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Home My WebLink AboutMiscellaneous - 25 ANDREW CIRCLE 4/30/2018N J �4_ Y � J Z 0 m N O C7 O C7 o m 0 North Andover Board of Assessors Public Access t. f M�ptM4 t ,sSACM1`�ES Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial I Page 1 of 1 roperty Record Card Parcel ID :210/047.0-0126-0000.0 FY:2013 Community: North Andover SKETCH Click on Sketch to Enlarge F] PHOTO Click on Photo to t� 25 ANDREW CIRCLE Location: 25 ANDREW CIRCLE Owner Name: FRASER, ALASTAIR C/O JERGER, ANDREW Owner Address: 25 ANDREW CIRCLE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 0.39 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1152 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 213,200 216,200 Building Value: 77,400 76,800 Land Value: 135,800 139,400 Market Land Value: 135,800 Chapter Land Value: 1. http://csc-ma.us/PROPAPP/display.do?linkld=2253453&town=NandoverPubAce 3/26/2013 00 N N 0o U ooVmV N N, t0 a) N C)a cu U— a) Cn m N CLO U) N C,O;rn wc) C s M , C LL O as W C J a O U N N Ca -0 C13 COU (n w Z Cr0 O) Q 00 er LO U N O Cn NW 0occoo41) W U W [[1 M U -20 00 lx J oW o rU �o y� oQ on.QLU. 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W LO C-4 '— C' U- CC W CO LL rn N, N iii L- M U cn V O w W +� In pCL.L-.:C 7 7L CO CO <n aD i LA- 0 0oNm�UC1_ U'C7cu cd -C Yto co p a) 7 l0 C 10 ' -C N N. N m f—CaLLZWm9W mco o Ix CVC9m U xC90Z a E � O � ~ ~ CL - v W rn Y (ov)ww2LLL =LLL MO a°3: Un Locationc7�. c3%,&2/1C�/L�itJ Cid No. 3� �" ��— Date NOR7N TOWN OF NORTH ANDOVER s A Certificate of Occupancy $ s�cwus Building/Frame Permit Fee $ Foundation Permit'Fee $ Other Permit Fee $ TOTAL $ Check # 3 24763 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued:AO—d-6 IMPORTANT: Applicant must complete all items on this nage Print MAP NO: ZPARCEL:,ZONING DISTRICT: J01, 132- 7 Historic District yes no Machine Shop Village ye no 100 year-old structure ye no TYPE OF IMPROVEMENT /I A /� o o Ips a 3,r L - ROPOSED USE y— Residential Non- Residential ❑ New Building ne family tj4/�i $ US /M ❑ Addition 43A.C,4F1/&S ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial "epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D,Septic '®Well' D Floodplain DFW _ d etlan 5' W t ershed]District", DESCRIPTION OF WORK TO RF. PFRFoP7vmr)- S' /I A /� o o Ips a 3,r L - d n/ X71 y— 5'7 n 14YL�,q US /M 44A-7r_,�Or 43A.C,4F1/&S ALS' v (Identification Please Type or Print Clearly) OWNER: Name: & 77r /_? / Phone 7d 7q3°- 0//!Y Address: CONTRACTORName: Address: 4a)4z-A G/ _ s7— Lt// C- ,A f Supervisor's Construction License: G 2 p Exp. Date: - ;L� / Z Home Improvement License: ARCHITECT/ENGINEER Exp. Date: Phone: Address: Reg. N FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ FEE: $ r'"i Check No.: J 2-s Receipt No.: NO ns c racting with unregistered con tYgct i do not have access to the guaranty fund �Siana ure.ofA 'ont/ .whet' . ' :::: ` -. - - S�gnat `a of c or Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ ' Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT COMME DATE APPROVED CONSERVATION Reviewed on Siqnature COMMENTS HEA,LTH Reviewed on Signature COMMENTS - Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Wafer & Sewer Connection/ Siqnature &Date Drivewav Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS, Located 384 Osgood Street yes no h C a A� M z ® w° cit O P w° U w O U w W C2 cin Cdcz w O U a w w w E r� Cl) o cn r - V : c o as c o ' c � O L CIO W o v C.i A y CcL CD :. C40= i. E a m� :_.2 M., CD y 3 o CD o 0 U20c `mIr ymy .m � = = y c ca C O m ca a c .