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HomeMy WebLinkAboutMiscellaneous - 1093 OSGOOD STREET 4/30/2018 W �, ---- �-- Date...... ORTN TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACM This certifies that ........... b.e!U....... ........................................ has permission to perform ...... �� 7?�,L4,P1.......... wiring in the building of...............&A 4J.0....... ......Sax?"'t"e. 73 4 rz :!r— so zl ../................A4.yl....)OAM,�Borth Andover,Mass. Fee... Lic.No...dd-01.F....... LECTRICALINSPECTOR Check # 7528 MASSAGE ESTABLISHMENT CHECKLIST Establishment name �I� U,4-�, `����� Date Address Wc� 7 05` 001 Tel. # �j � L7b2S 6-7 Massage Therapist "`y�`7 1. Well lighted 2 . Well ventilated 3 . Hot and cold running water r/ 4 . Toilet & washing facilities for patrons 5 . Sanitary, clean premises 6. heat/smoke detectors_ 7 . Linen sanitized V 8 . No food/bev Inspector z Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. -7S-?,0 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: au I,, 11, '1O fil City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or Per i ention to perform the electrical work described below. Location(Street&Number) ©Sg0OA Si, +9Ae1er QD,( CevAey-) ^9441"ee or Tenant 'Re 11 _ Jok 111a10 K Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building C�1r%yr%e r f I ej Utility A t orization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: T►S coh�%nuQ -01A V3 1 r t✓1 c t hd vewAa ve 6ek aawd W\ yo. Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and TotInitiatin Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals- Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Sectio f Devices or Equivalent No.of Water No.of No.of Heaters KW Data Wiring. Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: ti Attach additional detail if desired, or as required by the 11:spector of Wires. Estimated 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 COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 54 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: — Signature , e� LIC.NO.:dOS®I E (If applicable, enter "exempt"in the ' erase number; zee Bus.Tel. NoA_M-Sgo-�4Q6`.Z Address: 2S LO r vve pd� ,� A 018 4 y Alt.Tel. No.: *Per M.G.L c. 147,s. 57-61,, curity work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ a The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations UIP 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgamzatiowlndivtdual): I hq d V th Address: 2S Lo r ih IZd , City/State/Zip: V"P-4A�PJA� O �$y� Phone.#: Are you an employer?Check the appropriate box: r2. ❑ I am a employer with 4. ❑ I am a general contractor and IF e of project(requirJed employees(full and/or part-time).* have hired the sub-contractors New construction I am a sole proprietor or pager_ listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' Demolition [No workers'comp,insurance comp.insurance.# ❑Building addition required.] 5. ❑ We are a corporation and its 10.�Electrical repairs o 3.❑ I am a homeowner doing all work officers have exercised their myself.[No workers'comp. right of exemption per MGL 11.❑Plumbing repairs o insurance required.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees.[No workers' 13.❑Other MIP.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their worker'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractor must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the subcontractor and state whether or not those entities have employees. 1f the sub-contractor have employees,they must provide their worker'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 of criminal penalties of a fine up to$1,500.00 and/or one-year 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 Investi ations DIA for insuran a coves a verification I do hereby ce fy a er;he a andpenalties ofperjury that the informationprovided above is true and correct ` Si store• � — Date: J I 1 287 rhone#: Official use only. Do not write w this area,to be completed y city or town official City or Town• Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other _. ...._. ----- Contact Person: Phone#: N° ? _ U � Date.:....: �aORTM °!t °;•�"° TOWN OF NORTH ANDOVER O P * » PERMIT FOR WIRING SACMUSE� This certifies that has permission to perform wiring in the building of................................................................... .........................:`............ .........`.. ti;.� at " ................................. .North Andover,Mass. Fee/et........... Lic.No<t.W/s .......... -�................./ c' !��. ............. .... ... ELEcrmcALINSPECTOR ;i 02/23/99 10:47 100.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Rough Service Final WhP (10mmonwrait4 of A"JI814tMetu Office Use Onh Department of Public Safety G� BOARD OF FIRE PREVENTION REGULATIONS 527 1200 Occupancy & Fee Checked 3M lleave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be Wilormed in accordance with the Massachusetts Ewincal code,s27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE All INFORMATION) Dat e—�// f49 City or Town of Ai y n U 1)U J c`r'7- To the Inspector of Wires The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Number) /U S 3 d S GOOD S/ 'a rTfN-gr � 1 A 5hl J 91T I� Owner or Tenant D Owner's Address 5 NL Is this permit to conjunction with a building permit: Yes El No (Check Appropriate Box) Purpose of Building C o m M Ere e 114 L- Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd ❑ No_of Meters It New Service wimps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampactty t Location and Nature of Proposed Electrical Work /R 1V C (t1 NA Al 11 1 .� TOTAL No.of Lighting Outlets No. of Hot Tubs 11—'� No.of Transformers KVA In- No.of Lighting Fixtures oZ Sr Swimmin Pool Above E3md. Generators KVA No. of Receptacle Outlets U No. of Oil Burners No. Umm tss Lighting No. of Switch Outlets j No. of Gas Burners FIRE ALARMS No.of Zones Total No.of Detection and No. of Ran No. of Air Conditioners Tons Initiating Devices Heat No,of Sounding Devices No,of Disposals No. of Pumps Tons KW INo.of Self Contained + No.of Dishwashers Area Heating KW Detection/Sounding Otwita No. of Dryers HeatingDevices KW Local Connection on ❑Other mNO.of No.at Low Voltage No. of Water Heaters KW Signs Ballasts I Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusttes General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantia)equivalent.YES 13 NO O 1 have submitted valid proof of same to this office. YES G NO IJ If you have checked YES,Please indicate the type of coverage by checking the appropriate box. INSURANCE tJ BONO ❑ OTHER❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Stan Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME 0 n C G L E�rX I 'U L1C. NO. Licensee!g—1 tt)N y /)flee F Signatu tic NO. Address & S O n A F / ( it t S Bus. Tel. No. 9 78 S 7 -5-17 7 Alt.Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the licensee 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 IPWase check one) eeeu.T rrt It Location /050 0,5(2-0 O 4 S-k- No. 45-33 Date NORT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 37. si a ,SSACMUSEt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL 3,9' /D Building Inspector 1 n /1 02/23/99 11:02 39.00 PAID Div. Public Works PERMIT NO. d (33 APPLICATION FOR P ERMIT TO BUILD*** 7**NORTH ANDOVER, MA MAP NO. LOT.NO. 2. RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV.LOT NO. �� 0 0 S S' PURPOSE OF BUILDING i j LOCATION ; > N b►U L 3? OWNER'S NAME J Af L v JQ P,A NO.OF STORIES S OWNER'S ADDRESSA S L E✓ pp i ST BASEMENT OR SLAB RD ARCHITECT''S NAME SIZE OF FLOOR TIMBERS 1 2 3 BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM IAT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF Lor FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDINGALTERATION IS BUILDING ON SOLID OR FILLED LAND SVILL BUILDING CONFORM TO REQUIREMENTS OF CODE S IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNECTED TO TOWN SEWER + IS BUILDING CONNECTED TO NATURAL GAS LINE - a4'fi'k =jJtS?tl Q INSTUCTIONS 3.PROPERTY INFORMATION LAND COST aa© EST.BLDG.COST ty COO I PAGE I FILL OUT SECTIONS 1-3 FST.BLDG.COST PER SQ.FT. EST.BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUIL G INSPECTOR DATE FILED OWNERS TEL# 0 3- 993 cl C0N•IR.TEL# y7L699-7'9/? FEB j ' r LIC# SIGNATURE OF OWNER OR AUTHORIZED AGENT _ II.I.C.