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HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (41) ti �__ p� <�� 1 �� -- - - - Date. . . ,AOR To o? TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION �,SSA�HUSEt . . . . . . . This certifies that � �.. has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . at . !`! ?. - .: �!. ., North Andover, Mass. Fee—?-q �. . Lic. Nol".F. ' . ,!_ `-� . . . . . . . . . . . . GAS IN, ;,66TOR Check# 69Lr2 f, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CitylTown:; .. �� � Date: Permit# Building Locatic / G .. Owners Name: Lr% Type of Occupancy: Commercial Educational; Industrial Institutional ResidentiaAl GNew:; ; Alteration: Renovation' Replacement:' Plans Submitted: Yes: No FIXTURES WW Y W W O to = to Z I- Q Z -j v W �- � W iw W Z 0 w w a m 0 W W Op a 0 a H N H W J X > W Zrj) ~ w a a = U a W F- a W W w ? = w w o IX W a w W W Z () J < H O Z J z W N � Z I.- H I— _ z � W � a a m w o z o 0 a o LL 0 0 z z W O a W H > > O SUB BSMT. BASEMENT 1 FLOOR 2 NuFLOOR FLOOR 1 FLOOR 5 FLOOR 6 TH FLOOR 7 FLOOR 8TH FLOOR -- , Check One Only Certificate# Installing Company Name ' r y �� r'�' ��; n �. r� )' !.! �..t.. z Corporation rom, i ,,. ,..,..,,r. 0it /To � State MA Address wn/4,1 artners• W Fax . P hip �� -� Business Tel ��` r�� s ��� � � � fLy -� Firm/Company,..:.,. .. _. Name of Licensed Plumber/Gas Fitter:—.l ,„��/, rl.,;. ,,� "'q '� ,v • , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes ,No` M,t If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance otic `) ,k: Other type of indemnity y 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 W Agent " Signature of Owner or Owner's 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 Plumbing Code and Chapter 142 of the General Laws. _._. ............. ,__. ..__._... _..Type of License: By:.. ,.. ...- ..... „...,,._,..�k..n ...' Plumber Title ✓ Gas Fitter Signat re ofL'ce sed Plumber/Gas Fitter Master CitylTown LPrneyman I Installer License Num r: APPROVED OFFICE USE ONLY r -.1 r FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER,GASFITTER,LP INSTALLER LICENSE NUMBER: PERMIT GRANTED❑ DATE: GAS FITTING 1NSPECTIOR Date. . . 9. ... . . Of,NO DTM ,41 TOWN OF NORTH OVER O 9 V ` • PERMIT FOR GAS INSTALLATION 41 . � �7Sg.4c USEt This certifies that has permission for gas installation . . . . . . . . . ...a....!. . . . . . . . . . . . . in the buildings ofd. ..:� -. . - G-�- �' .r -C!. . . . . . . . . . . . . . . . . at .�'��!P '7 (�' z-. ..� `�.1��.?`��, North Andover, Mass. Fee. . .`. . . . Lic. I . . . . . . . . . . . . ., fl /y GASiNSPECTOR Check# /7-0 tr' 64. 94 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date F/71d NORTH ANDOVER,MASSACHUSETTS Building Locations /4T /7?'Vzw srlfe e-T Permit# �O y 9y /� S�T�'r✓ �"�'� Owner's Name Amount$ c� New Renovation Replacement P Doe Plans Submitted w rq U z V1 a ' OW F dF CO W a O O O Z F Fz z < W ��^, a z o o °o w SU B-BASEM ENT C > C6 F O BASEMENT 1ST. FLOOR 2N D . FLO O R 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH .' FLOOR 11brint or type) / Name_ : VZ ,zl f' Check one: Certificate Installing Company /' 11 Corp. _ Address .6-3 �S �itt b 41-' r/V,a 11'3 0 Partner. Business 1 eleptione Firm/Co. Name of Licensed Plumber or Gas Fitter G,y/ AN INSURANCE COVERAGE Check oo6. I have a current liability Insurance,policy or it's substantial