HomeMy WebLinkAboutMiscellaneous - 131 CRICKET LANE 4/30/2018 fN
f
l
,,Date......3. .... ..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
US
Thiscertifies that ............................................... ........ ................................
has permission to perform .... ....................
wiring in the building of .. ...... ...................................
at.....1 31... North Andover,Mass.
S;�
Fee..Vt-�.. Lic.No..J.56/j7t.........
........ ....
CLECTRICAL iNSP'E***"R
Check #
'10732
- commonwealth of Massachusetts Official Use Only -
a
Department of Fire Services permit No. 1 D`7� Z
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07] (leave blank) •
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00
(PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date:
City or Town of NORTH ANDOVER To the Inspector of wires:
By this application the undersigned gives notice ofhip or Jpr intention tope form the electrical work described below.
Location(Street&Number) 0; / � �lFl
Owner or Tenant �)( /�q r, wy Telephone No.
Owner's Address 5,-.V I,--t ,
Is this permit in conjunction with a bullying permit? Yes ❑ No [Ef-- (Check Appropriate Box)
Purpose of Building &—A; •. 14 Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
s. Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: .2 a,I:w
Completion offhefollowing table may be waived hV the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total '
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
nd. rnd. Battqy Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones I
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Tonsl No,of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons :_ KW No.of Self-Contained
Totals: "� . "' Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑ Other
Connection
l No.of Dryers Heating Appliances KW SecuritySystems:Y•
No.of Watero. No.of Devices or E uivalent
Heaters KW No•Si s Ballasts Data Wiring:
No.of Devices orEciulvalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
Icertify,under the pains//andpenallies ofpejjury,thn_t the information on ilii application is true and copT'ete.
FIRMNAME: 4v4rrl, n
!✓ ' k rz LTC.NO.: / ✓-. .
Licensee: Signature LIC.NO.:
(Ifapplicable,enter`exempt"in the licen a ni tuber ne.) .
Address: 1 Cis r�53 C tl n, C t•/t �k W N��• c 3 6 L 2 Bus.Tel.No.:t&!)
'Per M.G.L c. 147,s.57-61,security work requires Department of Pu lic Safety"S"License: Alt. Lie.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$
4
Information and Instructions '
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, j
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
Yk renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
f �
Applicants 1
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
N Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Iuvestigations
600 Washington Street
Boston,M,02111
TO,#617-727-4900 ext 406 or 1.-877,7MASS.AFB
Revised 5-26-05 Fax#61.7-727-7749
www.mass.gov/dia
Date. . . ..... ..
OE`NORTH 1ti
a= �` 6'6 TOWN OF NORTH ANDOVER
F D
• PERMIT FOR GAS INSTALLATION
. 9
SA US
This certifies that . j. . . . . . . . . .
has permission for gas installation . 4/7P4z�.Ivy . . . . . . .
in the buildings of . . ./5kV.c/T. . . . . . . . . . . . . . . . . . . . . . . . . . . .
at .����. r! 1.��?�. . . . . . . . . North �do�ver„Mass.
Fee. .11.i7l. . . Lic. No..
GAS INSPECTOR
Check# 1163
8060
i
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: VJO-t'"�N AjJy,jF% , MA. Date: y U Permit#
Building Location:� � �_('� 1.(Q� � hQ_ Owners Name: ji,
Type of Occupancy: Commercial ❑ Educational❑ Industrial ❑ Institutional❑ Residential
New: Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No, '
FIXTURES
- - - - - - - - - -loeW - - H -
Luto
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Z W CO m O a F W _
IY � U! U W0 W O W O W FWLL
—
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Z W >- ul "u Q Q . m w O Z 0 F- �' I.- 1-
V LL 0 0 = _ � O n0. � W H � j > � O
3t16-B311f1-�
BASEMENT
1 FLOOR
2 FLOOR
3 FLOOR j
4TH FLOOR
5 FLOOR
61HFLOOR
71HFLOOR
Ad-
-i"'-FLOOR
y �( CPQ
Installing Company Name: .p Kcqt�. Tr Check One Only Certificate#�-{�
t, �l
El Corporation
Address: / 1 �G�STK SR'��f City/Town: State:
EJ Partnership
Business Tel: Fax:
f ❑Firm/Company
Name of Licensed Plumber/Gas Fitter: Gl()
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YeK No❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity ❑ Bond ❑ j
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
❑
Signature of Owner or Owner's Agent Owner El Agent
By checking this box[];I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In
compliance with all Pertinent provision of the Massachusetts State Plumbi od nd Chapter 142 of the General Laws.
