Y,- Lic. No.......... .............................. /( PLUMBING INSPECTOR 01/26/98 13:58 97.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer NOTE: Persons contracting with unregistered contractors do not have access to the guaraigy fund Signature of Agent/Owner 27_t� Signature of Contractor-, Plans Submitted ❑ Plans Waive ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision receipt submitted yes Plannine Board Decision: Conservation Decision: DATE REJECTED 17 ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED ❑ 0 Conunen Comments DATE APPROVED DATE APPROVED El Ir SATE APPROVED 0 Water & Sewer connection sicynature & date Temp Dempster on site yeses no Fire Department signature,'datea Building Permit Approved and Issued by: TYPE OF SEWARGE DISPOSAL _ Tanning/A(lassa�ge/Body Ail Swimming Pools _i Public Sewer _ — Well Tobacco Sales — Food Packaging/Sales Permanent Dempster on Site Private (septic tank, etc. _.. NOTE: Persons contracting with unregistered contractors do not have access to the guaraigy fund Signature of Agent/Owner 27_t� Signature of Contractor-, Plans Submitted ❑ Plans Waive ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision receipt submitted yes Plannine Board Decision: Conservation Decision: DATE REJECTED 17 ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED ❑ 0 Conunen Comments DATE APPROVED DATE APPROVED El Ir SATE APPROVED 0 Water & Sewer connection sicynature & date Temp Dempster on site yeses no Fire Department signature,'datea Building Permit Approved and Issued by: Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Re uired Provides Required Provided DIMENSION Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on F,xterior dimensions. l )Ix IN:i I'14-110N:':I. Sf.1,V1(A-S 1;[j',%K l'MIJ6 V.1411 ( RN,10 Cn:dicJ .l\I( Jdn.=grin Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits J) wilding Permit Application �Pvebris Removal Form orkers Comp Affidavit :� hoto Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Pen -nit Application ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Form U ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report in all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SER% ICES DEPARTMENTMFOR1115 w W 0 Z H COD W LL W COD Z c c m c c :oma c ` N O c CC3 G3 .ate p, c A O m c :Z O O � Ea o o� CD o K N EE m c$ 0 0 t o c D� y CD o 3 N .m Cc.o := c N R tz N � m o N o 0 ;z o 10 CoQ N L m V CL C2, N Z W ri O CD CD a O o c': 10 +•+ N O w re Me c +-. = 4- E Ca Ca d 0 r= = N � O N �- Z dZ Cl g O F. �I O TIT P4 a O a� O E L v � Z � Q. O CO) Q � IC� OD CO .c � Q C MA E mm CD CL CD �3 .p O Q OL e_vv o a a cmQ S COD c cc Q d O CD co c Z tsCLO �..� CO) c C C c m CO2 ul U) 19 W LUW U) O wW a UW a O \ N a o o o Uw" q a w q w" W o w ia. ' w cn o cn W 0 Z H COD W LL W COD Z c c m c c :oma c ` N O c CC3 G3 .ate p, c A O m c :Z O O � Ea o o� CD o K N EE m c$ 0 0 t o c D� y CD o 3 N .m Cc.o := c N R tz N � m o N o 0 ;z o 10 CoQ N L m V CL C2, N Z W ri O CD CD a O o c': 10 +•+ N O w re Me c +-. = 4- E Ca Ca d 0 r= = N � O N �- Z dZ Cl g O F. �I O TIT P4 a O a� O E L v � Z � Q. O CO) Q � IC� OD CO .c � Q C MA E mm CD CL CD �3 .p O Q OL e_vv o a a cmQ S COD c cc Q d O CD co c Z tsCLO �..� CO) c C C c m CO2 ul U) 19 W LUW U) BUILDING PERMIT INFORMATION AGENT/ OWNER NAPE: JOB ADDRESS: TELEPHONE NUMBER: BUILDING LOCATION: TYPE OF CONSTRUCTION OF EXISTING BUILDING: Brick/ Concrete Block BUILDING USAGE: Commercial TYPE OF ROOFING: SCOPE OF WORK: Roof Replacement WASTE REMOVAL COMPANY: Grant Removal ADDRESS: 28 Walcott Street Rear, Readville Ma 02137 TELEPHONE NUMBER: +1 (800) 649-1616 DUMPING LOCATION: Taunton Landfill INSURANCE INFORMATION: The Protector Grou 100 Front St. Stn Floor Worcester, MA 01608 WORKMAN'S COMPENSATION: 00968796300 CONTRACT AMOUNT: $ rg ' ; �' ,. T �I i '� I�� IIi I � �� ' Ij �I� I; 'I ,I � i ,i � i, , I'' I �� � � II i � i � I �I i I � IlI I� � � j 3 ��� ' I I' � � ; I I 'I � II � � l I .� � �' � � � � � �� � ir� � �� I � �i r �, i , �; ', , i � �; �: i '� �I � �' �' �'I �'� � i I I iI ' � � � ���'� � ', �, k i `� � � ! � � i j � i � ' 'I I ' II - I I I I II' I 1 �I ', � I ' � I � � I I � � II' '. � } I II � I I II � '� �. � I I I '. I II �I I I II Iil � .I �":I I I II II i� II II '�, � � I I I I I _ � � I, I ��,� lI'. I I.. ,i I 1, I`, I I I' i I II �, li IIl '� �, �i � II i � i i � � � � �; '� � I � � � !, � "' I I I I � � I . II � 1� I Ili � II I ' �� I 'i'. II i I, i III i I I � 1 i ��.I�'�i � I � i I I I I �.. �' i �_ PROTECTOR GROUP 5088528500 02114 '06 15:35 NO.167 01/01 BUILMAJ-01 MENA AC4RDTM CERTIFICATE OF LIABILITY INSURANCE °"2141 pROUCER (508) 8524500 )rotvctor Group Ms. Agency, Inc. 100 Front Street, Suite 800 Noroester, MA 01608.1435 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NUPANCII~•T POLICY NUMBER INSURERS AFFORDING COVERAGE NAiC 0 INSURED Building Maintenance Corp dba US Roofing INSURER A: Acadia Insurance BMC Development LLC 38 R Pulaski Street Peabody, MA 01861 E,SuRm B. Commerce & Industry INSURER c` INSURER o: f 1,000,00 INSURER E: X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X7 I OCCUR COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. UL NUPANCII~•T POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LM9IUTY EACH OCCURRENCE f 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X7 I OCCUR CPA0085685.13 12/23/2005 12/23/2006 P - r - S ;rcnce $ 300,00 MED EXP (Any on* Person) ; PERSONAL A AOV INJURY S 110001 _ GENERAL AGGREGATE ; 2,000,00C EERL AGGREGATE LIMIT APPLIES PER: PRODUCTS - CONIMP AGO S 2,000,00 POLICY f X Vi F I LOC A AUTOMOBILE LIABILITY ANYAUTO MAA0085652.13 12123/2005 12/2312006 