# L FEE $ PERMIT GRANTED a 19 Revised 11/97 JM t4OR T Town of over o m No. D 3.3 * _ * � 19� s ; dover, Mass., 01 0 LANE 9A_COCMICHEWICK i'A• �w E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 130-tt-6r has permission to erect..G .. . .N7buildings on ...... .. S C """"' Found ation ........S.4 .... . . .... Rough to be occupied as.P r .. a o.....A4o101N Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final -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 MO)"S Final ELECTRICAL INSPECTOR G UNLESS CONSTRU lt Rough .............. Service B LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P P Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. � F DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 1 i Number- Expires: BirtSdafe: ^*� CS 061596 65128!1999 05129!1957 Restricted To : iG = NICOLR. CURAO 63 HAMPSHIRE ST t ME N MA '01644 _ THUE , �� 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. M-�***********"*********APPLICANT FILLS OUT THIS SECTION** /p V APPLICANT_ 1. �,I R VV PHONE S- b 21 V� J LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) JSTREETDSQnn !1 r,� ST, NUMBER ------�-*--^-:--"*,..*.*—"*****OFFICIAL USE ONLY**"'*'*' -* — RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS f' r DATE APPROVED C70R HEALTH DATE REJECTED $.EPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS ' PUBLIC WORKS • SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT �y" ✓� DATE RECEIVED BY BUILDING INSPECTOR The Commonwealth of Massachusetts Department of Industrial Accidents 9Xce o/IMS119171/aas _ = ; 600 Washington Street Boston, Mass 0 111 ~ Workers' Compensation Insurance Affidavit location: city phone# I am a homeowner performing all work myself. r7 I am a sole proprietor and have no one working in any capacity C] I am an employer providing workers' compensation for my employees working on this job. company r, fir; (, 5 ') phone#- ins rg nee co, policy address ... • �G GJG-7 fid', C] I am a-sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name 2ddress:. city:- phone#r insurance co: policy#. cc11?any 11ame: -: addresst cim. phone#: O Npy t/ 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. 1 do hereby eerrify under the pains and penalties of perjury that the information provided above is true and correct. /o - � Signature Date 2 g Print named/Q �ip�—� Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license q f7Building Department C]Licensing Board check if immediate response is required C]Selectmen's Office C]Health Department contact person: phone#: nOther (r"ued 3191 PIA) J CJ ► Date!. .1;1? ..... r NORTM TOWN OF NORTH ANDOVER �_ a `p PERMIT FOR GAS INSTALLATION t � s s so " � SACHUSEtt r This certifies that . -. .-�-�- . . .?. . . : . .' :. . . . . has permission for gas installation . !� in the buildings of . . . . . . . . . . . . . . . . at . . . . a te . �' . . . . . .,. , , No h Andover, Mass. ;% n,�� Fee:: --.7. . Lic. No. . . . .��.�:� ...z. . . . . -4- c9 / INSPECTo WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 1 3 MASSAf.PARCE 1EAPPiCATONFORPERNUTTODOGASM-MG ype or print) Date _ a 19 NORTH ANDD /� Building Locations It) 2- A���d S4,ee _ Od Ig U)4)q Permit 9 //// Amount S 20 a /�A J Owner's Name :1-6140 C✓�/Q�® New El Renovation Replacement Plans Submitted u Z _ Cn i.4 cn Z :a m z _ y iJ U E- z �- Z — J ^ z Et — :� — ` y n z C i C 2n z 't C — S1/ 6 -BASE �1 ENT B AS E ME N T IST. FLOOR 2ND . FLOOR 3RD . FLOOR 1"r 11 FLOOR ST ti . FLOOR 6T 11 . F1, 00R 77 11 . FLOOR 3'ril . F1, 00 R (Print or type) Check one: Certificate Installing Company Name SA l- .P,e A-Q Rlln bl A.12 t 1l-P�- �K. d F-1 Corp. Address ❑ Partner. Business Telephone ��f(_ G,f�r,_ 3133 © Firm/Co. h Name of Licensed Plumber or Gas Fitter S.4 Ivy Rz- C.,P,/2 r4c.) INS 'RANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes a No❑ If you have checked ves,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond E-1 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 ❑ 1 herebv 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. Bv: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber 'a 36 3 CitviTown Gas Fitter License Number iVlaster APPROVED(OFFICE USE ONLY) ® Journeyman Date.� r�� No 4. L.. 3 0 TOWN OF NORTH ANDOVER ° a PERMIT FOR PLUMBING �,SSACMUS� / �� This certifies that . .� . .- A . .l • . • • . . . . . . . • • • • • has permission to perform . . . `" • . . • • . . . . . plumbing in the buildings of . .. . . . .-. . . . . . . . . . l at . .% . . . . .-. -�- . . . . . . . . . . . . . .. N Andover, Mass. A� Fee!S. . ' . . .Lic. No..