HomeMy WebLinkAboutMiscellaneous - 135 LISA LANE 4/30/2018 - 135 LISA LANE i _ �_-
210/098.A-0063-0000.0
2 t
Date. . . . . . . .
7 TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
,SSAC04US
This certifies that . . . .. . . . . . . . h.t.C . . . . . . . . . . .
has permission to perform . . . 1-fla r. . . . . . . . . . . . . . . . .
plumbing in the buildings of -T/-7�- ... . . . . . . . . . . . . . . . . . . . . .
at . . .P 4.z... . . . . . . . . . . . . . .. North Andover, Mass.
Fee. . . . . . . . .Lic. No..
PLUMBING INSPECTOR
Check #
8372
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: L
--------�' MA. Date:- _-- -� /v Permit#_-�--
ii
Building Location:-_�J_ __ iu�C�__Lz,ice_ Owners Name: �/7-
Type of Occupancy: Commercial ❑ Educational.❑ Industrial ❑ Institutional ❑ Residential
New: ❑ Alteration: ❑ Renovation: ❑ _ Replacement: Plans Submitted: Yes❑ No
FIXTURES
F z
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Q Q N JO. Q O H Q a O = OJ . Q 2 0 0 0 H
Q m m u_ 0 _ Y —1 J to 0 1— 5 O
SUB BSMT.
BASEMENT
_TsT FLOOR
-
2Nu FLOOR
3 FLOOR
4 FLOOR
5 1H FLOOR
6 FLOOR
7 1 HFLOOR
81HFLOOR
Check One Only Certificate#
Installing Company Name:_ � �L-v_". .ta:
corporation
Addressl j/0101k_ City/Town:
N '�(___ State:
❑Partnership -------------
Business Tel:_�3 �_Z! _. Fax:—�e� �_7z ____
. ❑ Firm/Company ------___--
Name of Licensed Plumber: W /N%e'o
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes)�I_`No El
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 ❑
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
----- --------=----------------- Owner El Agent ❑
Signature of Owner or Owner's Agent
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 Plumbing Code and Chapter 142 of the General Laws.
By---------------------- Type of License:
-- ---- - -----------------------
---
riue lumber Signature of Licensed-Plumber
-- — — --- aster
City/Town — ❑Journeyman License Number:
APPROVED OFFCE USEONLY— --� G�--C---
_—
FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S)
FEE: $ PERMIT#
APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
SKETCH
PLUMBER
LICENSE NUMBER:
PERMIT GRANTED 17] DATE:
PLUMBING INSPECTIOR.
Date.....q.....`.. ................
NORTH
°�<<``°:•�4, TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that r l �Yl
has permission to perform .......F le o .�`
................. .................................................
wiring in the building of...7�!. 0 N—�
....................................................................
4 at !.J.S .... S�5 L /\J. ....................... .North Andover,Mass.
...... ..............................
1.
Fee..................... Lic.No..............6 ) � � . �E [u I
..............................................
ELeCTRICALINSPECTOR
Check # b
4723
THE C0MM0NWE4L7H0FMASS4CHUSE7TS Office Use only
DEPARTA&W0FPUX1CS4FE7Y Permit No.
BOARDOFFIREPREVEMONREGUL4HONS527CMRI2:00
Occupancy&Fees Checked
APPLICATIONFORPERMIT PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE W 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) �tiJ J L /r j G, G Y1 -e—
Owner or Tenant T 1 )Cj Y\.Lo
Owner's Address �35� L i 5 Gc t( ►\
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box)
Purpose of Building T d j 1 a-10 y) Utility Authorization No.