COMBINED SINGLE UMIT (Faaeadem) S 1,000,00 BODILY INJURY (Par Mrw-) X ALL OWN EAUTOS 3CMEDULED AUTOS X X 14 RGD AUTOS NON•OWNEOAUTOZ BODILY INJURY (Psraccide ) f PROPERTY DAMAGE lPK OcclCtrlltl S GARAGE LIABN.nY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO S AUTO ONLY: AGO A EXCESBNMBRELLA LIAIMUN X OCCUR 1 1 CLAIMSMADE CUA0085698.13 12123/200S 12123/2006 EACH OCCURRENCE f 6,000,000 AGGREGATE s 5,0w,000 B 'RETENTION f DEDUCYIDLE f f B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETORMARTNER/EXECUTIVE OFFFICERIMgMfjEOR�EXCLUDED7 09687863 12/23/2005 12123!2008 WC STAT'U- j( TH- LIMITS-� E.L. EACH ACCIDENT S 0 CL, DISF.ASE-EAEMPLOYEE S 500.0 SP f IAL P b H'ISIONS below F.L. DISEASE - POLICY LIMIT S 500100 OTHER A Installation Floater CPA0085685.13 12123/2005 12/23/2006 Job Site Limit Sw. A Special Form CPA00856B5-13 12/2312005 12/23/2006 Tmnsit(Temp IOC $50,40 DESCRIPTION OF OPOO ATNON& I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 2E: Intown Veterinary Group, 247 Chickering Rd, No. Andover, MA Town of North Andover Attn: Building Dept, Peter Murphy 400 Osgood St North Andover, MA 01846 - ACORD 26 (2001 SHOULD ANY OF THE ABOVE OESCRISM POLICIM BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER VnLLENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIPK:ATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SKALL IMPOSE NO OSUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR i SIGN PERMIT WORKSHEET Property Owner -^J a� �1 A3 Business Name —3c) J691? —Alul m Property Owner Address --7`-/ % Sign Location Address z e -- Zoning Zoning District i3 Allowed Area oZ ,s Proposed Area a y Allowed Height © Proposed Height 8 Allowed Setback Proposed Setback f� Map '7 6 Lot_ Estimated Cost $/ IOOO- Fee $ Permit Application Received Permit Approved / 0/ a 3 Inspector JB o r P rl �' N (D P- 3 3 m CD 0 D > z M 'n r O� M .� m m _ r D w O r r 0 --r UO m D n n m m 0 I Z) O (D v co m ri 0 n. 0 v v z 0 "'11� LD. cn6-0crv Z cn c Zr CD D 0 o C O ID 7 D tD n 0-0 (D CD O (DO . O Z ( cn �.CC �. cn O J O CD 3 -0w n cD3 cn D 0� m (u (0 0 (D- N. � -0 Cr v _ ---(n rn 0 lG Z 0 (D cn r o 0 CD � � � O°-�-- N -000��.30 _0 Cf)3 0 0 UO CD W W O DN C c� (D =r CD ^' n' 6 .G' =r (D CD -, 3 CD o CD 0- v v < CD 0 W (D 0_ o CD z3 (D cD -0 D" � -• (D 0 �• 3 o cn 0 (n' C cn 07 Co J LD. cn6-0crv Z cn c Zr CD D 0 o C O ID 7 D tD n 0-0 m �3���v Z ( _ in 0 �. o -0 cn cn O J O CD Jm 0 3 7 :3=rn —v o CD J m (u (0 N. O U) n O� m _ �00CD(D lG Z 0 (D o 0 cn � O°-�-- . -000��.30 _0 Cf)3 C N 0 UO CD W W O DN C (n —_ N (D =r CD ^' n' 6 .G' =r (D CD -, 3 CD o CD 0- v Z) 0- -, (D < CD 0 W (D n o CD z3 (D cD -0 3 CD m (D � -• 0 �• 3 o ?� o 0 O C cn 07 Co J CD C— T (D m U -0 O -0 O U) D. O 0 0 CD Cl) Q (D 77 CD'- . (r) �D o a y �11 l r—C)CTw O�0(ID O0 v (D C — cD . w r v (/N L N rn o_ 0 0 CD a cn ( w r, v D C O z m m D r n O z O z O -n z O w z C3 O m f i��;II �i N' t ,r 71 iol, 1 f i��;II ,r 71 iol, •f� ry ,ii S d — � r �IE3 s y Wit 'aM 7 P k. riY°��'.• p� TMk�gy�XyFT Pu.� mill — w"F k, vim. advance �' reproductions corporation Quotation 100 Flagship Drive • North Andover, MA 01845 • Tel: 978-685-2911 • Fax: 978-685-1771 • E -Mail: sales@advancerepro.com TO Bulger Animal Hospital 247 Chickering Road • North Andover , MA 01845 Attn: Matthew Pearson We appreciate your inquiry and are pleased to quote the following: Quotation #: 11831 RAJ Date of quote: September 09, 2003 Reference: DIGITAL IMAGING Terms: COD FOB: — -- -- Price-firm-for: Shipment Date: Quoted by: ITEM # QTY DESCRIPTION UNIT PRICE AMOUNT 1 1 Top lit Tx 8' double sided sign. Materials will be two 12'x 8" x 8" $10764.00 $10764.00 granite posts holding joined wooden signs with cut raised letters and moulding on all sides. Letters are black and logo is in blue as close as possible to Pantone 302 CV. 2 1 Digital photography and computer design time to produce redurings $250.00 $250.00 (note this is for work done for previous and new renderings) Comments: $11 014.00 Price includes installation of sign and connecting to customer installed power box. Price is based on customer T obtaining all necessary approvals and permits. A 50% deposit will be required before beginning any work. This quotation and purchaser's acceptance thereof include all the above terms and conditions and those shown on the reverse side hereof. We hope we may be favored with your order. Isosoo2 � e SCS 4.2.4 - 019 REV 00 06/01/03 pEClb'IFNEO COM/uE1 d CD O O W CD o b o 0 �' Cv � 0 ►o o 1—� o.?�1a�� o w o'aQ. y CD 0s Ex CD CD y ►0 o CD Loeb CD N��' o cu 5 o rp � z 0Cc, o (D u� yya���►r� w S ao ' - g00 M0 r� � CD (D(D CD MeD ►� �' 0 e S:, 0�ooa CD C �° p D' rA ON 9 0 CD O ice+ CDCD N C o � Q- o C o �• c� o C Ln 110 UA. CD 1 CD r♦ . { Date.: :'. r.'......... . 17 , NpR,M TOWN OF NORTH ANDOVER' 3? a• • pL o p PERMIT FOR GAS INSTALLATION; This certifies that . �,e�1.p . :`� .... �� /. • . , , has permission for gas installation t- : .............. . in the buildings of ../ . ( *......f.1" '/' , • -r at .............................. . North Andover, Mass. Fee./ .�, `. Lic. No..`K 'F... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TU DU PLUMIJIN(a (Print or Type) `�� i ``• vo /JoA � /� � • ©• �� ,Mass. Date .G�� 1rJT-z::L— Permit!! � � y g �''.