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HomeMy WebLinkAboutMiscellaneous - 130 MOODY STREET 4/30/2018 130 MOODY STREET 210/080-0-0011-0000.0 ► Location "X) No. Date - 2e" NORTiy TOWN OF NORTH ANDOVER Cf•„•c •'ti0 ►' A + Certificate of Occupancy $ s ;'s�cMust`� Building/Frame Permit Fee $ Foundation Permit Fee $ AL Other Permit Fee $ TOTAL $ Check #� ,-aG 15677 Building IrdIctor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 17113f@.;O"Wal-UN 000 BUILDING PERMIT NUMBER. DATE ISSUED. 624D rn v SIGNATURE: t71z, Builang Commissioner/I for of Buildings Dafe Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1 3 c) D , * Map Number Parcel Number y � 1.3 Zoning Information: 1.4 Property Dimensions: -r -q :Tr--�pTea/r— Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS(ft) [=-OZL S!�V Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40.1-54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Le L;C>� Ll Name(Print) Address for Service Signature Telephone I� 2.2 Owner of Record: Name Print Address for Service: rn S� nature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 1 = Ot-�-YZ- V-56--A VAS Licensed Construction Supervisor: O License Number wn Address D Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name rn Registration Number r Address r ^� Signature Telephone Expiration Date �+' SECTION 4-WORKERS COMPENSATION(M.G.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.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing BuildingRepair(s) V terations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �K L A N4 C, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant ............ 1. Building (a) Building Permit Fee X 4oebMulti lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X(b) 4 Mechanical HVAC 5 Fire Protection 6 Tota +2 +4+5 Check Number SECTION 7a NER AUTHO ATION TO BE COMPLETED WHEN OW . RS AWT OR CON CTOR APP OR BUR DING PERMIT s I, as Owner/Authorized Agent of subject property Hereby au orize V to act on My behalf, i all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB ' SIZE OF FLOOR TIMBERS lFr2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I0-IGHT OF FOUNDATIO& THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS 13UILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of Andover P. i t No. 170 __ C, 0 LA COCHIC dover, Mass., -CHIC TED H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.....................d5ax.&". ...... fb%W.0............................................................... Foundation has permission ..................... III!! s on ....... ..... =... .�.WM7.............. Rough • to be occupied as................ ....... Chimney provided that the person accepting this permit shall in every respect conform to the.terms o.f the app.I.ica. n..o.n..file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Co struction 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 UNLESS CONSTRUCTIO ARTS ELECTRICAL INSPECTOR Rough .............. ....A.......... ... .... .. ...................... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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 Ago- IV00pee r I WStreet No. SEE REVERSE SIDE Smoke Det. a The Commonwealth of Massachusetts Department of Industrial Accidents d Office of Investigations Boston, Mass. 02911 M S�ey�o Workers'Compensation Insurance Affidavit Name Please Print Name: 1 Location 19 W ciiy k j, Ak)-P0l/pe— Phone # I am a homeowner performing all work myself. 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: -- y 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' risonment_as_well_ _civil.pen ies-in-theformnfa_STOP WORK_ORDPR..and.aline_of_(.$1DO.00)-aiday.againstme. understand that. of this stateme may be fo arded to the Office of Investigations of the DIA for coverage verification. I do hereby certify un r the pains penalties f rjury that the information provided above is true and correct. Signatur Date Z Print name t 4c, c Phone# Y 20 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 0 Licensing Board ❑ Selectman's Office Contact person: phone#: ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number / 70 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: Al G Ise, . (Locatio Facility) Sign t r Per it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover - .\ Department Building g De � �--:• - ,�.�a 27 Charles Street D. Robert Nicetta North Andover, MA. 0184,5 4 A 1�very� ti Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE ioe LOCATION GO � J It - Number street Address I ..qq��•.Jjam�,, �Q 2 Map/lot iOMEOWNER ivvlbo Name ome Phone Work Phone ESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended tb include avvrier� of two units or less and to allow suet►hcxnegtivners to en upied dwellings not possess a license,.provided that the owner acts gage an individuaj forhke vwho does DEFINITION OF supervisor (State 8w7c�ng Code section 108.3.5.t) . HOMEWOWNER Persons)who owns a parcel ofland on which helshe resides or intends pp reside, there is, or is intended to be, a one or two on which cessory to such use and/or farm strUct re& A dwelling, �tached or detached strex�res ac- two-year period shalt not be'considered a person who �e fir►ane horse in a hoineoN,+rner_ The hundersigned"homeowner"assumes res Applicable codes, b possibility for comp&arrce vrith the State 8uildin . rules and reputations, g Code and other The undersigned "homeowner'certifies Building Department minimum ins action proh she understands the T P s .ores and r irements Andover �PIy with said procedures and requiremen _ d that hetshe will IOMEOWNER'S SIGNATURE 'PRO`dAL OF BUILDING OFFICIAL 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. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT 5e fv 4'1 0 �� P,es PHONE 90 e' ion 4 I f LOCATION: Assessor's Map Number PARCEL SUBDIVISION^ LOT(S) STREET 1 0 � ST. NUMBERJ0 ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT Sum PS4t,-- zS 1're a't 1911 v,-e, I RECEIVED BY BUILDING INSPECTOR DATE Q� Revised 9\97 jm Date.. ✓.:! .�. .... . ,,ORTH —..p �Oh��..o ,e,tio 3 TOWN OF NORTH ANDOVER O 9 • PERMIT FOR GAS INSTALLATION 5 SACMU5EtS This certifies that . . . � I. . . . . . . . . . . . . . . has permission for gas installation . . . /a::. . . . . . . . . . . . . . . . . . . in the buildings of . . . � '.� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . �'.G. All . . . . . . .. North Andover, Mass. Fee. . �. . . . . . Lic. No.. .1.1 . . �. . . . ... . . . . .. '` . . .. . . . GAS INSPECTOR Check# 1 ' ) 4141 MASSACHUSETTS UNIFORM APPLICATON FOR PERAUr TO DO GAS Frrr] TG (Type or print) Date �pFT ice, Z NORTH ANDOVER, yMASSACHUSETTS Building Locations ` I Ib5 T Permit# SGAmount$ Owner's Name �� W�� New Renovation �-- Replacement 0 Plans Submitted G 0 10 SUB-BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR ISTH. FLOOR 6TH. FLOOR t 7TH. FLOOR 8TH. FLOOR or ) F ���,� t one., CettiScate Installing Company Name AF��R.-�� e. 2� l�"� Corp. Address P�o- k z� Partner. o c:bl Business Telephone � F-r Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance poli it's substantial equivalent. Yes Noo Ifyou have checked Ys.please indi the type coverage by checking the appropriate bo;c 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: Signature of Owner or Owner's Agent Omer ❑ Agent Q i hereby certify that all of the details and ikon 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 ofthe M c us S Code and Chapter 142 0 curl laws. Signature of Licensed Plumber Or Gas Fitter Title ber 1�^.V _ City/Town itter License 1 umb er B�Master APPROVED(OFFICE USE ONLY) 0 Journeyman Date. .-. .. . . . . .. . . . °',".°�7:1�- TOWN OF NORTH ANDOVER 100 PERMIT FOR PLUMBING �,SSACMUSE� This certifies that . . I. _`��.< ��: 1, . • • • �! • ��. . . . . . . . . . has permission to perform . . . . Z!, . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . J. . . ... . . . . . . . . . . . . . . . . . . . . . . . at . . . . ._!. '.! . . . . . . . . . . . . .: . .. North Andover, Mass. Fee. Lic. No—/. � . . .(. . . . . . . .;. . . . . . . . . PLUMBING INSPECTOR Check # 53U" 5 MASSACHUSETTS UNIFORM APPLICATION FOR,PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS f Date '0 Building Location �OL�Si� Owners NameR-l�1® LO`�E'S Permit# Amount Type of Occupancy IRILIZ-�o New Renovation �-- Replacement 1:1 Plans Submitted Yes No ❑ FIXTURES F cf E- w w a Cr w z z xcc 0-4 a as A F a &MV Nr ISL ROM M MOM 3M H DM 4MHjOCIR 5M FLOOR 6M HD t 7MR 9MIL" (Print or type) i Check one: Certificate Installing Company Name_ (��FOR�J O� Q ,n1��0k' Corp. Address o° k ��� Partner. Business Te ep one �i,—(per5hn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type msurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnityE] Bond ❑. Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ® Agent I hereby certify that all of the details and information I have submitted(Dr 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 Plumbing Coode-_qnL�Qapter 142 of the General Laws. By: ifgnaturetof icense um er Tpe of Plumbing License Title (W' �'1 City/Town icense um er Master ou Jrneyman ❑ APPROVED(OFFICE USE ONLY Location /30 / � No. -5 Date �aRTM TOWN OF NORTH ANDOVER WITi • Certificate of Occupancy $ Eta Building/Frame Permit Fee $ swCHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # C14Y4- 18122 4 "1U122 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT i APPLICATION TO CONSTRUCT REP RENOVATE1 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. ; jq A0 S7 SIGNATURE: C Building Commissimlirlinspector of Buildings Date z SECTION i-SITE INFORMATION j 1 O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: umber Parcel Number O 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 34) 1.3. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Nwate ❑ Zone Outride Flood Zan ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT "i St(!Ct: YG mo rn 2.1 Owner of Record Name(Pn ress for Service Signature Y Telephone 11 Q 2.2 Owner of Record: �\ I _ �r r.Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number Address Expiration Date C a. Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 v ti Company Name rn Registration Number r Address r Expiration Date z Signature Telephone G) a w SECTION 4-WORKERS COMPENSATION(M.G.L C 152 f 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 it. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check a8 avolkabh New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: 11 ✓ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building �`� (a) Building Permit Fee 30 9�/ Multiplier 2 Electrical (b) Estimated Total Cost of % ^ i co Construction v lJq 3 Plumbing 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 COMIRACTOR OPLIES FOR BUILDING PERMIT as honer/Authorized Agent of subject property Hereby a rize i to act on My beh f all matters lative rk authorized by this building permit application. Signature o ` Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION �. I. as Owner/Authorized Agent of subject y' 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 Si ture of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 3RD SPAN DIMENSIONS OF SELLS M DIMENSIONS OF POSTS r DB ENSIGNS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE y a NpRTM TOWN OF NORTH ANDOVER 0_°;.�;`" p� OFFICE OF BUILDING DEPARTMENT �*� r 400 Osgood Street o North Andover,Massachusetts 01845 ass^C"MU) Telephone(978)688-95454 D. Robert Nicetta, Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: 1 SQL/ Number Street Address Map/Lot \� HOMEOWNER J ✓ ^Z � - b , q39 00 R9 Name Home Phone Work Plione PRESENT MAILING ADDRESS I 3D t_44 ora �5 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"c ifies that e/she understan the Town of North Andover Building Department minimum inspection procedures( d requir is and that h she will co with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL I10ARD OF,\PPFALS 4X8-95.41 Ct)NSFIRVATION 688-9530 IIYALI'Ii(,BR,)540 PIANNI\G GRR'>5a5 ----------------------------------------------------------------------------I----- --------------------------------------- -------------------- ----- ------- - --- --- ------ -- D. V-4 IW ---------- 16' 4'-1 7. 7-W 7/-/7 i T-B 7ir L ------ 31/2. -1 Vir -------------- ------------------------------ ----------------------------------- --- ---------------------------------------------------------------------------------------------------------------- 10, N-3 7/r F NORTH a Town of _: _?ir over Q No. �UB - - 0dover Mass. 3 T 0 - LA E 1 COCMICME WICK V �d AORA7Et) 7 H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........................ .... .............. .� ................................................................................ Foundation has permission to erect.... N�� �....... bui i son....� OO�Y •............... Rough ...... ........ ........... .... ............... ........... ......... to be occupied as........./........900- -oAq....w �.I�i.... . ........JN..../34 s foo �I............................ Chimney provided that the person accepting this permit s all 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 relping to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 90/ 11 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough to.— Final C- PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI S ART ELECTRICAL INSPECTOR C Rough .. . .. ... ... ..................... ............... Service BUILDING IN ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 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. 4093Date....... .. ...A3 00 TOWN OF NORTH ANDOVER AL oo ' 0 PERMIT FOR WIRING C M . .. .. ..... TPs certifies that ....... ......P.......MAII(ff....................... has permission to perform .......A/� �-l......................................... �-ring in the building of..........LAPe.-7..................................................... at../..�.3 ..... - V.d.� - w/......... .............. ......... .Northki er ......... rt V Fee.J' Lic.Nor.Mly.... .. ..... * ELECTRIC INSP�Ee R-*. Check # 7-3 =C0AM0NWEALTHOFA1A' SS4CHUSE7TS Office Voae only DEPARTNaNTOFPUBL[CSAFETY BOAROOFFIREPREVEVHON Permit No. It'EGUTA770NS527CNIRI2:OC1 Occupancy&Fees Checked Al'PLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) /3o Owner or Tenant Q Owner's Address Is this permit in conjunction with a building permit: Yes No M (Check Appropriate Box) Purpose of Building Al G. /GS/ �W�l.11&6_ Utility Authorization No. ExistingService Amps Volts OverheadUnderground No. of Meters New Service Amps / Volts Overhead =1Under round No.of Meters Number of Feeders and Ampacity Location anal Nature of Proposed Electrical Work AlL.. No.of Lighting Outlets No.of Hot Tubs --FR-o--of Transformers Total No.of Lighting Fixtures Swimming Pool Above Below KVA rounGenerators KVA d round No.of Receptacle Outlets / No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets /(O ! No.of Gas Burners No.of Ranges / No.of Air Cond. Total FIRE ALARMS C3 No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pum s TonsInitiatin Devices No.of Dishwashers KW g Space Area Heating KW i No.of Sounding Devices V / No.of Self Contained No.of Dryers Detection/Sounding Devices Heating Devices KW Local Municipal Other No.of Water Heaters KWConnections No.of No.of Si s Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER hufanoeCovetage A>istlutttotheie�tmana�sofM GalaalLaws [hawaanilLmbihtyhauatrePb ymdudLtgCmnp � orilssu�ai0grm�t YES ©�NO ID `hawvalidproofofsatnetotheOffic�YES lVddngthe 1f}otthaWched''tedYES,plea9emrlicatethe typeofwageby fflxT�naeNSURANCT; BOND OU-ER (Ply Spe*) EVirafimDate voiklDSlatt lrWe`fimE1&ReVestcdRot' t EStim&dvahleofl lWcdc$ ,ignedunder'&Rnaviesof _ Final IRMNAME LiocnseNo. i..:-. V1�7 $ rni171 ,Q Signahue I.iocwNo Busu�essTel No. .�- d� /.�D/�' WNl~T2 S INSURANCE W Alt Tel No. X16�f RIVER Iamawarethatthel- doesnothavetheinsurancecovetao�oritssubs=alegnvalulasregmedbyMasswhuRzcfnffWLam dthatmysignahueonthispemmappfi�thisroTmamtt 'lease check one) Owner Agent M Telephone No. PERMIT FEE . Igna ure o caner or gen Date.. . . .`.'. .`. �. .. . ... r NORTH TOWN OF NORTH ANDOVER O A • - PERMIT FOR GAS INSTALLATION SACIMUSE�S i This certifies that .✓.. .. . . ... . ..`. . . . . f'. . . f . . . . . . . . . . . . . . . . has permission for gas installation . . .L4. .f /. . . . . . . . . . . . . . . . . . . in the buildings of . . . j .l .,z . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . .f. . .��. . . .� . . . . �.. . . . . . . ., North Andover, Mass. Fee. . .�.� . . . Lic. No..