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HomeMy WebLinkAboutMiscellaneous - 254 GREAT POND ROAD 4/30/2018DiPietro Heating & Cooling Three generations of setting standards August 24, 2016 Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2035 North Andover MA 01845 To Whom It May Concern, Recently, we were contracted by Kevin Cunniff Construction located at 254 Great Pond Road to wire (2) new heating systems and (2) new AC systems. At the last minute Mr. Cunniff decided that he did not want to move forward with the project with DiPietro Heating, and Cooling's Electricians, and is having a different electrical company wire this job. Please void the Electrical permit that we had applied for on this job. The permit number in question is 21068. Also, if you could either refund the amount that was paid for this permit, or credit our account for the amount paid, it would be appreciated. Please do not hesitate to contact me should you have any questions and/or concerns. Sincerely, Deanna Covis Installation Coordinator DiPietro Heating and Cooling 0 F Jill *ElDcbtal PMA #21068 - � X + > C 1S !Jht�ps:/,Inortlianverma,viewpointc[oLid.com/#,Yecord,-1121068/42841 ":D 11, % (P 0 PJ a Apps & —ff-d—gN bod—. F. qA aaass, plain y— b.a —1. hwe m the bDd—ft b.. proat 6odanerkt row. TIMELME Subrii<sion rsxeived Aug 9,2016arld7pm Fleurical Permit Rvjie,oj C.mpl—dA.AIO.2016at6:52- 0 'PeId'A"."jq 10.2016 " . t 1:34o. 0 Issued Aug 'I'O,"2'0'1'datl:34pm Thank You This fee is paid in full Permit Fee $55.00 Fixture/Appliance New andt or Replacement (Commercial or $0.00 Residential) - Permit Fee I .... ... . ... ... . . Total Fee Amount: $55.00 Payments Date Method Note Amount Processing _......-I........--.-.......... Aug. 10.2016 Credit Card $55.90 $2.66 i -.- --- - - - - - -------------------- Say sannething aLout Lhis... ... .... .. ... - - .. ........ .. Tuesday, Aug 30, 2016 11:06 AM 8/30/2016 '{ 9 21068 This is an e -permit. To learn more, scan this barcode orvisit norlhandoverma.viewpointcloud.com/itlrecordsl21068 OF JAORT/i 44, 3� O0 m O A e 9SSACHUS�� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that Erik F Piermattei has permission to perform Wire (2) furnaces and (2) condensers. wiring in the buildings of DINAPOLI. ANTHONY. D. at 254 GREAT POND ROAD, North Andover, Mass. Lic. No. 18265 Date: August 10, 2016 ❑ ❑' 1/1 This certifies that .. S. d 5.... S c C�2 j f-?Sv�7- S .;e_ - has permission to perform ... J� cv!L ?-fY . S � 3?!!...... . wiring in the building of .... 1— C! ...................... at y .P�'` orth Andover, Mass. Flee ...... Lic. No. .<' ... ....... .. ,. COO .42- ELECTRICAL INSPECTO Check # -�l 312- 11003 12. 1X003 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed forin. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. 01 c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall-be limited as to the time of ongoing construction activity, and may be_deemed-bythe.Inspector_of_Wires abandoned-and_invalid_i£he—.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or.the installirig itity sfated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending•through August 15, 2012. ule — Permit/Date Closed: Note: Reapply for new per mAr 0 Permit Extension Act — Permit/Date Closed: f!/% r /�ommonwealt00 //h of /Y/q//�adjack//wat � Official Use Only C Permit No. ®On a[JePartmertt o�.�`ire S ruiceJ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 INFO ATION) Date: City or Town of: �00?T 1f 0cit- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform t electrical work described below. Location (Street &Number) C q �PPC Owner or Tenant O L t`t o x' /� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building R C�5 DE-)Tt b -- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ New Service Amps / Volts Overhead ❑ . Undgrd ❑ No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wires. No. Hydromassage Bathtubs JNo. of Motors Total HP v No. of Devices or E q uiva`)ent OTHER:(� cel V tx�-r j-6 E �� fit✓ / (� �%n d — c. -o Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work:(When required by municipal policy.) Work to Start: -}7-( 2 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 issuing office. 0 ® � CHECK ONE: INSURANCE ®-- BOND ❑ OTHER El (Specify:) ssca 1 certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: 23 ✓ �e't-1 , TTS LIC. NO.: lI ?9C— �h?c� �j/t , 7-jf- Signature -r LIC Licensee: . NO.:�o L� ��� (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 9 722 `22 2- 6J 3 y l Address: ry'Tt� �1�5 �'D� ��7�-t-i� Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License. Lic. No. 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 I PERMIT FEE: S Signature Telephone No. Completion of the fiollowin table may be waived b the I TUta r o No. of No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o mergency Lighting Ro++Pry Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initintin Devices No. of Ranges Total No. of Air Co d. Tons No. of Alerting Devices g Heat Pum Number Tons.... KW "' "' . .. No. of Self -Contained Detection/Alertin Devices No. of Waste Disposers Totals Municipal No. of Dishwashers No. Space/Area Heating KW Local ❑ Connection Other HeatingAppliances Kms, . pp Security Systems:* No. Devices or E uivalent No. of Dryers of No. of WaterNo. KW of No. of Ballasts Data Wiring: No. of Devises or E uivalent Heaters Signs Wires. No. Hydromassage Bathtubs JNo. of Motors Total HP v No. of Devices or E q uiva`)ent OTHER:(� cel V tx�-r j-6 E �� fit✓ / (� �%n d — c. -o Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work:(When required by municipal policy.) Work to Start: -}7-( 2 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 issuing office. 