��•' Building Location BL4 iiA � Gid Awner's Name J 0h � P AF- TIS F - New Renovation la" ,v; rH ►� 1 kv S Type of Occupancy Replacement LJ Plans Submitted Yes 1:7 No 1 FEATURES Installing Company Name AQ f_l a_��__ /i�9 I.J►J G; Check one: Certificate ' ` Address ��% -A 4J�._ b � _ ti corporation Lw R �!t/ C El_!1-1 Partnership G88—t1 01 ��3 5b8- Business Telephone �'�j� IJ Firm/Co. _ Name of Licensed PlumberQ j D -S INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes PS' Non - 11 you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy I;-� Other type of indemnity U Bond LI OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Owner 1.1 Agent I 1 I hereby certify that all of the details and information I have submitted (or entered) in above application aro true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title Cily(rown 111 M 1..-1.0 MMI /{M II111. KI II .II Typo of License: Mastor tl,"' Journoyman L7 License Number • ..- ■■■■■■■■■■■■■■■■■■■■■■■■■■■ Installing Company Name AQ f_l a_��__ /i�9 I.J►J G; Check one: Certificate ' ` Address ��% -A 4J�._ b � _ ti corporation Lw R �!t/ C El_!1-1 Partnership G88—t1 01 ��3 5b8- Business Telephone �'�j� IJ Firm/Co. _ Name of Licensed PlumberQ j D -S INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes PS' Non - 11 you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy I;-� Other type of indemnity U Bond LI OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Owner 1.1 Agent I 1 I hereby certify that all of the details and information I have submitted (or entered) in above application aro true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title Cily(rown 111 M 1..-1.0 MMI /{M II111. KI II .II Typo of License: Mastor tl,"' Journoyman L7 License Number . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) "o) A,)j ts, n& A, Mass. Date _ 19 Permit # Building Location f3kA Ig /at'.Jim,&, aw Owner's Name Jo1Lr4 kfiJ)fiS-C� zit -1 ►e £{Z ua ►�. Type of Occupancy Ati) m A i �O New Renovation Replacement ❑ Plans Submitted: Yes ❑ No - -co ,Installing Company Name A po I I o PQ3& N� or N Check one: Certificate # Address ST 2' Corporation 16 9 7 C. L N. R xl C , Nt ASS ❑ Partnership Business Telephone SOS- G!d L 7S5 ❑Firm/Co. Name of Licensed Plumber or Gas Fitter D(�N nS S R U i S r_ A,%i )c INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1 Yes e No ❑ If you have checked Vis, please indicate the type coverage by checking the appropriate box. A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent -. Owner ❑ Agent ❑ nereoy certtry tnat aii of the oetaiis and information I have submitted (or entered) in above application -are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: ❑ Plumber Q-A �iaC ❑ Gasfitter Signature of Licensed Plumber or Gas Fitter R* Master SC69 ct ❑ Journeyman License Number c Y W Z (6 2 co 8 0) W W o m Z Z o x � W m W H Q= ul 0 O W a. p W I- Q Wa: W- 000Ww cj)Z ►- O ~ U' z¢ FIII Z W J F- Q=} Z W W O � m j z tL g W z 0 W w 0 (n ►- W. _ I Q oC W = > 0 = 0= W D u_ Z � Q 3 M 0 Q 0< Q 0 O O W > E O O W W O SUB-BSMT. BASEMENT 1ST FLOOR ' a 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR ,Installing Company Name A po I I o PQ3& N� or N Check one: Certificate # Address ST 2' Corporation 16 9 7 C. L N. R xl C , Nt ASS ❑ Partnership Business Telephone SOS- G!d L 7S5 ❑Firm/Co. Name of Licensed Plumber or Gas Fitter D(�N nS S R U i S r_ A,%i )c INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1 Yes e No ❑ If you have checked Vis, please indicate the type coverage by checking the appropriate box. A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent -. Owner ❑ Agent ❑ nereoy certtry tnat aii of the oetaiis and information I have submitted (or entered) in above application -are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: ❑ Plumber Q-A �iaC ❑ Gasfitter Signature of Licensed Plumber or Gas Fitter R* Master SC69 ct ❑ Journeyman License Number c Office Use O_ni of 4e CEam IIIIt1 mlo of _M5c*U5Pft5 Permit No.L— _ Beprtmot of Public q Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 peeve blank)�� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR_ 12:00 .� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �� -� 00x/ or Town of NORTH ANDOVER To the In pect 910f Wires: -The udersigned applies for a permit) toerformtthe electrical work described below. (Street Street & Number) f �� ,Q Owner or Tenant �Cs ���� 1'�i f C� )�GS� �/c, Owner's Address Is this permit in conjunction with a building permit: Yes Ix' No ❑ (Check Appropriate Box) Purpose of Buildina Uir n Ic- ��pSCI 7',c �� Utility Authorization No. Existing Service Amps —J Volts Overhead �7_1 Undgrnd No. of Meters New Service Amps _I Volts Overhead Undgrnd C No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets I No. of Hot Tubs I No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pcoi Above.— In- Brno. _ grnc. - Generators KVA No. of Emergency Lighting No. of Receptacle Cutlets I No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges 9 I No. of Air Conc. Totai tons No. of Detection and Initiating Devices No. of Disposals I Heat Total No.of Pumps Tons Total ICbV No. of Sounding Devices No. of Contained No. of Dishwashers I Space/Area Heating KbV De[ac::on/Bouncing Devices t;on No. of Dryers i Heating Devices KW — Municmai Local _ Conner.:on 1 Other No. of No. of Low Voltage No. of Water Heaters KW I Sicns Ballasts Wirinc No. Hydro Massage Tubs I No. of Motors Total HP OTHER:SJq �( C/ ' ) L S 1 : '` h (4L s% �G f` (?er_ r/11� c(i, —(,,-rz U, "It sh n- ( — 2rC Gy %4S INSURANCE COVERAGEE: Pursuant to the requirements of '.Massachusetts General Laws I have a current Liability Insurance Policy including Comoietec Operations Coverage or Its substantial ecuivaient. YES = NO = I have submitted valid proof of same to the Office. YES = NO = If you have checked YES. please incicate the type of coverage by ing the prooriate box. INSURANCE BOND = OTHER = (Please Specify) (Expiration Datet surtiated Value of Electrical Work 5 WOM to Start Inspection Date Recuestec: Rough Flnai Signed under the P altiesjpf,p`erlury:`� FIRM NAME__ L = i!! 1 C `�f\ �� C ' _ LIC. NO. f l Licensee C'_' _,(14 rn t I L4, Signature LIC.NO. Bus. Tel. No. Address u v cJ ✓ ' ' �f ► Y� 4 SS �f (d c �� _ Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- cuired by Massachusetts General Laws, ana that my signature on this permit application waives this requirement. Owner Agent (Please checx one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-5-566 • 217 Date................... t� TOWN OF NORTH ANDOVER PERMIT FOR WIRING L� Ln This certifies that ..............: 1 1'. ........................................................."