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HomeMy WebLinkAboutMiscellaneous - 16 WENTWORTH AVENUE 4/30/2018N O m Q z o � g � o = o n 0 m t 7 :7 2 Date. .�'... �. �......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. C, Y-\ .'M. S �. `' `? ...'.. ............ . has permission for gas installation . !3 * .6! ................. in the buildings of ... !P` V� ! �?. h i I. IC.' at ..�" t c' "�" .'��-- ...... , North Ander Mass. Fee S -w .. Lic. No. 3.33 ... GAS INSPECTOR Check # I t Q (12- I have a current liability insurance policy or its ff you have checked Yes, please indicate the ty A liability insurance policy 91", ' OWNER'S INSURANCE WAIVER: I am aware th Massachusetts General Laws, and that my sigt Signature of Owner or Owner s Agent By checking this box ❑; I hereby certify that all of t accurate to the best of my Knowledge and that all p compliance with all Pertinent provision of the Mass By Title _ Cityrrown Tvpe of bstantial equivalent which meets the requirements of MGL. Ch. 142 Yes 91No ❑ of coverage by checking the appropriate box below. Ther type of indemnity ❑ Bond ❑ it the licensee does not have the insurance coverage required by Chapter 142 of the a ure on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ details and information 1 have submitted (or entered) regarding this application are true and Wbing work and installations performed under the permit issued for this application will be in Iusetts State Plua+king Code and Chapter 142 the General Laws. GG Fitter a re of Licensed �Iumber/Gas Fitter aster, loumeyman License Number: LP Ins&ller MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:A���Date v� i Building Location: (�(J ers Name: f Type of Occupancy: Comme cial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential (� New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ I have a current liability insurance policy or its ff you have checked Yes, please indicate the ty A liability insurance policy 91", ' OWNER'S INSURANCE WAIVER: I am aware th Massachusetts General Laws, and that my sigt Signature of Owner or Owner s Agent By checking this box ❑; I hereby certify that all of t accurate to the best of my Knowledge and that all p compliance with all Pertinent provision of the Mass By Title _ Cityrrown Tvpe of bstantial equivalent which meets the requirements of MGL. Ch. 142 Yes 91No ❑ of coverage by checking the appropriate box below. Ther type of indemnity ❑ Bond ❑ it the licensee does not have the insurance coverage required by Chapter 142 of the a ure on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ details and information 1 have submitted (or entered) regarding this application are true and Wbing work and installations performed under the permit issued for this application will be in Iusetts State Plua+king Code and Chapter 142 the General Laws. GG Fitter a re of Licensed �Iumber/Gas Fitter aster, loumeyman License Number: LP Ins&ller f -3 • I MIN I have a current liability insurance policy or its ff you have checked Yes, please indicate the ty A liability insurance policy 91", ' OWNER'S INSURANCE WAIVER: I am aware th Massachusetts General Laws, and that my sigt Signature of Owner or Owner s Agent By checking this box ❑; I hereby certify that all of t accurate to the best of my Knowledge and that all p compliance with all Pertinent provision of the Mass By Title _ Cityrrown Tvpe of bstantial equivalent which meets the requirements of MGL. Ch. 142 Yes 91No ❑ of coverage by checking the appropriate box below. Ther type of indemnity ❑ Bond ❑ it the licensee does not have the insurance coverage required by Chapter 142 of the a ure on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ details and information 1 have submitted (or entered) regarding this application are true and Wbing work and installations performed under the permit issued for this application will be in Iusetts State Plua+king Code and Chapter 142 the General Laws. GG Fitter a re of Licensed �Iumber/Gas Fitter aster, loumeyman License Number: LP Ins&ller The Commonwealth of Massachusetts- `� Deportment of RibticSoJCfy s•••r` a'' '` 13DARD OF FIRE VJJMN110H REGULAn63S S27 CMR 7240 . �/so ca... at...) