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HomeMy WebLinkAboutMiscellaneous - 140 ACADEMY ROAD 4/30/2018 BUILDING t a North Andover Board of Assessors Public Access Page 1 of 1 MORTp North Andover Board. of Assessors Of •�ao y:MO e A siroperty Record Card Click Seal To Return Parcel ID:210/096.0-0033-0000.0 FY:2013 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels i Search for Sales f 3 Summary Residence Detached Structure x � Condo 140 ACADEMY ROAD Commercial Location: 140 ACADEMY ROAD Owner Name: STEVENS,ROBERT DALE Owner Address: P O BOX 116 City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:7-7 Land Area: 2.85 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 8268 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 1,072,600 1,002,200 Building Value: 823,300 761,800 Land Value: 249,300 240,400 Market Land Value: 249,300 Chapter Land Value: LATEST SALE Sale Price: 0 Sale Date: 11/01/1985 Arms Length Sale Code: N-NO-OTHER Grantor: Cert Doc: Book: 02073 Page: 0040 http://csc-ma.us/PROPAPP/display.do?linkld=2256016&town=NandoverPubAcc 3/19/2013 Residential Property Record Card PARCEL ID210/096.0-0033-0000.0 MAP:096.0 BLOCK:0033 LOT:0000.0 PARCEL ADDRESS:140 ACADEMY ROAD FY:2013 PARCEL INFORMATION Use-Code: 101 Sale Price: 0 Book: 02073 Road Type: T Inspect Date: 01/11/2011 Tax Class: T Sale Date 11/_0.1/85 Page_ 00_4.0Rd Condition: P Meas Date 07/05/2002 Owner: Tot Fin Area' 8268 Sale Type. Cert/Doc: Traffic: _ 'M Entrance _ STEVENS,ROBERT DALE _ Address: Tot Land Area: 2.85 Sale Valid: N Water: Collect Id. SGC _ Grantor: Sewer: Inspect Reqs:_- M P O BOX 116 - — -. __._ ... NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% I Open Sp-B/L% I RESIDENCE INFORMATION LAND INFORMATION Style:, CL Tot Rooms: 9 Main Fn Area: 4134 Attic: Y NBHD CODE: 7 NBHD CLASS: 7 ZONE: R3 Story Height: 2.00 Bedrooms: 5 .Up Fn Area: 4134_Bsr it Asea: '1686— "Seg Type Code'Wethod "Sq-Ft' "Acres Influ-Y/N Value C1ass__7 Ro "" """ 1 P 101 S 43560 1.000 235,254 of: Bath �s:- 5�� Add Fn Area: �� —'Fh Bsmt Area: Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: G 2 R 101 A 80760 1.854 14,090 ' Masonry Trim. Ext Bath Fix:__'_0__ Tot Fm Area_:6268_ Foundation: 'CN Bath Wk "T RCNLD. 779962 DETACHED STRUCTURE INFORMATION Kitch Qual: T EffYr 9u lt: —1970 Mkt Ad - Str Unit Msr-1 Msr-2 E YR-Blt Grade Cond%Good P_/F/E/R Cost -Class` j; Heat Type? ST Ext Kitch: Year Built: _ ti.1846 Sound Value: G1 S f576 0.00 1988_ A A 501//50 9,200 _�.. B1 S 870 0.00 1988 A A 50///50 10,400 Fuel Type: G Grade V � Cost Bldg: 780,000 ' G1 S 435 0.00 1988 A A 50///50 7,700 Fireplace 3 Bsmt Gar Cap: Condition A Atf Str Val 1: - GR S 270 0.00 1988 A A 50/// 12,000 Central AC: N BsmtGar SF:' Pct Com tete " Att`Str VaI2 TAtt Gar SF: %Good P/F/E/R. //100/79 DW S 383 0.00 1988 A A ///85 4,000 1 VALUATION INFORMATION Porch Tvae Porch Area Porch Grade Factor Current Total: 1,072,600 Bldg: 823,300 Land: 249,300 MktLnd: 249,300 P 528 Prior Total: 1,002,200 Bldg: 761,800 Land: 240,400 MktLnd: 240,400 E 78 W 175 SKETCH PHOTO 19 \ w 1 q.Ft 22 32 23 4134 Sq.Ft + .