................� 4 has permission to perform wiring in the building of ...................................:..:...................t/.. f ..... ....... , North Andover, Mass. ... Lic. No. ,..!.....: !. Fee .. � .......... .............. f ELEcrRICALINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File uq1 l!amuwnweulih at fflour4usim PIMA wm: `"' 8eparnnrtit fJf public $nfciq OOCYWXy A Fie ate"d�° - BOARD OF FIRE PREVENTION REGULATIONS 521 UIR 12:00 iso PUM ftnk1 ----------------- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetis Electrical Code. 527 CMA i2:o0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ` A& Q* or Town of NORTH ANDOYFR To the Inspector of wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ) , CE'�d.4d Owner or Tenant 6c ---s > .4,1J , rv� 47 Ff Owner's Address 2 el c Jib Li r Is this permit in conjunction with a building per Yes�! No 01 (Check Appropriate 80x) Purpose of Building �e �J� . f 'o -y Utility Authorization No. Existing Service (/,DO Amps 4)61 -!or Voits Overhead '_i Una rna No. of New Service Amps _.� Volts Overnead _ Unagrna C No. of M�11Z Numoer of Feeders and Ampacfty Location and Nature of Proposed Electrical 'NorK No. of LIgntinq Outlets I No. of Oat -sI No. of Translormers Tote ' KVA No. of Linun I .>,ocve.— :n. q 9 Fixtures �� I Swimming P_o, r- Srro _ i;rna _ I Generators KVA Xvo . f EmEmergencyl,;gnunq rJ" No. of Receotacte Outlets a_ I No. of Oil c't.rners No ( No.Sarof Units , fs� No. Of SwtlCn Outlets I No. of Gas :urrers FIRE ALARMS No. of Zones No. of RangesI No. CI Air Cc. `1 'ota' ii No. of Oetectton and , roc Cns % Indlaunq Oevuee Q No. of Oisooaals. I No.ol Meat -o:ai �otai Pur-.cs ons PWJ No. of SounWng OevlC" lJ No. of Sed Contained No. of Oianwaanua I SoacerArea_.+eaurg K�.V OstectlonrSounang OewCN No. of Oryara I Heating Oav c@s KW Local ; Municioal Boum Connection No. of Low Voltage ; No. of Water Heaters KW I Signs 'alas:s Wiring ; No. Hydro Massage Tuos I No. of Moicrs ,oiai HP OTHER: INSURANCE COVERAGE. Pursuant :o ins reouiremenis z;t ttassac%sers ;@neral Laws 1 have a current Liability Insurance Policy incivaing C.:m- etec Ccerauons Coverage or its substantial equivalent. Yale No 1 nava suaminea valid proof of same to the Office. YES = VO = It you nave cnecxea YES. please Inti is Ifte ItIPe CbyM M, Clacking ins abproariais box. INSURANCE = BONO = OTHER = (Pleas@ Szac.''.J) Estimateo Value of E!ectncal Work S / i ✓ t ai0" w WOrk to Start '' - � 3 " `%/� Insoec:ton Oats �ac6as:ec. Rougn �%f 1 r C'¢ ` Fine Signea under me Penalties of perjury: FIRM NAME/_ C7 -L' � LIC. No. Licensee 3t�'3 /Y1cf4 �o ti Bus. Tel. No. :3a , 145-7 Addrsse /Yt Li i�/� ell All. Tel. 14o. — e, 4 3 _ ,//, r;Z ••r• �-.& .i OWNER'S INSURANCE WAIVER: I am aware inat the LXenses ^.ces not nave ins insurance coverage or its sucstanual equmelem Ousted by Massacnussits General Laws. ano trial my signature an �r%is :ermif aopticalton waives this reautrs"W". owner Agarlt tPleese CfDSCk bnor sisonone No. PERMIT FEE s (S•gnafuie of Owner or Agenif # N2 14 4 4. Date..� ...`.. _ �.? .-..��'.% .. ...... ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................. . .............................................................. ru CC) has permission to perform ,........-..::i.... - -moi ............ ......... I :........... ....... o wiring in the building of.... t/. .....:....................... J at ........ ...j.:.....r....:. ..../�' :�........ ,North Andover, Mass. .. i Fee.27... ..... Lic. NoL.l�!.{!............................................................... a WHITE: Applicant 0 ELECTRICAL INSPECTOR CANARY: Building Dept. PINK: Treasurer rw Town Of North Andover Building Department 27 CHARLES STREET 508-688-9545 APPLICANT: BULGER ANIMAL HOSP Project: BULGERS ANIMAL HOSPITAL. 247 CHICKERING RD ' NORTH ANDOVER MA 01845 RE: PROPOSAL FOR 3X6 FEET MASONRY PAD & 100 KW GENERATOR DATE: DECEMBER 21,1998 Title of Plans and Documents: BULGERS ANIMAL HOSPITALf Please be advised that after review of your Building Permit Application and Plans that your Application is DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements X Violation of Setback Front Side X Rear Insufficient Lot Area Insufficient Parking Violation of Building Coverage Insufficient Open Space Use requires permits prior to Building Permit Sign requires permits prior to Building Permit Form U not complete by other de artments Not in conformance with Growth By -Law Other Remedy for the above is checked below. X Dimensional Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Other Other Plan Review The plans and documentation submitted have the following inadequacies: 1. Information Is riot provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4. Information is incorrect. 5. All of the above. Health Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans 116 Affidavit Mechanical Plans and or details Plans Stamped by proper disci line Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities Site Plan Water Supply Sewa a Disposal Waste Disposal other ADA and or ABBA requirements Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4. Information is incorrect. 