The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 111 PETERS STREET 4/30/2018 -� -- - 111 PETERS STREET ` 210/024.&0000.0 � - --- i North Andover Board of Assessors Public Access Page 1 of 1 aoRTk North Andover Board "of Assessors t Lam_ s roperty Record Card Click Seal To Retum Parcel ID :210/024.0-0018-0000.0 FY:2012 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales J� °. Summary t Residence Detached Structure Condo 111 PETERS STREET Commercial Location: 111 PETERS STREET Owner Name: THE BROTHERS OF THE ORDER OF HERMITS OF ST.AUGUSTINE Owner Address: 214 ASHWOOD ROAD City: VILLANOVA State: PA Zip: 19805 Neighborhood:5-5 Land Area: 0.63 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3330 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 530,700 530,700 Building Value: 338,400 338,400 Land Value: 192,300 192,300 Market Land Value: 192,300 Chapter Land Value: LATEST SALE Sale Price: 880,000 Sale Date: 04/05/2004 Arms Length Sale K-NO-EXEMPT Grantor: ROYAL,ANNETTE Code: TR Cert Doc: Book: 8677 Page: 288 http://csc-ma.us/PROPAPP/display.do?linkld=l 888623&town=NandoverPubAcc 5/17/2012 I Residential Property Record Card PARCEL ID:210/024.0-0018-0000.0 MAP:024.0 BLOCK:0018 LOT:0000.0 PARCEL ADDRESS:111 PETERS STREET FY:2012 .�- - - - - _ PARCEL INFORMATION Use-Code .101 Sale Price: 880,000 _Book:` s 8677Road Type Tw Inspect Date X03/25/2008; Tax Class: T Sale Date 04/05/04 Page 288 Rd Condition P Meas Date 03/28/2008 - a_ -� Owner: THE BROTHERS OF THE ORDER OF TotFm Area 3330Sale Type P`- ' Cert/Doc: Traffic: M Entrance: C , HERMITS To Land Area 0.63 Sale'Valid K Water »Collect Id: RRC Grantor ROYAL;ANNETTE TR Sewer Inspect Reas C OF ST.AUGUSTINE .dl. __ ., ._ - w _ _ .. Address: Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / 214 ASHWOOD ROAD VILLANOVA PA 19805 RESIDENCE INFORMATION LAND INFORMATION Style CO Tot Rooms;' 9 Main Fn Area; 1700 ,-Attic: NBHD CODE: 5 NBHD CLASS 5 ZONE R4 ` Se T e; Code Method' Ft Acres InfI Y/N"- ValUeClass' >>I, Story Height 2.35 Bedrooms: 5_ Up Fn Area 1630 Bsmt Area: 1395 _9._ y_P.7_ _ ,_ x. �.s Fn Bsmt'Area: - 1 P 101 S 2 310 0.630 192,252 Roof `"�` G` Full;Baths 2 '-Add Fn Area Ezt Wall BV_'Half Baths` 1 Unfin Area Bsmt Grade DETACHED STRUCTURE INFORMATION Masonry Tnm Ext„Bath Fix '76:7716fFin Area: 3330 v° - - - - - -- -�-� - -- - - T`StrUmt Msr 1. Msr-2 E YR Blt_Grade Cond %Good P/F/E/R Cost' Class Foundation CN Bath Qual. T RCNLD: 316984 . - - -- � �.� , �,._m.�.a A �- ., •w d w -,.- - - G1 S 440 0.00 1988 A A 50///50 7,200 Kitch Qual: T Eff Yr Built 1965 Mkt Add: µ m .,__ Heat Type:- HW Ext Ketch:�� Year Built m_ 1920 Sound Value. PV S 684 0.00 1988 A A 50///50 13,800 Fuel T _ ._PT SE C . 120 0.00 1988 A A ///88 400 ype 0 � �mGrade: G CostBldg: 3'7,7,000' Fireplace 1 Bsmt Gar Cap:-, Condition m._ A µ. Att-Str Va11 VALUATION INFORMATION Central AC -N � Bsmt Gar SF Pct Complete:; Att`Str Val1' p -n Current Total: 530,700 Bldg: 338,400 Land: 192,300 MktLnd: 192,300 Att Gar SF: _ %Good P/F/E/R: /100//77 Prior Total: 530,700 Bldg: 338,400 Land: 192,300 MktLnd: 192,300 Porch Tyne Porch Area Porch Grade Factor P 50 E 120 M 176 Parcel ID:210/024.0-0018-0000.0 as of 5/17/12 Page 1 of 2 Residential Property Record Card PARCEL ID:2101024.0-0018-0000.0 MAP:024.0 BLOCK:0018 LOT:0000.0 PARCEL ADDRESS:111 PETERS STREET FY:2012 SKETCH PHOTO IW 12A 13;.116,Sq. 11 120'5 R: At g ' FU t IF 351305 Sq.v 15' 930 Sq.R 1395 Sq,Ft, � ,.•,;� ..<, ,. = �; , 25. 30 FM 30' 1700 Sq.R` t = 15 • 5 5: 50 '. 111 PETERS STREET Parcel ID:210/024.0-0018-0000.0 as of 5/17/12 Page 2 of 2 Date.......7......Lff..--./ . 1' a NOR7F� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ACHUS ..7 , This certifies that ............4744/...P! `e7v .............................. 12 has permission to perform ....... ....b21.. .............................................. 