� 0 Sq.Ft' Ass 35'35 ".Ft 54 29 1686 Sq2FtSq'Ft 5 140 ACADEMY ROAD 1 �.Ft Parcel ID:210/096.0-0033-0000.0 as of 3/19/13 Page 1 of 1 140 i -2,1�q� - T 0 W It" C L IE R K'S OF F QCT II: ~ A six wide,six foot deep hole will be excavated to instil alae tracker s portion of Mr.Wakeman s property. Tri T 17 Z1, V A'SSACT1,,?Ir r, re-cast concrete base,with the removed material backfilled arouxid the base.A 218'lori`g, 20"deep trench will be dug from the tracker to the house to connect the tracker with the home's electric service. ` Owner(Agent,Contractor) DO NOT WRITE BELOW?HIS LINE Received for historic district commission: Time: Date: By: 1-f ''� 2 c1 r;2AJ tl Application No: 4?' THIS APPLICATION FOR CERTRIFICATE OF APPROPRIATENESS: ( ) APPROVED ( )Disapproved Reason for Disapproval: A c iL;Vf✓T NA c ��Rc;>✓ILEO �C J s7`;,l �'� - (IJf NO CERTPJFICATE OF APPROPRIATENESS REQUIRED �'� F MIS iA1! G1', l� �'iC 6)L) G<:� U� UJ,1/Do �sr A CERTIFICATE OF APPROPRIATENESS IS FOR WORK DESCRIBED IN THE APPLICATION ABOVE AND ATTACHED DOCUMENTS SECRETARY: .p Chairman: _ /�� /2 Members It /v//21 7 I L I i F'n i . ., a pro{posed tra�k�r {�Cati01 I; I _ � 1 "S�h * �� ,j,} •' r ��, � ~����w miry j _ "tea.amt `t.e$ k.1��..$$j]j] l i ATFIE {,=' �yy Slj "i x ., i ..•\ 1� d is •�'a .x � �•� t All�.� � '\ '' � ►i�liaiiiRli 1+�� i + �' fi� � >sn < {, ,fir{� � t + a gffit �T►sfp j 1 +• I >f ,; \`_ jA �� �� '\1. \+ W 1 t 1 �lyy+zk .� �t�' y��` x,•x f., ,,,t,, LE WIF �,��„N + U�e� i p � a•, -ti i � 'c we .,,, LLL..333 r > r '•rya q.. O.1t�_ 1 1 1 I ,� Fl _ .r• \ XF '.� k i.� ��f ,€ _ _•_ _• 1 i I 1 4 I �� ,r'B+` {��-"j 'S gnq10 4Eat 13 sr jut (►p���r'- opµ p �, � � ., r °, �`1 +� y_ IF .0 'j}. u uw� 1^ i I L..' + LI� 1 i 1 © iL.l .�aL7fj ')�N'� �• ie ' 'r '' ss`.3 uuwWWl�Ll�ut�ll;�utw;►ui. Lu ;uuull��;+d olutit'' '41b� ,� , i,yfr } 0B d .r' �•. Coll 3� � �'S' -t -�1: ( •f ��� ..��✓ �'� f •S�`�b t w.3�i it}ta� 7 'ei{6Gt�LR3tx'KAmwJ�J��� 1i y k �( Sw y , 1 , proposed tracker foc.atior� a s f it Lhe Path Polygon Circle 3D path 3Dvolygon Map Leno: 432.79 1 Feet y� Ground Ltr9th., 432,82 h4 a•...� _ "- - - Headft: 245.21 degrees 'Wit i �. tf -�^ryryy �G 0 x DIVED cwni 4MI-It z-1171XX 10 1smsoweaYus 2017 OCT 13 AM 11: 5 7 -.0 A-w mw fkiff) jj1 —.—141"Uummlw SSVH' �VGAOONV ON U/ RU-07 JO UDW ovoy !reap emxv+:n ay oxrtwetWKlwtrueA 1 UV it i Wit ts zo-at 101 %Mr-POW-1 IN, liltt ws Ot'" aw TY %cNr A-M, -Wit kD)D(4 boq Y b !1W LM f1YeO/I e r' AU6MM7 A11CiO �ryq AZIAlkErv. V� .p11}IIIO'EY OV/IV/ Akdl .e7 �>! l/A.NIIP'I AEtl / 01 JAtl' IQM1Y e111/kRY,�lgy/W�Rlyl�my d.M. �� tnM • 'W �1/l�O1 MEfM JIpII�C/IC IL{V Qd•1.1o. P.Ls. Lar Is E81 ��o y 117 MW 99" M1KY Ittl J!lMTT ° Lm 1&-82 gl , /y .:�e� 27.359&F. A20L IZ I �tmamvr° C w rm. L q� .a., nt1��t l �•�;two.r,.r.av,.t. --- qq feI r nlJ�/'N�W'W/IJ/1J /VmoY OrAi/CCUOS Ai/t1¢e MI1M PAMW OWW ROAD Plan of Land in GR�A���°`°"` No. ANDO10F,, •MASS ~��t�•�7�`!i�i�i.J s}5�i''i �a °.�`ee s s.,.v.� n'�bw•.AA%''rkm� t} � i?� /dJ�p�, .var:/•�.m• v .r Jr w• r .wa.l:�tl/. it•i;.±. Xrn�JYRI.IILWOea+'merw/w A.AWJ! /27,5.,5.ar..J'3 mII fJLIIRIICIO MLb1 MA16Tllm YlAf iS om•.�a�n/mwcrRomonara�.v as�ygt/wn �� / �! ��6SR'���e•�.v -Y �AYMw�er AYa.'�X LJ � £t 1jo 1igd �, �.+�s..ti, twtaY/e..sanew reeve ♦(N I7B-C-aI JM M JAW A-$,[6153x14) a. ,eenrJbawa• .en�,er ar a s J' •r- tr�Mt�•aaa/-maaa 1, ,- _ //.ot.�Marc d-JADD a Date..?.........1.1.:.......... 