HomeMy WebLinkAboutMiscellaneous - 1145 OSGOOD STREET 4/30/2018 1145 OSGOOD STREET
/ 210/035.0-0006-0000.0
I
I
RECEIVED
Commonwealth of Massachusetts jui Z9 2014
City/Town ofWl� � TOWN OF NORTH ANDOVER
HEALTH t7E�+At�7 MINT
System Pumping Record �-
Facility Information:
System Location:
s
Address ")A
D�
City own State Zip Code
System Owner:
mt—
Name:
Adress (if different from location of pump)
City/Town State Zip Code
Telephone Number
Pumping Record
Date of Pumping /3 Quantity Pumped_ gallons
Type of System—IC Septic Tank Grease Trap Other (what)
System Pumped by:
Company: ROOTER-MAN 46 Portland Street Lawrence, MA 01843
Location where contents we re
isposed:
Signature of Hauler C' Date ' 1
s�►u cam. — �y— y i 1 � _ -�v!-f r _ u
t
QRTCDAi E INSPECTION MAN_
v '
VII
E s �
N
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N�i�H•`u►�''�P�S �'f33�t-t� �+�� � r x
*•e#*%,A%0 0^8M di A T^Nbt•LMVM. y Ofaf/N*ftTftj$4tHT iURVM AND 40 TO fii US=•OR MUffr "/' W-05ft ONLY.
INGeMOM THSNf�tK�1f1Rt NO? TO�ftA�fJMi
3 K COUNTY
fIDEE D REFERENCE. PLAN RF-191GRENCE: PLAN OF LAND
Location
No. Date b-
MOR,N TOWN OF NORTH ANDOVER
0��,.•o y,ti0
3? OL
f 9
Certificate of Occupancy $
�'S' °•t<�' Building/Frame Permit Fee $ •- �
s�cMus
Foundation Permit Fee $
' Other Permit Fee $
TOTAL $ 13 5-,
Check #
15 J 5` 5 Building Inspector
i
T OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER. DATE ISSUED: o/D r
SIGNATURE: ". 2Z
C Cys
Building Commissioner/I for of Buildings Date
SECTION i-SITE INFORMATION
1.1 Property Address: " 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information: 7.4 Property Dimensions:
Zonin District ._. : Pt osed Use Lot Area
Frontage ft
1.6_BUILDING SETBACKS 00
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Water Supply M.GJ—C.40.1 54) 1:5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 private ❑ zone Outside Flood Zone ❑ , Municipal ❑ On Site Disposal System b
SECTION 2-PROPERTY OWNERSHIPWITHORIZED AGENT
2.1 Owner of Record
bay e,
Name(Print) Address for Service
Signature z Telephone w'V`
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
d � G L
,icensed ConstructionSupervisor: d G 12
(6 License Number
lddress /. •7
( I _
1'3 J 5 Expiration Date
ignature, Telephone
.2 Registered Home Improvement Contractor Not Applicable ❑
Fop
ompany Name Z 8
`� S 1 (� [ Registration Number1100
ddress (7 ! O
3 SIMEM
Expiration Date
nature Tele hone
SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6)
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,.;.....0
SECTIONS Descrition of Proposed Work check aID a gcpble
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be `5
Completed by permit a licant '''`
1. Building (a) Building Permit Fee
COCD Multiplier
2 Electrical (b) Estimated Total Cost of
:Construction
3 PlumbingBuilding Permit fee tai X(b)
4 Mechanical. HVAC �i
5 Fire Protection
z
6 Total 1+2+3+4+5 Check'Nuinber
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN ry
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT d
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
i
1, 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
Print Name 1
Si ature of Owner/A ent Date q
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TEMBERS 1 2 ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
WoodPage of
Free I=stimates 105 Haverhill Street
Fully Insured Methuen, MA 01844
THOMPSON'S ROOFING (978) 691-1355
Shingles —Slate —Rubber Roof
Single Ply — Copper Work
PROPOSAL SUBMITTED TO PHONE DATE
Dan McCarthy9-18-01
STREETJOB NAME
Osgood Street ys vSC-CC �_r
CITY,STATE AND ZIP CODE JOB LOCATION
North Andover MA 01845
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
Strip off all roof shingles on house
Renail all loose boards and if any need replacement it will cost $3 . 00
a ft. lx8
Install aluminum drip edge around roof line
Apply ice and water shield 6 ft. up all along edges and in valleys
Apply 151b. felt paper on rest of roof area
Reshingle with a 25 year Architect shingle
Install new flanges around soil pipe
Cut in a ridge vent
Remove all work related debris
25 year warranty on material
10 year guarantee on labor
construction oic . #060112
improveemnt #128612
We VropogC hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
Foiir thousand two hundred ---------- dollars($ 4 , 200 . 00
Payment to be made as follows:
All material is guaranteed to be as specified.All work to be completed in a workmanlike manner
according to standard practices.Any alteration or deviation from above specifications involving Authoriz
extra costs will be executed only upon written orders,and will become an extra charge over and Signatu
above the estimate.All agreements contingent upon strikes,accidents or delays beyond our
control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully Note:This proposal may be
covered by Workmen's Compensation Insurance. withdrawn by if not accepted within days.
