HomeMy WebLinkAboutMiscellaneous - 24 FARNUM STREET 4/30/2018 (3)Location C 1 ([ FA tA.,&-,A, '
No. c>2123 Date
NORTq
TOWN OF NORTH ANDOVER
n Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
ass^c14U
Other Permit Fee $
Sewer Connection Fee $ ._
Water Connection Fee $
TOTAL $
`"' Building Inspector
13221/23/99 14:10 25.00 RAID
Div. Public Works
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06/28/1999 20:12 9786856471 ALL UNDER ONE ROOF PAGE 01
_ V1, i a,
67 (Policy Provisions: WC 00 00 Og (NM *ONLY), WC 00 00 00 A)
29
vM INFORMATION PAGE - WCIP
wz WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
INSURER. HARTFORD UNDERWRITERS INSURANCE COMPANY
HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
NCCI Company Number; i n THE Company Code: 6 1
') 3 HARTFORD
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POLICY NUMBER: lAAS RENEWAL
Previous Policy Number:
1. Naffed Insured and Mailing Address; NORMAN GAY DBA ALL UNDER ONE
(No., Street. Town, State, Zip Code) ROOF/PEST IN PEACE
028349269
FEIN Number; 70 JEFFERSON STREET
NORTH ANDOVER, MA 01845
State Ide+tti ication Numba(s):
The Named kwvxW is: INDIVIDUAL
Business of Named Insured: ROOFING
0dW W"kpiaces not ahOWn above: 70 JEFFERSON ST. , NORTH ANDOVER, MA
2. Policy period: From 11/09/96 To 11/09/99
12:01 a.m., Standard time at the insured's mailing address.
Produoees Name: MASS WORK COMP A R DIRECT
LENNOX INSURANCE AGENCY
PO BOX 462
producersLYNNFIELD, MA 01940
083477
Issuing oMce: THE HARTFORD
4801 NORTH WEST LOOP 410, SUITE 200
SAN ANTONIO TX 78229
rQQQ_52-7gi
01845
t ne D01+cY Is not binding unifies counters+gnad Dy our authorized representative.
Authorized Representalve
Forth WC 00 00 Ot A Printed in U.S.A.
Process Oate: 10/09/98 page 1 (Continued on next page)
ORIGINAL Policy Eiratlon Data: :11/09/99
a
a
2899
Date ..i7. ......
,F
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .�.` �.4-. �. �`....)•�'�. /.
has permission for gas installation . AA, -t4 ....................
f
in the buildings of .. . �. �� �.�?. ! .............................
at ��.. /=,h ti /.!'1-2 �...... • • • ...., North Andover, Mass.
Fee. !. O�i�19�40:22•'� ....................
15.W S INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
`i
MASSACHUSETTS UNIFORM APPLICATION
(Print or Type)
NORTH ANDOVER
t uilding
• New "t
9
Location
Mass.
FO (PERMIT TO
Date 4
Permit
Name_ -j�z�A� 5'i✓�i
DO GASFITTING
Owners
Renovation Lj Replacement 0 Plans Submitted n
FIY7-1IP=1z
(Print. or:.:Type)t ;,i''•i';', Check one: Certificate
InstalIing'Company;'-Name ANDOVER PI -13G. & HTG. CO., INC® Corp. 2122
Address 5731_' S0. UNION STREET Partner.
LAWRENCE, MA. 01843 Firm/Co.
Business Telephoa,ne: 978 685-8383
,Na icensed' Plumber
�:
or: Gas Fitter GEORGE._�,AROS
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t`it111ll
fit„ I
!iistlranch°aOoverge Indicate the type of insurance coverage by'Checking,the
appropriate box:,
Liability insurance policy Other type of indemnity Q Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
this application -does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 17 Agent F7
I hereby certify that all of the details and information 1 have submitted (or entered) In above application are true and acmate to the best of my
knowtedge and Mat Q plutnbing work and Installations performed under Permit issued for this application wiU•ae in eomplianoe with sU peatin aat
provisions of the Massachusetts Slate Cas Code and chapter 142 of the General LAws• —
By TYPE LICENSE:
Title Plumber -- -
Gasfitter- Sig ature of Licensed
City/Town: Master Plumber or Gasfitt:er
Journeyman 9983
APPROVED (ot=i=icE ust; ortcY) I,p License Number
MENOMINEE
MONSOON
MEMO
0
MEMEMINE
����■���������������o���■vim
(Print. or:.:Type)t ;,i''•i';', Check one: Certificate
InstalIing'Company;'-Name ANDOVER PI -13G. & HTG. CO., INC® Corp. 2122
Address 5731_' S0. UNION STREET Partner.
LAWRENCE, MA. 01843 Firm/Co.
Business Telephoa,ne: 978 685-8383
,Na icensed' Plumber
�:
or: Gas Fitter GEORGE._�,AROS
L
t`it111ll
fit„ I
!iistlranch°aOoverge Indicate the type of insurance coverage by'Checking,the
appropriate box:,
Liability insurance policy Other type of indemnity Q Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
this application -does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 17 Agent F7
I hereby certify that all of the details and information 1 have submitted (or entered) In above application are true and acmate to the best of my
knowtedge and Mat Q plutnbing work and Installations performed under Permit issued for this application wiU•ae in eomplianoe with sU peatin aat
provisions of the Massachusetts Slate Cas Code and chapter 142 of the General LAws• —
By TYPE LICENSE:
Title Plumber -- -
Gasfitter- Sig ature of Licensed
City/Town: Master Plumber or Gasfitt:er
Journeyman 9983
APPROVED (ot=i=icE ust; ortcY) I,p License Number
6
3753
Date. -7//- /l.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that,,, � .�.�-. r !�... ���?t .� .............
has permission to perform ... . l .......................
plumbing in the buil/dings of .. 1.c1. .... ... ........ .
at . ,;) Y.J',�,C�'f!(-�. <i � z ...S!� .......... North Andover, Mass.
Feea? Lic. No. � . ............................. .
PLUMBING INSPECTOR
07/08/98 10:21 25.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
�AaQA%.,HU!jF.fi75 UNIF011M A15f'L1CAT10N FOR PERMIT TO -DO -PLUMBING
—� IPrinl of I'M41
0
NORTH ANDOVER, Masa.
Building
Location
Date lv a
Permit
Owner's
Name e,44�.45KAy vi5wx
f.,
New Q Renovation O Replacement [� Plana Submitted: Yea ❑ No (]
FIXTURES .........
Check one: CertkIcate
Installing Company Name _ ANDOVER P L B G & H T G -CO. INC 0,C.. 2122
Address 5 7.a i S (l I I N T n ni S T R F FT ❑ Partnership
I AWRFNCF M❑Firm/Co.
Flrrflness Telephone q 713 f, f; , _ a 311:1
Name of Licensed Plumber _ G E O R G F I R R f1 C F
INSURANCE COVERAGE: ec
I have a current liability Insurance Polley or Its substentW equivalent, Yes No Q
It you have checked yn, ple_aseeIIndicaie the type coverage by checking the appropriate box.
A liability Insurance policy C3' Other type of Indemnity ❑ gond ❑
A
OWNER'S INSURANCE WAIVER: i am aware that the licensee
Chapter 142 of the Mass. General Laws, and that my signature onW j� � the Insurance coverage required by
, permit application waives this requirement.
Check one:
slurs or Owner Of owns. • AQ§nt Owner ❑ Agent ❑
1 hereby certify that all of the detaAs and Information I have sutxnttted for entw*4 In avow
knawlsdgs and that as plumbing work and Inslallaltons aPD�sUon ue true and axwale to the best of my
pwl"nt provisions of the Mauachutetts Stale Plum D ff*d trader the perrrA Issued for s appfkstion will be In compliance with all
bfng Cade and chapter 142 of the Laws.
By
TWO � ur e
City/Town
"11►r7VED (OfF10E USE ONLY)
license Number 9983
Type of Plumbing Ucsnss: Mader Q
Journeyman ❑
3042 Date . ........
j NORTH TOWN OF NORTH ANDOVER
pF4,.ao ,^ ,ti0
3? PERMIT FOR GAS INSTALLATION
9
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s � a
1
This certifies that . !� !!z. t :4 �. e !? ...!.. ..................
has permission for gas installation q. 5 . -/ . ..... .
in the buildings of. u?L? !�� w.. `�. ! c� e P., .1.. ................ .
at 2. V. North Andover, Mass.
Fee.,?a: .?3 -.........
It/$i�qg ' 25.04
�AS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS TT1NC
(Print or Type)
c NORTH ANDOVER, Mass. Date
1huilding Location ea—z Permit # p y z
Owners Name
�f
.- New ` Renovation .r] ¢I.Replacement Plans Submitted �]
S FIXTLIP=-c
(Print or Type) Check one: Certificate
Installing Company Name ANDOVER PLG. & HEATING CO. , IN . Corp. 2122
Address 5737 112 SO UNION ST. Partner.
LAWRENCE, MA. 01843 Firm/Co.
Business Telephone: 508 685-8383
Name of Licensed Plumber or Gas Fitter GEORGE )-AROSE
Insurance Coveraqe: Indicate, the type.of insurance coverage by checking the
appropriate box:
Liability insurance policy EOther type of indemnity F Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
this application does not have any one,of the above three insurance coverages.
Signature of owner/agent of property Owner 0 Agent El
I hereby certify that aU of the deuds and Information I have submitted (or entered) in above application are true and accurate to the best or my
knowledge and Mat aU plumbin; Work and ItttaWtions perfomted under' Permit issued for this application will be in co linnce with ali pe2Unent
Provisions of the Massachusetts Slate Cas Code and ChAptet 14: of the General LAwa. „
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
,TYPE LICENSE:
Plumber
Gasfitter Signa ure of Licensed
Master Plumber or Gasfitter
Journeyman 99$�
License Number
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2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name ANDOVER PLG. & HEATING CO. , IN . Corp. 2122
Address 5737 112 SO UNION ST. Partner.
LAWRENCE, MA. 01843 Firm/Co.
Business Telephone: 508 685-8383
Name of Licensed Plumber or Gas Fitter GEORGE )-AROSE
Insurance Coveraqe: Indicate, the type.of insurance coverage by checking the
appropriate box:
Liability insurance policy EOther type of indemnity F Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
this application does not have any one,of the above three insurance coverages.
Signature of owner/agent of property Owner 0 Agent El
I hereby certify that aU of the deuds and Information I have submitted (or entered) in above application are true and accurate to the best or my
knowledge and Mat aU plumbin; Work and ItttaWtions perfomted under' Permit issued for this application will be in co linnce with ali pe2Unent
Provisions of the Massachusetts Slate Cas Code and ChAptet 14: of the General LAwa. „
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
,TYPE LICENSE:
Plumber
Gasfitter Signa ure of Licensed
Master Plumber or Gasfitter
Journeyman 99$�
License Number