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Home My WebLink AboutMiscellaneous - 11 PINE RIDGE ROAD 4/30/2018 11 PINE RIDGE ROAD w � 210/065.0-0145-0000.0 i i I I I I I `'��1 �a �� - �� sc� off- �� 17 SPRUCE.ROAD READING,MA 01867 (617)944-3500 ..ti MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date 65 �uilding Location // r/�� tI C-,� Permit S Owners Name • Y New Renovation Replacement Plans Submitte FIXTUf?-c v, � W N Y ¢ Q; In F C N Q W0! taSO cc m Ld d w W FO- y 4 ¢ N d V W .. 'df a( Q O D W US ,u v� W z a = a ¢ a ca W t" W V z cI ¢ yw N O ? o ~ W O N = ¢ m ' Q W C W O 2 4 G 4 d O O W d O W k- az O Sua—as..IT. SASEMEXT t ST FLOOR 2ND FLOOR 3813 FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR TTit FLOOR 8TH FLOOR (Print or Type) t I Check one: Certificate Installing Company Name s�0` I l Q Corp. Address 17 rj C UC 2�. Partner. ec,�i1 a,el Firm/Co. Business Telephontgk7 1 S Name of Licensed Plumber or Gas Fitter 6e,` S i Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy kp Other type of indemnity Q Bond Ej 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. tgn ture of Owl er/agent of property Owner V 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 tint all plumbing Work and Installations perforated under Permit issued fo: this application will be in compliance with all pertinent provisions of the hlassachusetis State Gas Cade and chapter 141 of tho General Laws. n By TYPE LICENSE: �4) Plumber r_�� 1-z Title Gasfitter Signature of Licensed 6�7 City/Town: Master Plumber`�or Gasfitter Journeyman I0- APPROVED (OFFicE USE ONLY) License Number j� i pOR71y TOWN OF NORTH ANDOVER pf��so ,e 1h0 PERMIT FOR GAS INSTALLATION �9SSACHUSE� t [ This certifies that . . . .&10W. . .�� ' !�.r�' � . . . . .... . . . . has permission for gas_installation ./;" .. . .. ..t in the buildings.of , R-: 11tt. J !�' / . . . . . . . . � . . s ,�-� at 1' . . .,� . . l x .�. .: r • �.. . . . .. , North Andover, Mass. Fee. . . ..G Lic. No .. 3. �i. - AS.INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File Location 114 loe No. L Date —� M°RT" TOWN OF NORTH ANDOVER .A p Certificate of Occupancy $ # y Building/Frame Permit Fee $ ,sSACME� Foundation Permit Fee $ 06h-&V e—rmItiee $ U Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 7vl!o ) 3,-2 Z Building Inspector £ '�� 7 1'34 Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /AGE 1 —t► MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ZONE I SUB DIV. LOT NO. F—I- ;PAGE — LOCATION _ - '- - PURPOSE OF BUILDING ( NQ (,NIY`�MI . f/ OWNER'S NAME 1 '' NO. OF STORIES J.lw�� SIZE �� INx`7 •'1 OWNER'S ADDRESSW BASEMENT OR SLAB �� (/ • ' ARCHITECT'S NAME p'f3 pu'. �/ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ANVR•E.WS �uNrrE Go•SNC, SPAN DISTANCE TO NEAREST BUILDING /ZI DIMENSIONS OF SILLS DISTANCE FROM STREET /_n "' POSTS DISTANCE FROM LOT LINES-ASIDES 110 REAR GIRDERS AREA OF LOT FRONTAGE /J,2y4_ HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW zo(vetwivo Slr� )r h'j( 'y rJ'I�C7.7 SIZE OF FOOTING X IS BUILDING ADDITION �R.VV MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND- WILL BUILDING CONFORM TO REQUIREMENTS OF CODE '� , 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 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ST. BLDG. COST �1 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY �J f ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR !DA/TE' FILED V BOARD OF HEALTH SIGNATURE OF OWNER OR AfITHOftIZED AGENT FEE Uo OWNER TEL.