5. All of the above. The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to. be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. Building Department Official Signature Denial Sent DECEMBER 21, 1998 Referral recommended: DECEMBER 8. 1998 DECEMBER 21, 1998 Application Received Application Denied If Faxed : Fire Health Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to. be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. Building Department Official Signature Denial Sent DECEMBER 21, 1998 Referral recommended: DECEMBER 8. 1998 DECEMBER 21, 1998 Application Received Application Denied If Faxed : Fire Health Police X Zoning Board Conservation Department of Public Works Planning Historical Commission Other BUILDING DEPT cc: William Scott w Town Of North Andover Building Department 146 Main St. Town Hall Annex 508-688-9545 APPLICANT: Project: DATE: RE: 'Pl,-pna l �-a c3'>4 jo' f y)kz O VW NA -4- (Da KW G e Iv -e fk44 o,z Title of Plans and Documents: Please be advised that after review of your Building Permit Application and Plans that your Application is DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Sid Rear Insufficient Lot Area Insufficient Parking Violation of Building Coverage Insufficient Open Space Use requires permits prior to Building Permit Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By -Law Other Remedy for the above is checked below. Dimensional Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Other Other Plan Review The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4. Information is incorrect. 5. All of the above Health Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans 116 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal Other ADA and or ABBA requirements Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4. Information is incorrect. 5. All of the above The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be 'voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. Building Department Official Signature Denial Sent Referral recommended: /2 -JQ Application Received If Faxed : Application Denied Fire Health Water Fee State Builders License Sewer Fee Workman's Compensation Buildinq Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be 'voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. Building Department Official Signature Denial Sent Referral recommended: /2 -JQ Application Received If Faxed : Application Denied Fire Health Police Zoning Board Conservation of Public Works Planning -Department Historical Commission cc: William Scott 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT T (Print or Type)0 DO PLUMBIN ✓G LVM 6nOO � O N (7, A A; !gypF � , Mass. Date '�T/9 y 19 j� ST 11 Permit# Building Location _ Li 10 9- e w > M u Owner' J rs p R2AITI S �j _ s Name 2 C ►c I Zsi o3 �� V i .0 ,a yL t &0 Type,of Occupancy New ❑ . Renovation "-- Replacement Plan y ,k , s Submitted : %Yes O No`s t FEATURES` •,i Installing Company Name I� G Check one: ,tate Address S h AIT , $?'corporation 10 911 G w R E/VC e' A- • ❑ Partnership Business Telephone s� — (� $ �' I '� S' ®I 3 ❑ Firm/Co. Name of Licensed Plumber�J�A� ►� $ (�,Vj l SS ¢ f� t,{ x INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes e No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy I� Other type of indemnity ❑ Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature Of Owner Or Ownwr'c Owner ❑ Agent ❑ Anant I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of -my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in' compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. B y ,�! � �� n f• /1 D �1� A AOC+ Jlg,a,uo �i �wmwas r'lurn er Title ! `SAN � �` ` 1 Type of License: Master Journeyman ❑ City/Town ; License Number_ g -, Q APPROVED OFFICE USE ONLY F- OJ U rr H Q z LU U !_ Y W 0 O g D 2 Q m W o[ LLI 1: cn _¢ < = c� o w¢ a CQ o C/)O z= z z Q g Q 3= Y Z cr W a 0 V7 W Y Q E- Y¢ z a- O0 m o Q OJ u_ Q� F_ Q¢ 0 Q n z Q F- O¢ z¢ Y o= o Q w Q a¢ a¢ w 0 0 � > 3 0 Y 0 m X M cc cc 0 a S a G' 2 s SUB-BSMT. BASEMENT FFTT 1ST FLOOR R41-17 + ' ' 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR I 11 8TH FLOOR i r+H F--F--I— Installing Company Name I� G Check one: ,tate Address S h AIT , $?'corporation 10 911 G w R E/VC e' A- • ❑ Partnership Business Telephone s� — (� $ �' I '� S' ®I 3 ❑ Firm/Co. Name of Licensed Plumber�J�A� ►� $ (�,Vj l SS ¢ f� t,{ x INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes e No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy I� Other type of indemnity ❑ Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature Of Owner Or Ownwr'c Owner ❑ Agent ❑ Anant I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of -my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in' compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. B y ,�! � �� n f• /1 D �1� A AOC+ Jlg,a,uo �i �wmwas r'lurn er Title ! `SAN � �` ` 1 Type of License: Master Journeyman ❑ City/Town ; License Number_ g -, Q APPROVED OFFICE USE ONLY Date. II.0.,J *' .y >f �',:�•� :'�c TOWN OF NORTH ANDOVER glow PERMIT FOR PLUMBING ,SSACWSfct This certifies that { f.'. r.......... . /f j. has permission to perform ... �_' !! ..... �.'� ...... ... -yea.... . plumbing in the buildings of at ....'. !..'. !d!. ! ...... ....!...`...... , North Andover, Mass. Fee......... Lic. No..�./..7.. ............................. . PLUMBING INSPECTOR UID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Location 2 Z Z44y.52 No. Date MaRTM TOWN OF NORTH ANDOVER O?