0 ® � CHECK ONE: INSURANCE ®-- BOND ❑ OTHER El (Specify:) ssca 1 certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: 23 ✓ �e't-1 , TTS LIC. NO.: lI ?9C— �h?c� �j/t , 7-jf- Signature -r LIC Licensee: . NO.:�o L� ��� (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 9 722 `22 2- 6J 3 y l Address: ry'Tt� �1�5 �'D� ��7�-t-i� Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License. Lic. No. 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 I PERMIT FEE: S Signature Telephone No. C� �p - SSCO-000302 HORACE P Shum 241 BOSTON:ST —' TOPSFIELDIKA 01983 = '� ~ + s 05/16/2013 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..%/ ..5 44.x. ?irC? . . ll ....... ....// has permission to perform plumbing//inn the buildings of 6/!/�?>?'.� T' .................... at .. �? 7 ... t" ?cl! .. , North Andover, Mass. Fee,.;f40. Lie. No. ...... PLUMBING INSPECTOR Check # a�?S G 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes f -io ❑ 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: 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 Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and f of my and that all pl��mbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachu tts Slate Plumbing Code and Chapter 142 0; the General Laws. accurate a e the best o, my iy _ Type of License: n lumber Si g atur of Licensed PI er ity/Town 0iAaster ' PPROVED (OFFICE USE ONLY) ❑dourneyman License Number: �- r� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: '241'Z' _ MA. Date: /tp Permit# Z j— Building Location; /Z.2oq �feOwners Name': (,gyp Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ 7ResidentlalgNew: E]Alterati n: ❑ Renovation:ElReplacement: [� p)ans Submitted: YeNo ❑ V FIXTURES DEDICATED H z SYSTEMS Z H LU a 'n Ov h Z v� Z Fd- ' Q chi H w O ❑ a p m vzi a H in F- w Q y ON _z ❑ N Ln a w w ❑ Z a cc I7 -' = G ¢ tw- F - Q z Q ,�( y . 0 2 ❑ ❑ w N j `3 Z U a W � Q to ° ~ V Q ° a' Y 2 y Fw- W w ° y w a -SUB BSMT, m m o o LL$ g 3° 0 q BASEMENT 1 (D 1sT FLOOR 2ND FLOOR 3RD FLOOR 4T" FLOOR 5T" FLOOR 6T" FLOOR 7T" FLOOR 8T" FLOOR 111st,i3ing Crj;-nprn,? rGama: 0I �G OtW,1 '�� Chec?:One C:�' Address:�ll corporation �V City/ Town: 1 ` State: —, Business Tel El Partnership ` Fax: El Firm/Company Name of licensed Plumber: Ee5 INSURANCE COVFRnr;F• 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes f -io ❑ 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: 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 Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and f of my and that all pl��mbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachu tts Slate Plumbing Code and Chapter 142 0; the General Laws. accurate a e the best o, my iy _ Type of License: n lumber Si g atur of Licensed PI er ity/Town 0iAaster ' PPROVED (OFFICE USE ONLY) ❑dourneyman License Number: �- r J • The Commonwealth ofMassachusetts Department oflndustrial.Aceide> is Office oflnvestigations' 600 Washington Street Boston, MA 02111 SY www.massgov/cilia Applicant rnfnrmai;n„ Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name Address: City/State/Zip:�� Phone #:_f ?�F- 1 3 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with �P/ 4. ' ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sh55et. ship and have no employees These sub -contractors Lave working for me in any capacity. [No workers' comp, insurance workers' comp, insurance. 5, ❑ We axe a corporation and its required.] 3. ❑ I am a homeowner doing ,officers have exercised their 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 re' d Type of project (required): 6. El New construction� 7. 0ling 8. El Demolition 9. E] Building addition 10-ElElectricalrepairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 1i" >re i 13.[] Other I *Any applicant that checks box 91 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submitthis 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. lam an employer that is providing workers' compensation insuran inforination. ce fos my efnployees Below zs the policy and job site Insurance Company Name:_ Ael?,-_ Irl A Kv- Policy # or Self -ins. Lie. P Job Site Expiration Date: / X /- -�y Attach a copy of the workersi��ace/clp: ' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required Wider Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a flue up to $1,500.00 and/or one-year imprisonment, as well as civilpenalties in the form. of a STOP WORK ORDER and a fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the. DIA, for insurance coverage verification. t do hereby certify under the pains and penatties ofperjury that the inforhzation provided above is true and correct. ird.1As Official use only. City or Town: ,uo not write in this area, to be completed by city or town official. Permit/Lice n Issuing Authority (circle one): nse I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector S. Plumbing g inspector Contact Person: Phone #: Date .. �z......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that..4►4/C!QfU. .......... has permission for gas installation 6k -T. 6 ..�?.....Te.!� ....... in the buildings of ... �GIial?!w................ . ......... at a .. . , North Andover, Mass. Fee.�„%,�G Lic. No..C9344 .. . GAS INSPECTOR l Check #% 8028 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t'a _ _ CITY MA DATE PERMIT # Z JOB SITE ADDRESSNAME rt, 'TYPE OR rr$�(----]OWNER'S OWNER ADDRESS !