1T' wiring in the building of UST�cl h�tdl�� ............................ at........ ............ ......... ......................... .North Andover,Mass. F _.......po ELEC41CL ;S ECTo Check # COMmonyyealth of Massachusetts Official Use Only Department of Fire Services Permit No._��(� (�� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code EC520 WORK (PLEASE PR TflVIK OR YrpE ALL WO City or Town of NORTIJA7'1011� Date: �r� VER By this application the undersigned gives noti�ceo® r intention to perform To e imi�eetoY of Wires: Location(Street&Number) f electrical work described below. Owner or Tenant Owner's Address S L Telephone No. Is this permit in conjunction with a buildingpermit? Purpose of Building b'q ;g Yes L No ❑ (Check Appropriate Box) Existing ServiceUtility Authorization No. New_ Service Amps _ _Volts Overhead EJ �'d AUnd_ ❑ _ Amps Volts Overhead❑ Und rd Number of Feeders and.Ampacity g ❑ No.of Meters No.of Meters _ Location and Nature of Proposed EIectrical Work: �-/►S a �r b, l�V l i r i ,i /L'ew G�c No.of RecessedCom letion of the followin table may be waived by the Inspector of Wires. Luminaires No.of Ceil:Sus No.of p.(Paddle)Fans Total No.of Luminaire OutletsNo.of Hot Tubs Transformers KVA No.of LuminairesGenerators KVA Swimming Pool Abodve Elpn_ [� o.o mergency ig g No.of Receptacle Outlets nd• Batte Units No:of Oil Burgers No.of Switches '� X AjA S No:of z--nes No.No.of Gas Burners No.-of Detection and No.of Ranges Iaitiatin Devices . No.of Air Cond. Total No.of Waste Dis osers Heat Pum Tons No.of Alerting Devices P p Number Tons Totals: KW No.of Self-Contained -_........_......_._. No.of Dishwashers Detection/Alerting Devices Space/Area Heating KW Local[IMunicipal No.of Dryers gting App] Connection ❑ Other No.of Water PPhances , Security Systems: Heaters KW NO'of No.of No.of Devices or E uivalent Signs Ballasts. Data Wiring: # No.Hydromassage BathtubsNNo.of Devices or R va ring; lent o.of MotoErs Total HP Telecommunications Wi OTHER: No.of Devices o r E uivalent Estimated Value of Electrical Work: Attach additional detail i desired,,or as required Work to Start: G c� When required by municipal policy.) ed by the Inspector of Wares Inspectio to be requested in accordance INSU4t ANCE C dan OVERAGE: Unless waive ce with MEC Rule 10 and d by the owner,no ennrt upon completion. the Iieensee-provides proof of liability insurance including"completed P for the performance of electncaI work ma undersigned certifies that such coverage is in force,and has exhibited proof of same tocov rage or its CHECKpermit substantial equivalent unless CHECK ONE: INSURANCE ❑ BOND I certify ❑ OTHER ❑ (S ec' g office. under the pains and ena[taes o .(Specify:) I fP�lury,that the informati®n on this application is true and complete. FIRM NAME: l e-C ✓t�� C. Licensee: SrDiir� At LIC.NO.• /2-j�3 (Ifapplicabletefi — --Sratur e - LIC.NO.: G �rempt inthe license numbe line.)- Address: �.S G *Per M.G. A �'�h c�,� 6/t Bus.Tel.No: L C. 147,s.57-61,security work requires D11 1. - �y , f a OWNER'S INS ePmtrnent of Public Safety"S"License: Alt Tel.N°•' °S- C' WArV R: 1 am aware that the Licensee does not have the liability Lic.No. required by law. a ow,I herebywaive h'insurance coverage normally Owner/Agent flus requirement I am the(check one)❑owner Signature 11 Owner's agent Telephone No. ELECTRICAL PERMIT NO. INSPECTION REPORT: � ELECTRICAL W1-1 SPECTOR-7DOUG SMfALL I.ROUGH INSPECTION: Passed— Failed—[ ] gs e-inspection required[($50.00) Inspectors' comments: (Inspectors'Signature-no inits '' Date Z.FINAL IN PECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ Inspectors'comments: (Inspectors'Signature-no initials) Date 3.UNDER GROUND INSPECTION: Passed—[ j Failed—[ ] Re-inspection required($50.00) Inspectors'comments: y (Inspectors'Signature-no initials) ' Date 4.INSPECTION—,SERVICE: DATE, CAELL E1D" NATIONAL GID: ATATtx: Passed—[ ] Failed—[ ] Re-inspection required($50.00).