CCetDIYCe DfrDOgaI—The above prices,specifications and s
conditions are satisfactory and are hereby accepted.You are authorized to do the Signature
work as specified.Payment will a made as outlined above. g
Date of Acceptance: Signature
GJRTIFICATE OF LIABILITY INSURANCE
DATE 04.23.01 (MM/DD/YY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
PEI_HAM INSURANCE SERVICES INC UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER
1« BRIDGE STREET THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PELHAM NH 03076- 1 N S U R E R S AFFORD I NG COVE RAGE
INSURER A: Liberty Mutual
"'Rt0 INSURER B: The Maryland
Thomas Doyle DBA INSURER C:
Thompsons Construction & Roofi
8 West St. INSURER D.
Sa.em NH 03079
INSURER E:
COVERAGES
'HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NGTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE XCBISSUED
PERTAIN.
THE AFFORDED
HISCBD { FNSSUBJECT TO ALL
HEERS. ELUSIONSAND CONDITTIONSOFSUCH POLICIES. AGGREGATE LIMITSSHOWNMAYHAVEBEN9� .AL
I-LAIMS.
i�SYPOLICY EFFECTIV( Pr: ;v
LTA- TYPE OF INSURANCE POLICY NUMBER DATE (W", -:
GENERAL LIABILITY —----— - - - —__
B [x] COMMERCIAL GENERAL LIABILITY SCP 34865353 04-17-01 04.15.02 FIRE DAMAGE-(Any'one fire) $ 300,000
J Lr7 CLAIMS MADE [x] OCCUR MED EXP (Any one person) $ 10.000
[[ PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000.000
[ ]POLICY [ ]PROJECT [ ]LOC PRODUCTS - COMP/OP AGG $2,000,000
AUTOMOBILE LIABILITY
[ ] ANY AUTO COMBINED SINGLE LIMIT
[ ] ALL OWNED AUTOS (Each accident) $
( ] SCHEDULED AUTOS BODILY INJURY
l ] HIRED AUTOS (Per person) $
] NON-OWNED AUTOS BODILY INJURY
] (Per accident)
] PROPERTY DAMAGE
(Per acc•dent)
GARAGE LIABILITY
I ANY AUTO AUTO ONLY - EA A-_CiDENT $
j OTHER THA; EA ACC $
EXCESS LIABILITY AUTO ONLY AGG $
[ ] OCCUR [ ] CLAIMS MADE EACH OCCURRENCE $
AGGREGATE $
i DEDUCTIBLE $
[ ] RETENTION $ $
S
WORKER'S COMPENSATION AND (X] WC STATUTORY [ ] OTHER
AA EMPLOYER'S LIABILITY WC2-31S-314995-019 04.21.01 04.21-02 E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE-EA EMPLOYEE $ 100,000
E.L. DISEASE-POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Job: Roofing Job at 6 MIDDLESEX ST. NO. CHELMSFORD, MA
CERTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FRANK DEAMICIS THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR
6 MIDDLESEX ST. TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED
TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION
NO. CHELMSFORD, OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
MA 01863 REPRESENTATIVES.
AUTHORIIZED REPRESENTATIVE
(7/97)
Page 1 Tof 2
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER. DATE ISSUED.
ic
SIGNATURE:
Building CommissionE for of Buildings Date Z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
35 �
J//3 S umber Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
i�- 1 3 '? 30
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided R 'red Provided
v
1.7 Water Supply M G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No m
2.1 Owner of Record
naA A4 ,
ame(Print) Address for Se (
Signature Telephone 1 � _ / 96
G� ,_� •,C,
2.2 Ownef of Record: a
J"/ r Ila..Il ^alrS%-� O
Name Print Address for Servictf z
M
Signature Tele hone
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: 0
License Number mn
Address
Expiration Date
Signature Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑ v
Company Name m
Registration Number r
Address
z
Expiration Date G)
Signature Telephone V I
I
t
SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6)
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.......❑ No.......0
SECTION 5 Description of Proposed Work check all applicable)
New Construction �< Existing Building ❑ Repair(s) D Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
1� Ll! Y SfiI-v C4 C( o?o X 11v zU
�r'S G �o�r G�aO�vJ /�L U��S/�•.�SS
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 PlumbinE Building Permit fee(a) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUII.DING PERMIT
1, ,as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, r i Yt—C as Owner/Atheri�nt 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 b�ef
Print Name 4
Si a e of Owner/A nt Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2 ND 3 RD
SPAN
DMENSIONS OF SILLS
DIMENSIONS OF POSTS
DINIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
L
Daniel A. McCarthy
1145 Osgood Street
North Andover, MA 01845
Telephone 978-683-4741
Facsimile 978-681-8550
E-mail dmccar3825@aol.com
Michael McGuire
North Andover Building Department
27 Charles Street
North Andover MA 01845
April 11, 2004
RE: 1145 Osgood Street, North Andover;Request for Building Permit. m 3S-
Dear
SDear Mr. McGuire
I am interested in building a small commercial property adjacent to my home at 1145
Osgood Street. The property is located on route 125 across from the Loft Restaurant. I believe the
property is zoned R-1.