1 i 2 3 of"oar"_'tie TOWN OF NORTH ANDOVER * PERMIT FOR PLUMBING l��,ssACHU�Stg �� � �This certifies that.S- �........ ............................................................................................... has permission to perform...�.''...O�.....ti'°..0 "..�....w. ... . plumbi gin he bui dings of....W....� . ...................................................... at....... a... .+ ..........F-O'..:....................... North Andover, Mass. Fee .0.6. ......Lic. No. ..................` ................................................................................. PLUMBING INSPECTOR Check# v MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY bitoc o 'P!*d A MA. DATE Ll PERMIIT# 11.2f 3 Nor JOBSITE ADDRESS No 61C ��L�Vi'"-I l�� OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO ❑ FIXTURES Z FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYS DEDICATED GASIOIUSAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / WATER PIPING 0 HER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch.142. Yes& No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: 1 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 BOX ONLY: OWNER ❑ 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 Chapt 142 th eral Laws. PLUMBER NAME STEPRE0 C- GALIPSKY SIGNATURE LICW- 103/11 MP[?r JP❑ CORPORATION d# 19 b PARTNERSHIP F1# LLC ❑# COMPANY NAME 6AL4tjsKY PLUJAO Jim *- RVAT'ILIG ADDRESS: P.b• GGX 1701 > CITY j4AVCR"II-L. STATE rA-A• ZIP oi%3i EMAIL WWW• rod" ivrAbe 1 Co TEL COV-37q-1743 CELL 50t-,6001-5g0i4 FAX 976-x ,11-L4131 i ROUGH PLUMBING INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES s Yes No I THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ I FEE: $ PERMIT# PLAN REVIEW NOTES I ii 1 i 1i I i I II� 1 i Date..g1!7tk5 �,►ONTH i OF ..eo � 1ti TOWN OF NORTH ANDOVER " PERMIT FOR GAS INSTALLATION t Ss'�CHUSE p Phis certifies that ..... .........C-�•J..... ��`� .. .. `....................................... ............................. has permission for gas installation ... ..®. ?--....................................... in the buildings ofn.......WG �c e.inn,r4�.................................................................... at............. .......... ...A: ..+ ... ....................... North Andover,Mass. Fee..:3.0. Lic. No. ..�. .`.�......... GAS INSPECTOR Check# 10 M ' I � ' I -� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: �..�.C�tL1(� w�y F�-l!`'(S" MA. DATE: �• �1-� PERMIT# /d�g 3 Cr- JOBSITE ADDRESS: L�� PVC✓&IO C4-' j /t. OWNER'S NAME: GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALeR PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES? FLOOR­- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER 4 LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Y NO ❑ if fou have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY [ OTHER TYPE 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are tr e 9nd accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application w in colrwliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTERNAME: STEPHEN C. GALINSiCY LICENSE#. 