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HomeMy WebLinkAboutMiscellaneous - 103 ROSEMONT DRIVE 4/30/2018N O �I N2 r_ 5 1 0 Date....... .. ..0 .... ° ,"`° ;• "� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that /i l� �� v ........1........r�..1....0................. has permission to perform ...dr ..�../!. v i1 ........................................ Ori��� wiring in the building of................................................................................... at .......�.�)).... I ��!,.C.. :..:. ........... orth Andover ass. Fee ..1.� ..G .. Lic.'No. ww ,, � SP ...!`.',.......... L� ELECTRICAL INECTOR Check # CA 69/ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Up N 7,7�5 e0=M5,4Zr,W 07 X,45s,4e;7*s977s V0416tteat 4 Pd&a .S460 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO All work to be performed in accordance with the (Please Print in ink or type all information) Utticlal use unty Permit No. (Q/ Occupancy & Fee Checked PERFORM ELECTRICAORK Massachusetts Electrical Code 527 R72: 00 Date To the Ins a or of ires: Town of North Andover The undersigned applies for a permit to perform the el ical work described below. Location (Street & Number �J P �� Owner or T Owner's Address S0- Is this permit in conjunction with a building permit Yes C3,� No ❑ (Check Appropriate Box) Purpose of Building_ r-1 Utility Authorization No. Existing Service Amps Voits New Service Amps Voits Overhead ❑ Overhead ❑ Undgrnd ❑ Undgrnd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 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 f overage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) c �� iration Date) Estimated Value f FI tri al Work$ p Work to Start Inspection Date Resquested Rough Final Signed underthe en ' s f perjury. L FIRM NAME LIC. NO. Lkensee sfo/i Signature �— �7 S� LIC. NO.3 Bus. Tel No. �/y-J��� Address / l/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) r Telephone No. PERMITTEE (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ran es No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers I Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Winn No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 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 f overage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) c �� iration Date) Estimated Value f FI tri al Work$ p Work to Start Inspection Date Resquested Rough Final Signed underthe en ' s f perjury. L FIRM NAME LIC. NO. Lkensee sfo/i Signature �— �7 S� LIC. NO.3 Bus. Tel No. �/y-J��� Address / l/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) r Telephone No. PERMITTEE (Signature of Owner or Agent) 0 Location No. Date- - NORTH TOWN OF NORTH ANDOVER ••,MO F�O•,t``O � Certificate Occupancy • , , of $ ��s',•°''<�' s+CHU Building/Frame Permit Fee $ Foundation Permit Fee $ P Other Permit Fee $ TOTAL $ Check # 7 r rr Building) nspector 1.1 Property Address: /0� i ,QiuE 1.2 Assessors Map and Parcel Number: 95 Q 8 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: ZOne Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ slr! u i iON 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record Name (Ptirrti---rte_ Signature 2.2 Owner of Record: f-, Name 6/ 1 /Vo 103 Address for Service 6P& -'7j-1 Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ,0,w1P1t c°� 7'�L Licensed Construction Supervisor: RaD & k �ddress 3.2 Registered Home Improvement Contractor Company Name Address 0 90 7-15-?, License Number 9 28 001 Expirdtion Dat Not Applicable ❑ /00&0 �z Registration Number C12 F %a -a Expiration Date i LO ,wac 2 —"' SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I `Z *'X /6' SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 00c, . Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize ar k to act on tiers Alative to work autho zed by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,r�/. e ��// ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief �Z,,, Print Name 911,44 �:�/� 6:Z7 �a6 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB ND RD SIZE OF FLOOR TIMBERS 1 X �' 2 3 SPAN DIN ENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVIVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A P FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT PHONE O ASSESSORS MAP NUMBER LOTNUMBER� SUBDIVISION 4A 4v �N � LOT�UMBER 33 STREET °'� ° `' 2 STREET NUMBER OFFICIAL USE ONLY / V " X/6 ' 3 Sr_.t)S0 RE OMMENDATIONS OF TOWN AGENTS / As F^% car 7..^......f................................■.............................■ �C�^ w DATE APPROVED ` b� C SERVATION ADMINISTRATOR DATE REJECTE CON9AENiS� TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CON94E'NTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE l,Of 12(-2 rA BUYER: 0 S N 4P Woo (�A►Z w SEE== NONE ONE 1 ■ SSSS■■■ ONE ■®SSSS ■SEEN■ NEESEE ENN■N� NEs ■■o■■■■ ION OMEN ■W - !1■EE ■■■■■N■■E—riqkqb ■■ ■r - SEE -. ,, Erin MiNQ■■N N� m IN MEN MEN s MEN ■ ■IP Mimi ■■n _ - EON ■ � t • a, c -!;c m r o co f0.0 :;l�N fn CO ; � o F:i � Q a o Z G), c .. c me , d <� o W N .. .9h. V OO. N .,..s..... i { a-,-• � w,a.:ir a ; .y�:.R /TA!{ArStroXSws. fy0.^aF�',Gar9w,-t4v`kS:X---....— ......................v...,.. A CORDt CER fiIFICA. O /ABI I � NS' NAv C4E-> o5iosiz000 y ,. 3RODUCER (508) 655-0522 FAX ,(508)655-8853 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION arl i n Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE- 33 West Central Street HOLDER. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 14ti ck, MA 01760 ! COMPANIES AFFORDING COVERAGE COMPANY American Employers' -Insurance Co. -(CU) - ,ttn: Ext: A ........ ..... ..... .-.. NSURED M.G. Hall Inc. ... .._............. ;.... ....... ........... .-----_........... --___._._...-._..__.-----...__.._._........_...._._..........._....._ COMPANY Commercial Union Insurance Company P.O. Box 383 B North Reading, MA 01864 r The Northern Assurance Co. of America CU COMPANY C ) i C ._.._._._,._....__............... ... ......_._... .._...._..........._....... COMPANY i k..e. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _. ........... ........_......................._.............. —._ ... _.... _... ..... - ... _-- O TYPE OF INSURANCE j POLICY NUMBER .TR POLICY EFFECTIVE POLICY EXPIRATION LIMITS I DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY i GENERAL AGGREGATE S 2,000.000 X ' COMMERCIAL GENERAL LIABILITY I —' I j - - - PRODUCTS - COMP/OP AGG S 2,000,000 A^4 CLAIMS MADE I OCCUR , A .._. t_._.._I ABR557102 i 04/27/2000 1 04/27/2001 PERSONAL & ADV INJURY is 1,000,000 ------- OWNER'S & CONTRACTOR'S PROT i EACH OCCURRENCE $_ 1,000,000 _ FIRE DAMAGE (Any one fire) I $ 100,000 MED EXP (Any one person) Is 5,000 LIABILITY 1 _AUTOMOBILE I � ANY AUTO COMBINED SINGLE LIMB 1$ 110001000 ,000,000 BODILY INJURY ALL OWNED AUTOS j X SCHEDULED AUTOS B CBXB17461 i i 04/27/2000 ':• 04/27/2001---_..__.._._.._......____.._.._.____.`._5......__._.___.._._._.._.........._._. (Per person) _ X HIRED AUTOS BODILY INJURY ! X NON -OWNED AUTOS j i (Per accident) ; $ PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT is OTHER THAN AUTO ONLY: ANY AUTO I i EACH ACCIDENTi $ AGGREGATE $ ----- EXCESS LIABILITY ! I I I EACH OCCURRENCE 1$ , 000 , 000 B X UMBRELLA FORM tBDW43282 04/27/2000 04/27/2001 -3 CAGGREGATE is 3,000,000_ OTHER THAN UMBRELLA FORM I I —�- is — WORKERS COMPENSATION AND I I I..__I TORY LIMITS_ E EMPLOYERS' LIABILITY C IN ' ! .. j EL EACH ACCIDENT a 500,000 B 00 H16 44 98 THE PROPRIETOR/ I j INCL 04/27/2000 04/27/2001 ^ EL DISEASE - POLICY LIMIT j S 500,000 PARTNERS/EXECUTIVE C I..