[ ] Inspectors'cowments: (Inspectors'Signature-no initials) Date 1 5.INSPECTION-OTHER: Passed—[ ] Failed—( ] Re-inspection required($50.00)-[ j w Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLET)OUTAND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 YS TO DE CHARGED. J The Commonwealth ofMassachusetts Department of Industrial Accidents Office ofTnvestlgations 600 Washington Street Boston, MA 02111 Workers' Compensation Insurance Affidavit: B>t Rders/Contraetors/Elect • . APP licant Information r�cians/P•lumbers Please Print I,eRibl Name(Business/Organization/Individual): Address: C) City/State/ZiP:_YT if ihcie!d Phone#: Are you an employer?Check the appropriate box: r2. am a employer with 4. ❑ I am'a general contractor and I Type of project(required):employees(full and/or part time).* have hired the sub-contractors 6. ❑New construction❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and have no employees These sub_contractors have working for me in any capacity. workers'comp.insurance. 8. ❑Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9. ❑Building addition required.) officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing re airs or add' ' myself. [No workers'con�P• a 152, §1(.�)�and eve have no p itrons insurance reap-ired..] t euployees_ No:r , .. , 12.❑:�eofrep<t rs C jor�cers comp.insurance required.] 13 ❑Other %A-xy aPPEcant`tet ch=c'.ks box#1 m��c etc t also fill out the section below sho:v g weir we-k�:,'c, jp�aL:on ohov information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit di ting #Contactors that check this box must attached an additional sheet showing the name p , �f the sub-contactors and thea workers'comp.policy information. I am an employer that is providing workers'compensation insurancefor my emplo ees Bel information. iny ow is the policy p cy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: .. • City/State/Zip: Wing� Attach a copy of the workers'compensation policy declaration page(shong the policy number and expiration d h Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal ate). :fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER of up to$250.00 a da a al penalties of a Y against the violator. Be advised that a co and a'fine Investigations of the DIA for insurance coverage verification.copy°f this statement may be forwarded to the Office of Ido hereby cern under ains nd penalties o er u fP J 'y that the information provided above is true and coiTect Si ature: 1 Phone#: �� '�— s1►) Date.: Official use only. Do not write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 6. Other p for 5.Plumbing Inspector Contact Person: Phone#- Date./ TOWN OF NORTH ANDOVER o? 0 0 .10 '° PERMIT FOR PLUMING �,SSACNUSf - /� 4 , This certifies that . :`_. . ,. .r /3/1�Fes. ��l� . . . . 1 I has permission to perform .�. . .4./� )`�?. . . . . . . /. . . . . .�K-.�. . .plumbing in the buildings of ./ t . . . /.� T . . . . : . H µ: at . . . ./� : . . !l_�. . . . . . . . . . . . . . . . . I, North nWass. Fee.35: �. .Lic. No. . . . . . ./.��. . . . . . . . . . . . . . PLUMBING INSPECTOR i Check # 7833 y f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building LocationDate Owners Name Permit# f O` Amount T e of Occu anc New rl Renovation Replacement " Plans Submitted Yes ❑ No a FIXTURES U p aZ w x � O � A aLn C7 O H A A w O O v� U �FuxR MFLOO[Z 3aKaR 41HROCIR MHDM 6MKLO t ,nxFLt - MFit (Print or type) f Installing Company Name1 Check one: . Certificate . �'yyf ,4 / �/ S�u--� 13Corp. Address C) n �� ❑ Partner. usmess lelephoneC11 _ �- F1 Firm/Co. Name of Licensed Plumber: CtqAfzl , Insurance Coverage: Indicate the tyinsurance coverage by checking th appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance er. I, the und�rsi d,have been made aware that the licensee of this application does not have any one of the above three' Signature Owner 13 Agent ❑ I hereby certify that all of the details and information I have muted(or entered)in above applica on are true and accurate to the best of my knowledge and that all plumbing work and ins o s performed under P t Issue f this application will be in compliance with all pertinent provisions of the Massach S e P1umtCode Ch r f� L e General Laws. By: igna ure o -cense um er Title Type of Plumbing License City/Town -cense um er APP Master Joume ROVED(OFFICE USE ONLY man Y Date. . .