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6, -3o - 0-5-
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............................................. ...............................................
has permission to perform ......... .........
wiring in the building of ..... \AJ .............
S at .......... A
......:5....7............. .............................................. . North Andover, Mass.
Fee.3s`7 Lic. No.47./�? ........
Check #
567 r/
e
L\ Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. 2
r Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS P
[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 CM/R` 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:� O N E 3 V 10 Q
City or Town of.- a�� 4-2 To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 2 5- 9 ey 6" T- Map: Lot:
Owner or Tenant (eJyy & IZt.A4 a n/i a Telephone No.
Owner's Address' S -
Is this permit in conjunction with a building permit? Yes q No ❑ Building Permit#
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
1ne ` TIt de- VI C'!!2 to,
L-
Completion of the following labYe inay be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Sus P ( Paddle)
TransFans r Total
sformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
SwimmingAbove In -
Pool rnd. ❑ rnd. ❑
o. omergencyiging
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS I
No. of Zones
No. of Detection andInitiating
No. of Switches
No. of Gas Burners
Devices
No. of Ranges
g
No. of Air Cond. Total
Tons
No. of Alerting Devices
Heat Pump
Number
Tons
KW
No. of Self -Contained
No. of Waste Dis osers
P
Totals:
. ..
....
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
P g
Local ❑ Municipal ❑ Other
Connection
of Dryers
Heating Appliances KW
SteNo.
Sec No of Devi es or Equivalent
No. of Water
KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
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 lire 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. / hh
CHECK ONE: INSURANCE 4, BOND ❑ OTHER ❑ (Specify:) 6'r!"u 6
Gd) (Expiration Date)
Estimated Value of Electrical Work: ej,45 O ' (When required by municipal policy.)
Work to Start:
of O) Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties ofperjury, that the information on this application is true and complete.
FIRM NAME: Tf9 Til• I IP- L e CT A K. A1s 1. r- c- LIC. NO.: J7 y 7 Z A.
Licensee--, Ikl .n 7 f1r1nvA Z1- Signature LIC. NO.: # �S- e
(If applicable, enter 'exempt" in the license number line.) Bus. Tel. No.. p P IS -7151
Address: Alt. Tel. No.: Z -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent 'r-l....h--- tv,. I PERMIT FEE. S 3 �'
a
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. !!S -O
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 INFORMATION) Date r% V NE �; V , Z O
City or Town of: ff AN � J sj{ lk To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 9 8 J t'^ --J StT Map: Lot:
Owner or Tenant W, -3,V & (Z%- a4C ) A/pQ Telephone No.
Owner's Address <AOk--.
Is this permit in conjunction with a building permit? Yes qj NoE] Building Permit#
Purpose of Building
Existing Service Amps
New Service Amps
Utility Authorization No.
Volts Overhead ❑ Undgrd ❑ No. of Meters
Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
A0b ;otvtD (4,hc1uir- 2
Overhead ❑ Undgrd ❑ No. of Meters
ftoo
rti,, k�eb e L
iie a l 7« Cie -voce -v
Completion o the ollowin tabYe may be waived b the Inspector o Wires.
No. of Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above ❑In- ❑
rnd. grnd.
o. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I 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
g No. of Alerting Devices
No. of Waste Disposers
Heat Pum
Totals: P
Number
Tons
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
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 K BOND ❑ OTHER ❑ (Specify:) 6 -1 -ID to
,�(Expiration Date)
Estimated Value of Electrical Work: '9S 0 e W (When required by municipal policy.)
Work to Start:
6 q 10)r Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: -rAl fr k l tit I- I.ke cT 1L K !1L- : r LIC. NO.: 0102 A
Licensee W l 17C tsn r A 2. -L% Signature LIC. NO.: Ais—ti C
(If applicable, enter 'exempt" in the license number line.) Bus. Tel. No.. - 15"7/51
Address: Aft. Tel. No.• Z -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's
Owner/Agent
'r -l -,.,,,.,.o N,. PERMIT FEE: $
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Date .....
Op TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
�9SS�CHUSEt�y
This certifies that ...................
has permission for gas installation �.
A J�
in the buildings of
'414 .......
at..... ............
Fee .... Lic. No........... .
Check # 0.�/IkJ,
4648
h Andover, Mass.
MASSACHUSETTS
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
TON FOR PERMIT TO DO GAS FITTING
Date 0? ! J 0 /
Building Locations V Permit # 116 (116
Amount $ Cq�g, C>/
Owner's Name
New Renovation ❑ Replacement Plans Submitted ❑
(Print or type)!)
Name t
ie _ A T_ I l i-47 -1 7
Name of Licensed Plumber or Gas Fitter 1 L A, Lv � 1) l
f j' h 6^heck one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
1�►� v I
INSURANCE COVERAGE Chec on
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked yes, ple se 'indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity Bond ❑.
