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Miscellaneous - 21 BALDWIN STREET 4/30/2018
W -a Location No. �/ / a U f/ Date ,.oRTM TOWN OF NORTH ANDOVER L • o Certificate of Occupancy $ F.,��„S <� Building/Frame Permit Fee $ ` r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �tGd 23810 building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:—Y±% r // IMPORTANT: Date Received must complete all items on this LOCATION al ()k ��k>`<:Z�- Print Print J U MAP NCO /3. 0 PARCEL: Ooo b ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family )(Two or more family No. of units: - ❑ Assessory, Bldg _ ❑ Other "�� Flood lami� ®Wetlands i ❑ Industrial ❑ Commercial '$,Repair, replacement ❑ Demolition F,. J EWv - z'-; �5 ®We�"`11-per.:¢ 4`` ` ; o. At- ❑ Others: hb®__ Wa eONO Disthctt °�;�� - J'SUltlr 11V1V kJr W UIXIL t v fir, rr..E\r (3 `t Identification Please Type or Print Clearly) OWNER: Name: Phone: C11 b' (J Address: CONTRACTOR Name: ��, v1 �•� V. '�x1k2ri�Z� �; a'1 Phone: t.Q'a� • 1 Address: `�,:,L ��c�.vv.-s �v �1 z _ i�u �� �: YnC I L �1�1 a Supervisor's Construction License: ('�nLExp. Date: �� ► 1 Z Home Improvement License: Exp. Date: y 21 IZ- ARCH Phone: Address: - Reg. No., FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost:$ I (v,�(o FEE: $ Check No.: l ;_f Receipt No.: a 3 c�/b NOTE- Persons-Zaontractinz with *registered contractors rho not h4vr access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on - Signature ` COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT = Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Low -Income Multifamily Retrofit Program 9/26/10 Administered by LEAN North Andover- DRAFT Overall. Work Order For Program Approval Only North Andover HA Job 10-123-0 Multiple NORTH ANDOVER 01845 Joanne Crawford (978)862-3432 Section Measure Installed Unit Price Price Attic "Unfloored R-20 open/unrestricted Cellulose 11700 $1.23 $14,391.00 Sub Total 11700 $14,391.00 wall *All Walls Clapbd/wood/vinyl R-13 18720 $1.70 $31;824.00 Sub Total 18720 $31,824.00 Floor Floor Insulation Basement Overhead - R30 11700 $1.73 $20,241.00 Sub Total 11700 $20,241.00 Infiltration Airsealing w two-part foam 26 $75.00 $1,950.00 Sub Total 26 $1,950.00 Distribution Duct insulation R-5 520 $2.95 $1,534.00 Sub Total 520 $1,534.00 Grand Total $69,940.00 * Attic & Wall insulation savnmgs estimates are based on audit limited access evaluation of need, initial vendor walkthrough will determine the ability to install these measures w)d estimates will be updated at that time. 4J4i1 2li, ;1l # iO z rA i� x o a, LE Cl) � A w2 C2 U w .CO2 g. m m w W cn 1.14 F O0 w W P-444 a. m o cn Q o cn O y 1= c ICD OM o G _ CD c o a) .CO2 g. m m c v 0 CD o i O0 CD :.0 H O 0 c_Qv o a C os Q VCD V c ca C.) J .0 CL= c `^ V i CL C,3• C is A CL �..� co) C C Cc 'mom ts 0 CL 1 • o �cwaD �•oo �•(� n me C y is a: 32 �m CA Cc o coms y m C: CMNl o Z C C 06 C Q � [ � m C •O = m :moo N ~' COO eC.. fA m yam+ ~ ee = m y •y �... C MDcc °c •E CL=Z n E •y o v m o ® c CL g. COD 0).0 m� o� Cl O H cc L 09— a mem � O y 1= c ICD OM G _ a) .CO2 g. m m CD 0 CD co O0 CD CD 0 c_Qv o a o- os Q oZ� c ca C.) J .0 c Z CD 0 CL �..� co) C C CO2 1 The Commonwealth of Massachusetts Department of Industrial Accidents §S. Office of Investigations 600 Washington Street Boston, ALL 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Con.tractors/Electricians/Plumbers Applicant Information Please Print Le:ribly Name (Business/organization/Individnat):_.CA L\` Address: City/State/Zip: \ Phone.#: 6)3 - \ *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer'that isproviding workers' compensation insurance for my employees Below is thepolicy and job site information. Insurance, Company Name:- Policy # or Self -ins. Lic. #: , L bT)\a.G c>\Ga Expiration Date:- lsi\ Job Site Address: { I C� �r� L���� �� city/state/zip:--n •�i�� Attach a copy of theworkers' compensation 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 r 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 Investieations of the DIA for insurance coverage verification. Ido hereby certify under the pains•and penalties of erj that the information provided above is true and correct \ 1 ._Y c 11� Si ature Date: V use only. Do not 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 In§pector 5. Plumbing Inspector 6. Other Contact Person:_ Phone:#• Are you an employer? Check the appropriate box: I am a employer with \6 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.0 I am a 'sole proprietor or partner- listed on the -attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers'_._. [No workers' comp. insurance comp. msurance.t required.] 