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to ba perbnned M accordance with she mauachu.ens Ejrctrkal Code. S77 CHR 12.00 (PLEASE PRINT I21 nm OR =E INFOMIMON) Date �`� City Or Town ofdYL�. Io the Inspector of Wires: The une•rsigned applies for a permit to perform the electrical/vork described below. _ Location (Ctrect 6 ?cumber)_ LCL K T�� r 74 1�. *neer or Tenant T/ iy „ , _ _ _/ T Q+ner•s Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Sox) .. A:rposc of Building. Utility Authorization 1t0. Existing Scr.ice Z dd Amps / Volts Overhead tcndgrd ❑`' Ito. of :tt .ts__ " Set�ice Imps / Volts Overhead ❑ Undgrd ❑ No. of Meters " Number of Feeders and Ampaeity Location and !Nature of Aroposed Electrical Work 414,— .✓ No, of Lighting Outlets Ho. of Hot Tubs ao. of Lighting Fixtures Switz Ing Fool Above ❑ In- ❑ No. of Receptacle Outlets ICI Ernd- No. of Oil Eurners grnd. No. of Switch Outlets No. of Cas Burners No. of Fanges No. of Air Cond. Intal - tons INC . of DisposalsNo. of est =meal Iain a � x:40. of Dishwashers Space/Area lkating AN No. of Dryers Heating Devices XW No. of Water Neattrz leu No, of o, o Sirns Ballasts No. Hydro Massage 'Tubs No. of Motors Total HP OAR: No. of Transformers . Tota EVA Generators XVII No. of i'aergeney Lighting Battery tint r. FIRE ALAPYS No. of Zones No, of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ ?tsnteipal ❑Other Connection Low Voltage INSUFAN CE CO%-LRAGE: Pursue to the requirements of lrassachusetts Gtneral Lava I have a current Liabi assurance Policy including Cot lend equivalent. YES P Operations Coverage or its sub antial 0 I Have submitted valid proof of acme to this office. YES Ii you have checked YE$, please indicate the type of coverage by checking enc appropriate ppropriate box. BOND ❑ O—nm ❑ (please Specify) cam. Estimated Value of Electrical :cork S itUpirstlon atte Work to Star t_t"".7(.' ���' Inspcctlon Date Requested: Rou �+- gas_ Z /6'',+-Z_Z4F3nsl Signed under the penalties of perjury: FIRM NAME �e LIC.. N0. ��+ Licensee Signatur /.ddresa LIC. N0. 'didvz us. Tel. No. INSURANCE WAIVER: I as aware that the Licen ee does t+ot gave tht. Teel. urance o� is sub - application stantial equivalent as required by ?iaafaehufetts General va and that Qy signature on this pem application valves this requirement. Owner Agent (Please check one) Telephone No. P r Signature of Owner or Agent LRMIZ iIE S v" . x _,..� y,�t iw �.s• _. .._ .�.s,r,;.. r�zs-,. r.-W�+•*uv.—��-.-3F �-�•�'---_--- '`-s �-�'.r .., u-..,-ti.--.,�.--..-��.T^-,.,r.. _ Date. ............. ,f�....... 1262 !P' NORTH TbWN OF NORTH ANDOVER !: PERMIT FOR WIRING ,$SACHUSE� This certifies that ...................................... has permission to perform�� -- r,A:.- � t .e Cf .. .. .... .. wiring in the building of.... .. ........�... _ ................. ..:....,....:... at .Z.cle z r -c .................. . North Andover; Mass. Fee .:4 ........... ELECTRICALINSPECTOR WHITE: Applicant 10/3VRP A`R1 Ailding Dept. e 00 P19FRreasurer W 0 a JL 1 Q I A W m W r I i W� I I ,� ! ♦I �j u 1� x til i Z � y z u u O uu u O uu O a < w W W w J ty as ®.