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Home My WebLink AboutBuilding Permit #575 - 89 HERRICK ROAD 4/30/2009 BUILDING PERMIT- o� "°oT" qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: S Date Received ��SsgC►+us Date Issued: , IMPORTANT:Applicant must complete all items on this page LOCATION �'"✓ Print PROPERTY OWNER -DA4-E i ,2yin� Print � MAP NO:nPARCESZ-- ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE - Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District WaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: 1 Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ,�0 FEE: $ 6y Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gnature of Agent/Owner Signature of contractor �I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Privatese tic tank etc. P Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature f COkIMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire "Department-signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land`area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ 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) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance orspecial 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 SERVICES DEPARTMENTMFORM07 Revised 2.2008 Location d/ h4-m1 L k , No. Date U� f NpRTh TOWN OF NORTH ANDOVER O' .•o ,•'gyp ` Certificate of Occupancy $ . s Building/Frame Permit Fee $ zO Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I r 219 ,- 8 Building Inspector F V40RTH-C ' T01%M 01 Andover . No. dover, Mass., d T LAKE H11 COC NI CKEWICK A0RATED pP 'CC:) `S � BOARD OF HEALTH PERIVII001 I Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......�........" ............... ........ql. !`W.............. . Foundation has permission to erect.................�.... ......... ..... buildings on .... ...... .. .............dlt�...ll•�...... ..............�... Rough to be occupied as............ 4� � ..... ` ..4 .K1.0................. .... . ... . .�. ... ...... .. .Q.... 1. ,mn y h' e provided that the person accepting this permit shall in every respe onform to the terms oft app' tion on file i inal this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building. Regulations Voids this Permit. Rough �. PERMIT EXPIRES IN 6 MONTHS Final D ELECTRICAL INSPECTOR UNLESS CONSTRUCTI !� Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the. Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. � 0 MO pT f 1w TOWN OF NORTH ANDOVER OFFICE OF BUILDING.DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 �.,5�•.. "t� North Andover,Massachusetts 01845 SAcwuse Gerald A Brawn Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION plemmint A DATE: JOB LOCATION: Number Street Address Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) 1 DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department inspection P=edures and requirements and that he/she will comply with said procedures and nxJf�• HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Fo m Homeowners EnnVlion TIOARDOF %PPE:V.S(.,38-95 41 CO.NSERV.MON 688-9530 HEALTH 688-9540 •A w Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,associatiotn or other legal entity,employing employees.'However the owner1of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local iiedusing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence..oir compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither t3he commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presorted to the contracting authority." Applicants Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)acid phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for-the permit or license is being requested,notthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the numberlisted below. Self-insured companies should enter their self insurance license number on the appropriate tine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of'the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of lnvesti.p;ations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, A!IA 02111 Tel #617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7744 Revised 5-26-US www_mass.gov/dia The Commonwealth of Massachusetts kf ! Department of Industrial Accidents , 1 Office of Investigations t� i 600 Washington Street Jai Boston, MA 02111 K-; www.massgov/dia . Workers' Compensation Insurance Affidavit. Builders/Contractors/Eiectricians/Plumbers . Applicant Information Please Print Legibly Nanie(Business/prganizafion/individual): Address: City/State/Zig: Phone#: . Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I aro a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am.a.sole proprietor or partner. listed on the attached sheet.t 7. ❑ Remodeling ship and have no employees These su&contractors have S. ❑Demolition working for me.in any capacity, workers' comp.insurance. g, ❑ Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ PIumbing repairs or additions myself. [No•workirs'comp. c. 1.52, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13•7Other 'Any applicant that checks bo>rtf I must also flit out the section below showing their workers'dompensation policy information. t homeowners who submit this affidavit indicating they are daring all work and than him outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name df the sub•contractnrs and their workers'comp,policy information. lam an employer that is prowdtng workers'compensation insurance for my employees Below it the policy and job site information Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a fine up to$1,500.00 and/or one imprisonment. as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the infornwtion provided above is true and correct Sienature: Date Phone#: FBoard only. Do not write in this area,to be completed by city or town ofIcial n: Permit/License# Issuingthority(circle one): Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector rson• Phone#• Date..... � f pORT11, ° ,"'° '• "� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING COW This certifies that .. -�---�• -�-� ................................... has permission r.... .!v............. wiring in the buildin1g,of ...................................: at.... ...........! ... ...... ,North Andover,Mass. Fe66—..... ... Lic.No'.-T,???............... . . ... ELecr um lrrspe Check # r 8543 Commonwealth of Massachusetts Official Use Only Pei 11,11t No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 91051 (leave blanlo APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12-00 (PLL' --4SE PRINT IN JJVK OR TYPE 4L INF ON) Date: /01 ()S- City or Town of: To the Inspector of kices: Ry this application the undersigned olives notice of his or her .itention to erform the electrical work described below Location (Street & Number) Owner or Tenant Telephone No. Owner's Address Yes (Cliecl(Appi-opriate Box) Is this permit in conjunction with a bu'ldin- 11 pe Y El No D Purpose ol'Building F.�n W Utilit , Authorization No. 5-C li',xisting.Service 60 Amps /W1 -IdYOVolts Overhead IV Undard ❑ No. 01'Meters New Service Amps /�—/ 1J.—Volts Overhead V Undgrd ❑ No. of'Meters Number of Feeders and Anipacity Location and Nature of'Proposed Electrical Work: e 347,410 a 'L)[� -(00-TD----/&)-&r---- Completion of the following table inav be ivaived bil the Inspector Of Wires. [No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KNIA No. of Luminaire Outlets No. of Hot Tubs Generators KVA Aboveo In- No. of EmergE-nck-L1jTi[Fn jr&i `g------ No. of Luaires Swimming Pool grnd. grnd. El Battery Units No of of Receptacle Outlets No. of Oil Burners FIRE ALZRWS7No. of Zones No. of Detection and No. of'Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devices Tons Noof Waste Disposers Heat Pump N JKW No. of Self-Contained . ...... . -1............... ........ Totals: I Detection/Alerting E] Municipal Ej Devices_._-_-___ No. of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or E�lent N-0 of Wafer KW No. of No. of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No. Hydroinassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.ol'Devices or Equiv'lleat OTHER: Attach additional detail if desired,oras required by the hispector of I'Vires. Istiijiated Value of Electrical Work: ---- (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion INSURANCE 6VERAGE: Unless waived by the owner,no per-n-lit for the performance of electrical work may issue L1111tSs the licensee, provides proof of liability insurance Including"completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove X- ge is in force,and has exhibited proof f M t t�j pern-iit issuing office. g QJE�CK ONE: INSURAN( BOND E] OTHER E] (Specify:) el.the I a thein in form I Certify, tinder palijis.andpeizilffi s of Pejury,I I ation oil this /I is 11-Ue and complete. MRM NAME: a 9� LIC. NO.- "6 Licensee: „/ Signature LIC. NO.: (If applicabi v le V, — I/ Address: exeni ,In i el2se nwnbI1417e) Bus.Tel. M A ew Alt.Tel. N -- x Ch "A o.: *Security System Contractor License re ed for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Insurance coverage normally requixed by law. By my signature below,I hereby waive this requirement. I am the (check onc) EI owner El owner's aw.)t. Owner/Agent Signature Telephone No. PERM-IT FE,t $ i • MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING �S Corr Type) n Mass. Date 1g� Pe-milt # 3� Building Location—Z±22— )C'� L Owner's Name Type Of Occupancyj� New O Renovation O ReplacementJ Phan Submitted: Yes ❑ No ❑ FIXTURE✓S k i z Z y Z < y Y Fb y O Z - W y W Y J y 30. V < y n O 0: Q V 14 Q m b y Q Y < f y Z ¢ d 0 < d < 3 C W O 7 a: < W D J Z G d Z ur WCC W x < x 3 3 O Z S � �[ d ¢ F- < be < W tt Y W ` ! O Sy O y �" Z O OO y Z Z W h- O V Y �+ Y J m rA G p J ; j f• ea u v c < m O sue—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR dTHFLOOR 7TH FLOOR STH FLOOR I [—H— Installing