-.4 /. . . . . . . :. . . . Wit_. . . . . . . . . . . . ' PIUNtBING'INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PER TO ISO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /' Date Building Location V�Gfnn - lice Owners Name 3 O I4 OU C gPAo Permit# Amount Type of Occupancy New ® Renovation r Replacement Plans Submitted Yes D No - FIXTURES Cn Ln wCna a w H w H 7 � a a a. x W �" w d W A x x a F d a w x w a E~ CC &rl BASEA ' _ ]S1:MOOR 2M ROM �FLO(R 4IH FLaR SIS HOM 6TH FL M 7M MOM r SIH FIOQt (Print or type) Check one: Certificate a Installing Company Name '1gcuel?4c) 191cllb A Mlr4 i lqrvrlt�4 ❑ Corp. Address y Q/24 --5q LAweYti1-'? Partner. 1VN Business Telephone j 7 k 67 -3777 © Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by ch:cking the appropriate box: ❑ Liability insurance policy M Other type of indemnity 11 Bond Insurance Waiver:_L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance - Signature Owner iJ 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 Massac S e Plumping Code and Chapter 142 of the General Laws. �� By: r ra o icens um er Type of Plumbing License Title 34 City/Town rcense u l eta r Master ❑ journeyman APPROVED(OFFICE USE ONLY I I S UNIFUHM APPLICATION FOR PERMIT t U UU VLUMtsrnu �—•\ IPdni or Type) f vv NORTH ANDOVER, , Maas, Oate„ 1? _10 Buildin0 I' Permit rt9 � Location(3 t;�Ut l2 �/ 6"L-A Z 4 �r 19 �NFDOwners-3—° CfeF ! � Name . New O Renovation p Replacement p Plans Submitted: Yes p No.❑ FiXTUAE$ ......... M = li • N .1 � °u s s v M s of s s 44 s o O M a a 0 M r M rj r M F O 1~t M s ` .1 s Vl = IN .1 44 OON O M O J`` s .' O a t t y < i S M a i 0 $ es = ! F IL IL 0 v r . ; � 1 • ee un o 3 y s � e'ai �' taOc i t1Ut-11�MT. •ASKMaNT 1ST FLOOR 1 t INDFLOOR r 1IRO FLOOR 4TH FLOOR ITH FLOOR sTH FLOOR. TTH FL00R eTHFLOOR - Q 1 Check one: Certificate Installing Company Name CLIMA ID 9!/1/ ❑Corp. Address q G t7 c 2 .S� ❑Partnership L.&,,2 C--AyCG fi- 0 Firm/Co. Business Telephone q7? G? �5_ I``3 3 .Name of Licensed Plumber INSURANCE COVERAGE: Check one I havo' a current Ilabllty Insurance policy or No substantial equivalent, Yes ❑ No If you have checked y". please Indicate the type coverage by checking the appropriate box A Ilabilly Insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the Ilceniee does not have the Insurance coverage required by Chapter, 142 of the Masa. General laws, and that my signature on this permit application waives this requirement. r Check one: 1 1''11Owner (,� Agent p Signaluts o era of s AGeni 1 hereby certify that all of the detaAe and Information 1 have submitted for entered)in above application are true and awxate to the best of my knowledge and that s1 umbing work and Installations performed under the mA Issued for this application will be in compliance with aM pertinent provisions of Iii Massachusetts State Plumbing Code and Chapter 112 of the Gerwai taws. By Signature Title l,c fie.Nurt,bw Crty/Town Type of Plumbing Ucense: Master ❑ APPMVED(OFFICE USE ONLY) Joumeyman �] t&OR Town of over No. over, Mass.,-_ 44% 1901 01 LAKE HICHEWICK T rz D BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAJ�.().......................B..... .....N5.. ........... .............. Foundation ...........) . . 4 has permission to erect..,E buildings on ...... ...P.113..............5.4 ........S..06 .......... Rough .0r "' to be occupied as.A.4 r0 N.....upvto ......S..P 1* . .C.r L...................... Chimney ... ..... ...... .... .... .... ...... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. PLUMBIN9 INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ou PERMIT EXPIRES IN 6 MO ELEOMiCAL SP R jLESICAL ;I 100Y UNLESS CONSTRUCt A$611 <2EO�F> " ;INSP R X1 00 ....... . . ............. 6 .......... ... . ........... . . ............... ......................................... B 3 r7 LDING INSPECTOR /�9Z< Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. ytj Smoke Det. Date *7 40: Se9 397 °7M 1�o TOWN O NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUSEt f This certifies that ././..��"(� . . . . . . . . . . . . . . . . . has permission to perform . . . . plumbing in the buildings of— . .-. . ���- �- . . . . . at. �. . . . . , North ndover, Mass. �-. Fee Az? .�—"'Lic. No.�S,�. . . . . . . . . . . OF �. . ....^ .1 PLUMBING INSPECTOR 02/23/99 10:38 100.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer