HomeMy WebLinkAboutMiscellaneous - 10 PURITAN AVENUE 4/30/2018PM
Location
Z21N 6. Date
&ORT#1 TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
f oz,'
TOTAL $
Check #
152'12 Building Inspec
.�e
TOWN OF NORTH ANDOVER
BUILDING DE=PARTMENT
kPPLICATION TO CONSTRUCT REP,..R,:RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY. DWELLING
3UILDING PERMIT NUMBER- DATE ISSUED:
SIGNATURE: 1-a
Building Commissioner/Inspector of Buildhm Date
RCTION 1- SiTR INFORMATION I
1.1 Property Address�:/
M
1.2 Assessors Map and Parcel Number:
Map umber Parcel Number
44
License Number
1.3 Zoning Irdormation:
toriing District ..
1.4 Property Dimensictrs: ;
Lot Area: FrontB fl
1.6 BUILDING SETBACKS. ft
Front Yard
Side Yard
Rear Yard
Required Provide
red ProvlcYed
Required Provided
Not Applicable 0
Water Supply M.G.LC.40. '.
1.71.7 W 0 Private ❑
ublicEl
foration:
1.5. Hood Zone Inm
Zone Outside Flood Zone 0
'e
1.8 Sewerajge'Disposal Sys'tm:
Municipal 0 On Site Disposal System
SECTION 2 - PROPERTY OWNER /AUTHORIZED AGRNT
Registration Number
2-1 Ownero�f�Record J�
Name (Print) Address for Service
Signature
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Si nature
Telephone
hone .
- CONSTRUCTION SERVICES
f 3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
_ o
Address
Signamre Telephone
3.2 Registered Home Improvement Contractor
Company Name
Address
signature
Not Applicable 0
M
44
License Number
Expiration Date
Not Applicable 0
rl
r
Registration Number
r
Expiration Date
SECTION 4 - WORKERS COMPENSATIUIV (TvLfG.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application, Failu
in the denial of the issuance of the buildin permit.
Si ned affidavit Attached V--
TI
es ....., ,0 _ .No ........ 0
SECTION Descri"tion .afPro `"sed Work' check all a )actable.: .
New Construction 0 Existing Building 0 Repair(s) p Aherations(s) ❑
Accessory Bldg. Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
NECTION 6 - ESTIMATED CONSTRUCTION COSTS
item
Estimated Cost (Dollar) to be
Com leted:b rmit a licant
1. Building
2 Electrical (b)
f
3 Plumbing..B.uilc
4 : Mechanteal,. HVAC
5 Fire Protection
6 To.. -V 1+2+3+4+5 Checl
SECTION 7a OWN IER AUTHORIZATION TO BE COMPLETED Vi
C OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING ]
Bier
ted Totalleo§t r
vction
rmit fee (:� .x (b)
provide this affidavit will result
M
as Owner/Authorized Agent of subject property
Hereby authorize
to act on
My beha ' in all matters rel authorized by this building permit application.
Si nature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I> � �- c�1►��
property as Owner/Authorized Agent of subject
Hereby declare that the statements and information on the foregoing. application are true and aEctzrate, to the best of my knowledge
and belief g
Signature of Ovvner/Agent
SIZE OF FLOOR VERS s
SPAN
DIIviENSIONS OF SILLS
DMIENSIONS OF POSTS
DWENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
SIZE OF FOOTING
MATERIAL, OF CHI VINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Date
THICKNESS
X
0
FORM U .- LOT RELEASE FORM I Q -y
i% -
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.
*****************************APPLICANT FILLS OUT THIS SECTION
*********************** --I
APPLICANT_-�`�''�-�� PHONE
7-
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT (S)
`�- STREET �`� ��''�' ��
JL, ST. NUMBER /<f:;'
*****************************************OFFICIAL USE
ONLY***********************************
L RECOMMENDAT4ON-5 OF TOWN AGENTS:
CONSERVATION
COMMENTS
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMME
I Un DATE APPROVED 12-11-01
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97 Jim
DATE
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IN
7;SO!
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Location-�
.,No. Date
TOWN OF NORTH ANDOVER,
Certificate of Occupancy $
+�4 Building/Frame Permit Fee $ 7-'
Foundation Permit Fee $
CHU
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
/ / .2
Building Inspector
Div. Public Works
Location /0 I'Lt, ALe
No.