� m o f m cc -33:E, o . L E Z o c o c o a .o = m m=p N CL— ca: F— o o l— m CO3 'r cc 4D "" 10. ._. H •Go a= W o Z CD ca CD LU a c ¢H¢ J = A y •� O I.- = s a:E m S. z 0 U • UU 0 a 2 co O E � L O Z CL CD O CO) co cm CO) o o _ CD O .O mm O i c O d CL �a CCcC �� -J -0 .CIO C Z ts CD CL V y O C C C d i5 0 U) W W W N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): U, r . C (/ S 70g!!!!1 7/7u'16 o./ T& C Address: '?22 City/State/Zip: �V, G ztzl a . Q f 4; Phone #: cj .7 �- /,, r -- Are you an employer? Check the appropriate box: 1. [V am a employer with S 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of 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 *Any applicant tnat cheeks box # 1 must also fill out the section below showing their workers' compensation policy information. i 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: T"/t k ve, A z Policy # or Self -ins. Lic. #: J0 -3—;)L — l Expiration Date:_3 j 1 Lj _/Z Job Site Address: 3 x,=32 4-4V zZ4 Gt City/State/Zip: iii/�IV1-ice iYZ7 0,, Attach a copy of the workers' 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 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Official 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 VJ/28/2011 10:51 9785319442 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 86 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIEED HEREIN IS SUBJECT TO ALL THE YERMS, EXO!_USIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, #0584 P.001/001 CERTIFICATE 4F l.IABI�.lTY INSURANCE OPID KC DATE(MMIDDIYYY'Y) PRODUCER Ises Saocar $50000 CLAIMS MADE OCCURXP(Anyaneperson} NEWILN— 03/28/11 _... _.�_ 1 PERSONAL&ADV INJURY j$1000000 GENERALAWREGATE j s200.QoQo THIS CERTIFICATE IS ISSUER AS A MATTER OF INFORMAONLY TION Kilgore Insurance Agency I 1 CTT LbC AN CONFERS RTI CAPE DOES NOT ON THE 5 Centennial Drive AUTOMOBILE HOLDER. THIS IF EXTEND OR Peabody 1101 01960 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 978-533-6550 Fax: 978-531-$442 _._._ __ INSURERS AFFORDING COVERAGE INSURED A� NAIC # 04/05/12 CGABINED�INGLEUMIT {Ea accident _ JNSURERA WDlI4YA WOYld IMsVranO� Cop®ap '—_ Now England Custom Design INSURER B: safe Indemnity ins Co Ron Welnber 226 Lowell Ztxe t Unit 334-A Wilmington MA 0 88� INSURER C: -- _. Travalora PrpprYy L,y, INSURER D; ._..__.. _.._..... THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLJCY pw= INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 86 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIEED HEREIN IS SUBJECT TO ALL THE YERMS, EXO!_USIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR NSR TYP OFlNSU NCE POLICY NUMBER - p LICYEF EC FDAITCEYMMIDDY N LIMITS GENERAL LABILITY ;C-ACOCCURRENCE $1400000X COMMERCIAL OENERAL:LIABILITY NFP121•a5260 ETOR d3/14/11 03/14/12 Ises Saocar $50000 CLAIMS MADE OCCURXP(Anyaneperson} $2500 _... _.�_ 1 PERSONAL&ADV INJURY j$1000000 GENERALAWREGATE j s200.QoQo GENLAGGRErG TT�ELIMITAPPLIE5PER PRODUCTS•COMP/OPAGG $ lOOOOOO POLICY J I 1 CTT LbC Aumo R REsENTAnVE AUTOMOBILE LABILITY 8 A� 5054921 04/05/11 04/05/12 CGABINED�INGLEUMIT {Ea accident $ ALLOWNEDAUTOS ___. _ --------- X' HEDULED AUTOS ROPILY INJURY (Per person) $,250040 ED AUTOS 7- —.—. .•.•-.