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HomeMy WebLinkAboutMiscellaneous - 129 PINE RIDGE ROAD 4/30/2018 129 PINE RIDGE ROAD 210/065.0-0138-0000.0 Date.,�-C_ :—q 9 ".��T:.1ti, TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING ( ,SSACNUs� This certifies that . . . . . . .`. . . . . . . . . . . . . . . . .. .'• • • • • • • • has permission to perform ! . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . � at s . . .- *-ate: '. '� ~. t`f North Andover, Mass. P4M'/ ING INSPECTOR Check # ��� 8230 (r Tutt ur iypu) O � I'MA? ,Mass. Date Permit# �a Building Location J� �'�f".Owner's Name Owner Tel# -' Type:of Occupancy New. ❑ Renovation,Q leglacement. Plan Submitted: Yes 13 No FIRES 'Z O < ut a Ii., U Z p7 a m ac t o w • � .� F � I E<+ > F O . E<- a O- A c 3 BASEMMPr sr FLOOR ND FLOOR w MOOR ON fMqQX=M STM FLOOR 6"FLOOR _._7'"FLOOR — — - - At fustalbiip Company Nam;- beck otu;: Ccrtillcate ,4 Address �,rJ���'filJ�7�' GporationL. Business Telephone#le0:�514(13;57 ❑Firm/Co. Name of Licensed Plumber �'�[[ 5;,-AV�4 INSURANCE Cov I have a knrame policy or iia substantial equivalent which mats the regWratuerts of MGL Cit.142. Yes No.o If you have checked yes,ple ase the type coverage by checking the appropriate box. A liability insurance policytype of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage requited by Chapter.142 of the Massa General Laws,and that my signature on:this permit appiication waives this regairema t, Check one: Owtter ❑ Agent ❑ Sigttatuie of Owner or Owner's Agent I hereby certify that all of the details and information I have submined(or enured)in above application are no aqd accurate to the best of my knowledge and that all plumbing work andittsrallations�erformed under the rmit issued for this application will be incompliance with all pertinent provisions of the Massachusetts State Plumbing.Code and Chapter 142 of e BY — Sig of Licensed Plumber. Tide _ Type of Licenser Masteld� ! o �• City/Town i 71 .APPROVED(OFFICE USE ONLY) Licxnse,Number INAL INSPECTION 8F-LO}r0� BFFICE USE ONL� SKETCHES • . PROGQESS INSPECTION FEE , 6� . LfS AT'*JI3 F 0 S PERMIT TO Do GASOI7TIH0 ' . • � - • . : .• t8A1�E�.'���p•=' of Ci1JtLt3tNO ••i t � '• LOCK iO ©=-�.JTLgF:Fii 4, PI.&E3+ ata ©fit GvtSPaTtEEI PFAMIT 9RANTlD . • � Y. � '. "OAT! I' GAS INSPECTOR , N21 Date....... 1...J� /..l N_ 7 9 r 1 f pOR7M TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� This certifies that ........ .. .�. .l�.p�?.!�. .......... (PG.. .................................. has permission to perform 7 `'� L` P ' ....... .................. ................. .... ............................. wiring in the building of.......P .... ................................................. at.......... .......'t.+j. ......��.....`�......... .........,;North Andover,Masf t Fee.....( �4?... Lic.No.�1 ............. .................. �.. ... ,�`ELECTRICAL INS ECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer f o::lCe Use Only _- - Tn mmonwealth of Massachusetts Permit No. _ =' = Vn/ Department of Public Safety -=- (�cupancy s :ee Checked ARb OA DF FI E PREVENTION REGULATIONS 527 CMR 1'--00 3/90 (Itave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Maraachusens Electrical Code, S27 CMR 1 :00 (PLEASE PRINT IN INK. OR TYPE ALL INFORMATION) Date City or Town of— �1n Ail DQU To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ViriE R1 -� MAE Owner or Tenant L R V al C F-N ly 15—29 413 /� ' Owner's Address J C o&,8 fz!d PARCEL Is this permit in conjunction with a building permit: Yes ElNo (Check Appropriate Box) Purpose of Building �,��� S i Utility Authorization N0. ?+ Existing Service /L1 Amps 1 FY / 2 LIUVolts Overhead ❑ Undgrd ® No. of Meters-,- New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and ?.mpacity p Location and Nature of Proposed Electrical Work 0C->T51'(JC dp A% Tqv. 15 oA1 1� Cib 1 S a G`1�C'i(�tI r No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total l.'VA Above In- No. of Lighting Fixtures Swimming Pool grnd. ❑ grnd. 1:1 Generators KVA No. of Receptacle Outlets No. of Oil Burners fNo. of Emergency Lighting Battery Units i No. of Switch Outlets No. of Gas Burners FIRE ALARPIS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices r No. of Disposals No. of pUMDS Total Total Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Plunici?al ❑Other Connec-j.on No. of Water Heaters KW No, of No. of Low Voltage Si ns Ballasts Wirine _ .