5. ❑ We area corporation and its '3. ❑ I am a homeowner doing all work officers have exercised their myself, [No workers' comp, right of exemption per MGL insurance required.] t c, 152, § 1(4), and we have no employees. [No workers' - comp. insurance required:] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer'that isproviding workers' compensation insurance for my employees Below is thepolicy and job site information. Insurance, Company Name:- Policy # or Self -ins. Lic. #: , L bT)\a.G c>\Ga Expiration Date:- lsi\ Job Site Address: { I C� �r� L���� �� city/state/zip:--n •�i�� Attach a copy of theworkers' compensation 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 r 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 Investieations of the DIA for insurance coverage verification. Ido hereby certify under the pains•and penalties of erj that the information provided above is true and correct \ 1 ._Y c 11� Si ature Date: V use only. Do not 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 In§pector 5. Plumbing Inspector 6. Other Contact Person:_ Phone:#• ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 04!23/24123/2010 PRODUCER (800) 225-1865 Fred C. Church, htc. 41 Wellman Street Lowell, MA 01851 800-225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE _ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Advantage Weatherization, Inc. Two Two Adams Place, Suite 100 Quincy, MA 02169 INSURERA: Citation Insurance Company e; National Union Fire Insurance Company ofPittsburgb Selective Insurance Company INsuRER c p y of America INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADO'L ?r Typr O INSURANCE POLICY NUMBER POLICY EFFDECTIVE DATE POLICYE MPII TION LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIALGENERAL LIABILITY CLAIMS MADE 7 OCCUR PREMISES Ea occur nee S 100,000 MED EXP (Anyone person) S 10,000 C S1928883 4/2/2010 4/2/2011 PERSONAL$ ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000 PRO LOC POLICY 7 JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) A X X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BBNT98 4/2/2910 4/2/201 I BODILY INJURY (Per person) i BODILY INJURY (Per accident) S PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S _ ANY AUTO AUTO ONLY: AGG S EXCESS/UMBRELLALLABILITY X OCCUR 0 CLAIMS MADE EACH OCCURRENCE S 15,000,000 . AGGREGATE S 15,000,000 B BE1223010 6/20/2010 6/20/2011 s DEDUCTIBLERETENTION RX $10,000 S WORKERS COMPENSATION AND X I WC STATU-OTH- B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC001290194 6/20/2010 6(20/2011 EL. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 OFFICERIMEMBEREXCLUDED? S ECIAyes, descr L PROVISIONS SP)ba under below E.L DISEASE -POLICY LIMB S /,000,000 OTHER . DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate is Issued as evidence of coverage. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE At'UKU AO I/UUIIUO) Client# iTdRt Mst# 2010GL,Auto,WC,Umb Ccrt# ©ACORDCORPORATION 1988 p 0 .� n ' OD z D' :C p 7 D m d ! 4 .PC m to J otttzer � N .al C in 1 � t CD n C , N D H i _ 7 •S7 O i I o` kd ✓��.0 fnD ,yy, -CID, N m ?+ K N d O ry y ti Yr". LLQ O N , C7• p � 4 , i O p o` Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:, ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No, MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract -. ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.-C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance, Report ❑ Engineering Affidavits for Engineered products g0TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building permit Revised 2008mi Date.. !......-. �...j .... . a r'` ,nz' f NORTH 1 TOWN, OAF NORTH ANDOVER o p yLoo PERMIT FOR GAS INSTALLATION Irk This certifies that .�! :.` .�.......... "....... r f .. f . has permission for gas installation !? . ! . ? ...�. t -t. ! 1' ; in the buildings of f . . ' at......:... ; 6. ,"I�, F, ;`= - ` .. ', North Andover, Mass. Fee... x� a_` Lic. No... ...f.� r .........:......:... . i�L` •+t _ ` GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File • •••1M It NORTH ANDOVER. , Mass. Date S. 0 1g 96 Building Localfon =)/6 Permit dI Owner's �► o ver- Mass ' Name _ Ooik N & 2 -Noy aJousloik A0 ; "Oki Tr New ❑ Renovation Replacement ❑ Plans Submitted: Yes ❑ No ❑ installing Company Name_ Obert W . Srv, yr �` Sans ZnC: AddressA l l e y 3free-.+ . ' Business Telephone_ (0)-7-5&/- 04 `{ ' Name of Licensed Plumber or Das t=itter Check one: ��1 Corp. El Partnership ❑ Firm/Co. INSURANCE COVERAGE: Check one I have a current Ilablllty Insurance pollcy or its substantial equivalent. Yes J$ No ❑ If you have checked yLs, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ® Other type of Indemnity ❑ Bond ❑ Certificate 109d- C— OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hayo- 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: Owner ❑ Agent O S4gnature of Owner or Owner's Vient (hereby certify that all of the details and Information 1 have submitted (or entered) In above application are true and accurate to the best of my knovrledgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all partincnt provisions of the Massachusetts State Gas Uode and Chapter 142 of the General Laws. pY Te of License: Plumber Rnalute of I n"d Plumber or Gas Filter Title asfitlef (l WMaster License Number CltytTown Q Journeyman Ar'P m -n (OrricE USE ONLY) NNE NIN IINNNNINNINN MIN IN mown Ron Nunn NNN mom -----0000000000 0000900000 so installing Company Name_ Obert W . Srv, yr �` Sans ZnC: AddressA l l e y 3free-.+ . ' Business Telephone_ (0)-7-5&/- 04 `{ ' Name of Licensed Plumber or Das t=itter Check one: ��1 Corp. El Partnership ❑ Firm/Co. INSURANCE COVERAGE: Check one I have a current Ilablllty Insurance pollcy or its substantial equivalent. Yes J$ No ❑ If you have checked yLs, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ® Other type of Indemnity ❑ Bond ❑ Certificate 109d- C— OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hayo- 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: Owner ❑ Agent O S4gnature of Owner or Owner's Vient (hereby certify that all of the details and Information 1 have submitted (or entered) In above application are true and accurate to the best of my knovrledgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all partincnt provisions of the Massachusetts State Gas Uode and Chapter 142 of the General Laws. pY Te of License: Plumber Rnalute of I n"d Plumber or Gas Filter Title asfitlef (l WMaster License Number CltytTown Q Journeyman Ar'P m -n (OrricE USE ONLY) it -tint or i ype NORTH ANDOVER, , Maas. Date f ID 19 96 Buffdlng Permit Location OrA /— dol,%% 1 � Owner's Name- IlipA j N 14,r y �o� . r2 ��cs�suu c� Ao ' Hop-, r/ New C] Renovation 04 Replacement D plans Submitted: Yes U No p inslaiiing Company Nam -To 1k) - _Trvrn� Address kms. AIfey JFree_+. Mass. CIgoa-- Business Telephone to I -7 - 5V - c4�{ Name of Licensed Plumber or Gas Fitter Check one: Corp. Cj Partnership O Firm/Co. INSURANCE COVERAGE: : Check one I have a current liability Insurance policy or Re substantial equivalent. ; Yes J4 No O If you have checked Lee, please Indicate the type coverage by checking Ilia appropriate box. A liability Insurance policy ® Other type of Indemnity O Bond O Certificate toys C_ OWNER'S INSURANCE WAIVEn: I am aware that the licensee does not hays 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: Owner 11 Agent t] Signature of owner or owner's Agent I= certify that an of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my Itnovvled a and that an plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Mtlrvcnt provisions of the Massachusetts State Gas Cods and Chapter 142 o1 the Genwal Laws. gy T of sUceernse: er Title (13 nit Signature o M number hC or Gas fitter Master License NumberaNRown urneyman Ar"WWE-0 (OFFICE USE ONLY) EM� NOUN won IN Ono COS. 0 �■ WAdy ■����■ ■ I�fA �wlll■ ■ inslaiiing Company Nam -To 1k) - _Trvrn� Address kms. AIfey JFree_+. Mass. CIgoa-- Business Telephone to I -7 - 5V - c4�{ Name of Licensed Plumber or Gas Fitter Check one: Corp. Cj Partnership O Firm/Co. INSURANCE COVERAGE: : Check one I have a current liability Insurance policy or Re substantial equivalent. ; Yes J4 No O If you have checked Lee, please Indicate the type coverage by checking Ilia appropriate box. A liability Insurance policy ® Other type of Indemnity O Bond O Certificate toys C_ OWNER'S INSURANCE WAIVEn: I am aware that the licensee does not hays 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: Owner 11 Agent t] Signature of owner or owner's Agent I= certify that an of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my Itnovvled a and that an plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Mtlrvcnt provisions of the Massachusetts State Gas Cods and Chapter 142 o1 the Genwal Laws. gy T of sUceernse: er Title (13 nit Signature o M number hC or Gas fitter Master License NumberaNRown urneyman Ar"WWE-0 (OFFICE USE ONLY) I r -nnt or type! _. _. '", ,v. .. poll" NORTH ANDOVER, ,'Maas. Date D 19 96 Bu ding / PermR #_�C1� Location 3 �'h aree4 Di-4�r►c�o v�f' owner's +1 ri S Name —Von H dA 9na�i r2 6,?suur- Ao , "Oo j — I.r New ❑ Renovation Replacement ❑ plans Submitted: Yes ❑ No C7 Installing CompaNam ny L e_ v I I p l IQ. Sr V1 'Address A I JEre j- . nn pSS. OloiO�— B.usiness Telephone to t -7 - Sts/ - o4i tl Name of Licensed plumber or Gas Filter _�or (L7, .1 r v, v►e. Check one: Corp. d Partnership ❑ Flrm/Co. IMSUt7ANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equivalent. Yes J$ No ❑ if you have checked yes, please Indicate the type coverage by checking Ilia appropriate box. 'A liability Insurance policy N3 Other type of Indemnity ❑ Bond ❑ Certificate I/ a C_ ow..NER'S INSUnANCE WAIVER: I am aware that the Ilcensee dgell not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, end that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ nature of Owner or Owner's en I= hateby cattily that Cell of the details and Information I have submitted (or entered) In above application are true and sccurale to the best of my kna�ntedgo and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance with all parttncnt provisions of the Massachusetts Slate Gas Code and Chapter 142 of the General laws. �y Te of License:,� Plumber SIQA&turo of ucensed Plumber or Gas Fiter THIS Gaslitter Dmaster Ucense Number City/Town Q Journeyman App limi-o (OrricE USE ONLY) Win■■■■■■�■■■��MIN �■ ■■ ■ ■ HIM - Installing CompaNam ny L e_ v I I p l IQ. Sr V1 'Address A I JEre j- . nn pSS. OloiO�— B.usiness Telephone to t -7 - Sts/ - o4i tl Name of Licensed plumber or Gas Filter _�or (L7, .1 r v, v►e. Check one: Corp. d Partnership ❑ Flrm/Co. IMSUt7ANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equivalent. Yes J$ No ❑ if you have checked yes, please Indicate the type coverage by checking Ilia appropriate box. 'A liability Insurance policy N3 Other type of Indemnity ❑ Bond ❑ Certificate I/ a C_ ow..NER'S INSUnANCE WAIVER: I am aware that the Ilcensee dgell not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, end that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ nature of Owner or Owner's en I= hateby cattily that Cell of the details and Information I have submitted (or entered) In above application are true and sccurale to the best of my kna�ntedgo and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance with all parttncnt provisions of the Massachusetts Slate Gas Code and Chapter 142 of the General laws. �y Te of License:,� Plumber SIQA&turo of ucensed Plumber or Gas Fiter THIS Gaslitter Dmaster Ucense Number City/Town Q Journeyman App limi-o (OrricE USE ONLY) u not or Iypel NORTH ANDOVER, , Mass. Date ID 19 96 1/ Building Permit t* L lion_ --) 3 n A �V,04 Owner's prt�o ver, A.ss - Name 0bfk N A,c 2-1,Aoy Ajoosru(, Aos ; Hooj rr New C] Renovation Replacement C] Plans Submitted: Yes C] No (p %r Installing Company Name Tv[�f to. Srvlhe- r Suns �nc.: Address A I l t±j SEree-i- . M ass. C1904— Business Telephone to 1-7 - Sts/ - O4� Name of Licensed Plumber or Gas Fester Check one: Corp. d Partnership O Firm/Co. INSURANCE COVERAGE: Check one I have a current Ilablifty Insurance policy or Its substantial equivalent: Yes 04 No C] if you have checked res, please Indicate the type coverage by checking the appropriate box. Aillablifty Insurance policy ® Other type of Indemnity C] Bond C] Certificate 0 y;� �. 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 permlt application waives this requirement. Check one: Owner C] Agent C] Signature of Owner or Owner en 1 hereby certify that an of the details and information 1 have submitted tot entered) M above application are true and accurate to the best of my knowledge and that an plumbinq work and Installations performed under the permit Issued for this appliestlon will be in compliance wilh all parts 1 provisions of the Massachusetts Slate Gas Code and Chapter 142 of the General Laws. pY T e OIL" r tkense: Plumber Tula c1as11lter na ure o Licensed Plumber or as filter Master License Number M % OZ.S 5 CitylTown Q Joumeyman APPRYVED WFICE USE ONLY) WANNNAN��AASAAA�A mom���I��li�l�Awl�■ ■■ ■t■ �iiiiiiiiiCiiiwi�iiiii�iCC ■� %r Installing Company Name Tv[�f to. Srvlhe- r Suns �nc.: Address A I l t±j SEree-i- . M ass. C1904— Business Telephone to 1-7 - Sts/ - O4� Name of Licensed Plumber or Gas Fester Check one: Corp. d Partnership O Firm/Co. INSURANCE COVERAGE: Check one I have a current Ilablifty Insurance policy or Its substantial equivalent: Yes 04 No C] if you have checked res, please Indicate the type coverage by checking the appropriate box. Aillablifty Insurance policy ® Other type of Indemnity C] Bond C] Certificate 0 y;� �. 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 permlt application waives this requirement. Check one: Owner C] Agent C] Signature of Owner or Owner en 1 hereby certify that an of the details and information 1 have submitted tot entered) M above application are true and accurate to the best of my knowledge and that an plumbinq work and Installations performed under the permit Issued for this appliestlon will be in compliance wilh all parts 1 provisions of the Massachusetts Slate Gas Code and Chapter 142 of the General Laws. pY T e OIL" r tkense: Plumber Tula c1as11lter na ure o Licensed Plumber or as filter Master License Number M % OZ.S 5 CitylTown Q Joumeyman APPRYVED WFICE USE ONLY) tr'nnt or type) • • r v w. .. ..IT %.4 NORTH ANDOVER. , Maas. Date ID tg 96 BuAding Permit #� f Location__ o� ��/c�,r in �• Or-" / Owner's Or-" f-fh-9VP.1^ i%)0 -1S Name_ 0ojk rN AA 9noycrt New ❑ RenovationReplacement ❑ Pians Submitted: Yes ❑ No ❑ Installing Company Name_�ober t &Q. �rvr n ns�nc: Address �Sa_ AI_1ey Jlree�-. ass. O Business Telephone to I -7 - SIS/ - o4b tj Name of Licensed Plumber or Gas Filter r v 0 e, Check one: Corp. d Partnership ❑ Firm/Co. IMSURANCE COVERAGE: : Check one I have a current liability Insurance pollcy or its substantial equivalent. Yes J$ No ❑ If you have checked ,yes, please Indicate the type coverage by checking Iiia approprlale box. A liability Insurance policy H Other type of Indemnity ❑ Bond ❑ Certificate ty.-)- C__ OWNER'S INSURANCE WAIVER: I am aware that the Ilcensee does not haves the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's en 1 hareby 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 knorrfedgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all "tinont provisions of the Massachusetts Slate Gas Code and Chapter 112 of the General Laws. gy Te of License: Nu mber Title 039fitter -Signature of nseePlumber or Gas Ffflor Master License Number _ M 7d,55 City/Town D Journeyman Ar'i' m -o (OrrICE USE ONLY) NNW NN Nil Installing Company Name_�ober t &Q. �rvr n ns�nc: Address �Sa_ AI_1ey Jlree�-. ass. O Business Telephone to I -7 - SIS/ - o4b tj Name of Licensed Plumber or Gas Filter r v 0 e, Check one: Corp. d Partnership ❑ Firm/Co. IMSURANCE COVERAGE: : Check one I have a current liability Insurance pollcy or its substantial equivalent. Yes J$ No ❑ If you have checked ,yes, please Indicate the type coverage by checking Iiia approprlale box. A liability Insurance policy H Other type of Indemnity ❑ Bond ❑ Certificate ty.-)- C__ OWNER'S INSURANCE WAIVER: I am aware that the Ilcensee does not haves the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's en 1 hareby 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 knorrfedgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all "tinont provisions of the Massachusetts Slate Gas Code and Chapter 112 of the General Laws. gy Te of License: Nu mber Title 039fitter -Signature of nseePlumber or Gas Ffflor Master License Number _ M 7d,55 City/Town D Journeyman Ar'i' m -o (OrrICE USE ONLY) 0 111rint ofType) NORTH ANDOVER, , Maas. Date D 19 96 Building p Permit Location_ SSA Id . ir► V�r'e� 0� r1 Owner's !7h ov /� toss Name -hour I N A,r?_n����r Vousruc, rho moo,, ry New ❑ Renovation Replacement ❑ Pians Submitted: Yes ❑ No t'_] / Check one: Installing Company Name aris ±n C.: Corp. Address Alleq 31rec . El Partnership V1 n . ass . O ► 90 ❑ rirm/Co. Business Telephone b I -7 -5&/ - c4 - Name of Licensed Plumber or Gas ritter iMSURANCE COVERAGE: : Check one I have a cement liability Insurance poilcy or its substantial equivalent. ' Yee P4 No ❑ it you have checked yLs, please Indicate the type coverage by checking the appropriate box. Certificate 109zC— A IlabARy Insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNEWS INSUnANCE WAIVEn: I am aware that the Ilcensee does not have the insurance coverage required by Chapter 142 of the Mass. General I.Aws, and that my signature on this permit application walves this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I= certify that all of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my knovrfedgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance wllh all "Unont provisions of the Massachusetts Slate Gas Code and Chapter 142 of the General Laws. py T e of Ucense: Plumber Title (3Signature o Licensed Plumber or as Filler asflller Master Ucense Number M City/TownD Joumeyman ApptuyvEn (orricE USE ONLY) moo XNNMW own MIN" moo NNIMENNINNIMIN Moon / Check one: Installing Company Name aris ±n C.: Corp. Address Alleq 31rec . El Partnership V1 n . ass . O ► 90 ❑ rirm/Co. Business Telephone b I -7 -5&/ - c4 - Name of Licensed Plumber or Gas ritter iMSURANCE COVERAGE: : Check one I have a cement liability Insurance poilcy or its substantial equivalent. ' Yee P4 No ❑ it you have checked yLs, please Indicate the type coverage by checking the appropriate box. Certificate 109zC— A IlabARy Insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNEWS INSUnANCE WAIVEn: I am aware that the Ilcensee does not have the insurance coverage required by Chapter 142 of the Mass. General I.Aws, and that my signature on this permit application walves this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I= certify that all of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my knovrfedgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance wllh all "Unont provisions of the Massachusetts Slate Gas Code and Chapter 142 of the General Laws. py T e of Ucense: Plumber Title (3Signature o Licensed Plumber or as Filler asflller Master Ucense Number M City/TownD Joumeyman ApptuyvEn (orricE USE ONLY) tr not or 1 ype) ,........ • �. NORTH ANDOVER. , Maas. Dale ID 19 96 Buffding Permit # �� Location o? IrL, i-14n� D r`i'ft &Owner's +' oVP,v' lr! q5S Name _ L*Qfk N Air 9'nOyfza 9006ntita rloTHaR, _% New ❑ Renovatlon Replacement ❑ Pians Submitted: Yes ❑ No ❑ Installing Company Name -Tobe --t' it). -Try, ne, Suns Znc: Address_ 8� AIle.y JFrec+. Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Corp. d Partnership ❑ rlrm/Co. imsunANCE COVERAGE: Check one I have a current liability Insurance policy or No substantlal equivalent. Yes J$ No ❑ If you have checked ,yes, please indicate the type coverage by checking the appropriate box. Certificate ro y d C� A Ilablifty Insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVEn: I em aware that the Ilcensee 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: Owner ❑ Agent ❑ Signature of Owner or Owner's en I rrereny cetliry that art of the details and Informallon I have submitted (or entered) In above application are true and accurate to the best of my knorr 9e and that afl plumbing work and Inslailellons rlormed under the permh Issued for this appl"tlon will be In compliance with all "Umnt provislons of thhe Massachusetts State Gas Code and Chapter 142 o1 the (3erwal Laws. T e of LJcense: Title Plumber Riialufeof!Jcen-sed Plumber or Gas Fillir (lasfiller c+ty/Town C JMoumeyman Ucense Number 75 5 /lf'i'ww-n (orrICE USE ONLY) G��1 t1 ■ATI■ mono own IN NNNIN MEN NINE IN 0 Now �� ■ ■WNAUN■ ISN■ ■III A■ Installing Company Name -Tobe --t' it). -Try, ne, Suns Znc: Address_ 8� AIle.y JFrec+. Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Corp. d Partnership ❑ rlrm/Co. imsunANCE COVERAGE: Check one I have a current liability Insurance policy or No substantlal equivalent. Yes J$ No ❑ If you have checked ,yes, please indicate the type coverage by checking the appropriate box. Certificate ro y d C� A Ilablifty Insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVEn: I em aware that the Ilcensee 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: Owner ❑ Agent ❑ Signature of Owner or Owner's en I rrereny cetliry that art of the details and Informallon I have submitted (or entered) In above application are true and accurate to the best of my knorr 9e and that afl plumbing work and Inslailellons rlormed under the permh Issued for this appl"tlon will be In compliance with all "Umnt provislons of thhe Massachusetts State Gas Code and Chapter 142 o1 the (3erwal Laws. T e of LJcense: Title Plumber Riialufeof!Jcen-sed Plumber or Gas Fillir (lasfiller c+ty/Town C JMoumeyman Ucense Number 75 5 /lf'i'ww-n (orrICE USE ONLY) taint or type; NORTH ANDOVER, , Mass, bale ZD -Ig 96 Building / Permit Location_ c,'2 % P 8a.l c U.) i n �T. Ar -4 /�ndoyPOwner's Fl .v . l'j'1 - Name Il?o,� N A� 9'lla�ajl- r uta /�aTNvR1 TY New O Renovation R Replacement O Pians Submitted: Yes d No EI Installing Company Name Tobe -r+ 1() . -fv► vt 42.,�` Sons Address A I Ie -y 3tr'ec+ . Business Telephone to I -1 -,S&/ -Ohio Sf Name of Licensed Plumber or Gas rester Vo%er+ (,() Ir v ►,n e, Check one: Corp. d Partnership O rirm/Co. Certificate to y I)-- C— 1M5unANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equivalent. Yee P4 No U If you have checked yes, please Indicate the type coverage by checking Ilia •pproprlate box. A liablIfty Insurance policy Other type of Indemnity O Bond O OWNER'S INSURANCE WAIVEn: I am aware that the licensee dM no( 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: Owner C) Agent d Signature of Owner or Owner's Agent I hareby certify that all of the details and Information 1 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 the permit Issued lar this application will be In compliance with all Winent provisions of the Massachusetts State Gas rode and Chapter 142 o1 the Gomel laws. Clty/Town K 1110VE-0 (OFFICE USE ONLY) Te of IJcense: Plumber Signature of Ucensedinnbet or Gas Fillet Gasfilter 5 Master License Number M % CZ5 5 Q Joumeymen EMMM Installing Company Name Tobe -r+ 1() . -fv► vt 42.,�` Sons Address A I Ie -y 3tr'ec+ . Business Telephone to I -1 -,S&/ -Ohio Sf Name of Licensed Plumber or Gas rester Vo%er+ (,() Ir v ►,n e, Check one: Corp. d Partnership O rirm/Co. Certificate to y I)-- C— 1M5unANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equivalent. Yee P4 No U If you have checked yes, please Indicate the type coverage by checking Ilia •pproprlate box. A liablIfty Insurance policy Other type of Indemnity O Bond O OWNER'S INSURANCE WAIVEn: I am aware that the licensee dM no( 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: Owner C) Agent d Signature of Owner or Owner's Agent I hareby certify that all of the details and Information 1 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 the permit Issued lar this application will be In compliance with all Winent provisions of the Massachusetts State Gas rode and Chapter 142 o1 the Gomel laws. Clty/Town K 1110VE-0 (OFFICE USE ONLY) Te of IJcense: Plumber Signature of Ucensedinnbet or Gas Fillet Gasfilter 5 Master License Number M % CZ5 5 Q Joumeymen lr not or lypel NORTH ANDOVER, , Mass. Dale JD 1g 96 BuAding Permit # 1-611 atlon LoccAw-A c/ di i n r e � o ve.►�. /�"I �5 • Owner's Name 00A —iN A,c 9-naL/9rtj0';61uk Aa ,—HORr Tr New ❑ Renovation Replacement ❑ Plane Submitted: Yes ❑ No ❑ Installing Company Name Tot erf to. Ir yr n e - C Address 24- Alley JEree ass . 0190 B.uslness Telephone 6).-7 - Ski - 04b Name of Licensed Plumber or ass ritter Check one: Corp. d Partnership ❑ rlrm/Co. Certificate o y d C— INSURANCE COVERAGE: Check one I have a current liability Insurance policy or He substantial equivalent. Yes P4 No ❑ If you have checked yes, please Indicate the type coverage by checking Ilia spproprlate box. A Ilablifty Insurance policy ® Other type of IndemrtRy D ' Bond ❑ OWNER'S INSURANCE WAIVER: I em aware that the licensee does not have_ the Insurance coverage required by Chapter 112 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ �Jgnatuto of Owner or Owner's Agent I hereby certify that an of the details and information I have submitted lot entered) M above application are true and accurate to the best of my knorAedgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pvtinont provisions of the Massachusetts State ass Code and Chapter 112 o1 the Gowal taws. T e of License: i Plumber Signature of Ucensed Plumber or Gas filter Master License Number M D.)ourneyman py lisle atylTown ApPfio IEo (OrrICE USE ONLY) INN Installing Company Name Tot erf to. Ir yr n e - C Address 24- Alley JEree ass . 0190 B.uslness Telephone 6).-7 - Ski - 04b Name of Licensed Plumber or ass ritter Check one: Corp. d Partnership ❑ rlrm/Co. Certificate o y d C— INSURANCE COVERAGE: Check one I have a current liability Insurance policy or He substantial equivalent. Yes P4 No ❑ If you have checked yes, please Indicate the type coverage by checking Ilia spproprlate box. A Ilablifty Insurance policy ® Other type of IndemrtRy D ' Bond ❑ OWNER'S INSURANCE WAIVER: I em aware that the licensee does not have_ the Insurance coverage required by Chapter 112 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ �Jgnatuto of Owner or Owner's Agent I hereby certify that an of the details and information I have submitted lot entered) M above application are true and accurate to the best of my knorAedgo and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pvtinont provisions of the Massachusetts State ass Code and Chapter 112 o1 the Gowal taws. T e of License: i Plumber Signature of Ucensed Plumber or Gas filter Master License Number M D.)ourneyman py lisle atylTown ApPfio IEo (OrrICE USE ONLY) v■ 9 1 NORTH ANDOVER , Mass. Date 10 19 96 Building permit # Location Owner's . over' Name )ora —11.4 A<9-nol/Grt 900,510j k AO ;Hutt, T1 New ❑ Renovation Replacement ❑ plans Submitted: Yes ❑ No [] Installing Company Name o 7 10. Srvr Address ey 3[(,e -e_+. 019ni Business Telephone b 1.7 -Ski - 046 q Name of Licensed plumber or Gas Filter Check one: Corp. d Partnership ❑ Flrm/Co. INSURANCE COVERAGE: : Check one 1 have a current liability Insurance policy or Its substantial equivalent. ' Yes 04 No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy N Other type of Indemnity ❑ Bond ❑ Certificate Iy OW,,NER'S INSURANCE WAIVER: I am aware that the licensee doge 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 towner or Owner's Vient Owner LJ Agent ❑ I= certify that A of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my Imowtedgo and that anplumbing work and Installations performed under the permit Issued for this application will be In compliance with all partlnont provisions of the Massachusetts State Gas Gbde and Chapter 142 of the genal laws. Te of tkense: Plumber Signalute of ucensed Mumber or Gag Filter Title Gas(ilter CityRown ❑ Jou neyman Manse f Number M % 55 AF'i'nawn (OFFICE USE ONLY) ■ a�mum0 M■ CAN�CA��C iC mono NONE man mom IN 0 on 0 on no Installing Company Name o 7 10. Srvr Address ey 3[(,e -e_+. 019ni Business Telephone b 1.7 -Ski - 046 q Name of Licensed plumber or Gas Filter Check one: Corp. d Partnership ❑ Flrm/Co. INSURANCE COVERAGE: : Check one 1 have a current liability Insurance policy or Its substantial equivalent. ' Yes 04 No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy N Other type of Indemnity ❑ Bond ❑ Certificate Iy OW,,NER'S INSURANCE WAIVER: I am aware that the licensee doge 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 towner or Owner's Vient Owner LJ Agent ❑ I= certify that A of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my Imowtedgo and that anplumbing work and Installations performed under the permit Issued for this application will be In compliance with all partlnont provisions of the Massachusetts State Gas Gbde and Chapter 142 of the genal laws. Te of tkense: Plumber Signalute of ucensed Mumber or Gag Filter Title Gas(ilter CityRown ❑ Jou neyman Manse f Number M % 55 AF'i'nawn (OFFICE USE ONLY) u'rrnt or type) • - -- ----- • • .. ✓ ✓ ../ \..� �� ��, NORTH ANDOVER, ,Meas. Date 10 19 qb Building Permit #a_ Location o Owner'sn � Name _ Vojk i N A,r 2'1 cov J0061eu6, AO ; Hc„2i zr New ❑ Renovation Replacement ❑ Plans Submitted: Yea ❑ No ❑ Installing Company Name ToLer+ W. -Er V1 h4 US Znc: Address 2a- I1ey 3trev-+-. Business Telephone to l-7 -Stet - 046 y Name of Licensed Plumber or Das Fitter Check one: Corp. d Partnership ❑ Firm/Co. insuRANCE COVERAGE: :Check one I have a current Ilabllity Insurance policy or its substantial equivalent. ; Yes J$ No ❑ if you have checked Ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ® Other type of Indemnity ❑ Bond ❑ Certificate 1y.�- C- OWNER'S INSURANCE WAIVER: I em aware that the Iicensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permlt application waives this requirement. Check one: Owner ❑ Agent ❑ %natuto of Owner or Owner's en I hereby certify that all of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my hnordedgo and that all plumbing work and Installations performed under the permN Issued for this application will be In compliance with all Mtincnt provislons of the Massachusetts Slate Gas Code and Chapter 112 of the General laws. pY Te of License: PlumberSighattifie—oTLIcen—sed Plumber or Gas Filler Title Gasfilter Dmaster License Number __M 77,55 Clty/Town U Journeymen KTnoVEO (OrricE USE ONLY) . At■ 1■ ■A �I■ ■ moon moon N N N NONOWN Ono NNW WN SCCmom �mom ::::::::::::��':S N Installing Company Name ToLer+ W. -Er V1 h4 US Znc: Address 2a- I1ey 3trev-+-. Business Telephone to l-7 -Stet - 046 y Name of Licensed Plumber or Das Fitter Check one: Corp. d Partnership ❑ Firm/Co. insuRANCE COVERAGE: :Check one I have a current Ilabllity Insurance policy or its substantial equivalent. ; Yes J$ No ❑ if you have checked Ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ® Other type of Indemnity ❑ Bond ❑ Certificate 1y.�- C- OWNER'S INSURANCE WAIVER: I em aware that the Iicensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permlt application waives this requirement. Check one: Owner ❑ Agent ❑ %natuto of Owner or Owner's en I hereby certify that all of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my hnordedgo and that all plumbing work and Installations performed under the permN Issued for this application will be In compliance with all Mtincnt provislons of the Massachusetts Slate Gas Code and Chapter 112 of the General laws. pY Te of License: PlumberSighattifie—oTLIcen—sed Plumber or Gas Filler Title Gasfilter Dmaster License Number __M 77,55 Clty/Town U Journeymen KTnoVEO (OrricE USE ONLY) ype NORTH ANDOVER, ,Maas. Date ----ID 19 96 1/ Buliding Permit #,, Location_ 3/ 1 s�/d. �; r► `.TT owner's +' Name —Vork N A� yf),Oy �AJ0054AN, Ao Hopi Tt New ❑ Renovation Replacement ❑ Plans Submitted: Yea U No [p Installing Company Name 2vLC+ 10 - -fryl III e- Address A I JEree- . nn IQSS. 0)904 - Business Telephone W -7-59/-n404 Name of Licensed Plumber or Gas Filter Check one: Corp. d Partnership ❑ Firm/Co. i"sunANCE COVERAGE: : Check one I have a current liability Insurance policy or Its substantial equivalent. Yes rK No ❑ It you have checked ,yes, please Indicate the type coverage by checking the spproprlate box. A ItablIfty Insurance policy ® other type of Indemnfty ❑ Bond ❑ Certificate ro g OWNER'S INSURANCE WAIVEn: I em aware that the licensee doge 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent )hereby certify that an of the details and Information 1 have submitted (or entered) In above application are true and accurate to the beat of my It go and that all plumbing work and Instellallons performed under the permit Issued lot this application will be In compliance with all partlmnt provisions of the Massachusetts State oas Gbds and Chapter 142 o1 the Oetwat Laws. EY Te of lJcense: Number � - "It Dmaster c�asfiltet na urs o Dense Plumb—or er or as Mar License Number M 7 CZ55 City[Town U Journeymen IAF1110YED (OFFICE USE ONLY) Aom IINN10��■ owl NNNN Inn Installing Company Name 2vLC+ 10 - -fryl III e- Address A I JEree- . nn IQSS. 0)904 - Business Telephone W -7-59/-n404 Name of Licensed Plumber or Gas Filter Check one: Corp. d Partnership ❑ Firm/Co. i"sunANCE COVERAGE: : Check one I have a current liability Insurance policy or Its substantial equivalent. Yes rK No ❑ It you have checked ,yes, please Indicate the type coverage by checking the spproprlate box. A ItablIfty Insurance policy ® other type of Indemnfty ❑ Bond ❑ Certificate ro g OWNER'S INSURANCE WAIVEn: I em aware that the licensee doge 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent )hereby certify that an of the details and Information 1 have submitted (or entered) In above application are true and accurate to the beat of my It go and that all plumbing work and Instellallons performed under the permit Issued lot this application will be In compliance with all partlmnt provisions of the Massachusetts State oas Gbds and Chapter 142 o1 the Oetwat Laws. EY Te of lJcense: Number � - "It Dmaster c�asfiltet na urs o Dense Plumb—or er or as Mar License Number M 7 CZ55 City[Town U Journeymen IAF1110YED (OFFICE USE ONLY)