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HomeMy WebLinkAboutMiscellaneous - 175 SOUTH BRADFORD STREET 4/30/2018 (2)f *^� 0 , f') !- 4 LJ Date ..... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... ....6..� ... a ..... 4 .............. w .........................A4Ie has permission to perform ... kAA... ..... .......... plumbing in the buildings of, ... ........................................................................ at .../9.5 -5e) . ................. VO ... ................... rn-, .......... Siorth,Andover, Mass. Fee..41 .. 0 ... Lic. No. . .......... N ...... ... ............. ...................... F4LUMBING 14SPECTOR Check # 71.30 L/ V \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK POWNER TYPE OR PRINT CLEARLY CITY An do- MA DATE / PERMIT # JOBSITE ADDRESS <, M-6 OWNER'S NAME 1414D 5; /alv ADDRESS 7 S S&A (32/4 `(Ai) ' * TEL FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: ❑ REPLACEMENT: -9 PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FUaOR /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION !'WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have acurrent liabi lily insurance policy or its substantial equivalent which meets the requirements of MCL Ch. 142 YES j NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY C ECKJ NG THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY R OTHER TYPE OF INDEMNITY ❑ BOND ❑ OdMIER'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. a-ECK ONE ONLY: O1M�IEFI ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application rue a d accurate to the b t of my owledge and that all plumbing work and installations performed under the permit issued for this application will bec pli a with Pertine rovisi f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 1�bbel7 LICENSE# 533C SIGNATURE MP [a JP ❑ CORPORATION Z # 33 Vf PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME S/� C,-er�r�C l��t 1� ADDRESS en 136 CITY,,L CIL7"y 17d6L/-"k- STATE yha ZIP a TELAA FAX 1�� CELL �lS�i 3,S` EMAIL w � 7PL, t., �,r? � ,/40 C -0.,n 97a L/ V \ ops TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................................................................................... . - '? r- has permission to perform ........ . ........ .I ......................................................... e wiring in the building of .... /-/ ................. ... ............................................ at ..................... --, M North Andover, Mass. . ......................... 2 . ............. Lic. ............ .. Fee.... No: ELecrnI CTOR Check # 8 5 1 'J , .. Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Off`/ 3 Occupancy and Fee Checked 06 ed [Rev. 1/07] neavr 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 ININK OR TYPE ALL INFORMATION) Date: l a - $- app 8 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or r :njtn perfo the electrical work described below. Location (Street & Naber) 1 75 Soo_jr.V L, Owner or Tenant Owner's Address li Telephone No. MAW- 87/5 Is this permit in conjunction with a building permit? Yes ❑ No (� ®(Check Appropriate Box) Purpose of Building &-5Aevlce Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location nand Nature of Proposed Electrical Work: QS ' ;reA)(axe l ek;er-� Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters e Com letion o the ollowin table may be waived by the Ins ector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Abovd. 11e In d. El Batte o. o mergency tg g Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No of Zones No. of Switches No. of Gas Burners No. of Detection and Total Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices FNo. of Waste Disposers . Heat Pump Number Tons KW No. of Self -Contained Totals: `_ _.._....._......__. _ _ ..___. Detection/Alerting Devices \� of Dishwashers Space/Area Heating KWLocalMunici al ❑ Connecfion El Oma No. of Dryers Heating Appliances KW Security Systems:* No. of atero. of No. of Devices or Equivalent Heaters KW No. of Data Wiring: Si s Ballasts . No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: OVER: No. of Devices or Equivalent Estimated Value of Electrical Work: pz0d Attach additional detail if desired, or as required by the Inspector of Wires. 