Date
-16 4le
TOWN OF NORTH ANDOVEA
jsammaim%
Certificate of Occupancy s
41 1
Building/Frame Permit Fee $
Foundation Permit Fee $
mu
4
Other Permit Fee $
Sewer Connection Fee $
C09
A
Water Connection Fee $
li�
TOTAL $
ildi 'Ins
�'Dlv. P lic
0 2, 3
5!5 -
PERMIT NO. 0v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
I PAGE 1
MAP h40./07
LOT NO. IAI
2 RECORD OF OWNERSHIP iDATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO. /Xf�
x �
I i
LOCATION
PURPOSE OF BUILDING /n
NO. OF STORIES 917E
f
OWNER'S NAME A
OWNER'S ADDRESS y;i 1 ,) /lndux� �/�
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS 1ST Ay /D 2ND �r xlo 3Rgn�
eC
BUILDER'S NAME %%/_ 'r G
SPANO�
DISTANCE TO NEAREST BUILDING L/�i „ v //
DIMENSIONSi OF SILLS /a
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES ..ZU� -0 II REAR /}O i -
GIRDERS
AREA OF LOTA [� FRONTAGE j)) p_ a #/
IS BUILDING NEW V "
HEIGHT OF FOUNDATION /! p �� THICKNESS I/
SIZE OF FOOTING lb )e/ X
IS BUILDING ADDITIONAY-�
MATERIAL OF CHIMNEY `
_je
IS BUILDING ALTERATION A/,
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /Q
IS BUILDING CONNECTED TO TOWN WATER/ ;fes
Tloy
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE AID
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
A
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC 16ETEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED
AND
J/�APPROVED BY BUILDING INSPECTOR
DATE b14/KD /l d/d"Q/ ;
GNATURE OF OWNER OIC AUTHORIZED AGENT
FEE
PERMIT GRANTED
19
at
A
MAR 16 1998
raw
LESS FDA
5 1
DUE FRAME PERMIT $ 9 9
3 PROPERTY INFORMATION
LAND COST 4fC901 nry�
-EST. BLDG. COST !
EST. BLDG. COST PER SQ. 017.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BUILDING INSP96VOR
OWNER TEL. # � �`� �6?? J Q
CONTR. TEL. #
CONTR. LIC. #
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12 !
SINGLE FAMILY
MULTI. FAMILY_FICES
APARTMENTS
ORIES
r2F
_
I
CONSTRUCTION
2 FOUNDATION
8 INTERIOR
FINISH
CONCRETE
PIN
HARDE W -D
3
1
2_I 3
—
_
CONCRETE BL K.
BRICK OR STONE
PIERS
PLASTER
DRY VJAII
_
UNFIN.
3 BASEMENT
AREA FULL FIN. B M'T' AREA _
y, 1/7 '/, FIN. ATTIC AREA _
N_O B M T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
B
_
1
2 3
_
_
_
CONCRETE
EARTH
ASPHALT SIDING
ASBESTOS SIDING
HARDII✓'0
COMMCN
VERT. SIDING
_
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
_
ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR II POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
GAMBRELMANSARD
I
A
jt.1p
BATH 13 FIX.)
TOILET RM. (2 FIX.)
FLAT
I
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
_
WOOD SHINGES
yi
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR 8 GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
fir—
!r
TILE FLOOR
TILE DADO
6 FRAMING
I 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
r
N
B'M'T
2nd
13rd
_
I
ELECTRIC
� �-"+"�� r�'✓
1st
NO HEATING
.r �----'�"'='�__ �-=��
F,
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 local or state law,
regulations or requirements.
****************Applicant /fills out this section*****************
APPLICANT: o (_ . ��C i /0/,0 Phone g�5 = �3 ®
LOCATION: Assessor's Map /Number Parcel
Subdivision �6d�c�1'?d �sta`'Z��S Lots)
Street St. Number
************************Official Use only************************
REC DATIONS O�7 AGENTS:
`v
Date Approved
conservatio A ministrator Date Rejected
Comments
(66
Date Approved
own Planner Date Rejected
Food
Date Approved
Ins cto - ealth Date Rejected
Date Approved
t Sep c sp ctor-Health Date Rejected
Comments
Public Works - sewer/water connections � : L/-
- driveway permits
Fire Department/ ( �//`/e 'y n (. p, ,J i 1 J ( -2r
J�'*, 16e%i / �r%�C J�..Y.. %/�-�f'�.7 � / v/�,4e r OR trAm- ,? ��,n.%ZCv
Inspector Date
Growth Management Bylaw Exemption Statem
Town of North Andover Building Department ent
This form shall be used to assist the Building Department in their determination of exemptions under section 8. 7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant sha,
ll nr—AA
as requested below..
elow.
Name�Appli nt on Building Permit (below) Address of P
for Permit (below)
Map and arcel : Purpose of Application (check below)
Ph ne Number of Applicant: -SFL.ZSingle Family
Y�- 335y Two Family
I the undersigned applicant for the above property attest that theattached building
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party for which this
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
atus is subject to review bhe Building to this it
Further I understand that my interpretation of the EXEMPTION st
Department and is only officially accepted when the Building Permit iq issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a buildingrestoration, or reconstruction of a dwelling in
permit for the enlargement ,
existence as of the effective date of this by-law, provided that no additional residential unit is created.
ylaw.