Existing Serviced-OU Amps/ /Volts Overhead � Underground No. of Meters
New Service Amps olts Overhead =1 Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work1/•�r�u`� G (— Add i 4-)'0 i1
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
KVA
No.of Lighting Fixtures G Swimming Pool Above Below Generators KVA
ground round
No.of Receptacle Outlets / No..of Oil Burners No.of Emergency Lighting Battery Units
(p r
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
1
OTHER-
i
In.AuanceCowaage.Ptustlauttothe regmartaltsofb'1assadaCena'al
Laws
IbawaanerfliabilityhUanCCPblicyinchxln)gCoMPkte OPffaftOm CovWd9e0ritsMbsWfA legnvalffit YES 4E1 NO ED
IhavestllmtMdvandptoofofsametodrOfce YES ffyouhavedrcl�dYES Flt eir thetypeofcovaageby
clxcldrlgthe box
INSURANCE BOND OMER (P1se Specify)
ElgmationDate
Estiffl&dValaeofEbchJcalWotk$
6 �3 Fina[
- Dai
WotktoStatt h>.speatott Requested Rough �//
SignedundcrTr - of eajtny ` y1/
FIRM NAME ��- J Y11 !+!r°Il S�� I YC �( � Lim No. 3 / 10
�-S
LicMTC f k� �� . �Wl I Tom\ Signattue LKffwNo
(( //
Business Tel No. ,l50
Ate' 1lo � dllnYllSt �� - i �t`f► , 1� '- D/�aZ AttTUNo. 1`J�"�71=3y7D
OWNER'S INSURANCE WAIVER;I am awate aa the License does nothave the ilm uarim covmW orits substantial aluivalent as ieyt>uedby Massachusetts General Laws
and ttki my signahue on this permit application waives this mquiteamL
(Please check one) Owner Agent
Telephone No. PERMIT FEE$
Signature ot Uwner or Agent
_ w The Commonwealth of Massachusetts
G M
T Department of Industrial Accidents
Office of Investigations
F<
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Name Please Print
Name: �)('1 G IJ . �m I
Location: STB Me r C i
City �� Y Cct . IT rl021 Phone # �/? i�i�7
1 am a homeowner performing all work myself
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. Policv#
Company name: ,
Address
City: Phone#-
Insurance Co. Policy#
Failure to secure coverage as required under Section 2M or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,5oo.00
and/or one years'imprisonment_as_weU_as_civil_penattiesin.thelmn-fa_STOP WORK..ORDFR,and_a.fine_of_($1110M)-atlayagainst.me_ i
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
i do hereby certify the pa and a ofperjury that the information provided above is true and correct
Signature Date �111�'1 3 ,
Print name Of) A n Pbone# /Z� 4�7—7��3
Official use only do not write in this area to be completed by city or town offiaar
City or Town Permit/Licensi
El Building Dept
E]Check if immediate response is required 0 Licensing Board
El Selectman's Office
Contact person: Phone#: o Health Department
Other
c
Y
j Location
No. 90 Date R- -2 U_
r �
�ORTh TOWN OF NORTH ANDOVER
O64 ,60 ,•1ti0
F?'• •• O�
t s
• i ; , Certificate of Occupancy $
cMusEtn Building/Frame Permit Fee $
Foundation Permit Fee $ _
Other Permit Fee $ jD.nG
TOTAL $
Check #
Building Inspector
r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .qq
BUILDING PERMIT NUMBER: DATE ISSUED.
0 3X 70
�
ic
SIGNATURE:
Building Commissioner/Inspector of Buildings Date Z
SECTION 1-SITE INFORMATION 0
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
l lz AC�-j, 1 UU
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
R aired Provide Required Provided Required Provided
2J 2.
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System:
Public Private ❑ Zone Ontside Flood Zone Municipal -. On Site Disposal System 0
.,SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M
2.1 Owner of Record
ame(Print_) Address for Service
aiure elephone
2.2 Owner of Record:
SA✓"f-- p
Name Print Address for Service: z
M
Signature Tele hone
SECTION 3-CONSTRUCTION SERVICES 90
3.`1 Licensed Construction Supervisor: Not Applicable ❑
Incensed Construction Supervisor: b'S3 U Ol O
' Z �4 sd' (�L ���� � License Number mn
(Address
�b6 -s 5'
Expiration Date
Signto a Telephone r
i
3.2 Registered Home Improvement Contractor / Not Applicable ❑
Company Name b m
j C Registration Number r
ddre r
Expiration
Si nature r Telephone V
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.......0
SECTION 5 Description of Pro osed Work check au applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition
Accessory Bldg. 0 Demolition 0 Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be s. QF 'iCIALUE01 Y '
Completed by permit applicant
1. Building (a) Building Permit Fee
U -multiplier
2 Electrical (b) Estimated Total Cost of
Construction
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 CONTRACTOR APPLIES FOR BUILDING PERMIT ti
as Owner/Authorized Agent of subject property
ereby authorize to act on
y bMiaIl att rs r ative to work authori d is building permit application.
n 13b1
Si ature of r Date
SECTION 7 WNER/AUTHORIZED AGENT DECLARATION
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
I
in i e 61I
r.