# �Ga�683'�7 s PLANNING BOARD PERMIT GRANTED CONTR.TEL.II t•��_'L7Z'O2'� 1 19O� CONTR.LIC. ii --�1� BOARD OF SELECTMEN BUILDI G INfPECTOR 7 i BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY, STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES- _ LOT LINES AND EXACT DIMENSION'S OF BUILDINGS. WITH"PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B t 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. BM'T AREA _ FIN. ATTIC AREA NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE w 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I i l HEATING WOOD JOIST PIPELESS FURNArE 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 GAS 7 NO. OF ROOMS OIL B'M'T2nd — ELECTRIC 1st _1-3rd I NO HEATING KOkx LOrC4 rEAO' //r,...NO,,d if.0r. 1.1.. C,�/�/ST/�NSEN E'NG�NEE�/NG. Me- - c�owN 1Z£QUiR�11F5 •i � SELF- 0 • SELF-WJCHIN(r � ' ' • 4/S 't • `• r- Z Z.3 3. 6 Z / c,tao s ,aP46- STREET. CUENT: ,• �!fR. F;P;4iVEC ROSS/ .• ; , / CERT/FY 7/-/4T' 7W OFFSETS S/I014IN Acle FOR-, •T11/3 .LOT. Bllll-D/IV(� 51101VN PM.P18 ZON/NCS:.:,Oe rCRM1Md T/ON ./5 /1/�0�"/iY • �' �'L<1N C'DNFOeylS TO 'TSE ONLY.' 4VD,';rl,PE NOT•'TO BF ,4 FL000 7.ON/NG f3Y-L.4W-5 OF 71 c • V,5 FED 704% .481-1511 PPO 0, /YQ-Ay YAR PERTY• L�tUE .. N iWIEN CONSTRUCTED • � ZO f HOME IMPROVEMENT CONTRACTORS REGISTRATION ° Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 113772 Expiration 07/15/95 Type — PRIVATE CORPORATION ✓Z, el no.1.151 11 140.duu"z HOME IMPROVEMENT CONTRACTOR (� Registration 113772 ANDREWS GUNITE CO INC Type - PRIVATE CORPORATION RODNEY P . ANDREWS Expiration 07/15/95 6 REPUBLIC RD N BILLERICA MA 01862 ANDREWS GUNITE CO INC RODNEY P. ANDREWS 6 REPUBLIC RD ADMINISTRATOR N BILLERICA MA 01862 COMMONWEALTH e DEPARTMENT OF PUBLIC SAFETY , a t sec®trdat OF ONE ASHBORTON PLACE MASSACHUSETTS BOSTON,MA 02108 r Tfav aza:;on v b 1ie 0. LICEASE EXPIRATION DATE C O:q S T R. SUPERVISOR CAUTION Fr :H 03/14/1996 FOR PROTECTION AGAINST �c_Y �I� EFFECTIVE DATE LIC-NO. RESTRICTIONS THEFT, PUT RIGHT THUMB NONE 06/30/1993 027999 PRINT IN APPROPRIATE ° BOX ON LICENSE. > ROi)NEYP 'ANDREWS > ° 1 547 Li?' ELL R D ° BLASTING OPERATORS SS !1 026-26-7729 Z �ONCdRD 1ir� G1742 m MUST INCLUDE PHOTO. PHOTO(BLASTING OPR ONLY) FEf Q. 00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY t STAMPED,OR-SIGNATURE OF THE COMMISSIONER ' '.. HEIGHT: DOB: 03/14/1934 /t Z THIS DOCUMENT MUST BE Y 'v « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARR IEDONTHEPERSONOF A F NSEE ,; THE HOLDER WHEN EN• O gIl' h1 RINT GAGED IN THIS OCCUPATION. COMMISSIONER :::::.:::.:::::::::::.::::.:::::::::::?:.;:.:.?.;.:......................... .................... ......:.. :i..:....::..:.:....:i..::....:..:..:..n...i..i..i..i..:.?..,.;..i..i..i..S.i..:.C...:>.....i..i..i..:.?...:.:..:w.•%..•.:.n...4...i:..:•i.:.n..:.i...:"..i....:.i.'....:..i...:.v..i....:'..:..•..:"..i....:..i....;..i,...d.i....i....r..:...?.r.....?.:...{:;f..••..%..r•r...?:....?...r.rt..,r.;::..•..::.:r.::....:...vv...:....::.v.:.:..:.::..::...:.r:..:.m:.:n.:.:.:.:...::....::...::....::.....:.�..:.....::�..:•..::....::....::....::....:......:.:..:.:...:.:.::...:.:..:....:...:r...:...:...:.f.:n..:.:....:...::...:...:....:.:::...:..:....:.:........::.,..:n...<.�.:....:.:v.::.:..:.t...:.:...::..y.:...:..:.:..:.:..:.:..:.::.:.:i.:.::.:..::.:.:..:.:..:.:..:.:.:.:.:.:.:.:..:.:r..:..:.