___..._.__._..._._..._.____._..._......._........ OFFICERS ARE: EXCL : I j j EL DISEASE - EA EMPLOYEE $ 500,000 OTHER I I I VCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS addition to home. �ERTIFICA'TE�F�O,tLDER H ° � . CAt��CEL' A 10 ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Douglas & Gail Tenney BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 12 Angel Road OF NO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. No. Reading, MA 01864 A 'R ESENTATr Vitt 4CORDriffis-©ASO CSO 1 0 X198 Cl) m U) 0 m C _ ...: ao to CD CO2 10 CD O -e C= O CO) 'O cl' c O c CO) CD O _ CD CD vi' CD CO) IMP O —•CACQ H dO m 1 y O= m n O n y0CL m CD CL 0 CD =d O y CD -40 m y p N Ohm: m 2 > > m y o � 0 0 O up'* O G y n CD :� =y G CL o....�:� to o CD co CD to a� N y c m fH 1 CL CL m : ? CA H H� '� :� c CDm m � N 0C*): CD o t o� � is W H .� =; e 2 �0CD aI kft n c� o_ 1 ♦ = :A = Z 0= uocn 0 0 ry ;zrn rA Ir m cn7• n aoGv a- Cz C" w� oG GQ77- r m �o� a a 7 Cz7 r c nrD o n rD O p tTj z O w 0 0 d _ocation No. d" Date 4' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 'Z-2 Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ +le� "y r W Connection Fee r �U Z OTAL Building Inspector Div. Public Works , r A f+ Location l /5�� : �,� • iii %, No. / C, Date koRTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 41 - * Building/FranflgTgrmit fee $ AMU Foundation P4Me�,""- � Other Permit Fee $ Sewer Conne6ttttion Fee $ 4 Water ConnebiU Fej 11 TOTAL 55 Building Inspector Div. Public Works Location /03 PoSP/sr 01 4Dt Ao. Date 6-4--93 + t NORTh 1 TOWN OF NORTH ANDQVER p Certificate of Ocdupar cj::'L"t3' E0101. Building/Frame Permit Fee $ '$3 MUS Et Foundation Permit Fee `$ Other Permit FeeJU N f r® 190_ 7;!'r67 7— Sewer Connection Fee $ lew Z57 Water Connection Fee $ /GL's TOTAL A Building Inspector `� ._ 641- 2 Gi am m O A z 4 m v z m z _ a c m m C 1 v -4 m 0 m i � 1 z r 1 m m A p > 1 > 1 i O a A 0 N m D O , > m 1 m fD . c v ti i i i f i i ) ) 1. I r l" 1 ml 1.1 O o O A Z =+rri a -moi � r M n�rm- xt z m z _ a c m m C 1 v -4 m 0 m i � 1 z r 1 m m A p > 1 > 1 i O a A 0 N m D O , > m 1 m fD . c v ti i i i f i i ) ) 1. I r l" 1 ml 1.1 A ai a e a r w O n A n n 0 0 z °� m 'r.0 M m m p A A W g o z A S � p � w z o , z O w on Z O I C 0 U W r 69 0 Z O m I� 00 M UN WW UI F� N_d QI aha 0 CL _j L?0 0 N ZEN 0mU Wog NNW Z GNI QZF- WxW 36N NV_E F'X lz NWW IZj ZaN ONH UWW WZ NSW N N 10< id �oIIIII IIII �I II (IIII I I IIII III z_ITI-I « Q « II O OW 0 a02 2 X Wf ,n Z wLL Q« CL >Z I I I p roI �w « Q S U 0 W I I b - IT i I x N «� Y V� W < W Z a « QV' N Z 0 W J a W ~ U V Y G LL O Z? 3 N x« LL O = LL H Q « H~ p W Z F- 2 p W Q 7 �� QZ a « p Z _� J� « « �- OQ M°C V oYc O Z �nZOQ p «Wp 2 ,n wp w:E �-0Z QZS Q VQ «w yLL O V iZQ QK U.-pSS V «0 �~uwO S QSa-w a«p-Owai :: uS N Q a 2 G Z p p ZZaO u z .y Of O¢ V <0 w S V a Q �p N Q QOaQ`U"O�Q�� m r 3 Y Z to < ;7 I- d w N S Q « c (i "! Q W Z II TI TTI I I z IIIIII 0 w Up f O Z !2 « Z« } "> m« « N Z p Z J O O Z 0:20� h Q �d�m O 0 QZ Q � O o« Zw0 Y NwLL«p ['f O � vN Z ZZ < LL U S i W O 0 _ OwOO 0000 Z v LD0 Opxwo00z 2I� Q 0 a 0 2 Wm�UVUZOO wZ It)< Fi� SNZZUW QW� N0 O 80000m Q1N Nmm Q m� 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 loc1 or state law, , regulations or requirements. ****************�**1Applicant fills outithis section** APPLICANT: o ACid*************** \ �l, ' 2—\� x LOCATION: Assessor's Map Number LFA LIVC21? Subdivision Street Phon� ( q Parcel Lots) (� St. Number _ Z 3 ************************Official use Only************************ RECOMMENDATIONS OF TOWN AGENTS: l'laI-70 Date Approved Conservation Administrator Date Rejected Comments MAN11V NENIM'402 Town Planner Comments -;I A Food Inspe .�-Health Septic Inspector -Health Comments Public Works - sewer/water connections G --'?