The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6.c�are met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
Purposes of this Section "senior" shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction in density (buildable lots), below the density (buildable lots)permitted under zoning and feasible given the
,
environmental conditions of the tract, with the surplus land, equal to at least ten buildable acres and permanently
designated as open space and/or farmland. The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism
approved by the Planning Board that will ensure its protection.
adjacThis application represents a tract of land existing and not held by a Developer in common ownership with an
ent parcel on the effective date of this Section 8.7 shall receive a one exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building(i.e. all other permits from all other boards and
pers,
commissions have been received and the project is in compliance withrnitthose permits), and the Development Schedule
does not accommodate issuing a building permit in that Year, one building
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved fort U with this EXEMPTION. Permit will be issued per Year per
Please provide any and all information that would assist the Building Department in making a determination'
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate i ation, or the chec ' permit is
know ot, is gro ds for u, ff of an above item which does not comply, whether done to my
/// by the Building Department to issue a Building Permit.
tture o caner or Authorized Agent who signed the Attached Building Permit
a �d ��
form must be attached to the Building Permit upon application for such permit. Date
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�r«r 4 P-04 Spiry
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Llsse:Only
Permit No_
Occupancy & Fee Checke&36E • �
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)
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number lo 1�ve_ I 7.-,W A V' f
Owner or Tenant A, C /7 L) l L ID e /Z S
Date G
To the Inspector of Wires:
Owner's Address
Is this permit in conjunction with a building permit Yes I9-" No ❑ (Check Appropriate Box)
Purpose of Building 1_[ S 1 I) FA-) Ti A L— Utility Authorization No.
Ebsting Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters
New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters
Number of Feeders and Ampacity,
Location and Nature of Proposed Electrical Work 52 c U r 14" / f G i 0-1
OTHER: 1�p C U Y I "t ti �-I a✓ Y" '
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES !- NO =
have submitted valid proof of same to the Office YES'—NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE �rBOND = OTHER = (Please Specify)
Estimated Value of EI ork$ 8o o � 00 (Expiration Date)
Work to Start Inspection Date Resquested Rough Final
Signed underttl V 1Iltl $of A"r)ury� �1 '�JCt r i✓i _ �y
FIRM NAME S V H � 1-9 LIC. NO.C—
�v Xj.� r -� �Sly) � i v i•�r�
NO.
Bus. Tel No. -1-7,0 7 A
Address % 1yi / L A,,V S,T (46VIMAIC-L Alt Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
Total
No. of Light8ng Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑
In ❑
No. of Lighting Fixtures
Swimminq Pool gMd ❑
gmd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Snitch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di al
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
S ace/Area Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER: 1�p C U Y I "t ti �-I a✓ Y" '
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES !- NO =
have submitted valid proof of same to the Office YES'—NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE �rBOND = OTHER = (Please Specify)
Estimated Value of EI ork$ 8o o � 00 (Expiration Date)
Work to Start Inspection Date Resquested Rough Final
Signed underttl V 1Iltl $of A"r)ury� �1 '�JCt r i✓i _ �y
FIRM NAME S V H � 1-9 LIC. NO.C—
�v Xj.� r -� �Sly) � i v i•�r�
NO.
Bus. Tel No. -1-7,0 7 A
Address % 1yi / L A,,V S,T (46VIMAIC-L Alt Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
U 7 9 Date ... �—f 5�?
............................
0" TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
V
iesthat---"��.. .... ..........................................................................
This certif
has permission to perform ............................................
.................................
C .
......... ......................................
wiring in. the building of .. 14 ....... ...........
at / . ........ W ................................................................ . North Andover, Mass.
Fe6................ Lic. No. ...............................................................
ELEcrRicAL INSPECTOR
06/08/98 14:12 35- 00 PAID
W+iITE: Applicant CANARY: Building Dept. PINK: Treasurer
e
IF
Die Commoniveolth of 1tilossocIlusetts
Dcparfmcni of Public Sofcty
Oce vr/n/. a Ire O.ec�,�
BOARD OF FIRE PREVENTION REGULATIONS Q7 CMR 1200 3/90
APPLICATIONFORP6-c P"rmvd �ERoMIT T0� PERFORM a��LEc. ZGTR7 CMR iCAL W RK.