�.:...:w.:..:.:..:.:....:Y:..::..:::.::.:..:w::..::n..r::.iv.:.:.:F rF....�xr A:.rr.....:...:.•.-1...;...f.�.$.l.::.:Y:r?:::r?rrr.:f,.}.:•.:r..FJ.n.:r.?..h.>•?..•Yr..]•v:.•-:.r•f:..r:?...R�::....F..:.r..F/{�..,•r..Fr/,.'I:.. rLr:".:..:..:r.rF�:.i:....::F-.../.:.F•;.:..,.•�r.::..«;`:::!.:::1.:+r.::.y.rv:::..::::.i.v::.::.::;.::.ri.::•::r:::.::.'T:•ir.:i:;i..?::'.r.•:i:.;:?:.::irr,�::w :•:?.;..?si:.;::::::;::::�:::sj:::�::v:ti:.:x..�:..i.::'.'.?:•:..•i'.;ry.w::>'.;:r:;�.:i.r;..:.;...:..S..;.i..s i:.:.�.:..'n:.;.r.?•:.:v:ur.:;Y.y.•::.i:•.?.:i:.:�;i{..i;tr.t.j ?.rx:\?•t.•.:wi?::ri::.::i.i::.^.:?:.r.::: }::..:I.B.S..'U............. 1)E DAZE MMIDD/ ?. .'`x: . 4. ....1.. 199...4:.i,;:. ????.i? .:...:.ii..i....:.:. ...... . ................. .. a .. . 'PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Lakeside Insurance Agency Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 88 Stiles Road POLICIES BELOW. ............................. .......................................................... Salem, NH 03079 COMPANIES AFFORDING COVERAGE (603) 893-9450 ................................................................................................................................................................. COMPANY A CNA INSURANCE COMPANY LETTER COMPANY .................................................................................................................................. LETTER B INSURED _.................................._..........._.........-..........._.................._.......-...._....._.........._........_..............._............. ANDREWS GUNITE COMPANY INC COMPANY C LETTER 6 REPUBLIC RD ........................................_.... ..._........_..........._..............._...._..__........._...._....................._....... ....... NORTH BILLERICA, MA 01862 COMPANY D LEITER ............................._..._............_........................................................................................................... COMPANY E LETTER is.;:- i;:.iiiii;;ii;:.;:.;iiiii:ii;:.i:.;ii:.i:.;;ii:>::.::.i:.iii:.;;i::::::::::::::::.::::::::::::::::::::..:::::::::::::::::: :: ::::::::::.::::::::::::::::..::::::::::..::::.::::::........::::::::....:::::::::::: 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. .................................................................................................................................................................................................................................................................................... CO TYPE OF INSURANCE POLICY NUMBER :POLICY EFFECTIVE :POLICY EXPIRATION LIMITS LlA DATE (MM/DD/YY) : DATE(MM/DD/YY) ......_......................._...............................__...-................................-................;....._......_.._.....-....._..............._.............._.:....................................._........._............._........................ A IAB GENERAL LILITY GENERAL AGGREGATE,.,. ..... :s. 2,O O 0,O O 0 ` X ;COMMERCIAL GENERAL LIABILITY i 110731507 PRODUCTS-COMP/OP AGG. -_!.S ..1,0.00.'..0 0 0 .... CLAMS MADE R occuR. 02/20/94 02/20/95. 0N"L....aov........iY ... s 1,000,000 OWNERS 8 CONTRACTORS PROT. EACH OCCURRENCE S 1...O O O..O O O FIRE DAMAGE(Any one fire) :$ 50,000 ............................................................. .. .. . MED.EXPENSE(Any one Person):S5 0 0 0 ........................................................ ............................................................ ....... ............. .AUTOMOBILE LIABILITY COMBINED SINGLE pj: ANY AUTO MP001617269 :LIMIT .-. S- 1,000,000 ALL OWNED AUTOS ' 2/20/94 0 2/2 0/9 5:BODILY INJURY ?..... r X :SCHEDULED AUTOS :(Per pe son)............................ ................................... $ X 'HIRED AUTOS BODILY INJURY S r acc X NON-OWNED AUTOS (Pe idenQ GARAGE LIABILITY PROPERTY DAMAGE PR S ....................................... :.................................>.............................. ...............- . .... ... :............................. ..................................:.............................................. :EACH OCCURRENCE 1 O O O O O O EXCESS LIABILITY E ..........................................................................�............ / / AGGREGATE s 1,000,000 A X i UMBRELLA FORM � CU P110731524 02/20/94 0 2 2 0 9 5 .- .,.; OTHER THAN UMBRELLA FORM ......................................:........... ....... STATUTORY LIMITS WORKER'S COMPENSATION .......:.................................... ....................... A: AND WC120530275 03/01/94 0 3/01/9 5.EACH ACCIDENT.................... :s...........5 0.01..0 0.0 DISEASE-POLICY LIMB S S O O,0 0 0 EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE S 5 0 0,0 0 0 ................................................................... ..................................................................:.................................................................................................................................................... OTHER .........................................................................:...................................................................:................................:.................................:....................................................................................... DESCRIPTION OF OPERATIONS/LOCATIONSWMICLES/SPECIAL ITEMS N EL LATI. .. ...........:..:. ERTIEI ATE.�1<N-.......................................................: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO.THE TOWN OF HOPKINTON > LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR BUILDING INSPECTION LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ATTN: JUDY ".".-AUTHORIZED REPR TIVE HOPKINTON MA 01748 .e� .;:::.;:;:::?:•>.:•:;:;:::?:•i:s:i:::•i:i:::.:.?�::.:;:::.;:::.;:::.;:::.;:::.::::.>:;;.:::.>.;:::.i:s:y:::.;?:..;i:i.i::i.:i�:.:i;:::.:;:i:::..;>::?i;;.;;::.?i:i:::?:..i;i::;:::;:::..;:::..;;::. :::::>:::«:::::::•::>::.:::::.:::.»?::::::::;:::»:.::::<::i:.':•;:s:»:::::>::::s:::«:::::<::::;::::»:::::>:::«::<::::<::>::::?::>::::«::«::<::`:;:::::':::Y:>::,t.:::R::::::::::::II::.,.:::, RY0i .....:::. : ?.; .i.iii.;.;.i.i. : ,.: ` FORTH own of �r over 0 No. 097 9dower Mass �#AAA COCMIC ME WICK � ORATED F`P� ,�C-1 BOARD OF HEALTH Food/Kitchen s Septic System `. BUILDING ILDING INSPECTOR £ THIS CERTIFIES THAT....... �4,T71f ! ° ..eh Ye.. . ....... . .................. Foundation has permission to erect./.04#44.......... buildings on ............. �... � a�P .. � Rough 64 to be occupied as.....� �+i..�r. .. /. Q....00.44.....�.. ......................................... 