Company NameUniv Gal P 1 mb i ng & H a .i n g Check one: Certificate Adder 3 Breed Avenue O Corporation Woburn , MA 01801 ❑ Partnership Business Telephone---.6.l 7-9 3 5-9 3 3 9 �Flrm/Co. Name d Licensed Plumber John Blacker '\ INSURANCE CMERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Z No O H you have checked y". please Indicate the type coverage by checking the appropriate box A liability Insurance policy X$ Other type of Indemnity O 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 pem,ft application waives this requirement. Check one: nature of Owner or r int Owner ❑ Agent 0 I hereby certify that all of the de+mils and Information I have submitte�qt n above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed u issued for this application will be in compliance with all Pertinent provisions of the.Massechusetts State Plumbing Code and al ws. ey - TRW gnature of Licensedu r CRY/Town Type of license: Master U Journeyman ❑ License Number 11041 9 BELOW FOR OFFICE USE ONLY V FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE Nr APPLICATION FOR PERMIT TO DO PLUMBING NAME i TYPE OF BUILDING LOCATION OF BUILDING � PLUMBER PERMIT GRANTED _ DATE 1!i PLUMBING INSPECTOR V AI`11111►, CERTIFICATE OF INSURANCEDATEIMWr Q,YY, Al 06/17/97 PRoaJCEa THIS CERTIFICATE IS ISSUED AS A MATTER OF INF RMA I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Begreve, Hall & Rowe Ins , Agcy HOLDER. TH16 CERTIFICATE DOES NOT AMEND, EXTEND OR 820 Turnpike 9t, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NO. Andover MA 01845 _ AIS___ CO__M_PANIE$ AFFORDING COVERAOE Michael L. Segreve COMPANY ' P-nqnf He 501-975-1300 Fu No. A ArbelLa Mutual Insurance Co, Ih1URED — COMPANY B Centrsl Mutual COMPANY Qniverleil Plumbing C Workers Comp Plan of MA 41 Minot Street — Reading, MA 01867 COMPANY COVERAGES TSI$ IS TC CERT:FY THAT THE POLICIES OF INSURANCE LISTED EELOW HAVE 9EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOC :NaICA'ED, NOT'ry;THSTANDWO ANY REOVIR£MCNT, TERM OR COND;TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ^;a.':F:C:TE MAY BE ISSUED OR MaY PERTAIN, THE !INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, x:. .C, " E MS, E..-,,.$ .N$ aNt, .OrrD,:IONS OF SUCH POLICIES, UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE Of iNS'J"AhCE POLICY NUMYER POLICY EFFECT IV[ POLICY EXPIRATION Tp I DATE(MMIOD/YYI DATE(hIM/OD/YY) uMlTc G66'CxAIUABr,RF I f GENERALA00.REOATE 1 2, 000, 00-0 8 1 X CwNEaCAl.JENERAL ,IAel.l-v BOP7892284 09/08/96 09/08/97 PROOVCTS•COMPicPACC 12, 000, 000 � CLA,'.'S MACE CCCUa PERSONAL b AOV:NJVRY 11 000, 000 _T W•.Ea':6 CON'IAC TCR'$PACT I j EACH OCCVRRENCE 1 1, 000, 000 _•� I FIRE OAMAG E(Any one Ilrel 1 100, 000 MED EXP(Ary qnj p4r10N 1 5, 000 AL•TCMOB".E lIA$ILITY r^ ANY A)'C' i 7QF016971 05/24/97 ; 05/24/98 COMBINED SINOLE LIMIT 1 AL'.OWNED AUTO$ BODILY INJURY 6C*E)U'.ED AUTOS ( (Pit Potion) 1 100000 r^ �:RE:AL'TCS BODILY INJURY nC�DwnfD AJTOS IPeI acclCenq 1300000 PROPERTY DAMAOE 1 lOOOOO GARAGE LIASILITY ...., AUTO ONLY EA ACCIDENT 1 ANY AU'' OTHER THAN AUTO ONLY r— EACH ACCIDENT 1 AOOREGATE f : EXCfi&LIAIIL:TY R —•�_ r..— EACH OCCURRENCE 1 )M6.i[6.A rORM AGGREGATE . 1 — OTAEP T4AN UM8RE..A TORN' I 1 C WORAERS COMPENSATION AND EMit0YER6 LIa11lITY GTATV'OAY LIMITS I EACH ACCIOENT 1 100000 T^•'9C'q�`a• NC, I TO B8 I89UED 05/22/97 05/22/98 O;SEASE•POLICY uwT 1 500000 v LaT•,taS ExEC�r.�: Oaf CESS ARE lxGl DISEASE•EACH EMPLOYEE 1 100000 OTHSR I ( DEICR:o .Ok Of OPIAAT;ONS,LOCAT10N9NEHICLE6/$PEC,AL ITEM$ "Limits may have been reduoed by paid claim" CERTIFICATE HOLDER CANCELLATION COMMONW SHOULD ANY OF THE/I$OVE OEBCRIDED POLICIES BE CANCELLED BEFORE THE EXPIRATION CATE THEREOF,THE 168UIN0 COMPANY WILL ENOEAVOR TO MAIL Th a Coz-anonwealCh of Mn. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LER 600 Washington St . 7th alOOY OUT FAILUR6 TO MAIL SUCH NOTICE&HALL IMPOSE NO OOLIOATION U, BIUTY Boa ton MA 02 11% OF ANY KIND UPON THE COMPA Ti AGENTS OR REPRE6ENTA VES. AVTHORIZEO REPRC6ENTA TIVE ! Michael L. s.grevo / � d,� "ORD 25.9 ;3;931 �A 9 CO PORATIoA' `" ti COMMONWEALTH OF MASSACHUSETTS I IN PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THIS LICENSE TO j JOHN J BLACKER 41 MINOT ST C READING MA 01867-3541 11041 05/01/98 188033 Massachusetts 1, DR;VER'6 410ENSE U1� . t t�mute 014 LA-07-97 em: c.�stsmnua ustnrn M ;Q-47.63 A 6-08 84ACKE�1 i, &At 41 MINOT . ST: 5 READING MA . _. Date.�F, > 3 ? / 40Rr:'+c TOWN OF NORTH ANDOVER 3j •`_" 0 p PERMIT FOR PLUMBING +. •�,,..o•q''`ty �sSACHUSE� This certifies that . . . .. S!4 .4. . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . h plumbing in the buildings of A .v.A& . . . ,Al..? vu.-t . . . . . . . . . . . 4 at. . . . . . . . . . . . . . . . . . . . . North Andover, Mass. i Fee. �.,. . . . .Lic. No..1.U Yl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR I 08/08/97 12:25 15.00 PAID I WHITE: Applicant CANARY: Building Dept. PINK:Treasurer