1034 SIG ATURE COMPANYNAME: GALI► sKq Pf.c1MA106 -t 11415--WtIO& ADDRESS: P.o. RDX 1701 CITY: 9AVEg-Hi1,L, STATE: In-A ZIP: 01%31 FAX: 0179- 521-4 3i TEL: 97>3-374- 1743 CELL: 5�q- 6tDA_ S90q EMAIL: W-vv"v . m umbe 01 v+1 I MASTER[r JOURNEYMAN❑ LP INSTALLER❑ CORPORATION[�# 31�b PARTNERSHIP❑# LLC❑# r ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INS P CTION NO S 4 Yes No , THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES COMMO W ACTH OF MA SACHl1SETTS:. • SOAP j PLUMBERS AND GASF.:ITTERS 4 ISSUES THE FDLLaWIN� LICENSE a , 1 REGISTERED AS A PLUMB NG':CORPl I Zia I= STEPHEN C 'GALINSKY (7 GALINSKY PLUMBING � HEATING. INC(J j�vZ i P.D. BOX.: 4vU glH I LL MLA o1831-2401 o5, ,/01/16 199 i 31. , a COM ONWEAL H OF MASSACHUSETTS,` o • • - a e i BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE - r LICENSED AS A MASTER PL-UMBE13 w. ,N STEPHEN C GALINSKY ;r -� 4 PO .BOX . 1701 HAVER ILL MA 01831-2401 " 103`48 05/4..1/16 19.9248 a COMMONWEALTH OF MASSA HUSE, • @OARD OF I i' PLUMBERS AND GASFITTERS ' ISSUES THE FOLLOWING`LIirENSE LICENSED AS A JOURNEYMAN PLUMBERll STEPHEN C GALINSKY r4Saw z Y I�, N PO ,BOX 1701 :HAV€RHILL _ MA 01831 2401 20 11 Cr5i 05/01.C.1;6 199247 v ) ...................... Date....... / NOR T/, TOWN OF NORTH ANDOVER % PERMIT FOR WIRING t `P$gCHUgfc This certifies that ......... .. .L.G ,....f.,,. L ':j_ `" ................... .................................... has permission to perform .........L° � ......................... wiring in the building of.....................W.... c.M! ................................................. at ......./.q....0.... North Andover,Mass. OG Fee... ..........Lic.No. .. 1� ........ ..............l...................:.......... '....... ELECTRICAL 1NSPIyCTOR f Check# �� � / 717 n7 Commonwealth of Massachusetts Official Use Only � Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/071 leave blank N 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 INFORMATION) Date: 4 13., ,5 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. ' aJ Location(Street&Number) eu, ""c'r Owner or Tenant �, Wel.\.A �a��� Telephone No. 4;I1- ?,Jf- 73`I LJ \ Owner's Address kvw w .er Is this permit in conjunction with a buildihig permit? Yes ❑ No (Check Appropriate Box) Purpose of BuildingSZ,.c'�•e Utility Authorization No. IA1 1 1 3 t Existing Service op Amps \ / ,Volts Overhead N,.-XUndgrd❑ No.of Meters IL New Service 'moo Amps \ate / >\ko Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: _�), crr.reu.nA Sere weer , s�a� Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ced. Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones r No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Tot r. No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump i Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances ICS' Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (,,O 0 0 (When required by municipal policy.) Work to Start: 5.-W-I<- 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 cover is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties ofperjury,that the information on this application is true and complete FIRM NAME: a�� ` C_ LIC.NO.: ao Licensee: Signature LIC.NO.: (If applicable,enter"exem•,�t"in the license number line.) Bus.Tel.No.: q - -I BO Address: 'lk L-4 Ave QftJrtn ' Ml 6l1=35' Alt.Tel.No.: 7 -37 f le) *Per M.G.L c. 147,s. 57-01,security work requires Department of Public Safety"S"License: 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 1 Signature Telephone No. PERMIT FEE.