'SQ � .(When required by municipal policy.) Work to Start: /a. 5- 0008 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM N r CK .30#tJ5?aN 15 EC R C, LIC. NO.: 36330 £ Licensee: 1C a� 011 K n Signature LIC. NO.: (If applicable 1 ente�� .1exe t',int icens umbe line.) Address: lD in �on �� , �q'14�a1� �, 0381oS Bus. Tel. No.4AI 300 ^o?75d Alt. Tel. No.: 60 3 - MR— 535y *Per M.G.L c. 1474 57-01, security work requires Department of Public Safety "S" License: Lic. 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 Signature Telephone No. PERMIT FEE: $J i The Commonwealth of Massachusetts k� ! Department of lndustrW Accidents Dice of Investigations iata�� 1 600 Washington Street ti ! Boston, MA 02111 r j www nwss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plnmbers Nanie (Business/Orgeniza6on/Individual); HlCk 6 Address: (:o KI't1q,5�a A City/State/Zip:, ff 0315&Phone #:. (b0 3 - 306 - a 750 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2., D[� I am.a.sole proprietor or partner. have hired the sub -contractors listed on the attached sheet x ship and have no employees These suis -contractors have working for me .in any capacity, workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.) 3. ❑ 1 am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No -workers' comp. c. 152, § I(4),'and we have no insurance required.] t .employees. [No workers' comp. insurance required.] Typeof project (required): 6. ❑ New construction 7. ❑ Remodeling 8. [] Demolition 9. ❑ Building addition 10.® Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. [] Roof repairs -13.❑.Other "--•^ - ww n muat mso Irl Out me section below showing their workeft' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit anew affidavit indicating such $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their work=' comp. police infnnnation. l ant an employer that.isProviding workers' compensation insurance for my. enWioyem Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' eoutpensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby boa - --;t!5n , ry .that the information provided above is true and correct Officiad use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, assodiation, corporation or other legal entity, or any two or more of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. ' however the owner -of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their cenificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should, � be returned to the city or town that the application for the permit or license is being requested, not -the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'• compensation policy, please call the Department at the number listed below. Self-insured companies should enter their � self-insurance license number on the appropriate dine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permiMieense applications in any given year, need only submit one affidavit indicatiripcurrent policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations " 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.ma:ss.gov/dia Date .../-:. 2—..17F....... / ...... N "0' A TOWN OF NORT4\,��DR PERMIT FOR GAS INSTALLATION . ......... This certifies that�'I'l-p— .......... has permission for gas installation ........ in the buildings. of .... .... . ................. at 24- . . North Andover, Mass. Fee �' ..... Lic. Nom" d'J ....... ....... GAS INSPECTOR Check # A—,o<—) 6638 MASSACHUSE'T'TS UNN ORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Logations New ❑ Renovation El U B-BASEM ENT A S E M ENT ST. FLOOR ND. FLOOR RD. FLOOR TH. FLOOR 9 FLOOR TH. FLOOR TH. z TH. FLOOR a i U B-BASEM ENT A S E M ENT ST. FLOOR ND. FLOOR RD. FLOOR TH. FLOOR TH. FLOOR TH. FLOOR TH. .FL 0 —OR TH. FLOOR Owner's Name Replacement D cc a a F o Q c Date Perm # e,. G 2 g Amount $ s3 8-1LV.\A" Plans Submitted 0 F v� (Print or type) Name_ PIS M1pQ,— L.L� Check one: Certificate Installing Company Corp. - Address v� e X11-z2y3 , rs) k -i 0-471&K Partner. usmess a ep one 5"7 y_ :?w &11 X03 Q� l tQ°1i Firm/Co. _ Name of Licensed Plumber'or Gas Fitter «, INSUF+ANCE COVERAGE I have a current liability lnsurance,policy or it's substantial equivalent. YesCheck one: 1:1 If you have checked es please indicate the type coverage by checking the appropriate box. No� Liability insurance policy [3 Other type of indemnity D 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. Signature of Owner or Owner's Agent Check one: Owner 13 Agent13 I hereby certify that all of the details and information I e subm best of my knowledge and that all plumbing work installatio erformedered)rerPermit Isve sued for oth srapplication w I be ie true and accurate n the compliance with all pertinent provisions of the M sachuse a Gas d Chapter 142 of the General Laws. le y/Town, { VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber �A543 Gas Fitter (cense Number Master Journeyman J � (Print or type) Name_ PIS M1pQ,— L.L� Check one: Certificate Installing Company Corp. - Address v� e X11-z2y3 , rs) k -i 0-471&K Partner. usmess a ep one 5"7 y_ :?w &11 X03 Q� l tQ°1i Firm/Co. _ Name of Licensed Plumber'or Gas Fitter «, INSUF+ANCE COVERAGE I have a current liability lnsurance,policy or it's substantial equivalent. YesCheck one: 1:1 If you have checked es please indicate the type coverage by checking the appropriate box. No� Liability insurance policy [3 Other type of indemnity D 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. Signature of Owner or Owner's Agent Check one: Owner 13 Agent13 I hereby certify that all of the details and information I e subm best of my knowledge and that all plumbing work installatio erformedered)rerPermit Isve sued for oth srapplication w I be ie true and accurate n the compliance with all pertinent provisions of the M sachuse a Gas d Chapter 142 of the General Laws. le y/Town, { VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber �A543 Gas Fitter (cense Number Master Journeyman a- Date . ,% L 1/f ,X ......... • � i o� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION S^CHUSE� This certifies that ..Wef! 1?:..... ' . ........... has permission for gas installation ............ in the buildings of ....................................... at .,A ". .c r'. J ...... North Andover, Mass, Fee..).).... Lic. No.. .... ...-��: :-�. .�........ GAS INSPECTOw Check # 6264 fnPzl�; r,,3 - / a o 3 ,3 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) �• /%/obi (JE -12- ,Maas. Date leg -lo S- 0 Permit N_ Building Location 17< So, C>��•I WM's Name 0 l i�/3�� /'///d•j I �� Owner Tel# J% 7 141 — / -1( 9-J Type of Occupancy New ❑ Renovadon Replacemt:nt ❑ Plan Submitted: Yea ❑ No ❑ FIXTURES Installing Company Name 11l f./ C(7���L:11' ' °y Check one: Certificate Address ! / O So q7 -H iiiA/lN ST ❑ Corporation DDLE?oN MR- 0 1 ❑Partnership Business Telephone 4l9 7 ) a23 –13291 `(FlmVCo. Name of Licensed Plumber or Gas Fitter / / % G E L Q R y S C Q INSURANCE COVERAGE: have a currant AablAty Ir urance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1� No 0 ve &rack if you haed M. please Indicate the type ooverage by doWng the appropriate box. A uaWlty WMnnce porky,' Other type of indemnity 0 Bond ❑ OWNERS INSURANCE WAIVER: I am aware that Uta Itcertaee dm not hby ft k ataanoe coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit spocation waly a fhIs requirement. Chad one: Owner 0 Agent ❑ Sionature of Owner or Ownefs Anent knowledge and that all plumbing work and Installations performed under the >ertinent provisions of the Massachusetts State Gas Coda and Chapter 142 By Type of License: rab -Plumber -Gas Atter Y a Cityfrown • Journeyman APPROVED (OFFICE USE ONLY) 1 � z 1 � • Installing Company Name 11l f./ C(7���L:11' ' °y Check one: Certificate Address ! / O So q7 -H iiiA/lN ST ❑ Corporation DDLE?oN MR- 0 1 ❑Partnership Business Telephone 4l9 7 ) a23 –13291 `(FlmVCo. Name of Licensed Plumber or Gas Fitter / / % G E L Q R y S C Q INSURANCE COVERAGE: have a currant AablAty Ir urance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1� No 0 ve &rack if you haed M. please Indicate the type ooverage by doWng the appropriate box. A uaWlty WMnnce porky,' Other type of indemnity 0 Bond ❑ OWNERS INSURANCE WAIVER: I am aware that Uta Itcertaee dm not hby ft k ataanoe coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit spocation waly a fhIs requirement. Chad one: Owner 0 Agent ❑ Sionature of Owner or Ownefs Anent knowledge and that all plumbing work and Installations performed under the >ertinent provisions of the Massachusetts State Gas Coda and Chapter 142 By Type of License: rab -Plumber -Gas Atter -Master Cityfrown • Journeyman APPROVED (OFFICE USE ONLY) n above application era and accurate to the best of my Issued for Ift.applicoW wM b} ip2mptlance with an License Number (0 d 1 r.l 1--J, 014r Lfomtruium it of flnsartts Beirurtutalt of Public—Aafetq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only q 2 r Permit No. p( A Occupancy & Fee Checked 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / TU ti6r 9 �� (%)Q or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1-7, 's ©- R (Z VN3) Owner or Tenant t C to A ✓e P�o �--� A 7t> :T" ( A N Owner's Address SAF ,, t, &;— Is ;Is this permit in conjunction with a building permit: Yes No C (Check Appropriate Box) Purcose of Utility Authorization No. Existing Service v 00 Amps L -7-0 —J 2YO Vaits Overhead I _I Undgrnd No. of Meters New Service Amps _J Voits Overhead Undgrnd No. of Meters Number of Feeders and Ampacity Location and Nature of Pr000sed Electrical Werk �Cl.aOy VOCT–G iLi-< 7-c-tt&"1--) 4 D fl 70 S ua, �oo�.� IF ,�L31'o�a4 cN ��+2vtc� A�vL 7a �lC� CKi. �'No� a�- I / iotai No. of Lighting Outlets i No. of Hot Tubs — No. of Transformers KVA 6v/ No. of Lighting Fixtures i Swimming Pool grroe_ cmc. '_ Generators KVA \Jf No. of Emergency Lighting No. of geceotacie Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones INo. of Ranges No. of Air Cone. Totai No. of Detection and r, t7 g i tons Initiating Devices ` y treat –cat Totai f/I No. of Disoosais I No•of Purn, cs :ons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers SCace/Area Heating �o J� CbV Detection/Souncing Devices — Municioai No. of Dryers I Heating Devices KW Local i Connection _' Other No. of No. of Low Voltage No. of Water Heaters KW i Signs Sailasts Wirina No. Hvcro Massace Tubs No. of Motors Total HP OTHER: al INSURANCE COVERAGE: Pursuant to the reouirements of :tassacnusetts general Laws I have a current Liability Insurance Policy inctucing Comc.etec Oceravons Coverage or its substantial eduivaient. YES = NO = I have suomittec valid proof of same to the Office. YES IV NO = If you nave checxec YES. please indicate the type of coverage by checx)ng the appropriate box. 3� INSURANCE BOND = OTHER = (Please Sbec:to (Exoiration Date) Estimated Value of E!ectrcat Worx S Work td Start 1 ' insbection Date Recuesteo Signed unser the JPenalties of perjury: FIRM NAME <lk0 Licensee I-4 l�`°"�� Signa%;ie Rougn I 6 4t�c Final LIC. NO. ql5 :� LIC. NO. '1,2 V ?Z a O / �.�1 Bus. Tel. No. fO / 1`,J / /V s vo c– Address J �SO �'� �s �' —J'JV � • c 4 � f HOZ Alt. Tet. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee goes not nave the insurance coverage or its substantial eauivaient as re- quired by Massachusetts General Laws. and that my signature on tn:s hermit aepiication waives this reouirement. Owner Agent (Please checx one) Teieonone No. PERMIT FEE S (Signature of Owner or Agent) x-5505 2 3 t 21 Date ..'../r.;1... 0 0 TOWN OF NORTH ANDOVER miswift. PERMIT FOR WIRING ex This that /........... certifies ..... ........... .. ... .... .... . . ... ....... Pr e4IZIJ4�? has permission to perform ........./f. .................................................... wiring in the building of ....... ............................................... at ..... ...... ......... ............. . North Andover, Mass. or Fee........ Lic. ............. i . ........................ ELECTRICAL INSPECTOR ru C f( 41' 9,yd WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Location i� �y (ZeQ st- No. 2Z Date ,.ORTq TOWN OF NORTH ANDOVEW O Certificate of Occupancy $ A . `° Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee& 61� $ '�" N Sewer Connection Fee $ CU Water Connection Fee $ T TOTAL 0 $ � � Building Inspector ± -� p Div. 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