-43 Date Approved Q Date Rejected Date Approved Date Rejected Date Approved G� Date Rejected ,-7-�7 - driveway permit /'�Wf'4 Fire De ar-mentJ C9.4, C4"' Quo �vd �( p deceived by ilding Insp G Date 44 a i n 0 CA CD 0 Z O O O O O � a� v 91 CD fl. C CD 00 O CD =v D � o C: Cc CD z S'CA 10 CD a O 7 LTJ wal a, C7 CD O �F CD CD H. CD CO) a l J da of CTE�0 53" � d0con otm - y O CA cl m Z =-o N m o3.. T m aid = y --� O O N O N o 5 S, o = �D o� 0 O Z�•A� O N n 00 ' m n_ = t �a o W � O N sa 1 0 CD . � . c CL CD 0 O d CO) =. CA) o, „ i N :O..r m CO) d N ` :• �00 �: it yaw: COD 5 gCD X71 �1 T N c O IL -� 5Vv T. CK o : `. 2m C-. Qi %� O I d � o w aGc E. :5aC `° 91 t" Cr1 n Zi ►' 0 OCG a= � ( OAC � w �^ cn (D O 7Ctz O b c CLto M 0 c Q c� N F� 00 a• C F- U.) o` mo �, mnt �0 �m 0O mn ac 9 Cl) pc�m mr rn > 120 O 0 0 z 0 o r d 00 z w � ►�C "v� � o Cr1 %> c7 y z v � Y..1 d z H A A O � � t7 z � d � c CLto M 0 c Q c� N F� 00 a• C F- U.) o` mo �, mnt �0 �m 0O mn ac 9 Cl) pc�m mr rn > 120 O 0 0 z 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Type) f NORTH ANDOVER Mass. Date building Location ./0, v �� r� /l. C� Permit Owners Name > New '�i Renovation D Replacement Plans Submitted '` FIXTUP=S r� (Print or Type) Check one: Certificate Installing Company Name �_ (C IC C(� `�- r Corp. Address -7 1-1�1 ,r r 8C5U Business Telephone {2 Name of Licensed Plumber or Gas Fitter LI Partner. LI Firm/Co- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Q Other type of indemnity F --j Bond 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 coverages. Signature of owner/agent of property Owner 6� Agent 1 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 aU plumbing work and lnstxUations performed under Permit iuued for this application will -be In compliance with all patlnent provisions of tho htarsachusetts State Cas Cade and Chapter 142 of tho General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) ,+ TYPE LICENSE :��� ' Plumber Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman / b 'F-0 a License Number . • : Y • (Print or Type) Check one: Certificate Installing Company Name �_ (C IC C(� `�- r Corp. Address -7 1-1�1 ,r r 8C5U Business Telephone {2 Name of Licensed Plumber or Gas Fitter LI Partner. LI Firm/Co- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Q Other type of indemnity F --j Bond 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 coverages. Signature of owner/agent of property Owner 6� Agent 1 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 aU plumbing work and lnstxUations performed under Permit iuued for this application will -be In compliance with all patlnent provisions of tho htarsachusetts State Cas Cade and Chapter 142 of tho General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) ,+ TYPE LICENSE :��� ' Plumber Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman / b 'F-0 a License Number . ,ORTH Of 0 Date ..................... J, TOWN OF ,NORTH ANDOVER PERMIT FOR GAS INSTALLATION This 6extifies that ............................................ has permission for gas installation .................... in the (bifildings, of ............ ........... ................ at ...... ..................... I North Andover, Mass. . .......................... Fee. -. X -a ip .... .. GAS INSPECTOR WHITE: Applicant_, _��ARY: Building Ddpt. PINK: Treasurer GOLD: File n n O � 'n z ° z O G '� v G G x a � O Y O ^ a Ti C �071 0 T � co) Z D CD a Z O O CA 'O Ti r CD O D CL r. d � C'J O CLCD y O J 1 n ,.� G� CD CL ►•3 � cr CD CD O CD m P-_ w W a. C CD Vi �. CD CLO CO) to CD F v C„ o CD Z o CD 0 CCD Ch _ `5k6'"��N , tib` C,o z O F� .^� G O It � CD O � O G x Com" O G '� EL �,. G G x a � O Y O ^ a ° CD� c�i �071 0 d y IV Z z O J � n ,.� r i ►•3 � �3 0 c