_ _ - _ _ _ _ _ � TE --"FAX _ I PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONALRESIDENTIAL]-- CLEARLY NEW: K RENOVATION: (_� REPLACEMENT: (_) PLANS SUBMITTED: YES 0 NO[0 APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE - - = DIRECT VENT HEATER - - - - - - - - -- _A. DRYER -- - - FIREPLACE FRYOLATOR FURNACE- GENERATOR GRILLE - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT '- - - OVEN--- _ POOL HEATER ROOM/ SPACE HEATER s ROOF TOP UNIT - - - — - - -- - - - . - - _ - TEST - - - UNIT HEATER - UNVENTED ROOM HEATER WATER HEATER OTHER A INSURANCE. . COVERAGE - I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Fj BOND OWN ER'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 fj AGENT J.:D 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 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 Chapter 142 of the General Laws. _ a PLUMBER-GASFITTER NAME «��U �� $ iacl�Aru LICENSE � 3SI ATURE MP IMGF -1 JP - J JGF [ LPGI [ '� CORPORATION jo SCJ I PARTNERSHIP E�#� M LLC [ -#�x�, COMPANYNAME: - , s �f?U,�. J �N s` JADDRESS [Z3 C- 19,111,19 & - _ CITY tc�___ STATEZIP 1_JTEL CELLI i'EMAILE 1 W o z z 0 h U F� � � � 1 o� ti �z D0 o W o CL u LU 3 ® a W o � a � I w � W 10 0 O W � a Pci V J CL a- < 2 W H LL W E� O z z 0 0-4 F U G -a a z Ch z p D a a x c� 0 x, i Tire Commonwealth oflM nchtisetfs DepnpinaeErd'o, filttrfrtr6tt`rt6A'a��rteir�� t o of),"sdgarfott 600 WMItEttgkit SYred Boslo r, MA 0,2111 t'Wt:uttwwotldati or°[ttrxe Compo matiamInsurmice Affidavift. Btdf(loi�wICentmetordfflechiciamMmubers tf Ifw£ot-r�ttfiarti CC Plewa* pert L A��t>;�Sutcssdth�ttti�i►aaltndirTdttal� � � �DL t L�D"Z� �- V� S . ��.... M&v= Z-5 aw-P,4 A re ym an etrnpf%w,? C1iech the rtppropariate Dox: l :Q [ am, a etupla� +tr te^ith dr Q t air a general ca !tractor atxk 1 Tygtr° of ptrojer t (recptitmUy .1 employew (fall andsoa part -thud." tatve mired lire snprcmdractors fa. ONetti coustrcictiea Ii 2. 1 mu to sole proprietor or partner- listed on the attached sheet. t 1.. [ Remodeling Ship €ntF. We [to eapplo}ees 11me sub -contractor havo & El Dentotitidii working £o>; me pit mays capuept . cvorl e& comp. insurance. 9 Ef HU . ildingaddhion (KoNvochcr" cmnp. iusuranct; 5. We are a coiporation and its lQ Q Mectricapl mpairor,atddi is regtr W&I officers In"t exercised their 3. U f aim, a t!ioitYew er doing', all work right o£ecemption per MGLi 1f] Plumbing cq>�ers at additions tuietE (No workeW comp. c. [S2, f 1(-I), and lyealve no 12.0 Rooftreprtpss mtsnraarc rcg hV41 f etvployces [No worker s' 13.[] Other comp: pnstaranceregttired.), *AI%► CPDHCd f ffMf Ch:CiS hacur Blm-rr-@sa. fill fuse [6rsrotmn h insrehiaa nn H4.....,i,.t-..,•.,,, ...i➢�.. tsWstrtraIt*=ttMixafrAltsitirtdinitirgth uedouigalt%orkwtdtheatiiteoinsi&cattracttusoaustsuGwi!afte alCI t1imtie�iimosueta. i1ft-thAdrakWsbwcuw:tfitkncixd'sroadditi0attst?eet.sfi et rrkam2meGratastd[-OLImarctmand*drvibi se mals.pftyutGinitdim ! atat ataeuilrtat�cticat fs�izieftliatg nmrbee�'' cirngjettscr[icin hcsrtrairce foe tt{in et�rpfvtree� Delon- is *epoltep^ miqulpsfte ftxfocttparlt�t. � - lnstiraneccotnpany Policy a or Stf has Lio. #: ra-pieiitEoan pate: Job Site Mfress SriPt9 1 }� ��rJ JC %l. l�12.ciytatcJlLi: . Attach a copy fit= the war 0W eoac�pensttfroit paaiicy deciamtion page (shoMng the policy nttibber and esptrsit'i(m crate). Ti dine co secant" co ago as tegn:predi ttndersectimi 25A o£K1GL c. 152 can lead to the itt�ppc►sitio�b o£srii �tt�tti pi�� c�£a tine trpp to91,5Q4 60 and/or one-year mipirisonntente as, tc-elt as civic penalties in the, £drat of a STCiP=WORK ORDER otd a liar of, to $2150M, aa, cel; ggoaptst tho vidfator. Be adt [sed (hat a coPy o£this stated niay be fk ar&d, acs t� Q8[`tce o£ lttvestip6mis o£theDfA for ntstm. oce cov-aageveriticatioir. I dqberer5y,crrt f amferifi¢ iraft atarfjr¢uaflf�s ��r¢rfrtrg�fret Nre fn fQrnaraleti7xelxrac�treda bow s &ne oa,emer Of [ ftese ottty. Do traf an-ite lig Orb area, to be emigrfetedbyd& ortawif offletft! City or Town - Perini tfLicense 9 fsstiitip;.�tttTtoelt�g �ctidnoae [. ward of Ll:e:tltt't 2i BuRdpng Depaicittient 3. City!["otrit Cleric, 4. Cleetrica.t Inspector S. Ptn�etpi'rtg Iatsp tar 61011r Contact l'lroair tks Information rmat and Ins Ctions 1' � General Lanes chapter _152 requiies 0 employers to p ic%rvorke& ca 1 sant to thus statute an enipl©dee is ilefrned as a , ion for their ems by=. ... et�y person m tyre sertiice of annoth deratny contract ofhtre e�pr�ss or implied; oral or rvrit�" Aip enrptvjver is defined as "an indiAdtal, ppadWlshep;, association. cagxation or other le l eretrty, or any hvo or ri�re Of the foregoing engaged ire a joint enterprise, and ipchtdhu fife g legalpepreseaniatim of, evethe llicgg, deceased employer, or the mcehw or trustee of an ihndh idual, pattnnersiti N asmckti= or othm legal entity; ecrbptoying earployees 1 Ioiv owm of a dwelling hoose havintg, not more than &,Mapwtments and who resides tlrereiuy or the occupant lv the dTeltorrse of another who enrplay's persons to do rinannteata,n oa on: the gronnnds- or building appurtenant thereto, shall not because of s� ploy m endeemed to be, an enipl ywhiiction or repair woAc on such ffivffingt euse 1WGL chapter 152 :§25C(6) also states that "every state or local recent, sing ugenep shalt witlr}hold the mance or renewal of a license or permit to operate a lattsitress or to construct buildings in the commonwealth for any applicant IAU has. not produced acceptable evidence of compliance tn7th fire insurance " Additionally, MGL chapter 152. &250477 states "F�eittner the Comm coverage regained onevealth nor any of its political subdivisions shall' enter into any contract for the perforanance ofpublic work until acceptable evidencee of compliance With the insurance requhments of this chapter have, been: presented to the contracting authority " Applicants Please fill out tl,e Workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply siib-contractors) name(s), addresses a�tal phone mmmber(s) along tlr their ceartdtcate(s of insurance, Limited Liability Cegnpanies 7 orLim�ed and e Pntirneishi s rrnenRbers or partners, are not. r p gp) Iwiiir. t,o employees other than the required to carry workers° compensai�onsenannce. If an LLC or LLp does have e}Ttployees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insuratce .coverage. Also he sure to sign and date the affidavit The affidavit should be reftnrned 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 tile law or ifyou are required to obtain a workers' compensation policy, please call the Department at tine number listed beloIv. ;Self-insured cornpatries should enter their self -i aoce license nnrnnber on the gpropriate litre My or Town Officials Please be slue that the affidavit is complete artcl pritnted lebiEaly.fie IJitinment has Provided a space at the bottom af the, atfdavit. for you to fill out inn the event tie Qfffice of Investigations has to contact you r�ar�ling the applicant Ple ase be sure to ME in the perrilMicewe number tvlrich ��itl lac used as a reference tiucntber., In ad ng, an applicant nL that irurA submit multiple pennritdieense applications in an n, Ry t y, nicer only submit orm affidavit indicating current potieY i nforrnation (if necessary) and under ",Foie Site Address" the applicant should write "rill locations n tock)" A copy of the affidavit that has been ofi iat stamped r (city or � roped or rrnarked by fl,e city or town nay be provided'. to the applicant as proof that a valid affidavit is ort file for future permits or licenses. A nein affidavit: must be filled out each year_ Where a home owner or citizen, is obtaining a license o pe,mitrrot related to any busintess or cornnnercial venture (i e a dog license or pera,it to bum leaves etc.) said person is NOT required to Complete this affidavit. Tile OfI`rce of'Invesiigations would like to thantk you in advamnce for your cooperation and should you have, any questiotn� please do not hesitate to give its a call_ The Department's address, telephone and fax ntmiber: The f<DmmonXVwjth QfMassachuseM Dlepartnient of1ndusttiaf Acddlmts Office of Irnvesfigations; 600 Washington Street Boston, MA 421.11 Tel. # 617427-4900 ext 4o6 or 1-877-MASSAFE Revised 5-26-05 FIX 0 61.7-727-7749 WW%v.nMss.gov/diet Date .. // ! 7 !!.� ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas i/n�stallati�on/�. �!.f*4 . &... r �........ . in the buildings of . . G �1nl?1 f:'T.' ........................... . at ..*.'..�I�'`i..fA...... ... ,North nd ver'' Mass. Fee.J�r.vULic. No..0 c v� GAS INSPECTOR Check # 7910 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: t b Oiler 2__., MA. Date: Permit# Building Location: Owners Name: �� ,L,t✓j �� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential Fl— New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No'❑ 4'" FLOOR 5 FLOOR 6 OLF6 0RR 7 OLF OR 8 FLOOR Installing Company Name:��C1X/11�D •��_ Check One only n1��D /%� corporation � o(/( Address: �G � City/Town: !( State: Business Tel )LO Fax: ❑Partnership Name of Licensed Plumber/Gas FitterEl Firm/Company G-,eP� L� J Certificate�# %C3 V INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes<o ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy P 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signa ire of Owner or Owner's Agent Owner ❑ 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 Chapter 142 of the General Laws. By fU Type of License: �I-umber Title j/ �� ❑ Gas Fitter Signature o icensed Plum er/Gas Fitter ],Alfaster City/Town Lijourneyman 5r - APPROVED OFFICE USE ONLY El LP Installer License Number: W IX vi Z a U) W W Q _ CO W o W W W 0 co O ~ x rn W vi W z 0 z Z o W w N W 0 W CO W Z m 0 W b WX � U W 0 J W Z" 0 x W O 9 2 Lu Z W �� Z 0 W W z Z Q J W I— u I•- 0 m> Z .-I O 0 z u_ 0 fA > Z W F- LIJ x v o o u_ t7 C9 x Lu x 0 IL >>> O 16- SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4'" FLOOR 5 FLOOR 6 OLF6 0RR 7 OLF OR 8 FLOOR Installing Company Name:��C1X/11�D •��_ Check One only n1��D /%� corporation � o(/( Address: �G � City/Town: !( State: Business Tel )LO Fax: ❑Partnership Name of Licensed Plumber/Gas FitterEl Firm/Company G-,eP� L� J Certificate�# %C3 V INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes<o ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy P 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signa ire of Owner or Owner's Agent Owner ❑ 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 Chapter 142 of the General Laws. By fU Type of License: �I-umber Title j/ �� ❑ Gas Fitter Signature o icensed Plum er/Gas Fitter ],Alfaster City/Town Lijourneyman 5r - APPROVED OFFICE USE ONLY El LP Installer License Number: 'iUi3 r Date ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that............� 4n .. ... C `J has permission to perform ....... 5 ........... ,......... wiring in the building of ....................L Er-.4oUl................................... r at ............................... `..o�i�......2� PmmwcAL North Andover, Mass. ,.� 4. jIdo27 t Fee . Lic. No .............. .......................... ..... E INSPECTOR Check # Commonwealth of MassachusettsFPermlt O ffil! Use Only Department of Fire Services o.lugBOARD OF FIRE PREVENTION REGULATIONScy and Fee Checked L ev. 1/07j (leave blank APPLICATION FOR PERMITTO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrica41n 52 00 WORK ®RK (PLEASE PRINT!'