__._j_.._ ._ _....._.._.._. .. N-0WNFDAUTOS j URY (PorraactBODILYio0j) j$500000 PROPERYY DAMAGE�raec+den) $100000 LIABILITYAUTO ONLY- EAACCIDENT $ 113ARAGE AUTO . OTHER THAN EA ACC $ UMBRELLA LIABIUTYEACH AUTO ONLY: AGG $ L_I CLAIMS OCCURRENCEUR $ MADEA66REt3AYE UCTIBLE$ ENTION $EMPLOEPENSATION . X TORI! LI(1�ITS_ ER ' r AND EMPLOYERS LIABILTY - -' i �- � . ANY PROPRIETO"ARTNER=ECUTIVE 7PJUB-0239N23-2- 11 03/14/11 03/14/12 _ E.L. EACH ACCIDENT $100000 OFFICIERIMF-MSER F-XGLUDEIYt — _BL DISEASE • EA EMPLO 5100000 Ir ea, describe under St�ECIALPROVISIONSbdow OYntlR ' EL. DISEASE -POLICY LIMIT $ 500000 I VEHICLES I EXCLUSIONS - f tKIIFI(:ATE HOLVER %) PCYRD CORPORATION 1988 CANCELER I wry 3111111 SHOULD ANY OF THE ABOVE DESORMFD POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE Ce"'CATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY MND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Aumo R REsENTAnVE ArnRn 94 ronnlllnati %) PCYRD CORPORATION 1988 Massachusetts - Department Of public Safety:. . Burd of Building Regulations and Standards Construction Supervisor License r License: CS 8828 Restrict6d to: 00. VAL J LANZA 34 BIXBY ST y REVERE, MA 02151 Expiration: 4/20/2012 ( ('ununissiuncr Tr#: 20843 � . � i _ � ' . � '[/�0:))7dYLO0tClJCCLGCIL • .�• _. _ _ Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR ; 1 Registratioh:12467 Typs- NEW ENGLAND ' Val Lanza 226 LOWELL ST. i WILMINGMN, NIA INC. yi Undersecretary Restricted to: 00 ' 00 - Unrestricted 1G -1 2 Famify Homes Failure to possess a c}trrent edition of the Massachusetts State Building Code is cause for revocation of this license: Refer to: WWW.Mass.Gov/DPS License or, registration -valid. for ijWidul use only before the egpir'ation date:.Iffound return>toc Office of Consumer Affairs and 13 iness'Regulation Boston, MA 02116 I Dimension Number of Stories: ';Z, Total square feet of floor area, based on Exterior dimensions. Total land area 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 20117une/mi 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 ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products MOTE: 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 ❑ Fioor/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 MOTE: All dumpster permits require.sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o 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 a Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi -4 FA C Date.Z�k/ x, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... /I -C -, (-0( do ti / I-( /�,I ...................................................................................... has permission to perform ..... ......... wiring in the building of ........ C.P.n�� ........ at .... (.,j ..... ...................... ...... . North Andover as - Fee................... .. . . Lic. Nor. ......... ................................................... *>*Zi i( ELECTRICAL INSPECTOR Check # LICICO 0 i d i 0 Commonwealth of Massachusetts 4 �h Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official e Only /0K Permit No. V 7L1 Occupancy and Fee Checked [Rev. 11/991 leave blank 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 IN INK OR TYPE ALL IN ORMATION) Date: City or Town of: J� dTo the Inspector of Wires: By this application the undersigned gives of his or her intention to perform the electrical work described below. Location (Street & Number)4 Owner or Tenant " G / j�'J % �i �'I elephone No. , �5 Owner?; Address Ok.�_/;7", . k -t/ /�, __1 �on with'a building permit? Yes ❑ No� (Check Appropriate Box) Is this permit in conjun Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Loca ' n and Nature of Proposed Electrical WoTk: No. of Meters No. of Meters / Cmmnletinn V tree followinv table may he waived by the Insnector of Wires. No. of Recessed Fixtures No. of CeilSusp. (Paddle) Fans : No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures N Above ❑ In- ❑ Swimming Pool rnd. rnd. o. o Emergency Lighting Battery 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 Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local [IMunicipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of WaterNo. Heaters KW of No. of Signs Ballasts Data Wiring: I No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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:) !