Owner's Insurance Waiverl 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. 1:1 Agent
I hereby certify that all of the details and information I have submitted ( ntered i above application are true and accurate to the
best of my knowledge and that all plumbing work and installations pert ed d Permit Issued f r this application will t in
compliance with all pertinent provisions of the Massachusetts Sta o er 142 of t ra a
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
4gnature of Licensed Plumber Or GasFjtt�c,
Plumber
Gas Fitter License Number
Master
Journeyman
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SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type)!)
Name t
ie _ A T_ I l i-47 -1 7
Name of Licensed Plumber or Gas Fitter 1 L A, Lv � 1) l
f j' h 6^heck one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
1�►� v I
INSURANCE COVERAGE Chec on
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked yes, ple se 'indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity Bond ❑.
Owner's Insurance Waiverl 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. 1:1 Agent
I hereby certify that all of the details and information I have submitted ( ntered i above application are true and accurate to the
best of my knowledge and that all plumbing work and installations pert ed d Permit Issued f r this application will t in
compliance with all pertinent provisions of the Massachusetts Sta o er 142 of t ra a
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
4gnature of Licensed Plumber Or GasFjtt�c,
Plumber
Gas Fitter License Number
Master
Journeyman
3067
Date....... / ;-..
p• «w e 'h
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that gbh � c .: e ...4,e d". `��ie / f—• � ( -T! c
............... ...............................................
has permission to perform ...
/........ i.....!?..v!...r........�...�G.�^................
,wiring in the building of vY�i�.���./P ...��J�1j F%
cc......... /........
at ........11..`..1........ ..... .. .. ................ . North Andover Mass.
Fee,. -' _ : ...... Lic. No, .1.7f �;..... ., � ..... .. r.. ......
ELECCRIChf NSPECTOR
Check # ���,`—�—
l.,o�nmonwaa[!� a�cc�its�ac�tuda[�1 . .
..UaParinrant o�,}ira �aruica�
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
tev. 11/99] rt"aP t,t,..4►
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All .work to be performed in accordance with the Massachusetts Electrical Code (NIEC), 527 CMR 12.00
(PLEASE PRINTININK OR TYI'EALL livrolz '-17'ION) Onle: Z d Z
City or Town of: Al. hjtlouge To the Inspector o Wires:
By this application the undersigned gives notice ofhis or her intention to perform the electrical work described below.
Location (Street & Number) 17 — Jr- D -e Uo h
Owner or Tenant (,()pvct fL A& AQW a r, Telephone No. 27948970F3
Owner's Address /� UIDDe��t if 5tC �eoA
Is this permit in conjunction' with a building permit? Yes ❑ No, n " (Check Appropriate Box)
� n/� 'rA
Pit rliose of Building fSrCSlrl-mltt�-K Utility Authorization No. (14GOV6,
Existing Seri -ice c�dd Antps 1 Zd / Volts Overhead ❑ Undgrd No. of Meters
Ncw Scrvice 5Ab E Antps / Vulls Overhead❑. Undgrd ❑ No. of Meters.*
`(umber of Feeders and Ampacily
Location and Nature of Proposed Electrical Work:IZDIa� �..,�....1. C G.00aIL"r P
Cont-1—ion o%the fo!loivnI t 6! b
nisch aaarrtonai detail y desired, or as required by the haspector of Wires.
IivSUR-'UNCE 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 niforce, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSUTJkNCE BOND ❑ OTHER ❑ (Specify:) Zy;o j7/ At
Estimated Value of Electrical Work: (When required by municipal policy.) (Esp Date)
Work to Start:2 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I Certify, under the p !ns and penalties of perjury, that the information cit this application is true and complete:
FULN1 NAME:- ; P ui l ted q -e..�
Licensee: Off �1C� Signature LIC. NO.: �aos3y
(ljat,plicable, triter• "cccnlpe" in the license n anber line Bus. Tel. No,'
Address: b17� Alt. Tel. No.:Y
0WNER' INSURANCE WAIVER: I am aware that the Licetuee does not hatie the liability itusurance coverage normally
required by law. By niy signature below, i hereby naive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/A,,ent
Signature Telephone No.Pi:Ri1IIT FEE; S.
e
a e nra a caned b • fire !nscetor o0vires.
-
No. of Recessed Fixtures
. .