� N0. H dro Massage Tubs No. of Motors Total HP OVER: (A- 1,I le yjpk 1 eg We. Fbuyju� � R Cv�e v�oIATJuw b r 110 - 2 6 11 BS (39ck wall 6 c Rao AM 15 144A 3)rR-0-t INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws + I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YESE] NO F] I have submitted valid proof of same to this office. YES[] NO ❑ (k If you have checked YES, please indicate the type of coverages by checking the appropriate box, i INSURANCE ❑ BOND ❑ OTHER 7 (Please Specify) G��'ILg ��W (�� 0p ation Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final IP-f e Signed under the penalties of perjury: FIRM NAME -5 5 C) R i C 5��1vJ Ge LIC. NO. ,/� Licensee - Signature d t t LIC. N0. /3 Address 1 -)L 50 1Pt.e1 @&C-C Bus. Te Nioo. CgA5- G eC? �L��'"' OWNER'S INSURANCE WAIVER.: I am aware that the Licensee does not have the insurance coverage or its sub- i stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PEIL`1IT FEE S ,Sir,nnture of Ch:ner or Arent! I v�.+++•�� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) �• Mass. Date y — i/ 19ZZ' -- Permit #_ 3 3 D J /@• ,3 i3� Building Location Id /vL /a G c Owner's Name �. Type of Occupancy r�cc j New §3,— Renovation O Replacement O Plans Submitted: Yes O No O SEWERr FIXTURES B.P.-r' SEPTIC" • yr y y y y o` z �" > s4 la W X J y U < y d C 4) = 02 N < rr _' 1- O 2 y a Oy W } y �' V W y C < Vr U. J y y °• -4U Z O 7 a .) W ¢ { W = D < y V aC a 0 : 0 Lx+ W t-• }- W o ° • J y C }- < x ° w ° LL V 1 W - 1 2 x = x a o < k x 4J X J m h D D J T r- 'y u. V D D { 3 C m p O sua—ssMT. I sASErIEHT IST FLOOR 2ND FLOOR 177 I 3RD FLOOR 4TH FL70R STHFLOOR 6THFLOOR 7TH FLOOR 8TH FLOOR Installing.Company Name—M 0. C4 Check one: Certificate u Address o 1c 7 s'`f O Corporation 0 r,ct-e, cA."r sta 0 Partnership Business Telephone 9 S 7— 14S ` 7 :` ala Firm/Co. Name of Ucensed Plumber /L( roc �ca e- Q v c O u k _ INSURANCE COVERAGE: I have a cu ent labflity Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. o If you have checkedyes, please Indicate the type coverage by checking the appropriate box A liability Insurance policy �� Other type of indemnity ❑ 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: ' Owner ❑, Agent❑ Signature of Omer or Owner's Agent I horoby certify that all of the doWls and Information I have submitted(or entered)In above applicallon are true and accurate to the best of my kno%iodge and that all plumbing work and installations performed under the permit issued for this application will be In compliance with all periinont provisions of the Massachusetts State Plumbing C.8do and Chapt 142 o anoral laws. S7' C. Title gnalure of d lum er Cityfrown Type of Ucense:Mastect5f",'Q Joumeyman❑ -�rti.�;�.,::�=i-.is^^ '-��.�:�,,,,r � .__ �-t-•—,-.-.,...-*:�. Drys---.., t' Date. . . "SRT: do TOWNK OF NORTH ANDOVER . P PERMIT FOR PLUMBING i, SSACHUS� F w" "Lp This certifies that . . . . 4 -. . . _ . . . . . " has permission to perform . . . . . . . plumbing in the buildings of .. .`. . . ' at. . ��. . . , No h Andover, Mass. F Lic. No.,�U. f. . PLUMBING INSPECTOR Y 04/15/97 10:29 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer . '�57_ . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN* G 1 (Print or Type) NORTH ANDOVER Mass. Date 1huildin Location i/Y Permit II � g /�9 �� - a j&3 .� Owners Name �/ r;z Lel/ !� New '1 Renovation �"] Replacement � Plans Submitted D .r FIXTLIR=-I W N z Q of U3 a m -o rn = yr Of O V to H y Z us < ¢ Q O a o W z N N W 0. W tt W 0 o W m H v W 4 Q a W ttl 07 J x Q n: rt Q Q W ~ W V C7 tL a f. X ^ F- 2 �.. W W O ? U. ►+ W ..t l- W z Q W G �+ N '� O O N S Q Ls } .C W "t G 4 d O O W O W N R Z O O tt. O O 0 .t U I= ?• G a f— O SUE(-8S NIT. i BASEMENT IST FLOOR 2HO FLOOR 3110 FLOOR I 4TH FLOOR STH FLOOR 6TH FLOOR 7TK FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name ANDOVER PLG. & HEATING CO_.., Corp. 2122 Address 571- 1 /2 SO UNION ST Partner. LAWRENCE, MA. 01843 Firm/Co. Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter GEORGE I AROSE Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E] Other type of indemnity Q 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 Agent El I hereby certify that all of the detaUr and Infocmation I have submitted (or entered)in above application are true and accurate to the best of my will-be in co m iisnoe with all anent knowledge and that a plumbing Work and Installations performed under Permit isst:ed fo: this apptintioa P Pa 6 u p l< _ provisions of the Massachusetts Slate Gas Code and chapter 14:of the Genera!Laws. B /TYPE LICENSE: �— ' Y e Plumbbr Title Gasfter Si nature of Licensed Master Plumber or Gasfitter City/Town: - 99P� APPROVED (OFFICE USE ONLY Journeyman License t4umber i € T s, TO - 2183 Date. 5<`. . . ... . h i F p,pRTh qTOWN OF NORTH ANDOVER A ,s •yp ' or PERMIT FOR GAS INSTALLATION F p 41 is .- CH .. CPO This certifies that . . . . .. . . . . . . . . . . . q has permission for gas installation . . ''t- H �^ in the buildings of A4.0 R p .. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .1�1 n . .l t. .�a. . . . , North Andover, Mass. Fee. ./.�, . . . Lic. No..?. INSP }=. . :. . . . iGAS ECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File Location No. Date Z g r MOR7� TOWN OF NORTH ANDOVER w Certificate of Occupancy $ Building/Frame Permit Fee $ Lp s e t' Foundation Permit Fee $ Other Permit Fee $ e Sewer Connection Fee $ j A Water Connection Fee $ TOTAL r wilding Inspector i T2 10784 ' Div. Public Works :ry PER11IT NO. v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KJO LOT NO. ®1 • 2 RECORD OF OWNERSHIP iDATE BOOK PAGE / ZONE rt SUB DIV. LOT N . F I / LOCATION fh PURPOSE OF BUILDING /' _�1we OWNER'S NAME NO. OF STORIES (7 SIZE OWNER'S ADDRESS lap /� D,,� �1 1�{ � BASEMENT OR SLAB r3 _e`!1�✓1 ARCHITECT'S NAME d SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ,.� �S C-14-t SPAN -- DISTANCE TO NEAREST B` .LUIVILDING DIMENSIONS OF SILLS DISTANCE FROM STREET - POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION . M � 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 r SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILEANp PPRO.V/�EJD BY BUILDING INSPECTOR DATE FI BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT (� F E it OWNER TEL.# 6R?,I,,2zc!; PERMIT GRANTED CONTR.TEL.# Cd——6 11O 19 --(L—f--- CONTR.LIC.# OE () �t 7 H.I.C.# /0 _�o 7"- - !007 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S.ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE _ _ BRICK OR STONE HARDWO __ _ PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ y, 1/1 3/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIV D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS.8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BtK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR (� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH Q FIX.) _ GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT A SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE 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 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING OR Town of ®ver No. Q A Zover, Mass., 1'9�CO CNICNE WICK 91/ - ICE EM 0'�ATED BOARD OF HEALTH Food/Kitchen ijEnMIT T Septic System BUILDING INSPECTOR . . .................................................... THIS CERTIFIES THAT............................................. ................... .T Foundation has permission to*Ewt.....ftp:_.._f�. ............ buildings on ......../.� .T.........K"'Jz... . . ..... .... Rough to be occupied as................................................. ........... /%'t0'A'N...................................... Chimney provided,that the person accepting this permit shall in every respect conform to the terms of the application an 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 MONTHS Final t ELECTRICAL INSPECTOR S UNLESS CONSTRUCTION STAB- 'S 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 Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. —/07 Eq Smoke Det. he 8 2 985 DEPARTITENT OF 'UBLTC' SAPETY ONE ASHBURTON PLACE BOSTON, HA ::12i�'-1Gir• CONSTRUCTION SUPERVISOR LICENSE ,Umber: EXn]_res: Birt-hda.te: CS 050494 11/16/1998 11/15/1954 Restri.ctea To. 07. :STEVEN N COTE Detach bottom,— fold sign on - 20 AEOEIIN DR #15 �.