•� ••O. p Certificate of Occupancy $ -U J Building/Frame Permit Fee $ 41 VR S' 0 cHus� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector r:f 1+2/23/93 08M 6326 Div. Public Works In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the dcbris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as dcfincd by MGL c 111, S 150A. The debris will be disposed of in: BFI Tynasboro, MA 01879 (Location of Facility) r1r\ Signature of Permit Applicant NJ Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I 4 a -,`; 120 Main Street OFFICES OF: :t s �; NORTH ANDOVER North Andover. Massachusetts 01845 APPEALS BUILDING DIVISION OF ` (617) 6854775 CONSERVATION . HEALTH & COMMUNITY DEVELOPMENT PLANNING PLANNING KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the dcbris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as dcfincd by MGL c 111, S 150A. The debris will be disposed of in: BFI Tynasboro, MA 01879 (Location of Facility) r1r\ Signature of Permit Applicant NJ Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I 4 a J a� Y 0 i - -4 W { { U i 0 z 0 F 0 LL LL 0 N m d to L N � 1 aio , H < i v Z �Z M Q 0 NN Z 1 Z { N O N m W W N FF W ! W O (� Z ; lA 1 to .Z C 0 i IL O m J_ J_ ' F 0 t LL ( m F- N W Z i NI < 4 i N N W F W < W x LA 1- W N_ W Z A C ►' C' 3 0 < > 3 Z N O d O O ? � Z K W u W m m LL O L cx � O J O m J 0 r Z A O < Z J ~ ~C O O t d LL O O 0 O Z W 0:(Q s a m W LL n 0 F O N �j d Z N < W N N � cA O W ~ Q4 U j W d ; ic Z 3 O Z LA �- I N J _J to LL 0 0 Z 0 ;A- z z < F N O ' V N Q Z l7 Z o F O Z W { { U i z 0 F 0 LL LL 0 N m d to y N 1 aio i H < i v 9 �Z M 0 NN Z 1 Z { O N m W FF W ! 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H O 0 c4 0 O -0 U w O 0 4l N LL Z o m �mQ n 3 F N 3 Bulger Animal Hospital Medical Waste Disposal: Biomedical: Laidlaw Medical Services, Inc. Pathological: Pet Memorial Park Foxboro, MA 0 z cn m D O z T z D v. y C � O CO2CD C7 Cz CO) d0 0� r � � o CZ. = y nCc -0 � O � CD o v CDCLO O c� CD CD 0 CD _ w 00 a C CD y CD CL: Ov CO2 =O C= CD S- CO) O CD z CD o o v Co 0 CD y O tT Vi D O.00O - y = � m 0 � C7 HC7tSn a m Z =r= N O ._-► fid• m H T CL osy cL = y CD W -40 to y p o �CD CA m: n O O y0 CD CL r^ to C =r=r; � W O y COD c n W M d CD a: CA `-' O O1O H H a tS RC1 a N 01 C y w 1 CD s C CD C3 Ato W =CDC: �. W It i ce cn ~yh 5 kt r: ' : d�W o ^; m "J� 70 P; - 0 o t f D+ OIII two r O z r C zr r" M � z phi n G C O.. �J C � cn O 0, cn In O rD E Wrw M V 6 z O 0=3 0 .9 0 c CD CERTIFICATE OF USE & OCCUPANCY Building Permit Number 599 (1993) Date FEBRUARY 17, 1994 THIS CERTIFIES THAT THE BUILDING LOCATED ON 247 CHICKERING ROAD MAY BE OCCUPIED AS RENOVATE 2 OPERATING ROOMS: Animal IN ACCORDANCE Hospital WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO John K. Prentiss, s Bulger Animal Hospital 247 Chickering Rd. ADDRESSNorth Andover MA ��'r s But1ding Inspector O "Cl ERI * CN sN� D J Ed i l ' 11 • 14 O z LU CL O : d C . c O y O C.) 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O O co C Z ts CD V y c C C cc CL C c 0 • E¢ r.� O � O y }_ C V .00 CL MCC 0 C E ti Z VA to 0 C: cm m O CO C •C 0 0 Z 0 g cmF. El z 0 C/) ) 0 U CD L O Z O y Q C I CCM O CO) Q '� h O O 0 CD CD Z O � O d CL caac co O *.r cc� C V C. O O co C Z ts CD V y c C C cc CL C ;Z O • E¢ r.� 5 A-15 o a CA E c .00 of 0 c 0 m C y E 0 4 10 o 0 atm 'O C Z O O yO t� Z O CL H Q y 0 C 3 = m : 0� W CO ~Z= •y O C P E dZ 0,0 a' co m� o� v� FEW o H Z Coo E ti Z VA to 0 C: cm m O CO C •C 0 0 Z 0 g cmF. El z 0 C/) ) 0 U CD L O Z O y Q C I CCM O CO) Q '� h O O 0 CD CD Z O � O d CL caac co O *.r cc� C V C. O O co C Z ts CD V y c C C cc CL C FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. k****************************APPLICANT FILLS OUT THIS SECTION*********************** .APPLICANT o�n� �, P� en�is� gu�ae t fim"e'ej a , ,�) PHONE 6&x_99 0 S_ i ✓ LOCATION: Assessor's Map Number PARCEL_____ SUBDIVISION LOT (S) ATREET_�' C�iC.C,e I nI ST. NUMBER�� i { ***** **********************OFFICIAL USE ONLY RECO NDATIONS OF TOWN AGENTS: �CONSERvAXION ADMINISTRATOR DATE APPROVED - ag27 - DATE REJECTED i COMMENTS AA (Q I � TOWN PLANNER DATE APPROVED 1 DATE REJECTED I - COMMENTS `� ;/1C, LA&1,(l CA41 t7i Ate, — inn r\ N),, i , i fr FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT—0 � —/-F l4 -3a- �7 RECEIVED BY BUILDING INSPECTOR DATE Wt y Igppeal shall be filed hinw. (20) days after the date of tiling of this Notice In the Office of the Town Clerk. This is to certify that twenty (20) a have elapsed frau date of decision izd without filing of an appeal,. Joyce A. Bradshavl Town Clerk y SSAC MUst TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Property: 247 Chickering Rd. RECEI`rI- JOYCE BRADSHAW TOWN CLERK NORTH ANDOVER SEP 18 .1.59 PM 197 ,A'lme Copy AM 4 AIM 16, 1 - Tan oink NAME: John Prentiss (Bulger Animal Hospital) Date: 9117/97 ADDRESS: 247 Chickering Rd. Petition: 018-97 North Andover, MA 01845 Hearing: 9/9/97 I ne tsoara,.oT Appeals nein a regular meeting on Tuesday evening, September 9, 1997 upon the application of John Prentiss (Bulger Animal Hospital) requesting a Variance (Parking) and for relief of rear setback of Section 7, paragraph 7.3, Table 2 and relief from Section 8, paragraph 1 (5) for parking requirements of the Zoning Bylaws. Said premises is located at 247'Chickering Rd, which is in the G -B Zoning District. The following members were present: William Sullivan, Walter Soule, Raymond Vivenzio, Robert Ford, John Pallone, Scott Karpinski, Ellen McIntyre. The hearing was advertised in the Lawrence Tribune on 8/26/97 and 9/2/97, and all abutters were notified by regular mail. Upon a motion made by Robert Ford, and seconded by