HomeMy WebLinkAboutMiscellaneous - 250 BLUE RIDGE ROAD 4/30/201840M Date .:4Wf ...........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ..... i ... 6 ...
.... .. .....
has permission to perform .A.,...,.�.
V
plumbingin the buildings of ..............................................................................................
4
.... 3/ .. .. .........................
at North Andover, Mass.
Fee ..... Lic. No.
�
..,Y,1.4 .......................................
PLUMBING INSPECTOR
Check #
4A
Date-, �l ..hr ..............
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .... b4 a.... 4 ....................................
has permission for gas installation .409 ...4 . ...
in the buildings of ..................
..............
Fee,504.0 ..... Lic. No. A; ...I...K........
Check #
Lj>> Y2
......... ... .. N Andover, Mass.
INSPECT R
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
P
TYPE OR
PRINT
CLEARLY
CITY E WERMIT,
74- — _�_J'j MA DAT ! 6
JOBSITE ADDRESS ye— OWNER'S NAME xj
OWNER ADDRESS j TEL 97?,77 LCPA�IJJFAX =�'
OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL El RESIDENTIAL
NEW. F-11 RENOVATION: FREPLACEMENT:PLANS SUBMITTED: YES NO
x 'K
FIXTURES -1 FLOOR- BSM 1 2 3 4 5 1 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIIJSAND SYSTEM
DEDICATED GREASE SYSTEM j
DEDICATED GRAY WATER SYSTEM . ..... J
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER . . .... ...... J
. ..._....._i .. ........ ..
FLOOR/ AREA DRAIN
INTERCEPTOR (INTERIOR) . .........
KITCHEN SINK
LAVATORY F 71 F . F77 ....... . .......
ROOF DRAIN
SHOWER STALL ... . .... ... .
SERVICE MOP SINK
TOILET F .._._._I.= E -.. ....... . j
URINAL
WASHING MACHINE CONNECTION E.
WATER HEATER ALL TYPES r7_7 I 1= rF----
WATER PIPING .... .... ...
OTHER
. ................. 7--1
. ... ......
1-7 11 JI . .... . .....
INSURANCE COVERAGE -
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142, YES NOD
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
--4
LIABILITY INSURANCE POLICY A OTHER TYPE OF INDEMNITY F-1 BOND
OWNER'S INSURANCE WAIVER: I 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 [] AGENTE-j
SIGNATURE OF OWNER OR AGENT 4
1 hereby certify that all of the details and information I have submitted or entered regarding this application are tr nd accurate to the b st of my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in co the
Massachusetts State Numbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME LICENSE #` SIGNATURE
MP'� JP El CORPORATION L—j #=PARTNERSHIP [I # LLC D#
COMPANY NAME - - ----- _.__.-._J ADDRESS:
CITY jt)np111V STATE'ZIP OhG, TEL
FAX CELL EMAIL
=�
10
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY CV—MA DATEE PERMIT#CMILG-
JOBSITE ADDRESS NAME f_-, SA
-G
___3k,_�OWNER'S
OWNER ADDRESSFAX
TEI]_ _J1
TYPE OR
OCCUPANCY TYPE COMMERCIAL (j EDUCATIONAL RESIDENTIALPRINT
CLEARLY
I
NEW, [711 RENOVATION: El REPLACEMENT:% PLANS SUBMITTED: YES NOX
APPLIANCES 'l -, FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
j
COOK STOVE
DIRECT VENT HEATER =1 E-7-D F�-! [-_ J- F-
DRYER
FIREPLACE
FRYOLATOR
E:J
FURNACE
GENERATOR 7-1
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER--1
J L
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST F-I
UNIT HEATER17, 771 IF ---1 1 ...... ... .
UNVENTED ROOM HEATER
7-1
WATER HEATER L= L:::] [771- F
OTHER I E-j F--1 1===
j
INSURANCE COVERAGE
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL, Ch. 142 YES NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND [11
OWNER'S INSURANCE WAIVER; I 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: OWNERD-J AGENT
SIGNATURE OF OWNER OR AGENT
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
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
and that all plumbing work and Installations performed under the permit Issued for this application W111 be In comp with 11 Pert' t��
PLUMBER-GASFITTER NAME LICENSE # 9f7 GNATURE
_._
MP%MGFI.---][ JP01 JGF[--- CORPORATION D# PARTNERSHIPn
]I LPGI # LLC #
COMPANY NAME: ADDRESS
CITY F STATIfMZIP1 TEL
FAX CELL EMAIL
10
BOXFORD CHIMNEY SWEEP
P.O. Box 14 • Boxford, MA 01921
508-727-3715
I
s
boxfordchimney@comcast.net
www.boxfordchimneysweep.com
.