- z 3 z 3 z V a •r �r W 0 0 t N O 0 z O 3 O z a W a 0 z > Z W W t 1w LL 0 p r o. Z J J M �j CC t! r 0 I � 0 r w Z z w1- z Z w z Z p ] N W r C r Ck. 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Z 3' 10 -` zi 0 �^' nJ RR h h W J M Z O 0 h < O r < N W M IW < C < h Y 0 J 3 h W z u J W i Z O w I Z Z O I a i a h 0 W z O < i J < i u Z W k< O Z z z< M I" r F" M W Ir f i W r u Z r U Z u Z r 0 i O 0 0 ] 4 0 L wl<lz'' OV W Z W x Z u 0 h r 1- < ] a w J C 0 N JVJ 0 0 t o i w w 3 Z 0 0 a Z L 0 it L W Z 0 u H N Z O O u U W W r r p 0 0 w J J r 0 N r W W r L L 1 I m I' 121 I i W� I I ,� ! ♦I �j � I i W u u O uu u O uu O a < C r r � S s � 9 •r O O u U W W r r p 0 0 w J J r 0 N r W W r L L I I' 121 I i W� I I ,� ! ♦I �j � C r r � r' fi I to aS w x w aGO .oj u v o w° v N a a E-4 a zcn z Ca '� o zc w° 0W C4 o ' U w a a a m C2, w a a U •-� ;� a T: w a p w � x DO u: G w H A WW w COcG z cn v o c ui CL r :U z O U a� O E L O s Z a O y D C O cm I C C O•— h Q •� •CA g m m 0 CD 93- 4D 3 -t O� 3� CD p 0 CL CAQ CA o env V C O C ca CL y C2 O 0 T: O y T J. +=� C 0 •Cyi V gyp' : dC O m �:= �v`0m Ea c :mom o a Go EE .0= 'cam t; cm bi m c C` Mo ti m 3 C r m p .0 C y y c fit � � 'E m O :mo : CLU m 0 cm _c CL mom I m . c o v' c Q � y m C •p r y m S~ m •H c C O O W C=L CO CD v m o+ S NO O. ID H L 0- CL.,.. dr m �• r :U z O U a� O E L O s Z a O y D C O cm I C C O•— h Q •� •CA g m m 0 CD 93- 4D 3 -t O� 3� CD p 0 CL CAQ CA o env V C O C ca CL y C2 O FORM U - LOT REIZA.SE FORM INSTRUCTIONS: This form is used to verify approvals ONS: from Boards and Departments is h all necessary have been obtained. This does not relievethe havin landowner from compliance with an a 9 jurisdiction regulations or re Y pplicable local and/or requirements state law, ****************Applicant fills out this section******* APPLICANT: L'' ********** Phone -3S LOCATION: Assessor's Map Number -"- Parcel Subdivision Lot (s) Street ��.L�,02i �n.Q • St. Number ************************Official Use Onl **** REEC DATIONS OF TOWN AGENTS: Copse ation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections driveway permit Fire Department Received by Building Inspector a J ******************** V Date Approved 9 Date Rejected iA n A i Date Approved,'" Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date i" "IM ."ll ai� % JOB NAME f NO.: jJ11 ii !JOB . WCATION. ftl are 66 v'rnatamils gfiall, at ms wafted and g) The applicant must submit to the Town Planner a FORM M for all utilities and easements placed on the subdivision. The Board will sign the document and it must be recorded at the Essex North Registry of Deeds. h) All application fees must be paid in full and verified by the Town Planner. i) The applicant must meet with the Town Planner in order to ensure that the plans conform with the Board's decision. A full set of final plans reflecting the changes outlined above, must be submitted to the Town Planner for review endorsement by the Planning Board, within ninety (90) days of filing the decision with the Town Clerk. j) The Subdivision and PRD Decision for this project must appear on the mylars. k) All documents shall be prepared at the expense of the applicant, as required by the Planning Board Rules and Regulations Governing the Subdivision of Land. . 2. Prior to any work on site: a) Three (3) complete copies of the endorsed and recorded plans and two (2) certified copies of the recorded subdivision approval, Covenant (FORM I), Right of Way easements, and FORM M must be submitted to the Town Planner as proof of filing. b) All erosion control measures must be in place and reviewed by the Town Planner. 