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. OP/ �►C� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina` UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ....... Service BUILDING INSPECTOR Final 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 PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT V Office Use Only Gi Tamllml mmit 11f fitlmsaE�Mttfg Permit No. �C Q l 13gM-tMrjn of Vublic emfetq Occupancy&Fee Checkedlug,- -� BOARD OF FIRE PREVENTION REGULATIONS 5527 MIR 12:00 3/90 peave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT 1N INK OR TYPE ALL INFORMATION) Date 4G1� or To Lwn of NORTH NDO R To the inspector of Wires: s The udersigned applies for a permit to perform the efectricai work described below. Location (Street & Number)T�� /'�nP ��d�0 A Cl i= Owner or Tenant PlDLy I c� IL. Owner's Address Q/e Is this permit in conjunction with a building permit: Yes $ No i (Check Appropriate Box) Purpose of 8uildino Utility Authorization No. - _ Existing Service Amps _J Vcits Overhead Li Undgm,1 1. No. of Meters New Service Amps _J Voits Overhead _ Uncgrna r No. of Meters Numcer of Feeders and Ampacity Location and Nature of Proposed E ec c i Wcrr II No. of Transformers Total u No. of Lighng Cutlets I No. at -c; '.:cs KVA I .atcve'-- tis77- No. of LightingFixtures I Swimming ?cot c-no _ cmd. Generators KVA No. of Emergency Lighting No. of Recectac:e Cutlets I No. at CilBurners I Battery Units No. of Switch err I No. or Gas S_risers FiRE ALARMS No. of Zones Total No. of Cetection ana I No. of Ranges Na. a`. Air C�nc. tons Inittat!ng (Devices "ea: Teat Total No. of Disoosats Noor Pumas Tcrs KtiV No. cf Bouncing Devices No. of Sed Contained No. of (Dishwashers Saace7Area Heannc KW Oetec:tontsounoing Oevices �• KW Local - Municioat Other I No. at Orvers Heating Cevtces _ Connection No. at vo. of ` Law Vcitage No. of water Heaters KW I{{ Sic is Eailass I Win= No. Hvoro Massage Tubs f No. at Motors otat HP 0-HER:Qur� �� /-�- c 0)--� hd INSURANCE CCVEF;AGE. Pursuant to the recuirements at r:assacncsetts general Laws ivaient. YES NO I have a current Uaotiity Insurance Policy inc:ucing Cor ::etec Cceratiens Coverage or its sucs;antiai e4u m.= 1 have suamlttea valid proof of same to the Office. YES NC _ if you have checxeg YES. please indicate the type at coverage Cy checking the aoproonate Cox. a -01-p4 INSURANCE _ 8CNO = OTHER (Please Saec:fy) (Exatrati n Oatei Estimates Value of E:ec:ncal Work 5 lir.. wont o Start Insoecaon Cam Recuestec: Rough Final ; Signea unser;he Penalties of perjury:. UC. NO. FIRM NAME lA� Licensee �a,2� A �7l/Irm�4iJ Sighar_re UC. NO. TBus. -et. No. ACaress li✓ /T o 6 Alt. -el. No. OWNERS INSURANCE WAIVER: 1 am aware that the Lace see cues not have the insurance coverage or its suostanttal egutvalent as:e- ouireo by Massachusetts General Laws. ane :hat my signature on :as aermit application waives this reouirement. Owner� Agent {Please cnecx one) Teteonone No. PERMIT FE.3 (Signature of Owner or Agents :�=�� , Date...... Sr. .....- .. 2366 NOR7M � 4, TOWN TOWN OF NORTH ANDOVER PERMIT FOR WIRING o� ,SSACNUSEt A. >i � ... ............... - .This certifies that ... ..........� ................ R has permission to perform .... '. . ' . l wiring in the building of........ . 4:_:............... ........................................... at..........1.. f...:..:.:... ... ........... .... ,North Andover,Mass 4 Fee. Z," .t... ... Lic.No. .,/.....' ?............................................ � ELECTRICAL INSPECTOR X771 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File S