Type of License:
ByPlumber
Title Gas Fitter Signature of Lice ns Plumber/Gas Fitter
❑Master
City/Town Journeyman License Number:
APPROVED FFICE USE O LY) LP Installer/
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express 6r implied,oral or written.."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer.,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling-house' .of another_who_employs persons.to-do-maintenance,.construction or-repair-work-on-such dwelling house-- -- - -_—- — -
or on the grounds br building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,'§25C(6)also states that"every state or local licensing'agency shall withhold the issuance or `
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),addresses)and phone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with.no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be-advised that this affidavit may be submitted.to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date-the affidavit. The affidavit should
bb returned.{. 51 r4 ldA �C.y t 1A�+r'y i+L fr L.F.• P 9' t(•PYi P s beming t-, ' 7�
657- the city or toCS`li the,A.•� S •-+.t Jr tL' p✓1F.�FL o_ �.v Ve•1t�req�PtsevQ:,n�Ei the J-vp��ieit 01-
Industrial
TIndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' -
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant..
Please be sure to fill in the permit/license number which will be-used as a reference-number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business,or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would'like to thank you in advance f6r your cooperation and should you have any questions,
please do nbt-hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investibations
600 Washington Street
Boston,MA 02111
Tel. #617-72.7-4900 ext 406 or 1-977M ASSAFE
Fax#617-727-7749
Revised 5-26-05
i wviv,,Fnass..gov/dia --- -
Date. . `f;. 1 . . . ... ..
TN
OF
o� TOWN OF NORTH ANDOVER
-,� PERMIT FOR GAS INSTALLATION,
r +
SACMUSESS
This certifies that . . '��. ' �` � . . .
has permission for gas installation . . . A k'.'. .9. . . . . . . . . . . . . .
in the buildings of . . . .���! . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . .
at v. . . . . . . . ., North-Andover, Mass.
Fee. . ?. . . . . Lic. No.).
GAS'INSPECTOR
Check# f,r
5471
,vLk%ACHL;SFM UNIFORM APPUCATON FOR PERM TO DO GAS FITTING
(Type or print) Date 0-1
NORTH ANDOVER,MASS�ACHrUSETTSi _ y
Building Locations t �-l( C vac)LtL �� t/`�. Permit# ` ?�
Amount$
Owner's Nar7QX p A 4\ 1
New Renovation Replacement Plans Submitted ❑
M
oH
F" G x O O
C0
SUB -BASEM ENT
r
B A S E M ENT
IST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type�� e �� � � � C�one: Certificate Installing Company
Name 1 QQ Corp.
Address �� `�� 5 Partner.
AL
Business cep one (07 — '3&�--'XAj A Co.
Name of Licensed Plumber or Gas Fitter -AT3 Ak-t-tY
LNSURAiNCE COVERAGE- Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ® No®
If you have checked Les,please m nate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 0 Bond 13
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 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 13 Agent 13
t 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 .cork and installations performed under Permit Issued for this application will be in
,_cmpliance with all pertinent provisions of the Massachusetts State C�Crr W of the General Laws.
Si nature of Licensed Plumber Or Gas Fitter
Title
By. Plumber
CitylTcwn Gas FittertL �ense . um er
lfaster
�\-PPROVED OFFICE csE ONLY) ourneyman
Date ..............................
NORTH I
0-
TOWN OF NORTH ANDOVER
0
'PERMIT FOR WIRING
US
This certifies that ....eo iv-rl.P.v.o....
.............. . .. ...
has permission to performem, rTA,
wiring in the building of ... .. . 4............................................
at............1.3�. ...... ........... ,North Andover,Mass.
............... ........
...... ..............