%.�/r�� -} .. . .. . ,t NORTH - j' �p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTAL TION ' 9SSACNUSE� .. . L�,!J This certifies that . . . . . . . . . has permission for gas installation . . . . . .!?4� . . . . . . . . in the buildings of Z104—?!t . . . . . . . . . . . at . . . .�f/. . . � res . . ,.I7 . . . . .. . . . .. North Ando v r, Mass//. ' FeexLic. No.s�? l? �.. d� . . . . . . . . GAS INSPECTOR Check# 'r 652 '' MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FMING (Type or print) Date NORTH.ANDOVER, nMASSACHUSETTS -- Q Building Locations 11 p��=R s4— Permit# ® Rr-/Zol its, Owner's Name S Amount$ New❑ Renovation D Replacement Plans Submitted � a w vi H a UU14 Z m F x F W F W a p O p Z Ew„ W °� Z v w v, z dFd o a > W CCd7 F z F z x w W C czt F W F W C d x p w C F F z F W Fl+ w cli SUB -BASEMENT x 3 c .da. U > o a F p v BASEM EAT 1ST. FLOOR j) 2N_-D . FLOOR 3RD . FLUOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR. 8TH . FLOOR (Print or type) Name /�I �V ( Check one: Certificate Installing Company �`ahl S _' 0 Corp. � Address 80 \ �- ARA & FQY?Q( Partner. Business Telephone irm/Co. Name of Licensed Plumber�or Gas Fitter c = Ata/b INSURANCE COVERAGE I have a current liability Insurance policy r it's substantial equivalent. Chon If you have checked es please in ' e the type coverage by checking the appropriate box. No[3 Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: [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. Signature of Owner or Owner's Agent Check one: Owner 13 Agent hereby certify that all of the details and information 1 have submitted(or entered) in above application are true and accurate to the best of 13 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 o and Chapte 142 of Geiser Laws. By: Signature of Licensed Plumbr Or Gas Fitter Title 0 Plumber IF z- City/Town,. Gas r icense um er 4,k aster _ APPROVED(OFFICE USE ONLY) Journeyman io t'. Date./ ......':.....v...... HORTM TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING SACMUS� This certifies that has permission to perform, .. -� �.. -t .............. wiring in the,building of ...... .. ......... ........... //1 y l.l�. at.............................................................c:............... , offfiAndover,Mass. Fee... .:. ...... Lic.No `s 9�-.ry......�`. ._.�r.. ..... ..... ................... EbECMICAL IMSPE R Check # 54-99 t t ThEC0W0ArffEALTH0FMASSACM 'TTS Office Use only p DEPAI�IVTOFPUX1CSAFETY 7 Permit No. BOARDOFFIREPREVEMONREGUTATII 6527CM12.(b Occupancy&Fees Checked APPLICAHONFOR PERMIT TO PERF RMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSA7dbelow. TS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /0 —/ d Town of North Andover 1, To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work'describ Location(Street&Number) / / / ��'� rr Owner or Tenant 5-r AylsuS�/,u� Owner's Address V Is this permit in conjunction with a building permit: Yes 1:3 No (Check Appropriate Box) J Purpose of Building Utility Authorization No. Existing Service A> Amps 2e)/alld Volts Overhead ®Underground No.of Meters New Service 7-00 Amps�ZJ12-ye)Volts Overhead Underground r--J No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA . round round , No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units i No.of Switch Outlets No.of Gas Burners No:of Ra�tges No.of Air Cond. Total FIRE ALARMS 7ZonTonsNo.of