equivalent. Yes If you have checked es please' icate the type coverage by checking the appropriate box. No Liability insurance policy Other type of indemnity D Bond 13 Owner's Insurance Waiver: lam 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. Signature of Owner or Owner's Agent Check one: Owner 13 Agent 13hereby certify that all of the details and information 1 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 Massach State Gas Code andChapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title � Plumber -/// City/Town; ❑ Gas Fitter icense um er ❑ Master APPROVED(OFFICE USE ONLY) Journeyman a�j N2 1156 � ........ C.� pORTI� °ft °:•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACHUs�� This certifies that ...............'.:`.'.......:........:........... .......��1..................... has permission to perform wiring in the building of.....t.... .......................................................� at.. �� .. .6...ti ......................................:......:............................... .North Andover,Mass. .-v AF'ee' J.............. Lic.NoL/...<.. {I�....,...::.. ....::Z.............. .....,... ELECTRICAL INSPECTOR V ti 07/09/99 13:06 �, WHITE:Applicant CANARY: Building eft. MIDPINK:Treasurer MIIIO�THOFMASSAG1US= Office Use only MAP DEPARTMINTOFPUBLLCS4= Permit No. ` B OFF7REPRFYE'V77ONREGULATTOM527CWR 12-00 yl— Occuoancv&Fees Checked PARCEL PD?A1/IT TO PLOY =CMC L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACI-IUSSTS ELECTRICAL CODE, 527 CIvIR 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 de nibed b IfQRWARD Location (Street&Number) CD Owner or Tenant CS7.tJ Owner's Address Is this permit in conjunction with a building permit: Yes=/'Nci (Check Appropriate Box) Purpose of Building t6a�} 4 rc '(e 1't-�-+E7 WC Utility Authorization No. Existing Service Amps / Volts Overhead Underaround a No.of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampaciry Location and Nature of Proposed Electrical Work 4 /ALL No.oJf Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.qti Lighting Fixtures Swimming Pool Above Below ( Gencrators KVA ground eround No.of Receptacle Outlets No.of oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets 1-21 No.of Gas Burners No.of Ranges No.of Air Cond. Total FRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumns Tons KW hosting 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 F7 Signs Bailasis No. Him Massage Tubs No.of Moiors Total HP OTI-1E.f.: I k&rwc--Come Puam10thera�mz;IlCiIsdIvia��GeralLaws F7 I have a ctmin Limit-hmrance Pcbcy mcic CaTpim CjD�or r stst 3a eqz alai YES NO Iha�esbTuitcdvandpra#afsametetrOfficp-YES F7 NTOF-1 IfjruhawdrJcedYES,please typrci bycf zgttt INCE OTEgR � ?,i Me Specify) Exprmcn Date Wc�c�Start Vah2 Fr Wc�c$ co a y , Li�eNa Lxe � ,�/ AQ X,///- A;i.Tel Na OWNER'S UN`SUM T--- VANER;I am aware drt dr I i rye rices nd terve the a>stl>x cirz abs=-nal bra=as m4=bye Ctr I Laws and ttatmyaerntl2s pPW war es tltrs ra ¢cr (Please check one) Owner Q Agent Telephone No. _^_ _ PER'./fIT FEE $ Date. .?. � Tc. 4674 i �ha0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUS� This certifies that . fl. /,`i .s!�1 . . . . 1 . . . . . . . . . . . . . . . . . j has permission to perform . . . .0.