� (Expir tion Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: IdP K16.'5nspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the ain a d penalties of perjury, that thea rmation on this, application is true and complete. FIRM NAME: Z a I l -- !!q1 �2 �t_,tr ,, r LIC. NO.: Licensee: � e�'e / ��, Signatur ; G- (�'' � LIC. NO.: =7— (If ' applicable, en er ex pt"in th lie nse ny ber line.) n 3 p Bus. Tel. No.. Address: % �/'� �, `l C� jJed K K , A � Q 3c Alt. Tel. No.: r.'F OWNERS INSURANCE WAIVER: I am aware that the Lie ee does not have the liability insurance coverage nonnally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owners agent. Owner/Agent ,- Signature Telephone No. PERMIT FEE: $ K C;�J 3 '1 2 7' -? _ Date .. s ... l .! ............ . 0 pORTH , TOWN OF NORTH ANDOVER 3? ° ° PERMIT FOR GAS INSTALLATION` f P SSACHUSE� Ctl This certifies that ..........................................� has permission for gas installation ..., : ' . :: ::: l in the buildings of ...... .. ......................... at ...............' ...................... . North Andover, Mass. Fee....:.... Lic. No.:......... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �'d — MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFIT I.(3 (Print or Type) NORTH ANDOVER Mass. Date // 9 t§wilding Location Permit # L% Owners Name 7i-7 ' New '-I Renovation D Replacement Pians Submitted =] FIXTUR.=c (Print or Type). s;.t'.: Check one: Certificate Installing Company. Name ANDOVER PLBG. & HTG. CO., INCM Corp. 2122 Address 573} S0. UNION STREET Partner. LAWRENCE, MA. 01843 [_f Firm/Co. Business Telephone: 278 685-8383 s;, Name of,Lice s Pju ber. or Gas Fitter GEORGE ILAROSE Inst3"rancP C3. erage: Indicate the type of insurance coverage by,checking the appropriate box:: Liability insurance policy EE/"Other type of indemnity Q Bond Lj 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 u Agent El I 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 knowledce and Qat aU plumbing work and InstAltations paformad under' Permit Weed fox this application will -be In compliance with ani pestlncnt provisions of the Massachusetts Slate Cas Code and (73aples 142 of the General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY TYPE LICENSE:— - Plumber Gasfitter- Signature of Licensed Master Plumber or Gasfitter Journeyman 9983 _ License I -lumber Nunn all - (Print or Type). s;.t'.: Check one: Certificate Installing Company. Name ANDOVER PLBG. & HTG. CO., INCM Corp. 2122 Address 573} S0. UNION STREET Partner. LAWRENCE, MA. 01843 [_f Firm/Co. Business Telephone: 278 685-8383 s;, Name of,Lice s Pju ber. or Gas Fitter GEORGE ILAROSE Inst3"rancP C3. erage: Indicate the type of insurance coverage by,checking the appropriate box:: Liability insurance policy EE/"Other type of indemnity Q Bond Lj 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 u Agent El I 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 knowledce and Qat aU plumbing work and InstAltations paformad under' Permit Weed fox this application will -be In compliance with ani pestlncnt provisions of the Massachusetts Slate Cas Code and (73aples 142 of the General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY TYPE LICENSE:— - Plumber Gasfitter- Signature of Licensed Master Plumber or Gasfitter Journeyman 9983 _ License I -lumber