• WAW OR TYPE ALL INFO RW To the City or Town of: NORTR ANDO'VRgglO� Date:J ) I By this application the undersigned gives notice of his or her intention to to the l electrical work ires. Location (Street & Number) �� C-1 r_Ae .'_ . ^ A ,�described below. Owner or Tenant Owner's Address Is this permit in conjunction with a buildingpermit? Purpose of Building f Yes El Existing Service �7n11 Am Telephone No. No ® (Check Appropriate Box) Utility Authorization No. )/4 01 S'a 3 psvVolts Overhead ®' Und d New Service ❑ No. of Meters AAmps Volts Overhead ❑ Number of Feeders and.A.mpacity Location and Nature of .Proposed ElecWcaI'Work: No. of Recessed Luminaires Com lesion -,(',Y ej No. of Ceil: Susp. (paddle) Fans No. of Luminaire Outlets No. of Hot Tubs No. of Luminaires ------------ Jo. of Receptacle Outlets 10. of Switches lo. of Ranges ro. of Waste Disposers o. of Dishwashers o. of Dryers �. of Water Heaters 1KV o. Hydromassage Bathtubs Swimming Pool A o e No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Heat Pum Tons Pump Number Tons ] Totals: _......._....... __... Space/Area Heating KW Heating Appliances KW No. of No. of Signs Ballasts No. of Motors Total HP Undgrd ❑ No. of Meters Rn table may be waived by the InsDectOr qfWires. 0. of Generators IZVA o. o l.mergency ig g -aft Units FINF A'rA. R-MISN�Z--nes No. -Of Detection and Initiatin Devices . No. of Alerting Devices No. of Self -Contained Deteetion/Aiertin Devices Local ❑ Munici a Connee on ❑ Other Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or E uivalent Telecommunications Wiring: No. of Devices or Ranivnia"4. Estimated Value of Electrical Work: /� Attach additional detail if desired, oras required by the Inspector of Wires. Work to Start: (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no e the licensee provides proof of liability insurance including"completedP rmit for the performance of electrical work mperation"ay issue unless undersigned certifies that such coverage is in force, and has exhibited pro of of same to coverage or er its substantial CHECK ONE: equivalent. The • INSURANCE ❑ BOND [] OTHER P mg office. I certify, under the pains and penalties o ❑ .(Specify:) FIRM NAME • (perjury, that the information on this application is true and complete. Licensee: e LIC. NO.:��,� (If applicable, enter exempt in the license number line.) Slgnatur Address; LIC. NO.: *Per M.G.L C. 147, s. 57-61, security work requires D Bus. Tel. No.: OWNER'S INSURANCE W ePmtrnent of Public Safety "S" License: Alt: Tel. No.: required by law. B AIVER. I am aware that the Licensee does not have the liable- Lic. No. Owner/Agent y my signature below, I hereby waive this requirement. I am the (check one ms ance coverage normally Signature ) ❑ owner ❑ owner's agent. Telephone No. PERMIT FEE: $ ELECTRICAL PERAw NO. INSPECTxONREPOR : ELECTRICALINSPECTOR - DO -UG SMALL I- ROUGH INSPECTION: Passed — [ j 'Failed—[ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors, Signature - no initials) j Date Z. FINAL INSPECTION: Passed — Failed -- [ ] Re -inspection required ($50.00) Inspectors' comments: (InspectoftSigpnatureatDate 3. UNDERGROUND INSPECTION: Passed — [ ] Failed — [ j Re -inspection required ($50.00) -I ] Inspectors' comments: (Inspectors' Signature - no ii 4. INSPECTION•— SERVICE: - DATE C.Aj,LI;D NATIONAL GRE : Passed — [ ] Failed — [ ] Inspectors' comments: l (Inspectors' Signature - no initials) 5. INSPECTION - OTHER: Passed — [ ] Failed — [ ] Iuspectors' comments: i ---------------- Date NAS: inspection required ($50.00) - [ ] Date -inspection required ($50.00) - f i (Inspectors Signature - no initials) Date POOVAG8ARE TORE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE INSPECTION OF $50.00 TS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office Of LnVesfigations ..600 Washington Street Ur Boston, AM 02111 Workers' Compensation Insurance Affidavit: Ba ers/Contractors/Elect • . licant Information ri<e><ans/�i>ii>inbers Fume (Business/Organization/Individual): Address: City/State/Zip: Q yy� A d/gam phone #: Are you an employer? Check the appropriate box: 1 • ❑ I am a employer with _ 4. ❑ I am a general contractor and I Type of project (required):' employees (full and/or Part-time).* have hired the sub-contractors6. Necons 2. � I am a sole proprietor or partner- listed on the attached sheet. # '1• Remodeling construction ship and have no employees These sub_contractors have working forme in any capacity. workers' comp. " 8 ❑Demolition [No workers comp. 5. p�Ce' 9. ❑Building addition p ❑ We are a corporation and its required.] officers have exercised their 10. ❑ Electrical repairs or additions 3 ❑ I am a homeowner doing all work right of exemption per MGL I L ❑ Plumb - myself myself. [No workers' comp. c. 152 4 § 1 (), r;gid eve have zoo ng repairs or additions i11s21rance • required.] t em to ees. [No �Tlorcers 12•0 Roof repairs comp. insurance required.] 13.[] Other inY=rr=ica4t that checks box u1 must a1sU Y � outt Homeowners who submit this the section beloej, # she;=.• n� affidavit indicating they are doing all work and weir wo.=kecs' comY ysauoa poiiey i formst on Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy info information. then hire outside contractors must submit a new affidavit indicating such. C I am an. employer that is providing workers' compensation insurance for my employees Below is the policy and ' Job site Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address:����. ��P/3• � tie � � �n -.