No. of Ceil-Susp(Paddle) Fans
°' or
Transformers 'otal
KVA
No. of Lighting Outlets
No. of blot Tubs
Generators KVA
No. of Lighting Fixtures
Sisininring Pool Above ❑ In-❑
rad. rnd.
mergency ig i mg
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
t 0. of Detection and
Initiating Devices
No. of Ranges
Ranges
Total
No. of Air Cond, Tons
No. of Alerting Devices
N'o. of Waste Disposers
Heat Pump
Nunr er
Tons
K�
No. of el - ontaincd
Totals:
Detection/Alerting De-Oces
No. of Dishwashers
Space/Area Heating KAY
Local ❑ LV wucipa
Connection El Other
No. of Dryers
Heating Appliances KW
Security Systems:
00. of Nater
No. of No. of
No. of Devices or Equivalent
Heaters KW
Sighs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydroinassaae Bathtubs No. of Alolors Total i'IP lcleconrmumcatlons Wiring—
No. of Devices or.E uivalent
OTHER:
nisch aaarrtonai detail y desired, or as required by the haspector of Wires.
IivSUR-'UNCE 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 niforce, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSUTJkNCE BOND ❑ OTHER ❑ (Specify:) Zy;o j7/ At
Estimated Value of Electrical Work: (When required by municipal policy.) (Esp Date)
Work to Start:2 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I Certify, under the p !ns and penalties of perjury, that the information cit this application is true and complete:
FULN1 NAME:- ; P ui l ted q -e..�
Licensee: Off �1C� Signature LIC. NO.: �aos3y
(ljat,plicable, triter• "cccnlpe" in the license n anber line Bus. Tel. No,'
Address: b17� Alt. Tel. No.:Y
0WNER' INSURANCE WAIVER: I am aware that the Licetuee does not hatie the liability itusurance coverage normally
required by law. By niy signature below, i hereby naive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/A,,ent
Signature Telephone No.Pi:Ri1IIT FEE; S.
3395 Date . �`...o....`....... .
TOWN OF NORTH ANDOVER
�'• PERMIT FOR GAS INSTALLATION
P
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This certifies that ..171 U- !.r ...••••••••••••••
has permission for gas installation ... (: ......................
in the buildings of ... !l!!
S '
MASSA �17�1 P1CATON FOR PERMIT TO DO GAS FITTING
��Type or print) PARCEL Date
f- Q
NORTH ANDD INA, AfA!68*etftMr 1 15
f/G%�
Building Locations � Permit #
Amount S }
Owner's Name W P D YL � J �,e �1 �
New ❑ Renovation ❑ Replacement Plans Submitted ❑
(Print or typc)� q h�L
Name (J 11` iii
Address t �R
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
❑ Corp.
❑ Partner.
/ Firm/Co.
L100I
INSURANCE COVERAGE Check cone/-
I have a current liability Insurance policy or it's substantial equivalent. Yes I �/t No ❑
If you have checked ves, pi dicate the type coverage by checking the appropriate box.7�"
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have subfnitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installati s pert ed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts ode and Chapter 142 of the General Laws.
By:
Title .
CitviTown
APPROVEDfUFFICF I)Sc
N1. Y)
Signature of Licensed Plumber Or Gas Fitters
Plumber
Gas Fitter License Numoer
[Master
loumeyman
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8 A S E M E N T
1sT. F L 0 0 R
2N D. FLUU R
3RD. FLOUR
4T 11. FLUOR
3 T. FLOUR
6T5. FLUOR
7T 11. FLUOR
HT111. FLOG R
(Print or typc)� q h�L
Name (J 11` iii
Address t �R
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
❑ Corp.
❑ Partner.
/ Firm/Co.
L100I
INSURANCE COVERAGE Check cone/-
I have a current liability Insurance policy or it's substantial equivalent. Yes I �/t No ❑
If you have checked ves, pi dicate the type coverage by checking the appropriate box.7�"
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have subfnitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installati s pert ed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts ode and Chapter 142 of the General Laws.
By:
Title .
CitviTown
APPROVEDfUFFICF I)Sc
N1. Y)
Signature of Licensed Plumber Or Gas Fitters
Plumber
Gas Fitter License Numoer
[Master
loumeyman
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG
(Print or Type)
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NO ANDOVER _ , Mass.. .Date 9 / 3 0.199-5 95 - .. Permit #
Building Location 25 DEVON _COURT Owner's Name TOM WARD oO P
Type of Occupancy L --RES
New ❑ Renovation ❑ Replacement n . Plans Submitted: Yes❑ ' No ❑
Installing Company Name CALLAHAN A/C&HTG
Address 91 BELMONT ST.
NO.ANDOVER,MA.01845
Business Telephone ( 5 0 8) 6 8 9— 9 2 3 3
Name of Licensed Plumber or Gas Fitter JOSEPH K. CALLAHAN
Check one:
❑ Corporation
,E] Partnership
/11 Firm/Co.
Certificate '
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142
Yes ® No ❑ '
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy El Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application walves this requirement.
Check one:
Signature of Owner or Owner's Agent Owner❑ Agent ❑
1 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 Installallons performed under the permit issued for t is application will be In comp ante with all
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142A
eral La
BY
Type of Ucense:
LD Plumber e o ense um er or titer
Title aster > Aoyo
aster Number
City/To" Journeyman
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STH FLOOR
6TH FLOOR
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7TH FLOOR
aTH FLOOR
Installing Company Name CALLAHAN A/C&HTG
Address 91 BELMONT ST.
NO.ANDOVER,MA.01845
Business Telephone ( 5 0 8) 6 8 9— 9 2 3 3
Name of Licensed Plumber or Gas Fitter JOSEPH K. CALLAHAN
Check one:
❑ Corporation
,E] Partnership
/11 Firm/Co.
Certificate '
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142
Yes ® No ❑ '
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy El Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application walves this requirement.
Check one:
Signature of Owner or Owner's Agent Owner❑ Agent ❑
1 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 Installallons performed under the permit issued for t is application will be In comp ante with all
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142A
eral La
BY
Type of Ucense:
LD Plumber e o ense um er or titer
Title aster > Aoyo
aster Number
City/To" Journeyman
APMX7Vt O
Date.. qj �-... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that a L!4-4 w A: .... . �(� . I .........
has permission for gas installation �. .. L ........
in the buildings of-Taa ......
at cT . ........ . , North A er, Mass.
Fee. .. Lic. No..
�KK /12/95 11:49 2o.00 �s INSPEcroR
TE: Apple CANARY: Building Dept. PINK: Treasurer GOLD: File
Date .6 . Z x --Y—
<: •:1� TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that "............................. .
has permission to perform ... .................
plumbing in the buildings of . !-!-°.'. �. �. !A t— . t' .- 7 ............ .
at ... ( . (............... . North Andover, Mass.
Fee. .2..} Lic. No..? .C. 3! ., . ......../
UMBING INSPECTOR
Check !t y PL
6512
MASSACHUSETTS UNIFORM APPLICATION FOR PERM TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
j1 Date t; -
Building Location2.s Aw'1/ew eels r Owners Naae,/ 10/1 e/ckc�? /'7Uh'1 Permit # _ 1
Amount L Pa -
Type of Occupancy
n
ri
New Renovation Replacement Plans Submitted Yes No ❑
FIXTURES
(Print or type) / // Check one: Certificate
Installing Company Namet1/z.sc,1,y �L(��%///l� i /`i�%%%717Ct Corp.
Partner.
�Firm/Co.
Name of Licensed Plumber:`( If 1A is . f CSwI
Insurance Coverage: Indicate the type o 'insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity El 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
signature Owner
I hereby certify that all of the details and information I
best of my knowledge and that all plumbing work an
compliance with all pertinent provisions of the I sacl
OVED (OFFICE USE ONLY
❑ Agent
ttv.d (or entered) in above application are true and accurate to the
erfod under drmit Issued for this application will be in
P1ug,Cgnd Chapter 142 of the General Laws.
Type of Plumbing License
` �1�'
icense um e� Master
Journeyman in
I
Date.(-...- ?.....'........ .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..U- t . .
has permission for gas installationP/ ..` . - t ,: ' ............ .
in the buildings of .. -'!?. ....................... .
at . `L .. C- w4-% ............. North Andover, Mass, 1A INSPECTOR
Fee. `.. Lic. No..
AS INSPECTOR
Check # ri
5159
MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT GAS FITTING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date 16—,,2c / —0-S7
Building Locations � 4� C7��i Permit #
Amount $
Owner's Name �PJ1J.�� ����,
New ❑ Renovation Replacement Plans Submitted
(F
N
0
e 3-�
Check one: Certificate Installing Company
ElCorp.
ElPartner.
irm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 0— Other type of indemnity 13 Bond ❑.
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent 1
I hereby certify that all of the details and information I have submitted o , entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations rfoaed under Permit Issued fo this application will be in
compliance with all pertinent provisions of the Massachusetts to Ga/ode�d Chapter 142 ;/ee General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber 0(::� 3"/ 3
0 Gas Fitter Icense um er
0 Master
� Journeyman
IMIRS
7TH. FLOOR
(F
N
0
e 3-�
Check one: Certificate Installing Company
ElCorp.
ElPartner.
irm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 0— Other type of indemnity 13 Bond ❑.
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent 1
I hereby certify that all of the details and information I have submitted o , entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations rfoaed under Permit Issued fo this application will be in
compliance with all pertinent provisions of the Massachusetts to Ga/ode�d Chapter 142 ;/ee General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber 0(::� 3"/ 3
0 Gas Fitter Icense um er
0 Master
� Journeyman