• $ 1 vp�,vc�k _ zj 6- 26 - ''t t Date. . ... .. . TH Of NOR ,41 o� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION s a . y ACHUSE�,( \\}} 'rte. i This certifies that . . . . . . 4 ftp!. .`.� . . . . . . . . . . . .. . 'has permission for gas installation . �c c �f. . . . . . . . . in the buildings of . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . r�. . . '�?'- .---c . ., North Andover, Mass. Fee... '... . Lic. Kol,-;P, .. . .' ,� . . . . . . . . . GASINSPEGTOR w Check# 4621 i MASSACHUSETTS UNIFORM APPUCATOI(FOR P TO DO GAS FITTING (Type or print) Date -3—0'-/ NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount$ � Ro ue'2T S-'e f✓eois Owner's Name New❑ Renovation ❑ Replacement © Plans Submitted ❑ i k w � U 0 U � � � F d� a O O F a U dW xF� z OF p rt �j m a w x w w F a F z d x H c c Ox 3 A ca.7 U C > A a tw• SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH. FLOOR (Print or type) QfLegk one: Certificate Installing Company t Name T 411-4 Lj Corp. d Address d' 13 O X S 7.?, ❑ Partner. L4i4-j4epve,e 144 ea�a' SQL Business Telephone 97 (,b'S- 9 ,-o y ❑ Firm/CO. Name of Licensed Plumber or Gas Fitter TL/v,-jos 1144 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesE] No❑ Ifyou have checked M,please indicate the type coverage by checking the appropriate box. ,Uability insurance policy ® Other type ofindemnity ❑ 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 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code an Chapter 142 ofthe General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber a 9 4 33 City/Town ❑ Gas Fitter License Number ❑ Master APPROVED(OFFICE USE ONLY) © Journeyman �L . Date.t--P. a TOWN OF NORTH ANDOVER �• o PERMIT FOR PLUMBING ,SSACMUS� .l This certifies that . . . . . . . . . .'4'.' . . .'!. . . . . . . . . . . . . . has permission to perform —�� -�...{-. . . . . . . . . . . . . . . plumbing in the buildings of ... /:>=� :s!�. . . . . . . . . . . . . . . . . . . at . . . �`� . . .? �Y�� . . . r��-�. . . . , North Andover, Mass. Fee.... . . . . . .Lic. N . . . . . / PLUMBING INSPEc Check ff 5886 i i 1 MASSACHUSETTS UNIFORM APPLICA IO FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 2^3^o I Building Location/yo 4Ce4&-,n y R-0 Owners Name 1i06e,1T S7fUC"-'5 permit# !!�� Amount Type of Occupancy t✓(/U le j 1 i AJ New "ri Renovation Replacement .© Plans Submitted Yes No FIXTURES ri Cr Cr S WSW" ]ST)NID(Yt a (Pript or type) Check one: Certificate Installing Company Name T A LL r�"�� © Corp. Address f D - 6c>-e<, 5 7 0 Partner. Z A wfZ ,vice V-1A 0/sq Z— Business Telephonecj 7 5-X15 G y D Fmn/Co. Name of Licensed Plumber: 7�L/o Al 0 S f-411)1?1j^-j Insurance Coverage: Indicate the type of insurance coverage by checlong the appropriate box: Liability insurance policy Other type of indemnity D Bond D Insurance Waiver. L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance i-& ature Owner El 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 P bing Code and Chapter 142 of the General Laws._- By: rgna ure oT Licenseaum r Type of Plumbing License TitleAyr j3 City/Town ]C>-erase i um er Master D Journeyman APPROVED(OFFICE USE ONLY