- • Attach a copy of the workers' compensation policy declaration pa ashovv'City/State/Zip Failure to secure coverage as required under Section 25A of MGL c. 152 can lead tong the impositione Policy number bof criminal date). ` fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a Of up to $250.00 a da a mal penalties of a Y against the violator. Be advised that a copy of statement maybe forwardedO theffiRK E of d a fine 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 fr we and corp ec Signature- t Offcial use only. Do not write in this area, to be completed by city or town offciaL City or Town: Issuing Authority (circle one): Permit/License # I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing 6. Other Inspector' Contact Person: Phone. #: 9 14, CIVTI I�f•G� U co Z W MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: Q. tb crU� t--- , MA. Date: i /h/ Permit# Building Location: e���� /�y/L� //� Owners Name: V/ a. Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ CIVTI I�f•G� U co Z W Y V/ a. W wU' W=1 0 V N ~ .00 LL = flJ W N m= Z F- 4 Z J w N Lu 2 O Q H O Z u5 LU cn w g m 0 Q n. O Ia,_ W 0 w x W F- NR' 0 w w W Z 9 W= W W= Z w W W iY Z w> 1X 0 o! LL N J Q 0 w Q w m w 0 Z 0 0 W W_ H>>> Z Q X 0 V p ❑ u_ C7 t9 Z 0 2 IL SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR 3 FLOOR 4 FLOOR STH FLOOR 6 TH FLOOR 7 TH FLOOR 81H FLOOR �i C — bu� c Check One Only Certificate # Installing Company Name: ,A da6b 'corporation /Q.S Address: � � i e .Fid 4 0JCity/Town: /!%%� �f [ C` 44 // State: ./ -.,W- 7- ❑ Partnership Business Tel:11 1 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: ����' L_ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes4al o ❑ 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: 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 ❑ Agent ❑ 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 Chapter 142 of the General Laws. Type of License: By . 6 A`. umber Title ajuw IlInk ❑ Gas Fitter Signature oULicensed Plum erlGas Fitter ster �p Cityrrown Journeyman License Number: ` APPROVED OFFICE USE ONLY El LP Installer G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: b. O UL"a 1Z __ , MA. Date: Permit# Building Location: Seenf �`��,�,pj �B Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ Installing Company Name:C'bc �L Address:Z3 G 41t0d City/Tow Business Y msultANCE COVERAGE: I have a current liability insurance policy or its If you have checked Yes, please indicate the tyr A liability insurance policy 0--,- C OWNER'S INSURANCE WAIVER: I am aware tha Massachusetts General Laws, and that my sign, FIXTI IRFR Date .. //./. ! 7 l!.! ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that /� , ,���.or<). " . has permission for gas installation......... in the buildings of . e4lpt7171 " . at .. I..�'� �` .F C-�r. ...... North ndover , Mass. Fee.f?�.�?U GASINSPECTOR Check# 93.51,6 79"i0 Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box (1 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 a d compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.in By -11 Z�� fV Type of Licens Pill'umber Title �� /� �% ❑ Gas Fitter H-mou-s-irneyman terCity/Town APPROVED (OFFICE USE ONLY) 0 LP Installer Signature License Number: �-r 3o-cp Fitter The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigationg 600 Washington St Yeet Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Vacant Informntinn Name (Business/Organization/fndividual): Address: City/State/Zip-A1 I`P-,r`C4j 1 Z/ Phone �)7 j T— Are you an employer? Check the appropriate box: L ❑ I am a employer with % 4. ` ❑ I am a general contractor and I employees (full and/or part-time).* 2.E11 am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheget x ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all .officers have exercised the work right of exemption per MGL myself. [No workers' comp. insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp, insurance re it d , Type of project (required): 6. ❑ New construction 7. D-R-emodeling 8. El Demolition 9. [1 Building addition 10-ElElectricalrepairs or additions 11 -El Plumbing repairs or additions 12.❑ Roof repairs 11"must also fill out the secte ] 13.[] Other I Any applicant that checks box #1 ion below showing their workers' compensation policy information. Homeowners who submit this affidavit indiating they are doing all work and then hire outside contractors must submit anew 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. lam an employer that is providing workers' compensation insurance for my employees. Below is tlae policy and job site information. Insurance Company Name Policy # or self -ins. Lic. M Expiration Date: % Job Site Address GM z!5&&97` P-,dltkPe PO &�-wwstatelzlp. 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 ofMGL 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 ofthis statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. r «� G, euy cerzUy unaer the pains anJpenaltia OfPerjury that the 111P - D /% r_ A A /17information provided above is true and correct. Official use only. City or Town: "0 not tyrtte an Alis area, to be completed by city or town official. Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. PIumbin 6. Other g Inspector '/r 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 shallwithhold 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 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements ofthis 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 -contractors) name(s), address(es) and phone numbers) 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 au LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation ofinsurance 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 fixture permits or licenses. A new affidavit mustbe 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 NOTrequired to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: x110 Com.uowealtl; o,i Massachusetts Aepaftent of Industrial Accidents Ofte of InveAlgations 600 Washington Str,�et Boston; M.A- 02111 61.7-727-4900 ext 4406 or 1-877 MASS.AFE Revised 5-26-05 Fax # 6M727-7749 www-mass.gavaa t Location No.f i 3 Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL H H 8o igO -- 17 L 6 3 - 17L63 AM/V( - J� Building Inspector .,s BUILDING PERMIT NUMBER: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT Y DWELLING 6?3 I DATE ISSUED: a` a D D SIGNATURE: Building Commissioner/122QEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use Si nature Tel hone 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Front Yard Side Yard License Number Rear Yard Required Provide Required Provided Required Company Name I Provided Registration Number Address Expiration Date Signature Telephone 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System. 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: a: Si nature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name I Registration Number Address Expiration Date Signature Telephone F SECTION 4 - WORKERS COMPENSATION (MLG.L C 152 6 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b rmit applicant OFFICE USE ONLY 1. Building ` (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) O 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all -Patters; relative to wor authorized by this building unit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE y 0 z �: "` • U Ig ?: ac V :� t1 =bl sQ A _- H w.s �ma c L' A- Q co o d E�� o m u cm m c C _ y E r: CA h C c J C m �, ca��c 4 Ems v t'00 cm �Q N OR m �d CO3 N o G Z CRc H m y . O CL .. c3 _ m_N coo .y 'nz o c Z v .o o .6 o .g go C _ o o COD a mFF. o0 S CAA c m M C t a CL� COO C? O CD 0 CD CL OH � c � c C" co Ca C 'O CD CD Cc 0 cmcx co c cv Q 'v d O f0.. C COD zCL � V y O C — C•� C _c CO) 4 0 0 U) W W C9 LU 0 Pd x O u w v c!) U c9 A "a o I w2 g2 v U C X0 W a a, w W U a W c� c p w C7 92 w w A E nc o z �i � O cn y 0 z �: "` • U Ig ?: ac V :� t1 =bl sQ A _- H w.s �ma c L' A- Q co o d E�� o m u cm m c C _ y E r: CA h C c J C m �, ca��c 4 Ems v t'00 cm �Q N OR m �d CO3 N o G Z CRc H m y . O CL .. c3 _ m_N coo .y 'nz o c Z v .o o .6 o .g go C _ o o COD a mFF. o0 S CAA c m M C t a CL� COO C? O CD 0 CD CL OH � c � c C" co Ca C 'O CD CD Cc 0 cmcx co c cv Q 'v d O f0.. C COD zCL � V y O C — C•� C _c CO) 4 0 0 U) W W C9 LU 0 C North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall -be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: ! _ �-. ( / (J (Location ofFacility) Sign ture of Permit Applicant Da NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Date i Gh TOWN OF NORTH ANDOVER o .r - • dot PERMIT FOR PLUMBING This certifies that ... �.....:�.... ........................ . has permission to perform ....: ........................ plumbing in the buildings of ........`.... ... • ....... . at '. '� �• p'• i '� `" • • , North Andover, Mass. Fee%?. - .... Lic. No/�� 22 '....L./f4e-4 , ........ . r PLUMBING IN PECTOR 61 Ifx WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FO I R TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS p Date � '' rrc� Building Location (�/2�� N� & 3 Owners Name tl-t)"&�VD ' �� \�� Permit Amount Tvve of Occupancy I \ .� /�:-� 12e-1, New Replacement E3 Plans Submitted Yes No M A i '7 C'=:gy!:m)pany 1 ��lJl t�l�m�Check one: Name ; K� -� %� N G Corp. _ Address 10�' MA1 rV/ ST- 01402_ Partner. . Business Telephone 9-79-462--3-711 Firm/Co. Name ofLicensed Plumber U�i(/l�0ns/ l� l�An.TL Insurance Coveraae: Indicate the type of insurance coverage by checking the appropriate boar Liability insurance policy ® Other type of indemnity 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 rgnature 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 Mass usetts State Plumbin Code and Chapter 142 of the General Laws. BY Signatu ofEicensea PIUMDer Type of Plumbing License Title > a A 32- ' City/Town Eicense Numoer Master Journeyman ❑ APPROVED (OFFICE USE ONLY Certificate Location No. Date 5 00 s MORTM TOWN OF NORTH ANDOVER OL 9 Certificate of Occupancy $ ��SSACNUs �� Building/Frame Permit Fee $-- Foundation Permit Fee $ Other Permit Fee $ �s TOTAL. $ Check #16-13 S, 6, 5647 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATf2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ©� 8 DATE ISSUED: a J a a O ct SIGNATURE: _'4�2z Bb2lding Commissioner/I for of Buildings Date a oZ SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Joe ' A NT' 6 - ) `p, ap Nuq er Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: j rc'cTou ZoningDistrict Proposed Use Area- - Lot s Fran e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Q''D F7 7ku f>T- Name(Prin Address for Service Signature Telephone 2.2 Owner of Record: , Name P Address for Service: r Signature Ifelephone SECTIO93 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone ic z �J i pM N O O z M 90 0 ic M s zA A X I SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 DesciA tion of Proposed Work check au applicable) New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Descri tion of Pro osed Work C i ti 11 t I SECTION 6 - ESTIMATED CONSTRITCTinN COSTS I Item Estimated Cost (Dollar) to be ©h'FICIi; USE"(3NLY _.' m leted by permit applicant . 