>rlicense, ba• and _c'.inin:?.i _ card. i_ •1T T,TH.7@"EN, I�tA 01844 �..: J t, a Keep :_o}: for receipt and chancre of <,ldress notificD.ti.on. -- ,- �-- _ 05290 -�e &4mno4uveqM1 ilrPA T-I"ENT OF FU .� C , : FET Qr.jQ,vl ONE ASHBURTON PLACE. RI 1,01 BOSTON, I171 ( ^'i G�2, 1 61_J CONTRUCTION SUPERVISOR LICENSE Number: Expires: Birthdate: i CS 050854 11/10/1998 1.7./10/1964 Restricted. To: 1G 1 i G,TILLIAM T FOSTER D2'_ tch bottom. fold sign on ' • 65 COACI-F DP, �( ?zcl:. and. laminate license card. DRACUT, MA 01826 Keep top receipt i?t and chane 1 I f����� Grp I 1" OIL add,:I-e;+;"_ notlfiGdtlon. i 1-f Af TKC-P(,.)V!_f,V­rfl- n n'. HOME IMPROVEMEAIT 9, e91sf rat;nn 1C.7 T y PPIV"U rt'.K p COTE F'STER C Cr,i T sUven 1-1, Cob^ IDr/I In i t 15 ADMINISTRATOR M0 t hu 0 11 !"A 01x,1 Office Use Only 01 4E Liam I anuiratt4 of 11FIBBcar4usEtS Permit No. lRepartment of PubUr t6afrtta Occupancy& Fee Checked 00 3190 (leave blank)UJ 6 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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 IN INK OR TYPE ALL INFORMATION) Date (X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) /a 9 �/"('/� �i rf -c- /1'D4 c'J Owner or Tenant CA / /0 7/� / ydPfl V Owner's Address Is this permit in conjunction with a building permit: YesAT No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity ` Q/ 32914 Location and Nature of Proposed Electrical WorkQe2� ( ���: //�y,^of��1' Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In- No. of Lighting Fixtures' //; I Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units 9 1 No. of Switches I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No.of Heat Total Total No. of Disposals Pumps Tons KW -D No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices I. Municipal No. of Dryers I Heating Devices /! KW Local [IConnection ❑Other No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro.Massage Tubs I No. of Motors Total HP 8� OTHER: �U� ,04x1e 10, INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws _, I have a current Liability Insurance Policy including Compl ted Operations Coverage or its substantial equivalent. Y _ NO I have submitted valid proof of same to the Office. YES NO = If you have checked YES, please indicate the ty a of coverage of by . checking the a p priate box. oZ T� -,9r INSURANCE BOND — OTHER —� (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: `- 7 FIRM NAME G/r/ L LIC. NO. Licensee 2iC UMA! Signature LIC. NO. /— Bus. Tel. No. �3 Address n��Gl.O/I/ " Alt. Tel. No. OWNER'S INSURANCE WAIVER-11 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) �-� Telephone No. PERMIT FEE S /o 0. (Signature of Owner or Agent) x-6565 Date....{`......................../.... 857 € f NORTH, 3r;.�„`` "O0 TOWN OF NORTH ANDOVER ':. F A Y % PERMIT FOR WIRING F �,•D7�T.D r�,w� SSACMUS� r. J � CThis certifies that ........ w,�,_ .... ..................... has permission to perform ...... ��- lY?.1.41��tr � ....:........ wiring in the building of-C.....). ............... s ' g at—la �ij ... ...,� 1 Q.....f 4.(./G!-e- ......... North Andover Mass. Fee. 42C..w. Lic.No.A6.4.4(4........... yao-"� ' . .... gzac.t-' ECTRECTOR r 04/10/97 1 :41 100.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Insurance Adjustment Service Inc. 531 King Street • Unit 2, Second Floor Littleton, MA 01460 978-952-6966 • Fax 978-952-2459 Email: iaslittleton@netlplus.com Date: Board of Health:_/Ii Building Inspector: r Fire Department: -:CAO cF.NORiHANDOVLii 80A,1160F HEALTH Re: Insured: Location: Claim Number: MAY 2 3 2001 ��, 1.- , Policy umber:N � Our File Number: Cause of Loss: Date of Loss: 3-a 1-04 Dear--Sir/Madam: A claim has been made involving loss, damage or destruction of the above captioned property which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applied. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct that information to my attention and include a reference to the captioned insured, location, date of loss and file number. Thank you for your cooperation. Very truly yours, Scott O'Neil Adjuster Ext. 129