< X . . . . . . . . . . . . . . plumbing in the buildings of .s." A,Y . . . . . . . . . . . . . . '; . . . . . . . ., North Andovgx,,, Mass. Pv MBING INSPECTOR 07/13/99 14:44 27.50 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer �WARDMAP d m � o MASSACHUSETTS UNIFORM APPLICATION FOR 1?Af M G (Type or print) MASSACHUSETTS /t Date Building Location i�' �'IG�� S' / ' -_ Permit # y0 7 y Amount Owner's Name [Jdl�Gt ESTI U Ccs New[3 Renovation [2"/ Replacement [3 Plans Submitted a r FIXTURES W O � d } SLBBM a�mavr MRJOR �[11PLfXIt .1 �. Rnm 4tHiiLaR SIIi lE OR 616 Him 7MRJ R saRO R (Print or type) Check one: Certificate Installing Company Name Gal-in-sky P1umbine & Heating D Corp. Address P.O. Box 1701 pier. usiness Telephone- 978-374-174-3 Firm/Co. Name of Licensed Plumber: Stephen C. Ga l i n s k y Insurance Coverage: Indicate the type of insurance coverage by checking the 7propriate box: Liability insurance policy ® Other type of indemnity Bond Insurance Waiver. 4 the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent ri 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 install ions pe under it Is ed for this application will be in compliance with all pertinent provisions ofthe Massachus State P ng C d Ch 142 of the General Laws. By: Type of Plumbing License Title City/Town LIEW Woer Master a Journeyman 11 APPROVED(OFFICE USE ONLY Location / //'�/4/N -, No. a 5 Date / f "CRT" TOWN OF NORTH ANDOVER p Certificate of Occupancy $ r n + ; ; Building/Frame Permit Fee $ ci~us`� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ '— Water Connection Fee $ TOTAL $$ Building Inspector X6/23/99 14:01 97.00 PAID Div. Public Works PERMIT NO. a`S APPLICATION FOR PERMIT TO BUILD********NORTH AN OER, MA i MAPNO. LOT NO. 2. RECORDOFO%VNERSIIIP DATE BOOK PAGE ZONE SIIB DIV. LOT NO. LOCATION � /7 / PURPOSE OF BUILDING �UO OWNER'SNAME a /� / NO.OF STORIES SIZE OWNER'S ADDRESS � r BASEMENT OR SLAB ARCIIITECT'SNAME SIZE OFFLOOR TIMBERS 1 I 2 U 3RD BUILDER'SNAME �l G Z� p� SPAN + DISTANCE TO NEAREST BUILDING O DIMENSIONS OF SH.LS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM IAT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION 7P6- d rQ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNECTED TO TOWN SEWER 4 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUCTIONS 3. PROPERTY INFORMATION LAND COST EST.BLDG.COST PAGE I FILL OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST.BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. M ATI'AC1IED GARAGES MUST CON FORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING,INSPECTOR BUILDING INSPECTOR DATE FILED OWNERS TELN qMi kI 75C// CONTR.TELN CONT11.I.101 SIGNATURE: OF OWNER OR AUTHORIZED ADEN FEE PERM ITGR:�NTED 19 Revised 5/5/99 JNI Town of North Andover ,ORTt, OFFICE OF . O 4. COMMUNITY DEVELOPMENT AND SERVICES x 27 Charles Street ; North Andover, Massachusetts 01 845 WILLIAM J. SCOTT SSACHU. Director (978) 688-9531 Fax (978) 688-942 In accordance with the provisions of MCL c 40 S 54, a condition of Building Permit Number C9-5 I is that the debris resulting from this work shall be disposed of in a properly li _.nsed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (�Te VJOv Vqq (Location f 1=acilit 1gnature of Permit Applicant .17 Date NOTE: Demolition permit from the Town.,of North Andover must be obtained for this project threua-h the Office of the Building Inspector BOARD OI"APPEALS 628-9541 BUILDING 683-9545 CONS 1iRVATION 688-9530 HEALTH 688-95-10 PLA-\MING 68S-9535 = - The Commonwealth of Massachusetts Department of Industrial Accidents — Offics'9/IM511921189s - 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit MEMEN P, I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity r7 I am. an employer providing workers' compensation for my employees working on this job. t:ompary rate: addrtsat city:. hone 4- insarancc co: Doli v a 1 am sole proprietor beneral contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices. CoMp2riv ars d�g3`� Zf5 741 7`/_�'24 > f. iniurstricr c2 _Z company name ee�r I t-g) add � ..n� 7� c t)1,I rl tl/- 1 ( Qhone ' �P6 S_Q �QW7 -0 Cr Failure to secure coverage as required under Section 25A of NIGL 152 can Icad to the imposition of criminal penalriez of a fine up to 51.500.00 and/or one yean' imprisonment as well as civil penalties in the form of:t STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a COPY of this sratement may be forwarded to the Office of Investigations of rhe DIA for coverage verificarion. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signarurc Date Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/liccnse ( Building Department C]Licensing Board C check if immediate response is required (]Selectmen's Office C]Health Department contact person• phone b; —Other (rwum 3195 PIA) ze oowmo � acricue(l DEPAilEliT OF PURL IC SAFETY CONSTRUCTION SUPERVISOR LCEISE k f Number Expires: Birthdate: j CS - 935146.8710211999, 0710211959 Restrictedlo; 00 TIMOTHY'fl PERKINS -� 'p'f'd 14 OLO;FERRY:.RD HAVERHILLi MA 01830 ,f VEMENT G' ON. Registr °lon 11.931E70R Type INDIVIDUAL L, EXPiration. 09/07%99 �.. Zg , fMOTHY PERKINS "TIMOTHY N..PERKINS OLD F �MwisraAroR .. ERRY RD >.„ ;` HAVE RHIII MA 01830 ' �j ��Y�'�S�►� ��d S�� -77 i Il �PI If ii fir,.. t j . Town of dover No. 0 ? *- ?r__2 _ E h9' odower, Mass. 7 COCM� E N?�1! f f ADRATE D p � s s� BOARD OF HEALTH I Food/Kitchen PERMIT T D Septic System � BUILDING INSPECTOR THIS"CERTIFIES THAT.........4.1 .. ... ..................1..14'&.� .. ..S� l ........................................ Foundation has ermi$sion to erect.. �o.�. y� �I! IN S f' Q } ............... b ildings on .............. ........ . ................................................................. Rough 1� to be occupied as............. two Chimney provided that the person accepting his permit shall 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 relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough TZ OC46 66 PERMIT EXPIRES IN 6 MONTHS Final ` S *® UNLESS CONSTRUCTION ��-� ELECTRICAL INSPECTOR � &4 t • 0 Rough .............. ... .. . .............. ........... Now.P Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy .wilding 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 Street No. SEE REVERSE SIDE smoke Det. �! •, �0 / MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t (Print or Type) G NORTH ANDOVER Mass. Date 6 � uilding Location J �/� ��vl S ti Permit 2 G r Owners Name _ New renovation Replacement j] Plans Submitted FIXTU°=5 x z a: vi N ort U � F C a 0 cc .o = .tn Y t- w Q o v m l_ F s rn -' � W a y, z z 0 F- W . o w a cc a a a z t- 4 GI u? {✓ w w o n rz rN 4a yF' t4lV Q w 0 wzx wi < g w v o uss a a w z Q C a ¢ o o w a Ld t ¢ z o SUei—SSMT. BASEMEHT tST FLOOR A 2ND FLOOR 3Rn FLOOR 4TH FLOOR 5:H FLOOP. 6TH FLOOR 7TH FLOOR STH FLOOR .