1. Building ozb _ (a) Building Permit Fee so to ' Multiplier 2 Electrical = (b) Estimated Total Cost of Construction J 3 PlumbingC7 �aG = Building Permit fee t.8> X (b) , 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Na �as Owner/Authorized Agent of subject property Hereby authorize to act on My beha -:I' el 1v t wo utIreAzed this building permit application. Sigir o Own Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I ' I, ,as Owner/Authorized Agent of subject property r Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date I TIP 1. BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: -1-11" 1 Location ot Facility Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover Building Department A 27 Charles Street North Andover, MA. 01845ss •��'�� ,cause D. Robert Nicetta Building Commissioner (978) 688-9545 ,978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE C>d / J JOB LOCATION 37A Number Street Address Map 1 to "HOMEOWNER < O Name Home Phone Work Phone PRESENT MAILING ADDRESSC City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two•family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said; HOMEOWNER'S APPROVAL OF BUILDING OFFICIAL I O z 4 a v o O u. T Cf)v CL�v vp c) o U a4 Q0.4 w o w O rx C U C w a o w a t p C w a O u W w W p w u cn C w a O H O u; m G w z A w a w C co z �' u cn v o p cn ui am o o 0 LZ :w rw C N :� _O --1 t0CF ts r.+ M tq t 7m Ec z (n m C CL= �m� -m o 3 Cob cm : m� y W o z N c = O O o E m w U CO 0 CM E--, '' /^� a m m �/J cm 0 c os o c y a ►-� A%mo� m C.3 N Z O CM .r c c c = 1 H O d rr N N l W = ::sm r=... •N CL= O Z M O m .h co V , p m m !E _ h 0:2 m ` 2 O F— z w arm O co O O 0 COD y .iff CD L- CL co s C O v _cc ZL CO2 O Q M H C O V O L O V co C. CO3 C aDv, C co o� = m 0 U) U) M W w U) Location lei No. d Date o� H°oT;�tio TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ --"'—' 'SSACNUSEt . Foundation Permit F e $ Other Permit Fem $ 1� •U G� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ,C> Building Inspector Div. Public Works PEc(tST-X;�). _ 0 O ,-3 _ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK PAGE : ZONE SUB DIV. LOT NO. FI LOCATION �? ly L' /� 4 <j ( PURPOSE OF BUILDING IT OWNER'S NAME /l•N �) NO. OF STORIES SIZE OWNER'S ADDRESS /� !� BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW r G SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 d PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED PERMIT GRANTED OWNER TEL. # W CONTR. TEL. # Z' 19 L-- CONTR. LIC. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST ,G C) EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 31 BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PINE HARDW D— B 1 _ 2 13 CONCRETE BL K. BRICK OR STONE PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA 1/1 1/1 1/ FIN. ATTIC AREA _ N_O B M FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 _ 3 _ _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING CONCRETE EARTH HARDI!✓'D COMMC:N VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIORI� POOR _ ADEQUATE NONE 10 PLUMBING 5 ROOF GABLEHIP BATH 13 FIX.) GAMBREL _ MANSARD TOILET RM. 12 FIX.I _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T( 2nd I ELECTRIC THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1st 3rd NO HEATING L 9 rA 0 cd x w A x o C a w co z z m :3z C4 (L) e U c w" H w c z p °�° � w o a ¢ U U a W x °�° c�° cn m w x p U w a � z w w ..� v c o z v Ca v o O c c c ` O H VO V :� : •p -C CLC m c co :.0 O O co Ea o :0 S C- N CD 0 CMfti CD= E CL— L ti h CO) : a? 3 Co h CD A 'O • R O H _cc o-c�� m N m W Q� � cam¢ C N hCD V m C H C Q : i m C .O = m m y=CD ,., p N a 'COD VLU �E v E .y o O pm�C VD d m 'a 0:5 cc 0 H s *" a* zw I N1 CD O co O O D CO) co .E CD L a co i C O Q 0 Q i7 CO2 O O Q Q .a CA Q O Q cc CO) D L O s W Q. V! C H co L co 0 Q O fl. Q Q �•+ C Q Q J 'C zs co Q. CA C J Z LL. m Wi cc V.j CL } cr z z O W Q > Q LU w Cn > z 0 0 Or u Cl- v I ,XidCHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER ,Mass. kuilding Location 21 -S .A L H I Owners Date' 3 J-� Permit # Q Name f= A/ • New Renovation ID Replacement [] Plans Submitted ID FIXTUPFS (Print or Type) Installing Company Name ) �t Address C . ( � Q •h Ay-r_ � Business Telephone: 3 Name of Licensed Plumber or Gas Fitter Check one: Certificate Q Corp. Partner. Firm/Co. Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Ej 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 El 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 hnsaUations perforated under Permit iueed to: this application will -be in compliance with all pertinent provisions of tho Massachusetts State Gast ode and Chapter 142 of tho Genual laws. By TYPE LICENSE: JPlumber Title asfitter S/ ature of Licensed Master Plumber or G sf' ter City/Town: `/ �` APPROVED (OFFICE USE ONLY) urneyman LicenseNu�.mber • Y • ■t�����tt M■ EMEMEMENIM1■ .. ■EMEEEM�nONE EMEMEMEREMEN (Print or Type) Installing Company Name ) �t Address C . ( � Q •h Ay-r_ � Business Telephone: 3 Name of Licensed Plumber or Gas Fitter Check one: Certificate Q Corp. Partner. Firm/Co. Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Ej 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 El 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 hnsaUations perforated under Permit iueed to: this application will -be in compliance with all pertinent provisions of tho Massachusetts State Gast ode and Chapter 142 of tho Genual laws. By TYPE LICENSE: JPlumber Title asfitter S/ ature of Licensed Master Plumber or G sf' ter City/Town: `/ �` APPROVED (OFFICE USE ONLY) urneyman LicenseNu�.mber Date..................... of No oT ".,ti TOWN OAF NORTH ANDOVER PERMIY46R GAS INSTALLATION i,SSACNUS i (NC This certifies that ...:............:......................... . has permission for gas installation ............................ in the buildings of .......................................... at .................................... North Andover, Mass. Fee......... Lic. No........... .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File