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TOWN OF NORTH ANDOVER�''
PERMIT FOR GAS INSTALL TION
This certifies that . .1 ...................
has permission for gas installation .. //) ? .C1.-1 .............
in the buildings of .... 1. .. t..4 ........................ .
at ............... North Andover, Mass.
Fee.. °. Lic. No../ ...'. `.. ...... .. '� .....
6AS INSPECTOR
Check # ,1 ' , `
6392
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MASSACHUSETTS UNIFORM APPUCATON FOR PERNUF TO DO GAS FITTIN
(Type or print) �9-
Date e
NORTH ANDOVER, MASSACHUSETTS
Building Locations A -W / v J L-&/7 Permit # (� 3? -1-
Amount
LAmount $ 9 a
Owner's Name ` U
New Renovation Replacement D Plans Submitted
SUB -BASEMENT
BASEM ENT
1ST.
FLOOR
2ND.
FLOOR
3RD.
FLOOR
4TH.
5TH.
6TH.
FLOOR
FLOOR
FLOGR
7TH.
9TH.
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SUB -BASEMENT
BASEM ENT
1ST.
FLOOR
2ND.
FLOOR
3RD.
FLOOR
4TH.
5TH.
6TH.
FLOOR
FLOOR
FLOGR
7TH.
9TH.
FLOOR
FLOOR
Name �r fie) C/�L. �y f�-/t C Check one: Certifica Instglling Company
Address AEW" -16A:-1 �/
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BusinessTelephone Partner.
(> Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one-
I have a current liability Insurance, policy or it's substantial equivalent. Yes tT No�
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 0-1" Other type of indemnity D Bond 0
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.
Check one:
Signature of Owner or Owner's Agent Owner 13 Agent 0
t 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 perfo ��n((der Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas iW/a d Chapter 142 of the General Laws.
By: .
Title
1APPROV ED (OFFICE USE ONLY)
i (Y
,signature o;UaGsed kumer Or Gas Fitter
Plumber
Gas Fitter Icense Number
13 -master
Journeyman
Date... f".. /;' . ...
,aOtt Tly ''
Or Oya4..a° ,e,ti0 �
TOWN OF NORTH ANDOVER
ti D
,z PERMIT FOR GAS INSTALLATION
1 This certifies that ... .'.! .:7 �............. / .7-. -1 - ".
has permission for gas installation
in the buildings of � .'J.. r� *� `...............
at r' --1� -�^ .. , North Andover, Mass.
Feed.. Lic. No.. '.'/.. : ..........
�i GAS INSPECTOR
Check # 019d
6273
MASSACHUSETTS UNH ORM APPUCATON FOR PERNIIT TO DO GAS FITTING
(Type or print) Date /'���v
NORTH ANDOVER, MASSACHUSETTS
Building Legations _L/ `�
C -1-M
❑
Permit #Pao
❑
Gas Fitter
Q
Owner's Name
/ /�
Amount $
New
Renovation1:1Replacement
1-3Plans
Submitted
❑
Name of Licensed Plumber'or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check o e:
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked v '
s, please ndicate the type coverage by checking the appropriate box.
1 Liability insurance policyED 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
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ 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 a installations peerrfSormHed under Permit Issued for this application will be in
compliance with all pertinent provisions of the �ct�us Sta� -I Cop Chapter 142 of the General Laws.
Title
City/Town.
APPROVED (OFFICE USE ONLY)
Signature of I
❑
Plumber
❑
Gas Fitter
Master
Journeyman
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SUB-BASEM ENT
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B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
Name of Licensed Plumber'or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check o e:
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked v '
s, please ndicate the type coverage by checking the appropriate box.
1 Liability insurance policyED 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
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ 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 a installations peerrfSormHed under Permit Issued for this application will be in
compliance with all pertinent provisions of the �ct�us Sta� -I Cop Chapter 142 of the General Laws.
Title
City/Town.
APPROVED (OFFICE USE ONLY)
s# Plumber Or Gas Fitter
/Lo I
License Number
Signature of I
❑
Plumber
❑
Gas Fitter
Master
Journeyman
s# Plumber Or Gas Fitter
/Lo I
License Number
3 Location�.SO
e. No. Date
TOWN OF NORTH ANDOVER
A
p Certificate of Occupancy $
> = '
Building/Frame Permit Fee $
SSA :MU ' eta
Foundation Permit F e $
Other Permit Fe e$
Sewer Connection Fee $
�7. o lJ
Water Connection Fee $
,,gJOTAL $
6U44
Building Inspector
Div. Public Works
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OFFICES OF:.
APPEALS
BUILDING
_DING
CONSERVATION
LVATION
HEALTH
PLANNING
°
a..
Town of
-"� NORTH ANDOVER
t)IVINU)N (W
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIIZECI'011
120 main Street
North Attttover.
M:ISS;W ttLSC11S O 1845
((il 7)685.477 i
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number /.302 is that the dcbris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S
150A.
The debris will be disposed of in:
S ) o �&S�6'tv —T,
(Ucation of Facility)
Signature of Per ntt Applicant
Date
�aPrP�
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
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1 N�REBY C'eM,-Y YO Tye T/TLE IWS6!,Mr ANO
BAAl,r 7W47,T,YEOi✓ELG/.vG /S LOC.4TB"O O.c/
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!Y/Tip/ T//E r��,�/ OF,1/,�,/o>N= rc 20N/N6 CE6ULA7A:741S
,QL�G.O.QO/.vis SETBAC.t'S FROM ST.PEE7"S � LDT U.vES. "'
1 FvrT.srC,P CE.PT/FY 7,V f7- 7-1113. O/rELL/N6 /S it/OT
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TOWN OF NORTH ANDOVER
pt ,tea° ••.,�0
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A Certificate of Occupancy $
i Building/Frame Permit Fee $
'�� °"""° •Eta Foundation Permit Fee $ --
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Sewer Connection Fee $
Water Connection Fee $
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LJUL 2 1- TOTAL
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE
JOB LOCATION I&s d S/91 el +1 Si
Number . Street Address Section of town
:'HOMEOWNER"
Name
ome Phone
PRESENT MAILING ADDRESS 1k,56 5.19tel 5T
City Town
State
Work Phone
Zip code
The current exemption for "homeowners" was extended to include owner
-occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license, provided
that the owner acts as supervisor. (State Building Code, Section 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory to such use and/or farm
structures. A person who'constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to the Building Official, on a form acceptable to the Bulding Official,
that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes, by-laws, rules and
regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
North Andover Building Department minimum inspection procedures and
requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE_
APPROVAL OF BUILDING
CIAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.
V
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CARPENTRY CONTRACTOR
AGREEMENT
Property Owner
Date
Street
F �%
Job Location -
/ &510 _Wb ST
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City, State, Zip
Property Owner's Phone
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We hereby submit estimates and specifications for
30 V-30 ctrc 4,-,4LLS
W / v ✓ S /•vS7,11,W /G/1T 7u 7;AA GV69 i1/e2 Q cu n.e2/�
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e0AiP4e71V' . Cost 70
This contract is at the option of the Property Owner cancellable within 3 working days after the signing date. Failure to exercise
this option will render the agreement in full force and effect and work will commence immediatelv thereafter.
WE AGREE hereby to furnish material and labor complete in accordance with above specifications for the sum of:
%j 66% V' /3 �9/ PZ47/64 Cif ($ /I/ ztsv A2Li--
Payments to be made as f ol low
)",ft' 4L 6114,0E i9T C6 V/ C7706
All work to be completed in a workmanlike manner accord-
ing to standard practices. Any alterations or deviation from
the above specifications involving extra costs will be exe-
cuted only, upon written orders, and will become and extra g /0,14e�?A/A�
charge over and above the estimate. All Agreements con- Buyer
tingent upon strikes, accidents or delays beyond our control.
ACCEPTANCE OF CONTRACT — The above prices, specifica Signature
tions and conditions are satisfactory and are hereby ac
cepted. You are authorized to do the work as specified Seller
Payments will be made as outlined above.
Signature
Date of Acceptance Buyer
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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: &L d V,,� Phone 6 SS / 70
LOCATION: Assessor's Map Number
Subdivision
Street / �S-6 -.gl L EM
Parcel
Lots)
St. Number /9(570
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
V/ Date Approved
Conservation Administrator Date Rejected
Comments
Comments
/Food Inspector -Health
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Septic Inspector -Health
Comments
Public Works - sewer/water connections
- drivewa`y�permit
Fire Department _f�--
Date Approved
Date Rejected
Date Approved
Date Rejected
Received by Building Inspector Date
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Date
Approved
a
Town Planner
Date
Rejected
Comments
/Food Inspector -Health
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Septic Inspector -Health
Comments
Public Works - sewer/water connections
- drivewa`y�permit
Fire Department _f�--
Date Approved
Date Rejected
Date Approved
Date Rejected
Received by Building Inspector Date
hkm`u
WIN
FORM U - LOT RELF.ASE 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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: �AbC cL 1,4bz:,,- Phone 6f6_00_1
LOCATION: Assessor's Map Number Parcel
Subdivision
Lot (s)
Street / *S-6 s /l L 6:�^" 1 St. Number / a)
************************Official Use Only************************
r�REvCjOMMMENDATIONSS OF TOWN AGENTS: l
"l.� •m%Cfl�l,ll_ Date Approved
Conservationy �Administrator Date Rejected
Comments XA 0
G! r)
Town Planner
Comments
Food Inspector -Health
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NORTH ANDOVER BUILDING DEPARTMENT
400 Osgood Street
Tel: 978-688-9545
Fax: 978-688-9542
BUSINESS FORM FOR TOWN CLERg
DATE: /1 " -3- 0
NAME: �/--) V C. qu 0 -1
ADDRESS:
ZONING DISTRICT:
TYPE OF
BUILDING LAYOUT
v S19 LcWr S,
6 S j v.,u
AVAILABLE PARKING SPACES: Vn V
ZONING BY LAW USAGE: NO
BUILDING INSPECTOR SIGNATURE
ReviW 11.5.0/
BUS04US FORM FOR MWN CMM