11— 3.' Prior to any lots being released from the statutory t;ovenants: a) The applicant must comply with the Phased Development Bylaw, Section 4(2) of the Town of North Andover Zoning Bylaw. ,This project is exempt from Section 8.7 Growth Management as the preliminary plan was filed prior to May 6, 1996 and the definitive plan was submitted within seven months. However the exemption will only nm for eight years from the date of the endorsement of the plans as set forth under Mass. Gen. Law. b) A complete set of signed plans, a copy of the Planning Board decision, and a copy of the Conservation Commission Order of Conditions must be on file at the Division of Public Works prior to issuance of permits for connections to utilities. The subdivision construction and installation shall in all respects conform to the rules and regulations and specifications of the Division of Public Works. C) All site erosion control measures required to protect off site properties from the effects of work on the lot proposed to be released must be in place. The Town Planning Staff shall determine whether the applicant has satisfied the requirements of this provision prior to each lot release and shall report to the Planning Board prior to a vote to release said lot. d) The applicant must submit a lot release FORM J to the Planning Board for signature. F Brookview Estates Definitive Subdivision Conditional Approval The Planning Board herein APPROVES the .Definitive Subdivision Approval for a fifteen (15) lot subdivision known as Brookview Estates. This application was submitted by David Kindred, Brookview Country Homes, Inc., PO Box 531, North Andover, MA 01845 on September 2, 1996. The area affected contains approximately 43.31 acres of land in a Residential - 1 Zone off of Boxford Street. The Planning Board makes the following findings as required by the Rules and Regulations Governing the Subdivision of Land: A. The Definitive Plan, dated September 6, 1996, rev. 3/6/97, 3/17/97, 3/18/97, 4/2/97 includes all of the information indicated in Section 3 of the Rules and Regulations concerning the procedure for the submission of plans. B. The Definitive Plan adheres to all of the design standards as indicated in Section 7 of the Rules and Regulations. C. The Definitive Plan is in conformance with the purpose and intent of the Subdivision Control Law. D. The Definitive Plan complies with all of the review comments submitted by various town departments in order to comply with state law, town by-laws and insure the public health, safety, and welfare of the town. Finally, the Planning Board finds that the Definitive Subdivision complies with Town Bylaw requirements so long as the following conditions are complied with: 1. Prior to endorsement of the plans by the Planning Board the applicant shall adhere to the following: a) The catch basin design must be revised to show four foot sumps and hoods. b) The stone walls at the entrance must be eliminated from the plan as they are located in the right-of-way. c) The final roadway design and drainage must be submitted to the outside consultant and to D.P.W. for final review and approval. d) A detailed construction schedule must be submitted as part of the plans. e) A covenant (FORM n securing all lots within the subdivision for the construction of ways and municipal services must be submitted to the Planning Board. Said lots may be released from the covenant upon posting of security as requested in Condition 3(e). f) Executed right of way dedication easements for the proposed roadway shall be provided to the Planning Office at the applicant's expense. 1 , Notice to APPLICANT/TOWN CLERK and Certification of Action of Planning Board on Definitive Subdivision Plan entitled: Brookview Estates By: Marchionda & -Associates. , L.P . dated September -6, i9 96 The North Andover Planning Board has voted to APPROVE said plan, subject to the following conditions: 1. That the record owners of the subject land forthwith execute and record a "covenant running with the land", or otherwise provide security for the con– struction of ways and the installation of municipal services within said sub- division, all as provided by G.L. c. 41, S. 81-U. 2. That all such construction and installations shall in all respects conform to the governing rules and regulations of this Board. 3. That, as required by the North Andover Board of Health in its report to this Board, no building or other structure shall be built or placed upon Lots No. as shown on said Plan without the prior consent of said Board of Health. 4. Other conditions. a o -c z*Mrr, zCDC M _ ion{ C) NC:) = M y co • In the event that no appeal shall have been taken from said approval within twenty days from this date, the North Andover Planning Board will forthwith thereafter endorse its formal approval. upon said plan. The North Andover Planning Board has DISAPPROVED said plan, for the following reasons: -��— NORTH ANDOVER PLAN= BOARD Date: —April 16, 1997 By: Joseph V. 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MO TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ _ Other Permit Fee $ Sewer Connection Fee ilte Connection Fee $ TOTAL . G Building Inspector a 7336 Div. Public Works i4 �ocation Zwl No. Date -ld ,40RT#1 TOWN OF NORTH ANDOVER 0 4 Certificate of Occupancy 0 A&L Building/Frame Permit Fee .$ ZZ Foundation Permit Fee $ CHU r - Other Permit Fee $ ----------- Sewer Connection Fee $ Water Connection Fee $ TOTAL Buildinginspector 94 09:04 193.50 pAt� \ . xs� 3 Div. Public Works 45� f� 6705 er Connection Fee $ TOTAL Building Inspector' Div. Public Works +nil ,,Location. INo.a Date oT h,y TOWN OF NORTH ANDOVER CfiMO p Certificate of Occupancy $ 1 • C Building/Frame Permit Fee $ '�� °'„•°''� �” ;Foundation Permit Fee $� SSACMEt ..+M U rr,,. � Other Permit Fee ��- Sewer Connection Fee 45� f� 6705 er Connection Fee $ TOTAL Building Inspector' Div. 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INSTRUUX ONS: This form is used to .verify that all necessary approvals/permits from Boards and Deparf=emts having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section*****************APPLICANT: 16-;66A/� JPhone /� F 7 LOCATION: Assessor's Map Number Parcel Subdivision Lot (s) Street 42 "C ,P 2 St. Number 10 ************************Official Use Only************************ RECO10=ATIONS OF TOWN AGENTS: Date Approved j t lq5 Conservation Administrator Date Rejected • Comments Town PlannjU Date Rejected Health Aa Comments Public Works - sewer/water connections - drivewav per--.i-;-- Fire er-.it Fire Department & Date Approved Data Rejected Received by Building Insmectmr Dare c SIF oO ,f OUND4,%/lCaN P AN z ocoi D is o.Otaov! R. Mid lv(r WN64Aid D E&t NtrE tz l 1UG Gas,��. 3,3 W:4 L K E R IR o Al) Nu.Rr,t A NDDV1R, MN. LATS rly 1i5� lri /311 1-y3 sem: r;r NI ! X1.71: 60 FoQAi r>RTION Iv2,.G.a " 1 i JAN P 4 OJ�S,' TS VY0, tv 4A: i- !-At BVI4 D//►!G INSPICTo ' 0 Sh!C4US.E !S AOR, THF 6vr�ONIW PF ZiE'RAIiINW 101v offZCIVIAIC- OR /1(4A/ Cc wr 41'. ,spa o a��t; U/H 'N CQ/S/S?!�, 11GT�17 �a��.' C.? k x w o A x d v p O w e a v C/) o uw w � z 0 z d o p w O w v>1 C U C x a w c z , p r� G w a o a v U w p C4 v cn G w x o U C z p w co C w z w A x y W U) O p C/) }ov v L, �m � v o C) m O C +� 0 0 Qm nc E m a C42 �p C_ 4W4 � J .a :C o O V2 A O W y d r •E cm y m ' r= C=M o � w v:.CD C Z m CD o Z� y C.L o C V `p d m N m C C = o m 3 N D m m$� m s r- �, C ,r •cm d) C.L C Z oc �E o c to o ui CD ci COD Q g S W i A y '3 O F- - o.� m C an m W 4 LAW., L�4 . . O J O z E CD i o ~ � A CL z o. o �z ce � vs o z w ICD O � o cc a 2 �E O m m L z W C_ ~= C) v 0 •� O U i O c) C an m W 4 LAW., L�4 . . J O z E CD i o ~ � CL z o. o �z ce � vs o z w ICD > c �_ .O cc a 2 �E O m m L z W C_ ~= C) v 0 = O� O i O CD L CL �Q y •Q O O O C.3 J Q z .Q O J z Z_ C O CL H lL cc C cc w C.0 CO2 G z z � z w I It 111.1)IN( j C:()NtiI :i (VATION I l l -*A l: I'I I I'I.ANNIN(; ATE )CATION LINER'S NAME IILDER'S NAME:— SON'S AME:'SON'S NAME: kSON'S ADDRESS:, Yown of •'`'��" ', 111 '1:+11 IN I U 1'1,A.NNIN(;. & (,()Alr%lL!Nl'l'1' KA ;I :f. I I.P.NI :I .ti()N. i )ll (l :(A ( )I ( CHIAINEY APDL ICA f ION ANU PL-R.All I" .�✓ ��..✓cam .e;': iSON'S TELEPNON6i/2 ,TERIAL OF CHIMNEY: ' ✓ �i" IFERIOR CHIMNEY:_' ?",�. -= ;w/'�1 C EXI ERI OR I;IIIMNEY: .:E'J(' IMBER AND SIZE OF FLUES: / c3;v,.----- IICKNESS OF HEARTH:_�� AI:I�,C7u fll ra •Il•: a Iti•1 11; 171 PERK l'I'. #_ ,,C cicumtey an OiAep'Cace cu)t(anm to 41te u() the code culd have atice.3 cur(! -gutatiow been %ea-Zved: .GNATURE OF MASON:�`"-�---z :RMIT GRANTED: �— c/�� FLE�: 'BERT NICETTA ILDING INSPECTOR SPECTEO: — :MARKS: - SOLID BLOCK HEQUIItEU THIS PERMIT MC1SF GC: UISPLAVLU 014 111E VU1,11SCS: .•.h. .^5r l i �A..r twt z. � t \ �°:a iit y.�.: lU _._ .:..maaratiiti�`- ,u.�ssas;.,._�r-:,mn..�;...a�. aacY.;e-...+:_�:+s.,:�o.�=n,.s._.. ....._ CERTIFICATE OF USE & OCCUPANCY Town of North Andover 52 (1993) ,Date JUNE 9 1994 Building Permit Number � THIS CERTIFIES THAT ORTH AVE THE BUILDING LOCATED ON 16 WENIW IN ACCORDANCE MAY BE OCCUPIED AS single famil home WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Thomas Enri ht wONTM pd .o �.; 'S'p16 Wentworth Ave ADDRESS rt o O/: P \ �a °� Building Inspector { _, it I t \b # w ZIAg CL „ •� v' � `'`.. `,`• Q � moo`, a� �0 Q' c TA O CL= N A 4D m o 3�p ® N m Qf m J m • C N A E N m . � E -o aV i N m G>3 co ® N r ags c r "0,z . 3 Joao ao Nmc x m m, c W 4;uj C _®.. LU v. o omc p 0 y m C a R • m w z v � � O w CD ca z F— Cw O •� Q O O U) mm z > 0 c o 0 L co 0 Q L O Q Q Q C 6-1O cc to J -0 O Z co a y c J Q z LL 9 W H C� z � z � z LU Q LU JL U O1------------ c� u U' o a � cu .� c o x c � � � (� ,Wa � � > � c � w v � v o r c L ti cn w° Q� U w ) A°G cn U. W CIO cn _, it I t \b # w ZIAg CL „ •� v' � `'`.. `,`• Q � moo`, a� �0 Q' c TA O CL= N A 4D m o 3�p ® N m Qf m J m • C N A E N m . � E -o aV i N m G>3 co ® N r ags c r "0,z . 3 Joao ao Nmc x m m, c W 4;uj C _®.. LU v. o omc p 0 y m C a R • m w z v � � O w CD ca z F— Cw O •� Q O O U) mm z > 0 c o 0 L co 0 Q L O Q Q Q C 6-1O cc to J -0 O Z co a y c J Q z LL 9 W H C� z � z � z LU Q LU JL U MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) j NORTH ANDOVER Mass. Date 3 / iuilding Location �""i`!C WOIY%1� Permit 7Z Owners Name • - _ New F Renovation Q Replacement Q Plans Submitted j] r 11,2cc (Print or Type) Check one: Certificate Installing Company Name ��i�(f,�7?7/�ZG Corp. Address Ch" w2c)a Q Partner. / Firm/Co- Business Telephone: Name of Licensed Plumber or Gas Fitter 6; Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Q Bond Q Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. • Y • • • • • rrrrrrrrrrrrNOUN rrrrrrME HENN lrrllt,Irrrrrrrrrrrrrrrrr • nrrrrrrrrrrrrrrrrrrrrr�rrr • • rrrrrrrrrrrrrrrrrrrrrrrrrr • �rrrrrrrrrrrrrrrrrrrrrrrrr .. - rrrrrrrrrrrrrrrrrrrrrrrrr■ ... rrrrrrrrrrrr INIZEM rrrrrrrr • • - rrrrrrarrrrrrrrrrrrrrrrrrr .. MENNENrrrrrrrrrrrrrrrrrrrR .. - ■rrrrrrrrrrrrrr�rrrrrrrrrr (Print or Type) Check one: Certificate Installing Company Name ��i�(f,�7?7/�ZG Corp. Address Ch" w2c)a Q Partner. / Firm/Co- Business Telephone: Name of Licensed Plumber or Gas Fitter 6; Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Q Bond Q Insurance Waiver: 1, 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 Q Agent Q 1 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 sll plumbing Work and Installations performed under Permit isseed for this application wdl_be In complianea with all peztincnt provisions of tho Massachusetts State Gas Cade ind Chapter 142 of the General Laws. By Title City/Town: APPROVED OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman P 109 License Number ..r-,-��-.n..-.-:tet Date. 3. . �3 .` `/.... . N2 1474 NpR7M TOWN OF NORTH ANDOVER. fig PERMIT FOR GAS INSTALLATION t • s a SSACMUSEtty This certifies that ...// t!.e .rr�..... P ? Y .: . has permission for gas installation .11! . tv ..%!=r ::. ......... in the buildings of ti-, .! y. 7` ..................... ...... at ........... , North Andover, Mass. 3G>, T O, z }� Fee. L63h .51 30: ' Vaq.................. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer - GOLD: File Date. !."J/�• pf "ORT#q TOWN OF NORTH ANDOVER o PERMIT FOR GAS INSTALLATION ' This certifies that has permission for gas installation - in the buildings of h ........... Z. at E AFe Lic. No.,, . . ,Peck # Y 4579 North Andover, Mass. ......................... GAS INSPECTOR t ,s 11 MASS APPROVAL # - MASSACHUSETTS UNIFORM APPLICATION FOR PERMT GASFITTING IT _ (Print or Type) Z J0, �1Y L��-�Jl�`'��-� . Mass. e ��� - rmit Building Location A • Owne.'s Name )Iki Type of Occupancy - New ❑ Renovation p� Replacement ❑ Plans Submitted: Yesp No Q--�' Installing Company Name YANKEE GAS. Check one: Certificate Address 140 SOUTH MAIN STREET iK Corporation 103C MIDDLETON, MA 01949 [. Partnership Business Telephone 9 7 8- 7 7 4- 2 7 6 0 [ Finn/Co. Name of Licensed Plumber or. Gas Fitter WILLIAM R HARRIS INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which me -.s the requirements of MGL Ch. 142. Yes M No O If you have checked Yes. please Indicate the type coverage by checking the apvopriate box A liability Insurance policy 0 1Other type of indemnity p Bond p OWNER'S INSURANCE WAIVER: I am aware that the licensee does nct 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: Ownerj- Agent 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above ao�7aptio true an accura t my knowledge and that all plumbing work and installations performed under the perm for twi mp II pertinent provisions of the Massachusetts StateGas Code and Chapter 142 of the al taw gy T of License: Plumber gnature m r or mer Title Gasfitter Idaster License Number 3785 ph,/Tpym Joumeyman APPF;0IIED ( NL NONE on Installing Company Name YANKEE GAS. Check one: Certificate Address 140 SOUTH MAIN STREET iK Corporation 103C MIDDLETON, MA 01949 [. Partnership Business Telephone 9 7 8- 7 7 4- 2 7 6 0 [ Finn/Co. Name of Licensed Plumber or. Gas Fitter WILLIAM R HARRIS INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which me -.s the requirements of MGL Ch. 142. Yes M No O If you have checked Yes. please Indicate the type coverage by checking the apvopriate box A liability Insurance policy 0 1Other type of indemnity p Bond p OWNER'S INSURANCE WAIVER: I am aware that the licensee does nct 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: Ownerj- Agent 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above ao�7aptio true an accura t my knowledge and that all plumbing work and installations performed under the perm for twi mp II pertinent provisions of the Massachusetts StateGas Code and Chapter 142 of the al taw gy T of License: Plumber gnature m r or mer Title Gasfitter Idaster License Number 3785 ph,/Tpym Joumeyman APPF;0IIED ( NL