Name:
Address:�,Ooowv
City: otc
State: Zip Date: / J/
%l(
Flue Size: /-,/
CONDITION
REPORT
HEATING FLUE
1. Height
2. Cap/Screen FLUE
LINER
3. Crown/Wash
4. Brickwork/Mortar
Ing
lil Flue Liner
7. of ure Resistance Liu
FIREPLACE FLUE oho SMOKE
� SHELF
8. Smoke Chamber DAMPER
9. Damper
10. Firebox/Grate
LINTEL
1 11. Ash/Container
1 12. Spark Screen/Doors
ASH
13. Flue Liner
COMMENTS:
TOTAL
PRICE
NEXT SERVICING SU ESTED:
The National Fire Protect' Association Standard states the fire-
place and chimney should be inspected ye any structural
faults.
O
U
-
a
Chimney Professional's Signature
Q
cnCZCU
D
Z
RECEIPT/INVOICE
co
TOTAL
PRICE
The Commonwealth of Massachusetts
f Department of Industrial Accidents
a , a I Congress Street, Suite 100
Boston, MA 02114-2017
r
www. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Name (Business/Organization/Individual):
Address: 1�
City/State/Zip: Phone #: 9 g
Are you an employer? Check the appropriate box:
I. F1 I am a employer with employees (full and/or part-time).*
2. Iam a sole proprietor or partnership and have no employees working for me in
y capacity. [No workers' comp. insurance required.]
3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.t
6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c.
152, § 1(4), and we have no employees. [No workers' comp. insurance required.]
Type of project (required):
7. ❑ New construction
8. ❑ Remodeling
9. ❑ Demolition
10 ❑ Building addition
11. F1 Electrical repairs or additions
12.*lumbing repairs or additions
13. ❑ Roof repairs
14. ❑ Other
*Any applicant that checks box # I 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 is providing workers' compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company
Policy # or Self -ins. Lic. #:
Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certifAAdet the pains_qnd pen41tieyAfperjury 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 #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 1.52, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
May 1Z Z815 18:56:85 EDT FROM: FZM/176Z8878456 MSG# 18448843-886-1 PAGE 881 OF 884
The Hartford
FAX COVER PAGE
To:
Fax Number: 9787494636
Company:
From: "Services, Agency (Comm Lines, San Antonio/SCIC)"
<Agency. S ervice(dthehartford. com>
Date: 05/12/15 10:55:34 AM
Subject: Certificate of Insurance
Total Pages: 4 including cover page
PRIVILEGED AND CONFIDENTIAL: This electronic communication, including attachments, is for the exclusive use of addressee and may
contain proprietary, confidential and/or privileged information. If you are not the intended recipient, any use, copying, disclosure,
dissemination or distribution is strictly prohibited. If you are not the intended recipient, please notify sender immediately by phone, destroy this
communication and all copies.
Memo: Dear David Lumb,
Attached is the Certificate of Insurance for Town of Andover, Massachusets
Thank You,
Yuvisela "Uvie" Sandoval
Business Insurance Service Operations
Toll Free #: 1-866-467-8730
Agent Fax # 1-877-905-0457
Email: agency.servicesCa)thehartford.com
The Hartford's Small Commercial Call Centers have been recognized by J.D. Powerand Associates for
providing "An Outstanding Customer Service Experience". Our easyprocesses and service solutions
save time and let our customers focus on what's important -their business.
For J.D. Power and Associates 2013 Call Center Certification Program' information, visit jdpower.com
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free to send any feedback on my service to Stacey.Nunn@thehartford.com
May 12 2015 18:5628 EDT FROM: F2M/17629070456 MSGN 19448043-886-1 PAGE 004 OF 004
CERTIFICATE OF LIABILITY INSURANCE
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5�12/2o1.5
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(las) must be endorsed. If SUBROGATIONIS WAIVED, subject to the
terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
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CERTIFICATE NUMBER:
REVISION NUMBER:
TI IIS IS TO C"'E'"RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THF POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY RE001REMENT• 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,F,CC.)I.USIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE. BEEN REDUCED BY PAID CLAIMS.
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CERTIFICATE HOLDER CANCELLATION
( 1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Tolan G�.1; Ail(IOVE'L r M i.S.S3c:1')(.A;,F 1: ;
BEFORE THE EXPIRATION DATF THEREOF, NOTICE WILL BE
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AUTHORIZED REPRESENTATIVE
FU n C11 L, `.I':L W a 2.1.
h SALEM. ST
ANDOVI,IR, MA 0:1..810
( 1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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Date ... 7.' . . 7.
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that ...... ..... .............
has permission to perform ....k/.!9 z ..
wiring in the building of...................L!.........................................
at ......ffr d... f�/ �� ....�Z) ............... J�North Andover, Mass.
Fee.7�...�....... Lic. NoAd/.............. ,1 .........�
/ ELECTRICAL INSPECTOR /
Check # 7 G 6
/ H O
CommonweaGih ol /r/aisachueetts Official Use Only
cc�� Permit No. _ 47
eL p.,tmzni 4 Jim S"wice6
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank)
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:
City or Town of- /ll6 R I -N 19)V t 0V e-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),:? 6-0 1-31 y e
Owner or Tenant /]% o k e e - n/ / jr !VAI , Telephone No. 779
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service
New Service
Amps / Volts
Amps / Volts
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No, of Meters
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Q o U /3 y e 14-)A) J
rn "io,;,," nf the Allnwinv tahle may be waived by the Inspector of Wires.
Attach additional detail q desired, or as reyuireu Uy tr,e .rsap..„. • • •.
Estimated Value of Electrical Work: 3(oo , U 0 (When required by municipal policy.)
Work to Start://�/� -tl 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 issue g office.
CHECK ONE: INSURANCE ❑x BOND ❑ OTHER ❑ (Speci :
I certify, under the pains and penalties of perjury, that the inform on n pli ation is t
FIRMNAME: Castle Electric, Inc. LIC.NO.: Al h7 1
Licensee: James R. Prescott
(If applicable, enter "exempt" in the license number line.)
Address: Bldg.#21, Endicott Stri
LIC. NO.: 2 61 B 6 E
Bus.Tel,No._ 81-762-9891
Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires De rj(' t of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware tha th icensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby wai is requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE: $ V/)
Signature Telephone No.
N.0of Total
o. of Recessed Luminaires
of Ceil: Sus P (Paddle) Fans
Transformers KVA
No. f Luminaire Outlets
NoN Hot Tubs
nerators KVA
No. o uminaires
Above In
Swimm g Pool rnd. ❑ rnd. ❑
o. mergency Lighting
Batt e Units
No. of Re eptacle Outlets
No. of Oil rners
FIRE A ARMS
No. of Zones
No. ction and
No. of Switc es
No. of Gas Bu ers
iaDevices
I nitt
No. of Ranges
No. of Air Cond. TonTotas
No. of Alerti Devices
Heat Pump
I Numbe Tons
KW
No. of Self -Co ained
No. of Waste Disp sers
Totals:
.. .....
..................
Detection/Alerti Devices
No. of Dishwashers
Space/Area Heating KXof
Munici I Other
Local ❑ Conue14,
No. of Dryers
y
Heating Appliances
Security Systems:*
No. of Devices or uivalent
No. of Water
No. of
Data Wiring:
Heaters
Si ns
No. of Devices or E ui alent
Telecommunications Wirin
No. Hydromassage Bathtubs
No, of Motors Total HP
No. of Devices or Ecluiva nt
OTHER: 1,) Nd CU o Q dU /?1/Oven/
Attach additional detail q desired, or as reyuireu Uy tr,e .rsap..„. • • •.
Estimated Value of Electrical Work: 3(oo , U 0 (When required by municipal policy.)
Work to Start://�/� -tl 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 issue g office.
CHECK ONE: INSURANCE ❑x BOND ❑ OTHER ❑ (Speci :
I certify, under the pains and penalties of perjury, that the inform on n pli ation is t
FIRMNAME: Castle Electric, Inc. LIC.NO.: Al h7 1
Licensee: James R. Prescott
(If applicable, enter "exempt" in the license number line.)
Address: Bldg.#21, Endicott Stri
LIC. NO.: 2 61 B 6 E
Bus.Tel,No._ 81-762-9891
Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires De rj(' t of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware tha th icensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby wai is requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE: $ V/)
Signature Telephone No.
Date ... yl�. ? 6 ( ....
N
Ory . .14116
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ... 1q. La �l .'.° ....................... .
has permission for gas installation .. �!�". � .....................
in the buildings of ..... ... .. `.......................... .
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at. ?. �'....i�.1 `.`... I.�... S. �.......,��North Andover, Mass.
Fee. .1.? . ... Lic.' No. �. .... ....((.�
GAS INSPECTOR r
Check # —71 v L
65 4 2
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OWNER'S INSURANCE:WANER.-i am sWUM:
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f hwebY certify tW a!t of U. data .ane 1. -haw wb
wpb & that all . amen dl in above
Per* nt pr 4 t'c and �pedom�ed fmcw tM aPPficalion am true &W acmate.to:Ow b st.of my
°"s'°os of fhe Massadxusetts State Gas Cbee aid Chapter 1@ of fhe cer � aP�6cabioawill be in Ccmpkanoe *wag
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .../I% u .........................
has permission to perform .... (A . .........................
plumbing in the buildings of .F. (y. � !� ................
at. .�—.ca....1�314 T ' 5. - ......... North Andover, Mass.
Fee.. Lic. No. . ....... .......
P8ING INSPECTOR
Check #
6939
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HUSETTS
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PERMIT s De PLUM
BING
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- - -Owners kameAPlans Submittet Yes
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FIXTURES
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DOMAUMZOVERAGE
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CUFfeDt Yes � GaD' O ► or its subsurt;ar egs,;ra a,t
You haft -checked yes, Please ' wtbd' meets th& r� of Mr CIL ut
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A -g OMes type king the aWcPRate boat
DMMAM M WAMM l.am amity O Bond G
7�2 of the Umt the wee does not have the -
Laws' and that' y on thisDem,t co+ required
ire of owner cr pw„�s waives this
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