ELECTRICAL INSPECTOR
Check #
6 6
!L\ Commonwealth of Massachusetts Official rUse Only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Map&Parcel
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
WORK
All work to be perfomud in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA9 Date: ::�
City or Town of: .. IZ7-1/ .41,W1/.�� To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) l 3 C lZ /G'&',67E A¢fyr�
Owner or Tenant //�_J&Tg,� Telephone No�7�j)/„��.-
Owner's Address
h this permit in conjunction with a building permit? Yes 0 No ❑ Building Permit#
Purpose of Building CZWM/ Owkr.: Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volta Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: u//j2/ � �� /r � A,E/,"" V
Com letion of the foliowin table ata be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceti.-Susp.(Paddle)Fans o.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tuba Generators KVA
No.of Lighting Fixtures �` Swimming Pool ove n- f4o.Of mergency Lighting
rnd. arrid. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.of Detection an
Initlatine Devices
No.of Rankes No.of Air Coad. Toone tal No.of Alerting Devices
No.of Waste Disposers ea ump _Number ons _ ____ peoie
e oats n
Totals: ""' Detection/Alerting Devices.
No.of Dishwashers ��� Space/Area Heating KW / Municipal
Connetion � Other
No.of Dryers Heating Appliances KW ystems:
of Devices or E uivalent
No.o stet KW o.o o.o Data Whing:
Heaters Signs Ballasts
No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications g:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Vires.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
'
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE Q BOND 0 OTHER ❑ (Specify:) —9/17/,Ds
(Expiration Date)
Estimated Value of Electrical Work: (When required by,municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I eenO,under the pains and penalties of perjury,that the information on this appUeatlon Is true and complete"
FIRM NAME: LIC.NO.:A 1 1 9 8 3
Licensee: LOUIS CONT I NO Signature LIC.NO.:E 2 8 7 8 8
(If applicable,enter"exempt"in the license number line.) Bus.Tel.NoB7 8-3 6 3—5 42 0
Address:_ 1 DQNQX7AN nu iFcm NFWRTJRY NA 01985 Alt.Tel.No.,
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally `
required by law. By my signature below,I hereby waive this requirement. I am the(check one owner owner's agent
Owner/Agent PERMIT FEE:$
Signature Telephone No.
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. (v I( J 6
BOARD OF FIRE PREVENTION REGULATIONS Map&Parcel
. A
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMAT701� Date: _37,0A
City or Town of: No kTtf To the Inspector of Fires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) / 3 f C/Z /e4-,, 7- ,",z
Owner or Tenant/J% R'd-T-Ar44 Telephone No�
Owner's Address S
h this permit in conjunction with a building permit? Yes No ❑ Building Permit#
Purpose of Building S/JyUtility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No,of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: W- j -Z&4=-
Com1p
letion Of the ollowin table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Cell.-Susp.(Paddle)Fans o.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
oven- o.o mergency Lighting
No.of Lighting Fixtures �` Swimming Pool rnd. ❑ rnd. ❑ Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.of Detection an
Initiating Devices
No.of Ranies No.of Air Coad. Toone tal No.of Alerting Devices
No.of Waste Disposers Heat Pump I_�um er ons_ ___ o.oSelf-Contained
Totals: "�' Detecdon/Alertfng Devices.
No.of Dishwashers 0/1 � Space/Area Heating KW / Local ❑ Municipal El' Other
Connection
No.of Dryers Heating Appliances KW Security Systeamms
No.of Devices or Equivalent
No.o Water KW o.o o.o Data Whing:
Heaters Signs Ballasts
Na of Devices or Equivalent
' No.Hydromassage Bathtubs No.of Motors Total HP a ecommu ca ons
No.of Devices or E uivalent
OTHER:
,lttach additional detail if desired,or as required by the Inspector of Fres.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
! undersigned certifies that such coverage is in force,and has exlubited proof of same to the permit issuing office.
CHECK ONE: INSURANCE PA BOND ❑ OTHER ❑ (Specify:) 9/17/ 0,9
4
Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certijjy under the pains and penalties ojperfary,that the information on this application Is trite and eompide.
FIRM NAME: LIC.NO.:A 1 1983
Licensee:
LOUIS CONT I NO Signatu77���`
ztih�'' LIC.NO.: E 2 8 7 8 8
Af applicable,enter"exempt"in the license number line.) Bus.Tel.No.�7 8-3 6 3-5 4 2 0
Address: 1 TICINQ AN nR WF'CT NRWRTJRV_L4A 01985 Alt.Tel.No.;
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement I am the(check
r2g!JQ owner0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE.$
s
—gel,
i
Location �3/�/'iG .�174
No. Date rK
�ORTM TOWN OF NORTH ANDOVER
S.
Of,•J• �,7.0
F 9
• Certificate of Occupancy $
,'�s• E<�' Building/Frame Permit Fee $ `a y-� 0
s�cHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
19"17
Building Inspector