Disposals No.of Heat Total Total No.of Detection and Xi Pum s Tons KW Initiating.Devicesi Io.of Dishwashers Space Area Heating KW Np.of Sounding Devices Nd-,tSelf ContainedDetection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP i THER. mnceCovaage�Purs =tc)tbecegtmmyrlsofMa%achusetNc-oetallaws aveaamentLiabiEtyhnr&ixPolicyinchxkmgComplee Cover�georitssubstmUaquivalnt YES NO I awsubtivcdvalidproofofsainetotheOffice YES � Ifyouhavedled<adYES,plea�i thetypeofoovaageby tg the box SCT' CE BOND F OUTER r (PleaseSpe*) ,• ExpirationDale Estir 9DdvahaeofEechicalwatic$ xktoStEd kLTecaonDaleRegucsted Rough Final nedundcrMRnAescfpgjtuy: j MNAME / E GE' s LiomseNo. Signatute Lic=No BmirmTelNo- '1A W2 62 - - AttTel.No. I?K 3 1 r 5-->3�{ 'NER'SINSURANCEWANFR;Iamawatethat the-License does riot lm-ethe nq=)D,'MWrageoritssui alegtuvalentasre medbyMassattuscZC netalLaws that my signature on(hispe uit applicalion waives this rt quirernent :ase check one) Owner ® Agent ® �d Telephone No. PERMIT FEE rgna ure oT Owner or Tgenf u The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations Boston Mass. 02191 Workers'Compensation insurance Afdavit Name Please Print Name: Location: City Phone # �-1 I am a homeowner performing all work myself. L—J I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: ' Insurance.Co. Policy# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required.under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment-as well_as_civil.penalties inlhe form jof-a_STOP WORK ORDER.and..a line_of.(.$1D.0.0D)_a riay against..me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name P.hone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Q Licensing Board f-� Selectman's Offrce Contact person: Phone#: F, Health Department ❑ Other I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO.GASFITTING (Print or Type NORTH ANDOVER , Mass. Date + , �51-?e 97. 4uiiding Location /// %�=�`3 a77 Permit •� Owners, Name /U/A/ �/.��-• (;� New '-1 Renovation ; Replacement Plans Submitted �s n FIXT(.i�'-'� D N,.— v M yaj t+1 u r Q In M Us oc ,� s .a ti t- �. Us 0 tu W < � ore o o x w Z �+ w t W W .0 a s W .� �► y C W z V tC df W -C tL C H x W W V! J " tu ' C V O F- Z J f' 2 i. W us O cr T k t' W J F- W Z .d W d cc �+ ► y., N m '_� O O to Z t Q ,u > C W 5 " < G 4 a 0 0 W 5 O us t- cc x O v Y W a 01 -1 01 C > a o. t- O SUB/—MSTAT. BASEMENT IST FLOOR 2N FLOOR �Rtl FLOOR ' 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name r ANDOVER PLG. & HEATING CO., N . Corp. 2122 Address573 1/2 SO UNION S.T.- Partner. LAWRENCE , MA. 01843 [_] Firm/Co. Business Telephone: 508 685-8383 Name of Licensed Plumber. or Gas Fitter �nRrFi eQncF ' Insurance Coverage :`Indicate the type of insurance cov&-age ,by checking: the ; appropriate box: a. Liability insurance policy`. Other type of indemnity; ,Bond i l InsuranceWaiver: I, 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 ownerla ent. o property Owner Agent 9 9 P P Y � ii 1 hereby certify that all of the details and information 1 have submitted (or entered)in above application ate true and accurate to the bat o my knowledge and flat all plumbing work and Insatladons performed under"fermissse ied lot this application will-be i t co "Bathtance with all pent provisions of the Massachusetts Slate Gas Code and,ataptet 142 of the General Laws i By TYPE LICENSE: ► Plumber Title asfittdr Signa ,ure of Licensed ier City/Towny Maste>' 1'lbniber or Gasfitt : Journeyman 99A� APPROVED (oMdF_ UsE ONLY) License Number �?�Yesa cc� ,# Date. ".2 ..) .. �„ 254 F ,,ORT„ TOWN.OF NORTH ANDOVER ..,, o? PERMIT FOR GAS INSTALLATION:' ku SAC US This certifies that .. . . ... . . . . . . .. has permission for"gas installation . ' in the buildings ofi�tsr-.-. . . . . at �. . . . . . . . North Andover Mas s. Fee. . Lic. No.9.11- . GAS INSPECTOR v WHITE:App i7cant CANARY: Building Dept. PINK-Treasurer GOLD: File