HomeMy WebLinkAboutMiscellaneous - 15 STACY DRIVE 4/30/2018 15 STACY DRIVE
210/091.0-0029-0000.0
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SIGNED SECOND NATURE"' t�RECYCLED _ dam. FORM 74620
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The Commonwealth of Massachusetts
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Department of Fire Services
Office of the State Fire Marshal
� P.O.Box 1025 State Road,Staw,MA 01775 4 /
PERMIT Date: /(_c L l0
Permit No Dig Safe Number
(City of Town) (If Applicable)
in accordance with the provisio of M.G.L. Chapter 10as p=fAe,f
on 5 2 7 CMR 34
Start Date
This Permit is granted to: �� �`4rf?o/I ✓ //
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
' Restrictions: at end of workday
at T;0ef� 61
(Give location by street d no.,or describe in such manner to provied a quate identification of location)
Fee Paid S �'— �C��
oe (Title
TisPePermit wilexpire (Signat�'5f fcg permitOfical granting permit
=MOO` THIA PERMIT MI ICT MR t'_E lA1CPIC'_1 Inn 1_CI V P[9CTI=n 110nKI TWI= PRFMICFC "���
Ng FD 11871 Date .V17: .4.t.7....
Nor+rH
TOWN OF NORTH ANDOVER
O � 9
RECEIPT
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+ co
CHU5�t
This certifies tha�����/J.. l.�`.• ,�7v� c�•G•�t-.�...........
haspaid..... ......................................................................................
for...I..Vx'.��.S7�lt .....��.�.f?�F.�.............................................
Received by .......................
tt ✓
Department......�j/�
.... .... ......................................................................
I/ /' WHITE: Applicant CANARY:Department PINK:Treasurer
7 Ct 6 Date.. 1112..t ./.G....
HORTp
Of
3j TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
o.•• qh
SAC14USEt
This certifies that . Lt_.i.�.k-c ,:11� .f.
has permission for gas installation . . .t- 4, 41 r-r .c . . . . . . . . . . . .
in the buildings of . . .5.C.<-4 I/i./,I . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . .f. J ./i9. 1 .. . . . . • ., North Andover, Mass.
Fee.�0, . . Lic. No.//J-j.�.�. . . .�. .... ,.—,, . .
GASINSPECTOR
Check# 2i,
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: Np&Lt t A/VQ J&(L , MA. Date: i Permit#
Building Location: 5l tQ t_C`�1 1J�I Ck, Owners Name:
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New: ❑ Alteration: ❑ Renovation: ❑ Replacement:21", Plans Submitted: Yes❑ No❑
FIXTURES
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0 0 o LL 0 0 x x > O O W Z Z W Q 0
SUB BSMT.
BASEMENT
-iFLOOR
2 Nu FLOOR
3 FLOOR
r 4 FLOOR
-i'FLOOR
6 FLOOR
VH FLOOR
8 FLOOR
Check One Only Certificate#
Installing ConilAalae:Ptumbibq
1 Utopia RD. ❑Corporation
Address: l City/Town: State:
❑ Partnership
Business Tel: Fax:
irm/Company
Name of Licensed Plumber/Gas Fitter:
INSURANCE COVERAGE:
I 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 of coverage by checking the appropriate box below.
A liability insurance policy 19' 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 ❑ 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 an_-Chapte.F442 of the General Laws.
Type of License: •
BY ❑ Plumber
Title
El Gas Fitter Signaturiof Licensed Plumber/Gas Fitter
❑Master
City/Town ❑Journeyman
APPROVED OFFICE USE ONLY ❑LP Installer LicerSse Number: