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Home My WebLink AboutMiscellaneous - 162 HILLSIDE ROAD 4/30/2018 (3) 162 HILLSIDE ROAD 210/098.C-0021-0000.0 PO Box 55098 Boston,MA 02205-5098 617-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: MARK ALTERIO and MAUREEN MCDERMOTT-ALTERIO Property Address: 162 HILLSIDE RD,NORTH ANDOVER, MA Policy Number: HMA 0223209 Claim Number: BOS00054225 Date of Loss: 3/7/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Allan Leavitt Claim Examiner 3/10/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3213 Fax: (617) 531-8891 Email: AllanLeavitt@SafetyInsurance.com � ��- Date................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING HU This certifies that ........... ........44...... ............. .............................. has permission to perform ...... .4-1........ .... wiring in the building ...................... at..# North Andover Mass./ Fee.. L"ic.No./P� ... ............... ELECTRICAL INSPECTOR Check # 5 111E WtI1L A T I/ it Vl lI"JI.J..JI A-A- A A" Y / l DEPARTdIDVTOFPUBUCSAFM Permit No. 3 BOARD 0FFIREPREVEM70NRECUT4TT0AS527C VR 12:610 Vd Occupancy&Fees Checked PPLICATION FOR PERMIT TO PERF ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAS ;_ SACHI J TS ELECTRICAL CODE,527 CMR I2:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover Irk To the Inspector of Wires: The undersigned applies for a permit to perform the electrical desc ed below. Location(Street&Number) i(p;Z N 1 L , t L QZ lJ Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building AID Aeo 4 q><wd Utility Authorization No. Existing Service Amps / Volts Overhead r7 Underground M No.of Meters New Service Amps / Volts Overhead [= Underground r__J No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground El ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units 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 Municipala Other No.of Water Heaters KW No.of No.of Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER— w IrrnrmlloeCaa-ate Ptastalttr�thetagtmarets�GalaalLaws Iha%eaaxmtlnbt7dyhtstr&=PbhyurhudngCanpi** CmeraworilsaksbrtWafivalat YES�— NO Iha%esubmJttedvatidpoofofMM1DdZOTM Y6 E? r7 l6whawdrdodYES,pkmhdu*thetAxcfwmaWbyd7admgtbe qpupd*bcpL INSURANCE EJ_ BOND o OHiER a ftm ) A6,_P;Z4.f YR�r_vV'7d,J EArn*dvaluedUmtrical Work$ WorkinSlart Irq)erfirnD*Ra c9Wd Rough Feral SignedundwI i lkrultimallwfiay. J FIRMNAME "CS -� L Liar>SeNa 1�s X5797 Limrm-C�aT � E Lioa>SeNo Btsi<=TeLNa 7$1-799-Saa,�_ OWNER'SINSURANCEWANFR,Ianmm dxtlheLi=mdoey_ not( etkrertstraroet�aaageails Iergrivalei>tasrarltt>QedbyMa55adtitsellSGeireralLaws a4dtmtmy secnitaspem*Wpfc3bmwaivmibisraw'mnem {(Please check one) Owner E3 Agent M Telephone No. PERMIT FEE$ DEPARTMENTOFPUBLICS4MY Permit No. BOARD 0FFIREPREtVM0NREGUL9770AS527CHR 12. 0 Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERF ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHU TS 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 rk des ed bbelow. Location(Street&Number) (p N I L L. t Q 1 Owner or Tenant Owner's Address A-fn C Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) t' Purpose of Building 141D AAO J% (""Oy V3�6 fid` Utility Authorization No. Existing Service Amps� Volts Overhead a Underground No.of Meters New Service Amps / Volts Overhead Underground J= No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units 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 0 Municipal a Other No.of Water Heaters KW No.of No.of Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER' h>StsarlceCmOW-Pt�suatbtireragaerlarlsotIld�dtse�Ciar®ILaws hateatz>rrartLiabtlily6tstrarrePb6tyrt3d�gCaript CoArdg ritssubstrt�egivdbt YES NO ha%est.hnA edv lidptudbfsanebtheO�YES Ifjcuha%edxdwdYES Pkmi&*the4W foaeageby�tgthe but F— B� oT� 0 (�s�cy) ff59zc.+ IR,yrvZ.�e� ti/o� FViWmD* Esft mtedVakred edncalWak$ bStart hq)eAmDa eRaVcs ed Rargh Frlal NAME SES a c- Li=WNTa _1�- 15,797 fid? Signa n YLitxw?,b Btai=Td.Na 781-7y9-5-03q, Ak.TCL Na f 'SMRANCEWANER;IanawaethattheLicalsedulsnot lr the, tzwvWarts [egtmdatasrt:pWbyMamaduMCmaalLaws `-� s�aernlh'span>tapp�irnwa�dnste�errat. check one) Owner a Agent Telephone No. PERMIT FEE$ WoLp FEED Sw l i Location�(� No. 01C C Date �4 1 16a �aRTM TOWN OF NORTH ANDOVER Cf,•� o ,•17. F 9 • : ; ; Certificate of Occupancy $ �7S C14MU Building/Frame Permit Fee $ JCUS Foundation Permit Fee $ Other Permit Fee )C61 $ d• 0o TOTAL $ Check #15596 J e� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH Add OR TWO FAMILY DWELLING TWS $eGtiOlii for(?t ii Use fll®1 BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/In ctor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr osed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqwred Provided Re aired Provided v 1.7 Water Supply M.G.L.C.40.5 54) 1.5. Flood Zone M mtation: 1.8 Sewerage Disposal System: Public ❑ Pm,ate ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 _j SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service i Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor --- Not Applicable ❑ Licensed Construction Supervisor: License Number mn Address Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number r Address Expiration Date z Signature Tele hone r^.y 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 Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee J oc C Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 3 —^� 5 Fire Protection 6 Total (1+2+3+4+5) Check NumSer SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of 0,,vner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2ND 3 SPAN DNIENSIONTS OF SILLS DIMENSIONS OF POSTS DiMENSIONS OF GIRDERS HE'lGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUGLING ON SOLID OR FU.,LED LAND IS BUII.,DING CONNECTED TO NATURAL GAS LINE NORTH own of E 4Andover 0 No. o� COCHIC dover, Mass., A- '7,9 AoRgrEo P �(5 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR j THIS CERTIFIES THAT..... . . . ....... .�. l../!./D................... . .. . .... .............. . . .... ' "' Foundation has permission to erect... ............ buildings on ..........1 ...... �. / .� ��........................ Rough to be occupied as....... � r It i r f �i. Chimney p cS. : ......, .w.... ............Q.l.......� ........R.. J..........y, �c� . .. ............................... provided that the person accepting this 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. 4ys C /a/ I( sm QWNWWW PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTH$ Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .......i00.000� ............................... ......................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. rf SEE REVERSE SIDE Smoke Det. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: oZcZ �— /0-30 -- o Z X SIGNATURE: Building Commissioner/Ip4mt&of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �tc2 N ° S 2 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dia6c-t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record MY)IRK 11-�LTC6: Name(Print) Address for Service: Signature( Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Mn Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 v Company Name Registration Number r Address r Expiration Date /z Signature Telephone Y 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.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee C' d -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 I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DLMENSIONS OF SILLS DRAENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE 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******`k**************** APPLICANT M 8191� A)-'WRN0 PHONE LOCATION: Assessor's Map Number Cy C PARCEL �( SUBDIVISION LOT(S) STREET f�"( l f 1�`�— ST. NUMBER 0 ************************************OFFICIAL USE ONLY*********************************** RE C MENDATIONS OF TOWN AGENTS: C r NSERVATION ADMINIST TOR DATE APPROVED DATE REJECTED ti COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm NORTH Town of E Andover 0 0 -_ - - Z _ / =gyp �o O C C dower1 Mass., COC MIC I AORATEO P'? Cl S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ' BUILDING INSPECTOR THIS CERTIFIES THAT..... . ..�.�....... ., .�. !„/�,I .. . .... .............. . .... ... Foundation .. ... ... .. . has permission to erect...�. .� ' y.�........ buildings on ..........�� a...... �. .,5.�...... ................ Rough to be occupied as......rS. ....> .r. ......PAO........te..W41�!..'..as./J,�,......*/*4.910 Chimney provided that the person accepting this 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. oys C /a' ;( so. .mwmw� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTH$ Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .......................................................................... Service BUILDING INSPECTOR 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. -3 0 W 3 Bay State Gas Company GAS INSTALLATION AUTHORIZATION y Date Issued to - 5� 2Z�_ - Address For Installation of: BTU Input . 1,� ' Restrictions BSG Representative PERMIT ISSUED _ BY INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: ❑ Heating System (BTU Input ) ❑ Range ❑ Water Heater ❑ Clothes Dryer ❑ Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO.721 LAWRENCE,MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840 N° 2757 Date/Z...`5...� ......... NORTI{ °�<<``°:•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING C04 This certifies that ....n.................. : has permission to perform ................................7��............................................... wiring in the building of ' at�............ :s .:-�t..................................................... .North Andover,Mass. Fee '6 .. Lic.No..............Jam...... 1................. ' ...................... � / ELECTRICAL II�]STIEC•COR Check # 7/C1 ( (/ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer IrmUU1Y11Y1V1VWrV1L1"VCIYL9Jr.]r4U"GaL113 OfficeUseonly DEPARTAffiWOFPUBLIC&4FM Per-mit No. 7Y BOARD BOARDOFFMEPREVEM ONRWUMTIOAN527CM 12DO Occupancy&Fees Checked �r APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 _ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date S �_ ZoOo 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) Ro 2 H I LL S lO L= 1121 Owner or Tenant m nk K A LT t--R I o Owner's Address 5A M L Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building A ]b 1 t�o 0 Utility Authorization No. Existing Service '200 Amps L!2.L2Zge Volts Overhead Underground M No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work F-W2 Y)bb it- N iA '1-IlA TcJ ,Iga in IAe�5 e No.of Lighting Outlets ' No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures 1 ` Swimming Pool Above Below Generators KVA lJwound El ground No.of Receptacle Outlets O No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets 1 L 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 r7 Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER hmaarapeCo�a-�Ptasua�k�tltetagtmanaes�C>�alLaws lhaNeaomutLmbdtyhum=PbbcymdudmgCanpiftOpma6crisComaWcritsabuMe4ivakrt YES NO IhawakmiaadvalidpicofofsanvotheOffm YES 1._J F-1 Ifjcuhaw diedWYES,please hdr&the4pecl'wmaWbydxd gthe 11`IS[JRAT�KE F-1 BOND F-1 OT1fR F-1 ftaselpeafy) Exprtatim Date Eshm&dValuedEledrical Work$ WakiDShatt hnspxtimDakRiqxs(ed Rough Final Sighted urxlerTr of FIRM NAME R��7 N Fi iK I'�LTc'J� Q Licatsee Signolune BusitmTel.Na 14 1 L(.51 cr d2 Al Tel.Na OWNER'S INSURANCEWAIVER;Iamaw=drttheLxmsedues irt $>ea>straneoo�erageor�ss>t rt ale astagt>IIadbyM C,enxi1am and thatmysi maseonthispemffiapplicMwwai%csthis rtviretestt. (Pleas one) Ow Agent _ dl Telephone No. 6,85-9120 PERMIT FEE$ U. Date. . . . . . . . . . . No "pR'" TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SSACMUSE� f I This certifies that & . . . . . • • • • • • has permission to perform . .:�. .� �. � . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings ofl:?� . . . . . . . . . . . . . . / �-!'l t1.-rpc fid/ at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... North Andover, Mass. F'ee�)(. . . . . .Lic. No.. . . . . . . . . . . . .. . . . . . . . . PLUMBING,IINSPECTOR Check #/� ' WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location Owners Name WA-A7 c,'�>'l] Permit# L Amount �� T e of Occu anc j?t-S. c��C� New Renovation Replacement Plans Submitted Yes—� No FIXTURES r w z a �" aEna E~ ��, cca a a x w w d cc w A a x W d E, z w x F l a a a a d SLRBM 1 BASEMM mRaF r 2n FLOOR IMFLOCR 4MH Sly HIM s;�FLoa� 7MFLOCIR 9IH FLOOR (Print or type) ^^ Check one: Certificate Installing Company Name Js* 1�� Sf l.�a,,,, r t /�oll� Corp. Address t-0 ST Partner. a OV le-1-4 Business Telephone 6 �;-7 '7 :2 �.Firm/Co. Name of Licensed Plumber V o t— S G r4 s �� Insurance Coverage: Indicate the type of insurance coverage b checking the appropriate box: ❑ liability insurance policy FA Other type of indemnity ❑ Bond Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner F� 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 M s husetts State P bing Code and Chapter 142 of the General Laws. By: gna i ns er Type of Plumbing License Title 9 City/Town License 114umoer Master ❑ Journeyman v n APPROVED(OFFICE USE ONLY �J Date/. .. . .. .. ... ........ ,&ORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION SS C IN4 5 This certifies that . . , -1991 . . . . . . . . . .. . . . . . . . . . . . .?1i. . :. . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING `J (Print or Type) NORTH ANDOVER , Mass. Date o, /Y h building Location Permit # 132- 2— .� Owners Name S fd✓-P -Ty 6 .A- New Renovation 13 Replacement p Plans Submitted FIXTURES to x rz v; a h rr W V! O U W r t Z N o uai �" a x = `p 1. w a m to h a '� o 0 O x h cc m e w w h. N a W y 4 W tu Cr W O W 2 < x W cc W cc Q 1• to h S O h 2 j h 2 f, W W p O > k h W -4 F W Z 4 W G fr ... h y. to pj = O Z O N x d ,m > W , 2 < cc Q Q O O W 5 O W I.- t= x O t7 x u. n a c7 .r V W > Q a F- O sea—ssa�T. BASEMENT f IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR --d I i d - 1 ±::— (Print or Type) Check one: Certificate Installing Company Name �C �}��,,lr e /'d'/ Q Corp. Addressers—b 73�.0�Fd /t-�( - -� "i L _✓� . Partner. Firm/Co. Business Telephone: 6 TZU Name of Licensed Plumber or Gas Fitter PL/4 � a Insurance Coverage. Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E;]�Other type of indemnity Q Bond E] Insurance 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 Agent i hereby certify that all of the devils and information I hire submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing worts and Installations performed under'Permit iuLed fo: this application will-be in compliance with all p "ent provisions of the Massachusetts State Gas Cude and chapter 142 of ow Genual 1Aws. ' By TYPE LICENSE: Z-Plumber Title Gasfitter Signature of Licensed City/Town- aster Plumber or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) License Number