�— (Print or Type) Check one: �Ceertti,ffiicate Installing Company Nam91 -2c-L- IV- ' �/ [ Corp'-�—`— Address ( )—O GOA _,_ T7 Partner. Firm]"Co. —o Business Telephone: -Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond �( InsuraAce Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent i.hcreby certify that all of the deaths and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that 1Uplumbin; work and installations perforated under'Permit issued fo: this application will-be-in ooraplianoe`►Ith ell eat provisions of the Massachusetts State Gas Code and Gupta 142 of tho Ceneral Laws. TYPE LICENSE: By Plumber Title Gasfitter Signature of Licensed .aster Plumber or G fitter City/Town: Journeyman Liceis APPROVED (OFFICE USE ONLY) N e "- .:-<>,,, — .♦-.. �-L-i-s..Cts..�. e. � .. -"Y..."J,`•. r S -0 225.; Date. .:. "?.:g.4... .. .. ro m „ORT#, TOWN OF NORTH ANDOVER O V �O � y�s, �O 3 PERMIT FOR GAS INSTALLATION p t • si a O �9SS�1CtMU5Et�y aThis certifies that . (�d t� has permission for gas installation . . .�'��.� c!9 �!c�, .?. . . . . . . in the buildings of . .5. ��4A . . . 4•. . . . . . . . . . . . . . . . . . . . . . . i at •�!! fI!!'�. .I ?� � . . . . . . . .. North Andover, Mass. . Fee. .7. c?,.:': . Lic. No../.Q. .`/d . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File 1 \ t office Use Cnfy T u�1E LIIiITIIIIlTIIIIEIII IIf �IIcZL�I1LE Permit No. !s Y 3 '9=z1 =Tt a iruhiit �afztg OCCuOanoi Fee C`ecked 2tc-0 (leave blank) � 7r BOARD OF FIRE PREVEN710N RE:�UUTIONS �Z7 C..R 12--00 APPLICAT i0N FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts =iectrical Cade, -427t CMR 1 0000 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date QM or Town of NORTH 4N L— R To the Inspector of wires: The udersigned applies for a permit to perform the electricai work described beiaw. �\ Location (Street 3 Nunber) Cwner or Tenant C`lvner's Address _ Is :his permit in anjunc:ion with 3 bulking permit: yes X Na _ (Ctieck ,!,co. rconaca -CX) ?urccse of E'uiidirc Utility Auchcrization No. �_ /Circ OVerre=d Unac-nC No. of Meters =X. stirc 5arjice Amps _ Ne,., c=- r•ice .amps —J �/attS overheat _ Urtcg'^a _ No. C Meters Numoar ofFeeders ana Amcac;cy I I )a `- Location ana Nacur_ ct ?rcaosec =ieccr:cal '."c'x \,JkC1.� t�1f ��t�4rt-d P t� •� (CE-Cc-�r-- atal I No. c yys No. at -anscormers No. a. _:gnang Cutlets i .above.— ;n- — i CVA No. T Licr,nng ?fixtures % i Swimming ?=ci grna. _ Crr•C. ! Generators No. at Emergency Lignting ,113arzeri UnitsNe. at =eCeataC:e Cutlets �x,J Na. ot Oil :-:urrers i - I F.PE ALA.P.MS Na. of =apes No. of Switch Outlets No. Cr Gas ourr,ers otai No. of --etec:ion ana- No. at Ganges No. cf Air --arc. 1 ;cns Inmaung Oavices Heat TLotal Tocai .No. et �7isoosais i I No.cf ?,r__s :ons �'�f I No. cf Seuncing Cev�ces I No. of Sait Canta,nec 1 S=aceiArea Heating 4�! Oetec::enrScunetng Oev cps No. of ��isnwasners I i cv �ccat Murnc:eat — Other No, at Or/err Nea:;ng Ce-ces Connect:cn '— No. of No. of Law Voltage Nir:nC No. of VNater Heaters (ty K\11 �, Sicns Sadasts No icro Massage ubs No ^f tears 1 oto: *? OTHa INSURANCE COVE^AGE: ?ursuant :o me recturements at '.tassac-usat-s ;er,erat '_aws NO _ nave a current Liaouity Insurance pout•/ nc:ucmg Coro:etee Oceraucns C.:verace or ,ts sues:anttai ecuwatent. YE3 v ,v0 _ if •;cu rave cnecxea "ES. pcease �naicate ,ae ryca at :average =y nave su=mtttee vatic =roof of same ;o one Croce. ._c-� _ cnecxtng :ne aocrocriate cox. INSURANCE = 3CNO L- OTHE? = lP'ease S=eth/j (Exarauon Oatet Esumatec Valuet4lf c'-ctrtcal 'Nark 5 f�,G��� =nal ,Nerx :a Start 16-T t" Inscectton Oate Aacuestac: ?ougn Signea uncer :he Penalties at perjury uC. NO. :Rtit NANIE �V .