We would like to build a shop for my wife's dog grooming business. Please advise me
what steps need to be taken to get a building permit. Will we need a variance, special permit or
any other requirements?
Please contact me at the above telephone number to advise me what is required.
V truly yours
Daniel A. McCarthy
t
f
- MORT+t3AC3� tNSP�C:T{ON PLAN
ti
5 k op, i
*A*4A.-T■ern+«r -M,o W4 joif
� v
�d Oil
T-W 06-W N*A*=ON A TAPt MMWvWY O#Of/Mi T*K UOM Non morwrA"h*ww-Q*ft ONLY.
Ai kWMYIt4LO N4't MM'tg JeNAMH
CoumTy
DEED DEFERENCE: PLAN R"IERENCE: PLAN OF LAND
...
,m�dP?Ty
Zoning Bylaw Review Form
° y Y� Town Of North Andover Building Department
4 7 T;rrto Vis" 27 Charles St. North Andover, MA. 01845
�C-"'J5` Phone 978-688-9545 Fax 978-688-9542
Street:
Map/Lot:
Applicant: D A N s e 4. -To 6 , ✓vl_c C A r�l-i�
Request: ao xti oI
�ovu�w sr�ess
a,jn� C� C, �6� �3�
Date: y a[� d
Please be advised that after review of your Application and Plans that your Application is
DENIED for the following Zoning Bylaw reasons:
Zoning
Item Notes Item
Notes
A Lot Area
F Frontage
1 Lot area Insufficient e 1 Frontage Insufficient
2 Lot Area Preexisting e 2 Frontage Complies
3 Lot Area Complies 3 Preexisting frontage t, 5
4 Insufficient Information 4 Insufficient Information
B Use 5 No access over Frontage
1 Allowed G Contiguous Building.Area
2 Not Allowed 't-c-S 1 Insufficient Area
3 Use Preexisting 2 Complies
4 Special Permit Required 3 Preexisting CBA
5 Insufficient Information 4 Insufficient Information
C Setback H Building Height
1 All setbacks comply 1 Height Exceeds Maximum
2 Front Insufficient 2 Complies
3 Left Side Insufficient 3 Preexisting Height
4 Right Side Insufficient 4 Insufficient Information re
5 Rear Insufficient I Building Coverage
6 Preexisting setback(s) S 1 Coverage exceeds maximum
7 Insufficient Information 2 Coverage Complies
D Watershed 3 Coverage Preexisting S
1 Not in Watershed 4 Insufficient Information
2 In Watershed Sign
3 Lot prior to 10/24/94
1 Sign not allowed
4 Zone to be Determined 2 Sign Complies
5 Insufficient Information 3 Insufficient Information
E Historic District K Parking
1 In District review required 1 More Parking Required
2 Not in district 2 Parking Complies
3 Insufficient Information 3 Insufficient Information C 5
4 Pre-existing Parking
Remedy for the above is checked below.
Item # Special Permits Planning Board Item # Variance
Site Plan Review Special Permit Setback Variance
Access other than Frontage Special Permit Parking Variance.
Frontage Exce tion Lot Special Permit Lot Area Variance
Common Driveway Special Permit Hei ht Variance
Con re ate Housing Special Permit Variance for S;--
Continuing Care Retirement Special Permit Special Permits Zoning Board
Independent Elded HousingSpecial Permit S ecial Permit Non-Conformin Use ZBA
Large Estate Condo Special Permit Earth Removal S ecial Permit ZBA
Planned Develo rent District Special Permit S ecial Permit Use not Listed but Similar
Planned Residential Special Permit S ecial Permit for Sign
R-6 Density Special Permit Special permit for preexisting
Watershed Special Permit nonconforming
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons for Any inaccuracies,misleading information,or other subsequent
changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the
Building Department.The attached document titled'Plan Review Narrative"shall be attached hereto and incorporated herein
by reference. The building department will retain all plans and documentation for the above file.You must file a new permit
application form and begin the permitting process.
L �
® � �a� o
Buildrng Department Official Signa>.ure Application Received Application Denied
� W
Plan Review Narrative
The following narrative is provided to further explain the reasons for DENIAL for the
rAPPLICATION for the property indicated on the reverse side:
7�
vr+
F
—Q� c>V I.�t9 L, 7 /p? /
209 7L
�i0r>✓ 7'h,a� 7w � CaS ,Q,en�e,��-
7' 2 Kc�S7-(ti roSS l���or a ria 7'h
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C�Weti U/tt So vg �d 7�- -rho
00 U O �Wc(
4 SuC-A I>cSt_� iri
Referred To:
Fire Health
Police Zoning Board
Conservation Deartment of Public Works
OtherPlanni
Historical Commission
Other Building Department
`.1QRTIy
E
Town of = over
0 .„ '4'
'A
No.
p aoo/
a�A COCH C1P,y dover, Mass.,
DRATED pPay
S u G
n BOARD OF HEALTH
Food/Kitchen
IJERMIT T D Septic System
� • P BUILDING INSPECTOR
THIS CERTIFIES THAT.............. 1 .. ..1..........jM....�!............
�............................................... Foundation
has permission to erect.........." c. ............ buildings on S Chi Rough
to be occupied as........ ..... "Pe—r�-C ��S��SNC� Chimney
.................................................... ................................................................................. y
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 7B -Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. 3� PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
Rough
CService
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
--- •� 1 - vr4rrvrl,nn AI-I-LIk;AIIUN FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER, , Maas. Date
Building Jy � Permit
Location / ��j�.�/ S
Owner's a
Name 'mac e-"a"-4.(,
New ❑ Renovation ❑ Replacement Y Plana Submttt Yes ❑ No
ao7a -7 �
„ -
„G .
ffi � Z C ,�
w w h a: o %
W h
z c s H s y, _ = 0 t~ a
d „ tom- W p d 4 y ~
tl t'- Z j r- 9 1, M tl p > ri do 0pt J r r
1i �. t C
0
J etlt e°e i
sue—eaMT.
SAIRMENT
IST FLOOR
IND.FLOOR I
SRO FLOOR
4TH FLOOR
STH FLOOR ;
4TH FLOOR
7TH FLOOR t
STH FLOOR
r Check one: Certificate
Installing Company Name Co
Address • .�e�?�- ✓l,z/ d Partnership
❑ Firm/Co.
Business Telephone-
Name of Licensed Plumber or Das Fitter
INSURANCE COVERAGE: Check one
1 have a current Ilabllfty Insurance policy or Its substantial equivalent. Yes-El-,-- No ❑
If you have checked yea, please Indicate the type coverage by checking the appropriate box.
A ItablIfty Insurance policy ,la Other type of in lemnfty ❑ Bond ❑
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:
-qgnature of towner or Owner's Agent
Owner ❑ Agent ❑
i hereby certify that all of the details and Information 1 have submitted (or entered)M above application are true and accurate to the best of my
knowledge and that all plumbing work and Install ntlons perfprmed un7;ns7r
it Ithis application will be In compliance with all
pertinent provisions of the Massachusetts Stele t3all Uoda and Chapta.
T of Ucense:Plumber a ense u errnb Gasnitef
Master eeume �?/� ' �fJ�
C yRown L,Journeyman
AF'fnowD(OFFICE USE ONLY)
Bay State Gas Company
GAS INSTALLATION AUTHORIZATION
y Date —
Issued to
Address
For Installation of:
BTU Input
Restrictions
BSG Representative
PERMIT ISSUED _ BY
INSPECTOR
This Portion of Authorization To Be Returned to BSG.
Inspection Has Been Made of the Following Gas Equipment:
❑ Heating System (BTU Input ) ❑ Range
❑ Water Heater ❑ Clothes Dryer
❑ Room Heater
Location
All Work Has Been Done In Accordance With The Massachusetts
State Gas Code And Is Ready For Use.
INSPECTOR
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
BUSINESS REPLY CARD
FIRST CLASS PERMIT NO.721 LAWRENCE,MA
POSTAGE WILL BE PAID BY ADDRESSEE
BAY STATE GAS COMPANY
ATTN: SALES DEPT.
55 Marston Street
Lawrence, MA 01840
IIi1111fill 111l„I11l1111111l11l1l,1If��II��I���I�II
2284 Date..1.. ...
NpRTM , TOWN OF NORTH ANDOVER
pF ,oto tip '
0_ '� a � `p PERMIT FOR GAS INSTALLATION
"•`ty
�9SS'A u5E� E�.,
This certifies that . . �. .,�. � . . . . . .
has permission for gas installa 'on . . . . . �... QjL l . . . .
in the bui gs of �� a. L:"� w- . . . . . . . . . .. . . . . . . . . .
at . . ./ A' . .,1 . . . . ., North Andover, Mass.
_ �o
Fee. Lic. o. ty� . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File
g'