Si ature of Owner/A e Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINIBERS y„ 1 s 2 ND 3 RD
SPAN t
DIN ENSIONS OF SILLS
DINIENSIONS OF POSTS
DINE,NSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY Md
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
pati xj
I
J oYcE
I
bSf
-LOT 3LOT
V 0 D 23
Jo w IRY
,135
n
kN �Girclp�\
U) %
180.2'7'
LISA L/ ,AE_
. mwrairoHOF =
uNEs'c�TlON
HOF ONLY.AMOREACCURAIElOC1T10N
WLLREOtW1E AN k151RUtdBIT
JOHN S�AVEY.
HENRY
CIARCIA
10G13
Scale:
-iAQC�A
§SIGNAL LANDSURVEYOR, AMERICAN SURVEYING COMPANY
' 'NEREBY. ERTIFY THAT THE
OYfg�AOH7GAGE INSPECTION 1264 tV4tifl Stmt,WBIttlarn,tIAA 02451 (781)893fi4n
Lti
WAS:
AS PREPARE '
I OL
rToeP R, -
I IS NOT INTENDED OR REP E. Mortgage Inspection Plan
IS N07 INTENDED OR REPRE-
ITE SURVEY.
BEA LAND RN RS WERE THE LOCATION OF THE ORIGINAL RECORDED AT COUNTY REGISTRY OF DEEDS
ROPERTY
SURVEY.NO CORNEAS WERE 9 ` '
IT.�IyQI BE USED FOR ES DWELLING SHOWN HEREON EITHER BOOK �� P C. bZ L8 N96G
ILISHING FENCE. HEDGE OR WASINCOMPWINCEVMTHELOCAL PLANA Efi:RENCE:
INNGUNES.THELANDASSHOWN APPLICABLE ZONING BYLAWS IN EF•DRAWN PER TOWN OF ASSESSORS
' IEON IS BASED ON CLIENT FUR. FECT WHEN CONSTRUCTED WITH RE-MAP I PARCEL DATED
4ED INFORMATION AND MAY BE SPECT TO HORIZONTAL DIMENSIONAL ADDRESS'145- H{{SS- P. YVl
UECT TO FURTHER OUT-SALES. REOUIREMENTSONInORISEXEMPT
WMEASEMENTSANDRIGHTSGF FROM VIOLATION ENFORCEMENT AC:GORROWER:SU Z6kw s 4 V I)JGt:%r'['T1 onJT .
!.ma RESPONSIBILRV IS E•%•TmuNDERmAsS-GJ-mTLEvgCHAP. x
DEDHEREINTOTHELANDOWNER 40A,SEC.7,UNLESS OTHERWISE SURIECT DWELLING UES IN FLOOD ZONE
OCCUPANT,IT 6 NOT INTENDED NOTED OR SHOWN HEREON.A CON-AS SHOWN ON NATIONAL FLOOD MU
R NCE pppGggy�F�pOg
IE RECORDED. FIRMATORY INSTRUMENT SURVEY INSURANCE RATE MAP DATED. `JAI pJE L�1`7%3
moo U"ADVISED WHEN STRUCTURES ARE COMMUNITY_PANELS aSo o9 I>'a6c
F SHOWN TO BE 1.OR LESS FROM
.Nr.1'n\)4i'P?l FIELDED DRAFTED CHECKEo
o cs0 t O PROPERTY OR flEOUWED ZONING SN2 E'T" -we-
_NT REF�t^^, __ SETBACK LINES.
III
9
1 72> A
FORM U - LOT RELEASE
. SE 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 c>2�,•,� 1�, ,��, f� �-,/�,c PHONE_-, --5-335- �
LOCATION: Assessor's Map Number M PARCEL .A 0)63
f
SUBDIVISION LOT(S)
1
STREET ST.NUMBER__L3_!r-
***' '''. � `y'*►� OFFICIAL USE
RECO MENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRA OR DATE APPROVED O 3
DATE REJECTED
COMMENTS
-V
TPLANNE DATE APPROVED
g p pC%rd) DATE REJECTED 5 9003
COMMENTS n ry
PLANNIi
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED j
i
SEPTIC INSPECTOR-HEALTH
DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS-SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
I
• _ ` a The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02111
`''�+M 5�•'' Workers'Compensation Insurance Affidavit
Name Please Print
Name'
Location:
City Phone # a,Z
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 rry employees working on this job.
Company name:
Address -RD 4"-+",c
City: N i L . �"�► 0 !'i`2 Phone#- C1 11�� (��i/i3
Insurance.Co. LL'a C4 v Poli: l./ L✓�--L(Z,� �rj
Company name: ,
Address,
City Phone#-
Insurance Co. Policy
Failure to secure coverage as nequired.under Section 25A or MGL 152 can lead to the imposition of criminal pernalties d;a fine
wpto si.saai:cw �
and/or one yews'imprisonment_as_welLm-cbd wakies.io3heSoun-d-a.STOPYAORICDRQER.and;afine-f_.(giDp, )AjIWat 1
understand that a copy of this statement may be forwarded to the Office of Investigations of the bLA for c wAwage verification.
/do herb ee►tdY 'rip s anapena/ties of perjury that the inrormafidn provkJad above is true and connect.
I: i
Signature pate 1 l31 U s
Print name e�..�
�w.r � Phone S1� �i•533.�'
Official use only do not write in this area to be completed by city or town oinciar
City or Town PermMicensing
❑ Buildin .
Check if ►espon mediate se its u'ed 9 Dept
�
l
r
L%Ce
Licensing Board9
❑ Selectman's Offilce
Contact person: ?none# E] Health Department
❑ Other
i
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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 is that the debris resulting from this work shall be disposed of in properly
licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A.
The debris will be disposed of in:
(Location of Facility)
Signature of Pe ' App 'cant
it
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
I
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Scoa Lo Giles, ]IoRL.S.
s
Land Surveyor
FRANK S. GILES
50 Deer Meadow Road Bus. (978)683-2645
North Andover,MA 01845 Home(978)683-3924
7/28/2003
HEIDI GRIFFEN
TOWN OF NORTH ANDOVER
27 CHARLES STREET
NORTH ANDOVER, MASS. 01845
RE:PROPERTYAT#135 LISA LANE, ASSESSORS MAP 98'A'
PARCEL 63:
PROPERTY IS LOCATED IN THE WATER SHED
PROTECTION DISTRICT:
THERE ARE NO WETLANDS WITHIN 400'OF THE LOCUS.
IT IS THEREFORE MY OPINION THAT A FILING FOR SPECIAL
PERMIT IS NOT NECESSARY FOR AN ADDITION THE OWNERS
ARE PLANNING TO PUT ON.
VERY TRULY YOURS
SCOTTL. GILES R.P.L.S.
Scott— L. Gil
La nJ Surveyor
FRANK S. GILES
50 Deer Meadow Road Bus. (978)683-2645
North Andover,MA 01845 Home(978)683-3924
712812003
HEIDI GRIFFEN
TOWN OF NORTH ANDOVER
27 CHARLES STREET
NORTH ANDOVER, MASS. 01845
RE. PROPERTY AT#135 LISA LANE, ASSESSORS MAP 98A'
PARCEL 63:
PROPERTY IS LOCATED IN THE WATER SHED
PROTECTION DISTRICT:
THERE ARE NO WETLANDS WITHIN 400'OF THE LOCUS.
IT IS THEREFORE MY OPINION THAT A FILING FOR SPECIAL
PERMIT IS NOT NECESSARY FOR AN ADDITION THE OWNERS
ARE PLANNING TO PUT ON.
VERY TRULY YOURS
SCOTT L. GILES R.P.L.S.
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xAORTH
E
Town of And -
O .-1.
No.
y
O dower, Mass.
' T lAK /�'�)
C OC MICM 1 It�t
ADRATED PPa��S
S �
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........ � C...� ..... 1Q..!V' .........................................................................
Foundation
has permission to a_rect..1C.P. XoZ. .......... buildings on ........ ..Jr..... !.5.A.:.::,l�..A:N.e--............: ,, Rough
�- /'Yl♦ w G iV Chimney
to be occupied as........P" ..........� ....... o, �!?......a�.a..... Via.!' ......m.�?. . . . ........��i....
provided that the person accepting this permit shail in 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 relatin to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. of � d 3 a 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
/n /�j� Service
BUILDING INSPEC'T'OR
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.
• Date. . .f 1. . . . f. . .
RECEIVED PAYMENT,
�ORTM TOWN OF NORTH ANDOVER
OF t.neo ,6 q�L0
0
32,ry A 0 4 iftMIT FOR GAS INSTALLATION
ndover collector
9q _
SA US
This certifies that . . . . . . . . .``. . . . . . .. . . . . . . . . . . . . . . . . .
has permission for gas-install tion . ': . . . . .
in the buildings of . . . . . . . . . . . . ' w/.L . : . . . . . . . .
at . l.- . . . . . . . . . . . . .A . . . . . . . . . . . .. North Andover, Mass.
Fee. .0. .�Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant� Nql Building Dept. PINK:Treasurer GOLD: File
OVIA55/'1t„J`HUSEa •.TS UNIFO.�:f_RM APPLICATIO.�..� .�:C„C� 3��ffii8-.�3*.�tr�_.'"•4ti+,_�-E'9sf�a:JSE1ia27Y4�..aC3 ffi:s.:+NueCdC:.:.: :smW.i.YS.x'v::.�.. L-.SlasyEi:c+a.es3.<tx:a*4.-•-
TN FOR PERM TO DO QASFITTINQ
(Print or Type)
y NORTH ANDOVERI-, Mass. Date 1.213
Building
Location_ /3 Permit # 3
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Vo, N�oU� Owner's
Name JO�coaol/��i�, `✓
Renovation Replacement ❑ plans Submitted: Yes ❑ No p'
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ClJAJU1,71IA/� lL1Ur1-8Oft1T.
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0A0eMeHT ,
�•���f[ 1 OT FLOOR
2ND,FLOOR
Nem l '
!Rb FLOOR
4TH FLOOR
i OTH FLOOR }
OT" FLOOR
W TW FLOOR �
OTHFLOOR
Check one: Certificate
Installing Company NameOQse n//� Gq�? AA
- . Q Corp.
Address 9 ? ,(icy ,�A.1ir d partnership
NO �l/�OvP ❑ Firm/Co.
Business Telephone 48?-O.4O'
Name of Licensed plumber or Gas Fitter_ JOSeRl k y1A, Cq1�Q Aar/
INSURANCE COVERAGE: :Check one
I have a current liability Insurance poll cy or its substantial equivalent. ' Yes [I NoX]
If you have checked yes, please Indicate the type coverage by checking the Appropriate box.
A liability Insurance policy ❑ Other type of Indemnity ❑ Bow ❑
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.
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I Check one:
Owner ❑ A Ant❑.>ry��atuiv u� 5e g
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
kno�Medge and that all plumbing work and Installations performed under the permit Issued for this application will be In etale to the with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genera!
Type o1 License:
Title Plumber n e o nse um at or as or
Mastilter � , `�
�,/T� Master License Number ,
. L�Joumeyman
AfT90YED(OFFICE USE ONLY)
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES
PROGRESS INSPECTION
FEE
NO.
t
APPLICATION FOR PERMIT TO DO GASFITTJNG
i
NAME A TYPE OF BUILDING
LOCAT'!:: OF BUILDING
PLUMBER OR GASFITTER
LIG NO,
PERMIT GRANTED
DATE,x_19
GAS INSPECTOR
f
Date. ,� �/<'2. . . . .. .
RECEIVED PAYMENT
F NORTH N TOWN OF NORTH ANDOVER
Q jt�ED .b'tiQ
H 2 3 fRMIT FOR GAS INSTALLATION
• 9 over Copector
�SSACHUSES
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This certifies that . . ;!`. . - ! : . . . ! . . . . . . . . . . .
i
has permission for gas installation . . . . . . .
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in the buildings of .s.PXX t. . .el X//I. . . .J.R. . . . . . . . . . . . . . . . . . .
at .Ef. . !� . . . , North Andover, Mass.
Fee O??... . . . . Lic. Noi '. . . . . . . . . . . . . o . . . . . . . . . . . . .
GASINSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING/t''�
(Print or Type) C�
. Mass., Date 19 /Permit # G/G/•
Building Location !( LV� '� Owner's Name
ul --/6 �/?
Type of Occupancy Rr-_S 1 PF:Q'(i A►
New Renovation ❑ Replacement ❑ Plans Sub itted: Yes❑ No,
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SUB-8SMT.
.BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
.Installing Company Name CAV 5TA rF—' CiAS (n t Pk09A") Check one: Certificate
Address_ 55 M A R5TQQ <�—1 Corporation C)4 ,c,
!_A W R EtJ E UP, 01841 ❑ Partnership
Business Telephone - 6 8 7- S ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter G�
INSURANCE COVERAGE:
have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
If you have checked yes. 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 Insuranc 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 Owner[] Agent ❑
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 the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GMW
BY. T e of Icense: -lal-ltf 1
Plumber Signature of cense lumber or Gas atter
Title Gasfitter
Master Ucense Number
CRY/Town
PP O E( O I mo_ Journeyman
BELOW FOR OFFICE USE ONLY 'n
FINAL INSPECTION --SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
}
t
I
r
NAME & TYPE OF BUILDING
LOCATION OF BUILDING
t
i
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
a
DATE ..19
__ GAS INSPECTOR '