(PLEASE PKIKT I21 nTK OR =E ALL I2iFORMATION) Date %
City or Toon of �/i) �� Io the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & tfu/m�ber)__/0 L-Xi`1i'3,,V / �
Owner or Tenant C. awll-dl9j /,./ (-
Owner's
Owner's Address 3 3 (,i/gt ITf/1 ),r},/
Is this permit in conjunction with a building permit: Yes a No ❑ (Check Appropriate Box)
Purpose of Building --AV S f Utility Authorization NO.�
Existing Service,,Asps / Volts Overhead ❑ Undgrd ❑ No. of titters
d
New SerTice O 0 Aeps_Id- U Yo volts Overhead ❑ Undgrd
No. of tSete:
Nuaber of Feeders and Ampacity L y
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Lighting Fixtures
No. of Receptacle Outlets
No. of Switch Outlets
No. of Ranges I
No. of Disposals
No. of Dishwashers
No. of Dryers I
Ho. of Hater Heaters KW
No. Hydro Massage Tubs
DIM:
No. of Hot Iubs
Swimming Pool Above
grnd. ❑
No. of Oil Burners 11
No. of Cas Burners
No, of Air Cond. I Totaltonstons
Heat Iotal Total
No. of v....... _ --
Space/Area Heating RW
Heating Devices KW
Not of o, o
Signs Ballasts
No. of Motors Total HP
No. of Transformers 'Iota
KvA
❑ Generators K:VA
No. of Emergency Lighting
_Battery Units
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
❑ Municipal
Local Connection❑ Other
Low voltage
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts Central Laws
I have a current LiabilityInsurance Policy including Completed Operations Coverage or its substantial
equivalent. YES O NO [ 1 have submitted valid proof of same to this office. YES ❑ NO ❑
If you have checked YES, please indicate the type ofcovcrage by checking the appropriate box.
INSURANCE ® BOND ❑ ar ❑ (Please Specify) G //V
Estimated Value of Electrical Work S . O O "'r M�Lration ate
Work to Start Inspection Date Requested: Bough LLI� c Final
Signed under the penalties of perjury:
IRM twr� � i S c,,..,.. -✓Aa c�� F�i`c� N!: � � �.
.LIC. N0.-Aklli-lx
Licenseeli1Q / ,12j^� _ Sttuature —
LIC. N0.
AddreaaS/7 ,r,¢Lf» /z/. �iQAi /ham au:. Tel. No. YS�/-03 Y'?
AIt. Tel. No.
PER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts Ceneral mss,and that my signature on this pe it
application waives this requirement. Owner Agent (Please check one) / 7
Telephone No. PERMIT FEE S �v d v
Signature of Owner or en
Ag[
IN%
ro 0
Date ..... W .. ....
1 �A
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
g -4��
12c) C -
This certifies that ........ 2 .... ...... ....... ................................................
t= has permission to perform .......... ( . AA .... ..........................
wiring in the building of ..... ............ ........................
at .... /() ..... PR Pxl. L . .................................. . North Andover, Mass
Fee.��J-dj. Lic.No.-AIV ... .......... *iILE**c'*r* R*i*c'A-L-1*N-S'P-E' c -r'0- R—
C (; tf cc� 4 R , I
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
CERTIFICATE OF USE &OCCUPANCY
Town of North Andover
Building Permit Number as—Date 1010) fig
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 10 PV h 1i 414 V
MAY BE OCCUPIED AS RPb"FJN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO A.(w . V I l d
6. e oL
ADDRESS 3 C) i K
"`""' uilding Inspector
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
�` (Type or print)
NORTH ANDOV X/f
C US ,�/ Date
MV Building Location /� 6/X7 Permit #
Amount. 2_
J
-/ / T/Y Owner s Name
New [Er Renovation ri Replacement Plans Submitted ri
FIXTURES
(Print or type)
Installing Company Nam)e
Address z
Check one: Certificate
Corp.
Partner.
/� Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
101
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 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 installations performed under Permit Issued for, this application will be in
compliance with all pertinent provisions of the M huse StageP bing Code and Chapter 142 of the General Laws.
By:
Signature OT LIcenseaof
Title
Type f Plumbing .License
��
City/Town License � uQ m6e'r Master
APPROVED (OFFICE USE ONLY
Journeyman ❑
•
_
..
•
NMI
(Print or type)
Installing Company Nam)e
Address z
Check one: Certificate
Corp.
Partner.
/� Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
101
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 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 installations performed under Permit Issued for, this application will be in
compliance with all pertinent provisions of the M huse StageP bing Code and Chapter 142 of the General Laws.
By:
Signature OT LIcenseaof
Title
Type f Plumbing .License
��
City/Town License � uQ m6e'r Master
APPROVED (OFFICE USE ONLY
Journeyman ❑
3686
. Xi;
Date. 61-A Ok
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform ... ..............
plumbing in the buildings of . '('—
.........................
at.. / '-". - '. 1.,q "
.2 3— . /13. itj.� ................... I North Andover, Mass.
Fetmt�, �-. 7. Lic. No. .7 ................
PLUMBING INSPECTOR
04/22/98 08:43 225 00 Dom
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer