HomeMy WebLinkAboutMiscellaneous - 235 HICKORY HILL ROAD 4/30/2018 (2) `''� �*
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9 Date.
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".o R7 TOWN OF NORTH ANDOVER
10 0
PERMIT FOR PLUMBING
,SSACMUSE�
This certifies that . . . . . . . . . . . . . . . . . . . .
has permission to perform . .! 1 ���.}T. . . . (,d1 �'+;/t . . .am. I% '
plumbing in the buildin s of . . ..�QQ. . .� . . . . . . . . . . . . . . .
at,.,. . . . . t1.i.G. `�. . . . f. . . , N�or�t'hAnfdover, ass.,
Feeee. .��.Lic. No.. J}� ?�. . . . . .��% . .. .!. . . .tr
PLUMBING INSPECTOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING .
I
City/Town:..._ Nc �y_,. !�i�or�l'T > MA. Date Permit#
s
Building Location: Z � �Uco,Z� Owners Name:
Type of Occupancy: Commercial Educational Industrial - Institutional Residential
New Alteration Renovation:, Replacement:, Plans Submitted: Yes No s
FIXTURES
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SUB BSMT.
BASEMENT
1 FLOOR
foy-F—LOOR
3 FLOOR
4 FLOOR
VH FLOOR
6 FLOOR
7 FLOOR
FL10OR
CheckOne Onfy Certificate#
ing Company Name t ,LLC
IS man Dfive..... -- CftWTM n Sraffbrd. .. state: 'MA :
Business Tei 978-556-5617 _._. . I=an ' 8-372-6138 _
= FiMeOwnpany
-Mmm of Licensed Pkmw .
]INSURANCE COVERAGE:
letorent 22k ertsuraeete-cgs-__` € J�W X€l lis €t '2�t stiwhir- g-44%ONA s rs t} • —'LAM � „se
If rw terve checked IM p1ease i fate Oro tyw of ccwemage try Ghe.—AM�the zpppqpr L� b-x "
s�.aeaea:Eck aesua�easas� a��ass ,� aa €: sra aa �sAs�v a s�
es vE se E- Fceovoae-i6ev� ER RFCbF6.6 caca esar'crse ca eras sccc c w�aec erE.c�aeasc.ae�-sr brec ece�csc�cac,c Fes a'�vaa 'c��scss cca cs�s�sea�,rcce ��s�csc SSPE
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e".{l:� ��?�d P.6i�� �c'g"•. 4@Ea ." ;r� '+ra a� s� nr��m+ s� � ��..ar *p
Type cci License-.
_._ ..- -_ - -- ---" ------` ------ - --- --- --_ =--- ---- =----- -- - -mow- --- -- _.__-
.8AA - EGq_•7#Sf-/.E
9 ••• _ .._,. ..,.. .3 ,�'"}r3'�S3't�!! ] =6L4�➢6�a:�E�9Ais E€SLi.. S�4f ,
COMM®hllNEALTL4 OF[MASSACFiU+SE`d"GS .
lye e, . ,. • -� �
LICENSED AS AMA
TERPLUMBER
ISSUES THIS LICENSE TO
ROB`ERTO FtA2ANI
15 DOR I'AN DR
BRADFORD MA 01835 85 s
. :. 13471 05/01/12 7.59211
f:
7 1,_
;
CONTROL# F86500
! IMPORTANT i
If this license
Is lost or destroyed, notify your Board at the:
Division of Professional Licensure,238 Causeway St.,
s
MA 02114.
5th Floor,Boston, ed notify yoLir board t',
ro er mailing of next
If your name or address shown is changed,proper
our license number. i
of correct name or address °referrto your r
Renewal ApplVcation. Alwaysrovisions of the General Laws
This license is subject to thepPro', e,and must not be loaned
as amended.It is a pother person. Keep this Ilcense on your
or assigned to any required by law, '
osted as req ,
;
person or p ;%RNING PAIS I7()U'W'1Er4T
I:h�•,r rart.0 SECuRfTY t��?-�tPt _.. �� ,
a
r
7 4 J 1 Date..� 4f •�......
NORTH
o� TOWN OF NORTH ANDOVER
41
• PERMIT FOR GAS INSTALLATION
�,SSACMUSES
This certifies that . .?-0 . . :S. . . . . Ft-4. . . . . . . . . . . .
has permission for gas installation . .I.L)a . . . � . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . .. . . .
at,� �� . . i.C_. �.t:. . ��_, North Andover, Mass.
Fee.Q'0-.0 Lic. Noj,3.LT'.�.j . . . . . P .�Q1
GAS INSPECTOR
Check#
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town:
' Permit#,_Date•
Building Locatia ._ 2 3- . � Co/L/, � ._ -� Owners Name
Type of Occupancy: Commercial T Educational _ Industrial Institutional Residential
New.. Alteration Renovation Replacement:; ✓� Plans Submitted: Yes No
FIXTURES
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S o o U. ` `�`z g o fL a > > > 3 0
SUB BSMT.
BASEMENT
15T FLOOR
2 FLOOR
3 FLOOR
4THFLOOR
5 FLOOR
e FLOOR
7 FLOOR
8 FLOOR
Check One Only Certificate#
Installing Company Name: 9
Robby's Plumbin .
_ "tin Draincleaning,L-L-C_ --
. -
Corporation
Address 15 Dorian Drive City/Town:., Bradford State MA
Partnership
Business Tel 978-556-5617 Fax: to 978-372-6139
;FirmlCompany
Name of Licensed Plumber/Gas Fitter: Roberto Flaiani
INSURANCE COVERAGE:
I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch: 142 Yes: No
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy: Other type of indemnity Bond ,
OWNER'S INSURANCE WAIVER:1 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.
Check One Only
Owner Agent °TM
Signature of Owner or Owner's Agent
By checking this box❑;i hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Cha er 42 of the General Laws.
Type of License: ---.G
BY Plumber
- Gas Fitter Signature of Licensed PlumberlGas Fitter
Title.- Master
_ T
City/Town ., _. Journeyman License Number: 13471 (�
APPROVED OFFICE USE ONLY LP Installer
r 2
Locationd&---;�
/
No: Date
r
,t N°oT ,ti TOWN OF NORTH ANDOVER
a A Certificate of Occupancy
' Building/Frame Permit Fee $
Foundation Permit Fee $
S�cNuSE
Other Permit Fee $ �
A �
Sewer Connection Fee — $. S A
" Water Connection Fee $ � G-
4
TOTAL
, Building Inspector
y
"` .4.".0 739 Div. Public Works
locatonv ,_
r. � �-C
Date
pCRTN TOWN OF NORTH ANDOVER
„ Certificate of Occupancy $
` ;Building/Frame Permit Fee $ `
Foundation Pe it dee
Other Permit Fee $
Sewer Connection Fee
ra I er Connection Fee $ �'
TOTAL $ C�
47
k � fj Building Inspect
7246 0 Div. Public Works
g3*
� �oc.ation;:
M`
No. Date 'y
�_ of 'A°oT;�ya TOWN OF NORTH ANDOVER
� e •�^ f�? �!,P a pL .
F p ,Certificate of Occupancy $
Building/Frame Permit F
�SSAcNUSEc. Foundation Permit Fee $ f
Other Permit Fee $
Sewer Connection Fee $
.: Water Connection Fee
TOTAL $ • )C)
Building Inspector
Div. Public Works
Location Z3 f �G o/ of f lzw 33
No. 6 Date
NORTH TOWN OF NORTH ANDOVER
o�<z•° ;. hoc ,.
Certificate of�Occupancy $
B: A
+ o ,s Building/Frafne Permit Fee $
SACMUSEt� Foundation Permit Fee $
Other Permit.Fee $
# v G37
Sewer Connection Fee $ >b6o
p 331 Water Connection Fee $ /txp
N TOTAL $
0 00,
Building Inspector
_"dl/6004/412/
6928
/aa/04/4 f/ 2:03 1,0M,00 rw
V 9 2 8 Div.�ubjk Works
i
PER.AttT 1�'� 0 1,51 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. �,� �J.�v2 �JPAgE, 1
,MAP h40. 6-zI LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE —
ZONE SUB DIV. LOT NO.
? 1-6,VZL
WiC E 4
LOCATI01 URPOSE OF BUILDINGs .1
A F ✓�'vW't
OWNER'S NAMETa L/- NO. OF STORIES • SIZ
S.F.
OWNER'S ADDRESS (G, ( % BASEMENT OR SLAB (3 ^ q
ARCHITECT'S NAME S. C "1 SIZE OF FLOOR TIMBERS 1ST ' 2ND 7�+ yOcla RD
P.BUILDER'S NAME °? _ /,��n SPAN �t(%. p a
DISTANCE TO NEAREST BUILDING k ✓C_.��s"I C✓_F I DIMENSIONS OF 1SILLS �7 �,
DISTANCE FROM STREET r_C11
��" ,t.. POSTS S" r P! 51(----
LSC
DISTANCE FROM LOT LINES—SIDES ( L REAR f 0 f` '• GIRDERS(./4/)?
AREA OF LOT j j/ j TT FRONTAGE��AA ?
i z)-7 / HEIGHT OF FOUNDATION C— cC�/ THICKNESS /
I C� 6 O r
IS BUILDING NEW / i SIZE OF FOOTJNG X
IS BUILDING ADDITION !� MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
t WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ✓lam C
�1 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 'yefT Clj
6V IS BUILDING CONNECTED TO NATURAL GAS LINES
INSTRUCTIONS 3 PROPERTY INFORMATION
• c LAND COST -
SEE BOTH SIDES > I'�D11A}T ■� EST. BLDG. COST FE
(+�Q
PAGE 1 FILL OUT SECTIONS 1 - 3 �.W r f/ii � o�,- EST. BLDG. COST PER SQ. FT.' _iv
SUE�E PERM S "'ii. EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12 YYG f
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED. BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FIL D / rt-
b BOARD OF HEALTH
4igifiTURE OF OWNER A ORIZED AGENT
f�
FEE {
PLANNING BOARD
- PERMIT GRA ED
---+r----F-
19 II
' I
OWNER TEL.# BOARD OF SELECTMEN
7 CONTR.TEL.
CONTR.LIC. ���y/�
/ `CJ �` BUILDING NSPECTOR
i
f
_. BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY Ve S-ORIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI, FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH" PORCHES, GA-,
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS\REP.LACES PLOT-PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 3 1 2 13
CONCRETE BIL PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL _
UNFIN _
3 BASEMENT I _.
AREA FULL FIN: B M AREA
'/ 1/1 '/ FIN ATTIC AREA
NO B M T FIRE PLACES \ T
HEAD ROOM MODERN KITCHEN
4 WALLS II 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE- ��_ t
WOOD SHINGLES %'EARTH _
ASPHALT SIDING HARDWD ��—
ASBESTOS SIDING COMMON
VERT. SIDING ASPH. TILE +
STUCCO ON;MASONRY- _
STUCCO ON FRAME I— `� [O
BRICK ON �MASONRY� ATTIC$TRS. 8 FLOOR ! r7+ .�QF .
BRICK ON,FRADE /& Z23 ij
CONC. OR'CINDER§LK. P' i�F'"s
STONE ON MASONRY: WIRING
STONE ON FRAME
SUPERIOR II POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE HIP BATH (3 FIX.) A
GAMBREL MANSARD TOILET RM. 12 FIX.) g
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD $HINGES KITCHEN SINK ✓_
SLATE NO PLUMBING _
TAR 8 GRAVEL STALL SHOWER - b
ROLL ROOFING MODERN FIXTURES lole,
TILE FLOOR -
TILE DADO
T
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
_ FORCED HOT AIR FURN.
TIMBER MS COLS. v STEAM a
STEEL BMS. COL HOT W T'R OR VAPOR
WOOD RAFTERS �pl AIR CONDITIONING
RADIANT H'T'G '-
UNIT HEATERS
GAS
7 NO. OF ROOMS OIL - J
Y
B'M'T _ 2nd ELECTRIC _.
1st 13rd NO HEATING
w
i
P
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: �!!d lYaa`S - hoc G� Phone 6 �
LOCATION: Assessor's Map Number 6 Parcel
Subdivision i G�6 /lel f /( Lot(s)
Street Ga �7�//�Oqle
St. Number
Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved -1
Town Planner Date Rejected
Comments
Date Approved
Heal h Agent Date Rejected
Comments
t
Public Works - sewer/water connections
- driveway permit
wa
Fire Department
Received by Building Inspector Date
i
1 4
� 1
SLI
PROPOSED SITE PLAN
U07 : .O lC KOR.y HILL ROAD
- //000, -
o
L or 33 ;
24,236 S.F.
8� Sy
.Q v'u 1
H! s o � GGo y3�
C x J�
RY 41 5
✓OyN
NOa
N
A2p$63
o m�
STEFt�
��i
)ITICH.'s OF: To
wil
1 2f l r;r:trlt .a�t•r•r
'
NORTH ANDOVER r.ttllrl:�lt,i
1i1111.1)IN(i �% -: - LI:Ititi:u Iltra tl':•ul)tI
C:()N HI IVATIM ",wr 111VI::11 IN 1 11° 111 I ;11 illn.1 ;-!; •.
ISi.ANNIN(; !'1.�1.NNIN(;. Itc (;t)Ill[lillNl'i'1' I)l;��lal.Ul'1111:N'1'
I I.P. NEI.tit )N. I )il(I:(:I( M
(
' CHIMNEY APPLICAI'IOIJ ANO ITRAI
arE � ; •
1 ERN I.I. # fi 1
)CATION 33 �
UNER'S. NAME: �p
1ILDER'S NAME: ' ' ' 1 y _S ' � 40
' iSONS NAME:
kSON'S ADDRESS:
MR'S TELEPHONE: �'4� 9F,6 7x�)?�Z
\TERIAL OF CHIMNEY:
I1'ERIOR CHIMNEY: ��� — L'XIERIOR CHIMNEY:
IMBER AND SIZE OF FLUES:
IICKNESS OF HEART11 ' Kj� _.. . .
:,u clLullney aa 6iAep.Cace con(Imm to .tlle Acqubten1e1113 u( •I.IIe Wde (11111 I11(ve : 11Ce.3 (111d
:gutat i.alvs been Aecewed: -Y _ --
TE: ! /I6 4-
GNATURE OF MASON:
:RMIT GRANTED: /�. �' FEE
e
'BERT NICETTA
ILDING INSPECTORIL —
SPECTEO:
:MARKS: -
SOLID [BLOCK RLJ 1Id
� � /� THIS PERMIT 1JUSr GE OISPLAYLO 014 ME ITL1,IISIS
CERTIFIED FOUNDA TION PLAN
LOCATED /N NO. ANpOVER, MA.
SCALE: /"= 40' DATE: 5/26/94
Scott L. Gi/es R.L.S.
50 Deer Meadow Rood
North Andover,Mass.
Q
LOT 3.3 ;
i' 241f 236 S.F.
LOT 32
`4
26' LOT 34
h ..
2I�f 28' » • N \
�. FOUN
,Sr. N
E X •• moi%
N ••
n
,o2.5' 24'
33'
=107.28
X75 OD L- _ fz�
l l-L' _. U E 51994 i
HI GU�s_EUYI s DE r@ t' '
/
CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE � li -r
THE OFFSETS OF THE BUIL DING /NSPEC TOR ONL Y
sc
SHOWN COMPLY AND SUCH USE/S FOR THE
WITH THE ZONING DETERMINATION OFZON/NG x3972
BY LAWS OF CONFORMITY OR NON-CONFORMITY
NO. ANDOVER. MA. WHEN CONSTRUCTED.
WHEN BUIL T 5/26/94
CERTIFICATE OF USE & OCCUPANCY
Building Permit Number 089 Date OCTOBER 19, 1994
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 235 HICKORY HILL ROAD (Lot #33)
MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR IN ACCORDANCE
GARAGE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Tara Leigh Dev. Corp.
235 Hickory Hill Rd.
sADDRESS North Andover, MA
a �7�.R.S�iff
Building Inspector
P
1
w
®
o ' 1 a
on,\ over
_
�..�
No. 0 3 �<
1 '
L N rthAndover, Mass., Of A&V I
q comic iwnrc '
E D
9 U
BOARD OF HEALTH
PERMIT To ` B Food/Kitchen
Towf)'!E�.v
Se t_ y tem
3 BU LDING INSPECTOR
THIS CERTIFIES THAT......... ►. ,�. �i....�D '..�0. / ............`. �.r.......3....
Foundation -e"-r W.L°
has permission to erectAW0.00 ......... ...... buildings ...AR....... Rough 13v w
to be occupied as., ,/..0W.........9: I# ,Q� rd w �
provided that the person accepting this permit shall'In every respect conform to the atinn or 111Sin Final
this office, and to the provisions of the Codes and By-Laws relating to the Insp i -�I of 9�—
LAT B.C..
Buildings in the Town of North Andover. 4.8- PLL IN IN ECTJOW
VIOLATION of the Zonin or Building Regulations Voids this Permit. _
ug
Zoning g g DATE = '� FEE PAID
PERTAff E IN 6 Ik/K)1*_pFVTJS
ELEC RICAL INSPECTOR
Rough
PERMIT FOR FRAME/BUILDING
Service
...... .....
� — ) BUILDING INSPECTOR
DATE FEE PAI1'j`
of Ci 1pC11"1Cy s 'L i"l l l i1. J j - ?!1.?CC ;;? �. )",_I q: +.' 1-3u-14, GAS I PECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove U 61/
y
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRP l , NT
Burner
PLANNING FINAL CONSERVATION FINAL Street No. IS
pR'' .
�AFINAL
Smoke Det.
SFWFR /WATERT/zr r� DRIVEWAY ENTRY PERMIT . • Y �'`
/ a i PHOi1E CALL
A.M.
FOR DATETIME P.M.
M
OFA" a P-1
PFIgNEC3
SAM T.,ON
PHONE �+3t#1 {wF ...'
AREA CODE _R EXTENSION
MESSAGE i��EASE GAS t'
1ttlILL GI�Lt..
C:AC�tt 'fifJ ':.
SIGNED TOPS FORM 4003
NOTES
4
1
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NORTH '9A.
t4ED /6 'YO
�6 0
y r
y
.�. Q t6. LAKE
COCMICMEWtCK`v
A0R4TEO
SSACHUs
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
ADDRESS/LOCATION OF PROPERTY: �A
0
r. fQ17 1b �
DATE REQUEST FILED/READY FOR INSPECTION: IIIl9
CLOSING DATE ON PROPERTY: / /,q
L
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REOUIRED.
ALL WORK AND SIGN-OFFS-MUST BE COMPLETED WITHIN THIS TIME FRAME.
A RE-INSPECTION FEE OF TWENTY DOLLARS ($20,700) WILL BE CHARGED IF
THE STRUCTURE DOES NOT MEET ALL APPLIC—IA-BRE CODES.
SIGNED:
4 y ,
3 Q 1 1 Date. ,// y'../f '•r. ..
,f
oeTN TOWN OF NORTH ANDOVER
pF 4�.eo ,e,tip
PERMIT FOR GAS_INSTALLATIM
*00
,SSACHUSEt
This certifies that . . f!.�. . . ���/ t7. . !.x.. . . . . . . . • . .
has permission for gas installation . . . . . . . . . . . .
N
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . .
at , Neth Andover, Mks.
Fee. 2?. .: . Lic. No. %.l. . . . . ..
!a S INSPECTOR
WHITE:Applicant CANARY:Building 0 pt. PINK:Treasurer
9ypeMASSACHUSETTS URIFORM APPLICATOR FOR PERMIT TO DO GAS G or print) Date�y NAV l 9 o
NORTH ANDOVER, MASSACHUSETTS \\
Building Locations
cy,� cLC•l \ Permit# 1701/
Owner's Name Amount S
New Renovation ❑ Replacement ❑ Plans Submitted
::t rri
n rn C
z C w =e = Z C z
Gij
ZZ
Z -t 'rJ :t " - � n v Z ^ Z
w Z -* -c C — C w MEN ENT
B A S E M E NT
IS'r. FLOGR
2ND . FLOOR
3 R 0 . F L O O R
Tr 5 . FLOG R
5 T H . F L O O R
6T H . F L O O R
7T It . F L O O R
8TH . FLOOR
or�*C'� �e��`a �a�S��4 ` heck Corgi Certifrat�lnstalling Company
Name
Address ❑ Partner.
�Zu 7SV o 7-\5�
Business Telephone q'j l.. 5- Lo ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I haveva current liability Insurance policy or it's substantial equivalent. Yes ® No
Ifyou have checked yes,pl se indicate the type coverage.by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ED
b
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 and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massa,, Zs St GassCCcdean hapter 142 of the General Laws.
c- -�
By: Signature of Licensed Plumber Or Gas Fitter
Tide Plumber. ry�13 S
City/Town Gas Fitter License i umoer
Master
Journeyman
APPROVED OFFiCEUSEONLYI ®