`:... . . . . . . . . . . .f l. . . : �r �^ . . . . . . . GASINSPECTOR Check# a 3 - - 7 vnv� MASSACHUSETTS nt TFORMAPPLICATON FOR PERMITTO DO G,kS FITI'IIYG or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations �ID m CIQA4 l )-r+ Permit 9 Amount S Owner's Name /����� I'Ilur-PhLJ NewElRenovation ❑ Replacement Plans Submitted ❑ n In Z J Z Z 7 Z J n u — u �_ z 5n R .\ SE .M Ey "r � I s'r. F L O O R 2:N D . FLOUR 314 D . F L O O R 4'r it . FL O G It Silt . FLOG R 6'r 1I . FLOG R 7'rIII . FLO G It El 3 T 11 . F L O G R (Print or type) Check e: Certificate Installim,Company Name Andover Plbq. & Htp. CO. , Inc. Corp. 2122 Address 20 Aa9Pan JD-r- Ifni t-10 ❑ partner. Methuen, MA 01844 Business Telephone (978) 685-8383 ❑ FIrm%Co. Name of Licensed Plumber or Gas Fitter (;pnrc7P I ROSP INSURANCE COVERAGE Check one: I have a current liability Insurance polio it's substantial equivalent. Yes ❑r No❑ Ifyou have checked Nes. please ind to the type coverage by checking the appropriate box. 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 I42 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 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 pertortned under Permit Issued for this application will be in compliance with all pertinent provisions of the:Massachusetts State Gas Vde and Chapter 14 the General Laws. F ienature ofLi ensed Plumber Or Gas Fitter Plumber 9983 Town ❑ us Fitter (cense wumoe: IVIt15Ier A-PPROVED UNE')NI.Y) ❑ Joumeyman Date.�. . . .... .C. .. .. .. .. NORTH �4, TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION • • I i �IssZ".USEtth This certifies that ,.,-/r : ��. :: '�.. 0� ,/r has permission for gas installation . . . .. . . . . . . . . . . . . . . . . . . . . . in the buildings of . . .fit .. . . . . . . . . . . . . . . . . . . . . . . . . at . .�.: .,. . . :'l�:. . . . . . . . e'!. . . . . . . . . . . . ., North Andover, Mass. Fee.2.%. :. . . Lic. No..` f. .':. . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# ) r 3 , 3 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) 3 NORTH ANDOVER,MASSACHUSETTS Date 6 Building Location 30 ood S Owners Name Permit# Amount Type of Occupancy Vis' New Renovation Replacement Plans Submitted Yes ❑ No FIXTURES r w . w a � A a A A � Q SLRB9 E E LIDQZ OOK LOOR OM OM OOR (Print or type) Check o : Certificate Installing Company Name _Andover Pl bq. & .Htq. Co. , Inc. orp. 2122 C Address 20 Aegean Dr. Unit-10 Partner. Methuen. MA 01844 Business Telephone (978) 685-8383 Firm/CO. Name of Licensed Plumber. e Insurance Coverage: Indicate th #e o insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner F1 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 Massachusetts State mbmg Code and C apter 142 of the General Laws. By: igna ot Lic-ensg0lumoer Type of Plumbing License Title City/Town 9 9 fi � �� Joumeyman APPROVED(OFFICE USE ONLY j rcenseum er Master • a Date. AN � i � NORTh TOWN OF NORTH ANDOVER 3? a ......'• OL PERMIT FOR PLUMBING y SSACMUSE� n r This certifies that .��.�''4n? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .... . . .�t r` S plumbing in the buildi igs of . .5.r!`.If O. . . L,.Q.F.G.'4- . . . . . . . r� at . . �.0p. . . . . y. . . . . . . . . . . . .. Nortp Andove , Mass. Fee. Lic. No.. . . . . . . . . -R- PLUMBIN,6 INSPECTOR Check # y _ 6426 MASSACHUSETTS UNIFORM AZPPLICAN FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS \ Date /'q �dch Building Location �4i�- Owners NameL Permit# Amount T4 e of Occu a Wei iN New Renovation Re placement Plans Submitted Yes No ❑ F TURES 06 09 SZSBHVIC >�iFLoc�t 3�II FIDQt �)HI1X12 4IH)HI�[I2 SII3FLOCR 6II31FID(It 7M FUM 91H KJOCR (Print or type) / /� n ,L� Check one: Certificate ,+ Installing Company Name Corp. Addres� t e— f' Partner. `y _ 14 usinessTelephone ITFirm/Co. Q�ss }C Name of Licensed Plumber: Insurance Coverage: Indicate tVtyof insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 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 installationsperformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass St lumbi Code and Chapter 142 of the General Laws. BY Signature of LicensearIUMDer Type of Plumbing License Title _ 79. City/Town icense lNumoer Master Journeyman ❑ `' APPROVED(OFFICE USE ONLY