Ray Vivenzio; the Board of Appeals unanimously voted to GRANT relief as requested with regards to 21 feet on the rear setback, and reduction in the amount of 7 parking spaces to 30 on the condition that the new addition be limited to training and education purposes for those who are employed in the existing building, and the condition that the new addition not be considered for purposes of expanding customer base. Voting in favor: William Sullivan, Walter Soule, Raymond Vivenzio, Robert Ford, Ellen McIntyre. The petitioner has satisfied the provisions of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from. the intent and purpose of the Zoning Bylaw. Note: The granting of the Variance and/or Special Permit as requested by the applicant does not necessarily ensure the granting of a Building Permit as the applicant must abide by all applicable local, state and federal building codes and regulations, prior to the issuance of a building permit as requested by the Building Commission. BOARR/DL OF APPEALS � ` William J. Sullivan, Chairman`.' /testdec/7 1 1 ' "0. Registry of Deeds Northern District of Essex County Lawrence, MA 01840 10/22/97 NTISS AN ,TWIN FRE 11.9 Rec: Type FLAN Copies 0 120 Rec: Type DECSN Postage Total 0 121 Payment Cash THANK YOU! Thomas J. Burke Register of Deeds 25.00 L5 10.00 0.32 37.57 37.57 name: __ ( ula-.r Anima fksvi k( (,TJ,, k. Po -Ass") i,6 nq city A r 6, phone# (q%a) 6$x'9905 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am a -sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed have Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature al DlDate October 27, 1997 Print name Carol A. Markey Phone # 508-685-4706 official use only do not write in this area to be completed by city or town official city or town: permittlicense # OBuilding Department Licensing Board check if immediate response is required OSelectmen's Office pHealth Department contact person: phone #; 00ther (revised 3/95 PJA) 9 u Marcea Constructon Corp. t , Fred Marceau Pres { P.O. Box 66 / 28 Os9 ood street r ` Massachusetts 01844 4706 Methuen, 1-800-783- k; I (508) 685-4706 Fax: (508) 685 3852 i { t. ` Iesincta To. A 0 lona tiE l4uoQrr only,. , �'�_ � j A-if2rallyBms tailure4o possessto camut edition at th Kulaccts stat Bdilakg ; . is Cause hof ravacs i orth' 9 > i ,catic*j No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1 ' sA E�� cW Mus Foundation Permit Fee $ ` Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL' Building Inspector Div. Public Works m m O z Z m m m r r 1 1 O N r F r 0 c N m n J 0 z N N 7 O m r F r 0 c 1 01 m n i 0 z N w N m m m 0 I o� mm N 11 N i M c n J 0 z N • a m* 0A z r H c w c m> C>>>> o 0 m o m m> c 0 A I 0 f m 0 F m> r 0 N; 0 Z ° 0 m E r ° r ° r ° O r z n m z n m z n m m- m 6 m n A m A N m > m ° O G1 r L1 o O0 m m 3 m 3 0 z z N z >z O A > m z r to n Z>In m° z -� F r 0 m> '� z 3 m 3 m Nr1 m 0 0 > 0 z 1 r z mj m 1 V C p 0 -1 0 Z 3 0 Z m N c r ' D z m m c N z (l1 O Z O z N rl 0 U) 0. 0 n ° m A 0 -4 > A m > A ' n m tll m c N m c N m c N m c ; > -i m N m m = O 3> z N 9 z N N> m m q m Z 0 0 9 c A N ° zzzzP ° ° ° > q m 1 0 N 0 M r m Z 1 a 1 N m m n 0 0 0 0 0 0 0 Z 0 n 0 i z m 0 c N r 0 0 A 00 p a m 0 Z p Z n Z n Z n NO r ; z O° -1 0 0 q> r mm _c r i 0 �I 0 M 0 0 o 0 f p z m m y m 0 0 Z 0 > -4 0 0 0 0 * T r 0 I m I c z * z ° > 0 > a r A 1 z N z N m - v� Di z m x z m N W A O �I ID m 0 G o00�-0 c W s � N .�m0 m C') O y W n c 3, 7m0 CD c7 an^►a 0Fn- CD W � O W N O —I c aW CD n W c C 0to as O y, n C m C ?O� r a 0 / ca O ? \JJ m W N . / W C» ^--Ji W rn O N N W t0 :1 -4 . O C 3 W to M.. CD .-. O 0 �O z C0 'O O W CD . W COD CD SCD. n d a1 O C2, o cn CA 'fl o� o O co C"3 1 O CD .Z ca CD �. -r2 CD y 'C O Com') ...t CD CD CD O CL Cr CD O CCD c CD y, CD ZQCD � CA v O 'o CD Z 0, CSD 0 CD 0 G o00�-0 c W s � N .�m0 m C') O y W n c 3, 7m0 CD c7 an^►a 0Fn- CD W � O W N O —I c aW CD n W c C 0to as O y, n C m C ?O� r a 0 / ca O ? \JJ m W N . / W C» ^--Ji W rn O N N W t0 :1 -4 . O C 3 W to M.. CD .-. O 0 �O z C0 'O O W CD . W COD CD SCD. n d a1 O C2, o cn cn o� o 2 � cn -n a :71o a (D d o rt C x n O rr > � z z o t� -- a -�:�•,:.:,• - - —_ — -- _= - — -- = _ =- - :,nom:>.r«-e�'...'.: i�..v.=�,..t .. _ w OFFtci:s OF:: j;120 Main Street _-.=. t'���• -voh�ndover. APPE.u.S NORTH ANDOVER husens Massald O 1845 BUILDING CONSERVATION Dri1StQ�t OF HEALTH Pt�.NNING PLANNING & COMMUNITY DEVELOPMENT KAREN. H.P_ `EL..SO`, DIRECTOR In act--rd:mce with the ji.a:$:� �S '.i��r:. C S j-». 3 Condition of Buildirc Pe::ait Number dctris resulting irem this work shall be disnosed e( ... a ?rete:i. :iCr.-sC. solid ;+ste _=Cscl :ac:.;r by ,%tGL c iII. S == O y - i ne debris will be disposer' cf in: LL.. C—on CI =2C:ati1 S:cna?U,re of Perritt[ Applimnt �1�N�,� Date l NOT=: Demolition permit fr= the Tou-n of North Andover =ust be obtained for ~ this project through the Office of the Building Inspector. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /VOj ,Mass. Date JO2 19 Permit #__ Building Location Owner's Name JdAN PKEN J I s -2 Ce ks:0.? kis-1 Q Type of Occupancy kfr521 G New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ Installing Company Name A Po}il � � N� Check one: Address t OL ar u c Certificate # { ST V Corporation -j O 9'y C L Aw CSI ❑ Partnership Business Telephones– G34�_ — L 7 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter j N S Yc U 15 s F_ AgI Y INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes e No ❑ If you have checked y.ejs, please indicate the type coverage by checking the appropriate box. A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent------------- ------- Owner O Agent ❑ —� y moo• L r t -k all Ul ti it: uetaiis ana intormauon t have submitted (or entered) in above application -are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: I:1 Plumber 1 1 Gasfitter Signature of Licensed Plumber or Gas Fitter 44" Master 1:1 Journeyman License Number I rn U) Y w vi pUCc Z U CC U) 0 W U W FO O m F- S m H CL OO Z cc W Q tr W O U U W = m Z� a0 Q> hW- W O I— Z J H ¢ Z W W o m W ~ W W ~ U = M Q ZQW o_ J �� F ~}� Z 8zwOwx � J W = 3 0 3°> o a o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name A Po}il � � N� Check one: Address t OL ar u c Certificate # { ST V Corporation -j O 9'y C L Aw CSI ❑ Partnership Business Telephones– G34�_ — L 7 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter j N S Yc U 15 s F_ AgI Y INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes e No ❑ If you have checked y.ejs, please indicate the type coverage by checking the appropriate box. A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent------------- ------- Owner O Agent ❑ —� y moo• L r t -k all Ul ti it: uetaiis ana intormauon t have submitted (or entered) in above application -are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: I:1 Plumber 1 1 Gasfitter Signature of Licensed Plumber or Gas Fitter 44" Master 1:1 Journeyman License Number I NNW MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) -f - o, �. A IYDOV �2 Mass. Date % % 197rY_ Permit # Building LocationRvLb em. A,v I pv%.rL [10Gp Owner's Name New N Renovation 0 Replacement U Type of Occupancy Plans Submitted: Yes ❑ No ❑ X, Y ir W (n Cl)Q [[ Cf) t- jr W U) W U m Z (n < m (n F- ¢ W p Z 0 a 0 F W W Q W Z H (n = w< > W FW Z J J t- Z t_ W W U M W O W 0 J W � i m Z Z o w_ 0 0=>> 3 0 Q o > a 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR i 7TH FLOOR 8TH FLOOR � I Installing 'Company Name (� 1 r C - Address y C l.p Gr Business Telephone(---Z>S)C, s'06 ' /7S'� ❑ Check one Corporation Partnership Firm/Co. Name of Licensed Plumber or Gas Fitter _�,0A Q�) 'DF5 INSURANCE COVERAGE: Certificate # IC)cjgC_ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 5k No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy. V 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: I �o, I) Plumber1 7 PlumGasfiterSignature of Licensed Plumas Fitter I J Master I License Number J Journeyman 1 "� 7 7 J Date., .....:e............. .► cf M0 pT , TOWN OF NORTH ANDOVER A N•OL PERMIT FOR GAS INSTALLATIOW r / / This certifies that ... .. �.......'............. has permission for gas installation in the buildings of at ... `��......... r . ......... North Andover Mass. Fee j. .. Lic. No.: ... ......... GAS INSP..EC..TOR............ . WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ..H MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Typpee) /7 % 164V Mass. Dat 0 7-319 �Permit Building Location c2& (_ jG[(L°&/jjJ9 �Q Owner's Name SULqMAw imo Map: Lot: Zone: Type of Occupancy _6 HA M ej;� U 14-k= New Renovation .J Replacement J Plans Submitted: Yes ❑ No ❑ Installing Company Name .r•-- `z t ern F'ro',e ne G s- Inc. Check one: Certificate' Address 171 W a t- r t. De r v e r s, N f'_ C]. 4' �+( Corporation Estimate Value of Work: — J Partnership 1 • ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Installing Company Name .r•-- `z t ern F'ro',e ne G s- Inc. Check one: Certificate' Address 171 W a t- r t. De r v e r s, N f'_ C]. 4' �+( Corporation Estimate Value of Work: — J Partnership Business Telephone J Firm / Co. Name of Licensed Plumber or Gas Fitter�%— INSURANCE COVERAGE: have a curre1nt Iia�tlfty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes rY No J If you have checked y.Ls, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ] Bond J OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner O Agent O signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene r. BY Type of license: Plu ber Signature of ce tnsed Plumber or Gas Fitter Title asteter Master License Number !/ City / TownH Journeyman APPROVED (OFFICE USE ONLY) If'1� LN. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) pB I,1V1aOV Mass. Date /+/j —19-1? Permit #�S Building Location -e-,. /kvs , Owner's Name G�h�e Type of Occupancy New 19 Renovation 10 Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES B.P. # SEWER # SEPTIC # Installing Company Name �� 0la0 fn 4 Ai(a Cr Check one: Certificate # Address �k y e oAl �'g Corporation I O q rT Q,— Business Business Telephone ❑ Partnership ❑ Firm/Co. Name of Licensed Plumber -S)N DES2ui 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 have checked yes, please indicate the type coverage by checking the appropriate box. A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By _��`� Signature of Licensed Plumber ^� Title Type of License: Master--Rl Journeyman U City/Town License Number APPROVED (OFFICE USE ONLY) z Z Y z Q W Cn J } O W Q Z OO Y � W W ~ (n _ OW C7 a U Fn W a: (A m � rn w w} H U W t- W Y Q o¢ (n) O¢ ZZ_ a Z M 0 W z W 0 m W 3 0 p J z U3 � m Q Y p n. lr D J u - 0= Q H> H O 0° W = Q H Z Q 0 (n z Z W tW- O u_ . V M 3 Y g m� o o 3 ta- Wi 3� cal o< m 0 SUB-BSMT. BASEMENT ' 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name �� 0la0 fn 4 Ai(a Cr Check one: Certificate # Address �k y e oAl �'g Corporation I O q rT Q,— Business Business Telephone ❑ Partnership ❑ Firm/Co. Name of Licensed Plumber -S)N DES2ui 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 have checked yes, please indicate the type coverage by checking the appropriate box. A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By _��`� Signature of Licensed Plumber ^� Title Type of License: Master--Rl Journeyman U City/Town License Number APPROVED (OFFICE USE ONLY)