�� D �i ►. t � _S attire NO. _:censee S - gr P. F-•i�N\ ,1 )""■� W SN A — - _ Alt. -et. No. Actress - - OWNE:q'S INSURANCE WAiVEF: I am aware that :ne -:cen5e9 eoes not -+ave the nsuranca coverage or is suenr. Oat eeurvate A as te" ouirea ov Massacnusetts General Laws, ana :nat -may signature an :':s =ermu a=oucaaon Narver iris reauuement. Cwner ,P!ease cnecx one) _ -etecncne No. ��PMIT iSignature at Cwner ar.germ Date............. . .. ..�i..... Y 512 r� °f`'o°r° TOWN OF NORTH ANDOVER O: a �� PERMIT FOR WIRING o At ( �,SSACHUS� This certifies that ........ .................... ....... .:................................ has permission to perform ... ... ....... .. .... '...... ................................ a+ wiring in the building of..... .. ...... ........... ...... ..... at......./ ( .. ............................ orth Andover,Mass. Fee. Lic.No.............. ............................................................... ELECIR[CALINSPECTOR i WHITE:Applicant CANARY: Building Dept. PINK:Treasurer " ' '""'""�••��•-+ +� �+��rurvvs MrriJ�.AI it,IfV f Vts f Ct1M/1 1 u uv rt-u+vru++.v lftt er type# NORTH ANDOVER Mass. Otto (e Bunding permit Location--/L x YL-`l 14,w Owner's ' Name 4A /fig w '51,1 New O Renovation ❑ Replacement Q Plant Bubmitted: Yes❑ No,p FIXTURES ......... s « « o s ►�- w r ~ s M 44 a s 7 e) w « t IR Sir 161 x 8 11- 6 0111 s s� ti w• s • � =4as — s ° ro a1a ` •' `ss « 41` � 1 s o K s t• o to $ _ = s 0 u t e s S ss a = p « .. °. . ss • w a e � � s � w � i i i s ! os i o aAetY�NT 1r1T FLOOR SNOFL00N one FLOOR NNW -mom ITN ILOON ITN PLO011 ITH FLOOR. TTN FLOOR etM /LOONT -J Mit Check one: Cartlflcale 'ihstklflhg Company Namek -e 13 COW Address j, oZ ro AL S ❑Partnership business Telephone Name d Ucbnsed Plumber c� w F"'S ANCE COVERA(2E: a one a current liability Insurance policy or Rs substantW equivalent, . Yes p-� No ❑ have checked y.", Please Indicate the type coverage by checking the appropriate box , . liability Insurance policy Other type d IndenMMy Q Bond p 'bWNER`S INSURANCE WANER: I am aware that the Ilceniee does riot have the Insurance coverage required by Chapter 142 of the Masa. General Laws. and that my signature on this permit application waives this requirement. t Check one: tyre of of N s Agent Owner ❑ Agent ❑ Imsbype"h that all of the details and Information 1 have submitted to enbred#In above are tr and eocurals to the best of my T- a and that as pknnblrp work and Installatlone performed under the pew I to ingot provision of a Massufiusetts State PknbbV code and Chapter 11 201 atain" will 77oomptlance with ill •EY r 77 urs { own lkense fVumMr /t �, Type of Pkrmbin License: Maslen ,1�1'1il"1VE0 tOF•F'ICE,USE ONlY1 a Journeym n 0 J ~ Date. .7 ' 33330 ,,Or 1(, 143 f HORTp TOWN OF NORTH ANDOVER 1ti 49 PERMIT FOR PLUMBING ,SSACNUS� This certifies that has permission to perform . . . U..... . . . . . . . . . . . . . . plumbing in the buildings of k . ('N' , C at. . . . �.GF•�• . . . . .14.! A'6A� /rpGt!Sk1rth Andover, Mass. Fee.45, G Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 06/06/97 11:49 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer.