HomeMy WebLinkAboutMiscellaneous - 257 MAIN STREET 4/30/2018n°Rm
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Town of North Andover
Machine Shop ViHage Neighborhood Conservation District Commission
s ,.o 1600 Osgood Street North Andover, MA 01W
Application For EXCLUSION From Certificate to Alter
Certain alterations are excluded from review by the Machine Shop Village Neighborhood
Conservation District Commission in accordance with the Bylaw. Applicants for exempt projects
must fill out the form below and submit to the Commission Chairperson (contact info below).
Date: Q `tG-2d1'j�
Contact Name & Address: j p _ �
Denis U'S Se�ot+�' Jk(YM- W+rA14 , d10[+tS
Project.
Project Description (attach additional pages, if needed):
Re'rtaee '-�' bilAJowS i At6
Exclusion From Review Requested For:
❑
1. Interior Alterations
existing conditions including materials,
LI2.
Storm windows and doors, screen
design and dimensions.
windows and doors.
9. Replacement of existing substitute -
doors, substitute siding or substitute
❑
3. Removal, replacement or installation of
windows with new materials that are
gutters and downspouts.
substantially similar to the existing
condition.
4. Removal, replacement or installation of
window and door shutters.
❑ 10. Replacement of original fabric
windows or doors with substitute
❑
5. Accessory btuddings of less than 100
windows or doors that maintain the
square feet of floor area
architectural integrity with respect to
form, fit and function of the original
❑
6. Removal of substitute siding.
windows or doors.
❑
7. Alterations not visible from a public
❑ 11. Reconstruction, substantially similar in
way.
exterior design, of a building damaged or
destroyed by fire, storm or other disaster,
❑
& Ordinary maintenance and repair of
provided such reconstruction is begun
architectural features that match the
within one year thereafter:
MSV NCDC Page 1 Cnarnt Chair: Liz Fennessy, 77 Elm Street, lizettafennessy0yahoo.cvm. 978-688-2915
� tt°RTry R
Town of North Andover
f Machine Shop Wage Neighborhood Conservation District Commission
1600 Osgood Street North Andover, MA 01845
'�ig1i*..too ✓'�
SSACAUSE
Application For EXCLUSION From Certificate to Alter
For terns 9,10 or 11, provide the following documentation:
Photoaldrawings of existing doors, windows or siding, as applicable
__1Description/Catalog Cuts of proposed materials to be used for doors, windows or siding
Plan and elevation of reconstruction forltem 11
Determination:
This project is determined to be
e empt
❑ not exempt
from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects
that are not exempt must complete the Application for Certificate to Alter, available from the Building
Department and be reviewed by the Commission.
Determination made by.-
Sign
y.
Sign ure
Neighborhood Conservation District ommission
Date
MSV NCDC Page 2 Current Chair: Liz Pennessy, 77 Ern Street, ]izettafennessy@yahoo.com, 978-688-2915
OMS Ver. 0002.03.00 (Current) BAKER, Kathy
Product availability and pricing subject to change. Ultrex Replacements
Quote Number: HL6LVJK
Architectural Profile Number:
UNE ITEM QUOTES
The foilowing is a schedule of the windows and doors for this project. For additional unit details, please see Line Item
Quotes. Additional charges, tax or Terms and Conditions may apply. Detail pricing is per unit.
Line #1 Mark Unit: Son's Room Net Price:
Qty: 1 I Ext. Net Price:
USD
874,87
874.87
Net Price:
Ext. Net Price: USD
Stone White Exterior
j Stone White Exterior
White Interior
53.40
*�� • visa.,
Integrity Traditional Insert Double Hung
65415
Integrity Traditional Insert Double Hung
Wood-ultrex
Wood-Ultrex
Inside Opening 33 3/4" X 68 3/4"
Inside Opening 27 3/4' X 68 3/4'
8 Degree Frame Bevel
8 Degree frame Bevel
Top Sash
Top Sash
I IG
IG
Low E2 w/Argon
Low E2 w/Argon
7/8" SDL - With Spacer Bar
43.61
7/8" SDL- With Spacer Bar
Rectangular 2W1H
Rectangular 2W1H
3 Stone White Ext -White Int
rn.ear,rF,nK
Bottom Sash
!s F:aes9 Fmt
Ex&tiar
IG
7Ct�.c c•
Entered As: 10
Low E2 w/Argon
Entered As: IO =
I
FS 33 3/8" X 691/8"
; 7/8" SDL- With Spacer Bar
43.61
IO 33 3/4" X 68 3/4"
i Rectangular 2W1H
I
10 27 314' X 68 3/4"
Egress Information
Stone White Ext- White Int
Egress Information
Width: 29 23/32" Height: 29 3/8"
I 1 oil Rubbed Bronze Sash Lock
47.17
Net Clear Opening: 6.06 SpFt
Exterior Aluminum Screen
32.93
Performance Information
Stone White Surround
Processed on: 7/28/201511:53:17 AM
U -Factor. 0.28
Charcoal Fiberglass Mesh
ENERGYSTAR: N, NC
***Screen/ComboShip Loose
Solar Heat Gain Coefficient: 0.28
31/4` Jambs
Condensation Resistance: 56
I Thru Jamb Installation
Visible Light Transmittance: 0.47
Existing Sill Angle 10
CPO Number. MAR -N-424-00210-00001
I '**Note: Divided lite cut alignment may not be accurately represented in the OMS drawing. Please consult
Performance Grade
your local representative for exact specifications.
Licensee 91123
AAMA/WDMA/CSA/101/ I.S.2/A440-08
!
LC-PG40107GX2146 mm (_42X84 in)
i
LC-PG40 DP +40/-40
FL 6525
i
Line #2
Qty 2
Mark Unit: Master
Net Price:
Ext. Net Price: USD
863.30
1,726.60
j Stone White Exterior
1 White Interior
53.40
Integrity Traditional Insert Double Hung
642 58
Wood-Ultrex
Inside Opening 27 3/4' X 68 3/4'
8 Degree frame Bevel
Top Sash
IG
Low E2 w/Argon
7/8" SDL- With Spacer Bar
43.61
Rectangular 2W1H
Stone white Ext - White Int
!s F:aes9 Fmt
Bottom Sash
7Ct�.c c•
Entered As: IO =
I
Low E2 w/Argon
FS 27 3/8' X 691/8"
7/8' SOL - With Spacer Bar
4361
10 27 314' X 68 3/4"
Rectangular 2W1H
Egress Information
Stone White Ext - White Int
Width: 23 23/32' Height: 29 3/8'
108 Rubbed Bronze Sash Lock
47.17
Net Clear Opening: 4.84 SgFt
Exterior Aluminum Screen
3293
Processed on: 7/28/201511:53:17 AM
Page 3 of 5
OMS Ver. 0002.03.00 (Current)
OMS Ver. 0002.03.00 (Current)
Product availability and pricing subject to change.
Performance Information
0 -Factor-. 0.28
ENERGY STAR: N, NC
Solar Heat Gain Coefficient: 0.28
Condensation Resistance: 56
Visibfe Light Transmittance: 0.47
CPD Number: MAR -N-424-00210-00001
Performance Grade
Licensee #1123
AAMA/WDMA/CSA/101/ IS.2/A440-08
LC-PG401076X2146 mm (42X84 in)
LC-PG40 DP +40/-40
FL 6525
L:
BAKER, Kathy
Ultrex Replacements
Quote Number: HL6LVJK IN
Architectural Profile Number:
Stone White Surround
Charcoal Fiberglass Mesh
**'Screen/Combo Ship loose
31/4" Iambs
Thru Jamb Installation
Existing Sill Angle 10
1 ***Note: Divided lite cut alignment may not be accurately represented in the OMS drawing. Please consult
your local representative for exact specifications.
Line 43
-T
Mark Unit: Daughter's Room
Net Price:
•"J
874.87
Qty: 2
"•.-.. = o>o,.
Ext. Net Price:
USD
1,749.74
}y{�
Stone White Exterior
•"J
White Interior
53.40
"•.-.. = o>o,.
Integrity Traditional Insert Double Hung
654.15
&an to ago
Wood-Ultrex
Inside Opening 33 3/4" X 68 3/4"
8 Degree Frame Bevel
Top Sash
IG
Low E2 w/Argon
7/8" SDL - With Spacer Bar
43.61
Rectangular 2W1H
Stone White Ext- White Int
45 W-0 From 74t
Bottom Sash
9lafor
IG
Entered As: 10
I
Low E2 w/Argon
FS 33 3/8" X 691/8"
I 7/8" SDL- With Spacer Bar
43.61
1033 3/4"'X 68 3/4"
Rectangular 2WiH
Egress Information
( Stone White Ext - White Int
Width: 29 23/32" Height: 29 3/8"
1 Oil Rubbed Bronze Sash Lock
47.17
Net Clear Opening: 6.06 SgFt
Exterior Aluminum Screen
32.93
Performance Information
' Stone White Surround
LI -Factor: 0.28
Charcoal Fiberglass Mesh
ENERGY STAR: N, NC
I ***Screen/Combo Ship Loose
Solar Heat Gain Coefficient: 0.28
31/4" lambs
Condensation Resistance: 56
Thru Jamb Installation
Visible Light Transmittance: 0.47
Existing Sill Angle 10
CPD Number: MAR -N-424-00210-00001
***Note: Divided lite cut alignment may not be accurately represented in
the OMS drawing. Please consult
Performance Grade
I your local representative for exact specifications.
Licensee 51123
I
AAMA/WDMA/CSA/101/ I.S.2/A44O-08
I
LC-PG401076X2146 mm (42X84 in)
LC-PG40 DP +40/-40
FL 6525
Project Subtotal Net Price: USD 4,351.21
6.250% Sales Tax: USD 271.95
Project Total Net Price: USD 4,623.16
OMS Ver. 0002.03.00 (Current) Processed on: 7/28/2015 11:53:17 AM Page 4 of 5
KORT1{
Town of North Andover
# - Machine Shop Vffiage Neighborhood Conservation District Commission
1600 Osgood Street North .Andover, MA 01845
Application For EXCLUSION From Certificate to Alter
Certain alterations are excluded from review by the Machine Shop Village Neighborhood
Conservation District Commission in accordance with the Bylaw. Applicants for exempt projects
must fill out the form below and submit to the Commission Chairperson (contact info below).
Date: q IT
Contact Name & Address:
D ei) ni s Uamdl - N oe��' Mum W 'h v 6 lutiws
Project
Project Description (attach additional pages, if needed):
R.e ne, wiftJovs f nt'0
N[ a-efe,b)(i
Exclusion From Review Requested For:
❑ 1. Interior Alterations
❑ 2. Storm windows and doors, screen I
windows and doors.
❑ 3. Removal, replacement or installation of
gutters and downspouts.
4. Removal, replacement or installation of
window and door shutters.
❑ 5. Accessory buildings of less than 100
square feet of floor area.
❑ 6. Removal of substitute siding
❑ 7. Alterations not visible from a public
way.
❑ 8.Otdinaq maintenance and repair of
architectural features that match the
r-�4t3 ,
existing conditions including materials,
design and dimensions.
9. Replacement of existing substitute
doors, substitute siding or substitute
windows with new materials that are
substantially similar to the existing
condition.
❑ 10. Replacement of original fabric
windows or doors with substitute
windows or doors that maintain the
architectural integrity with respect to
form, fit and function of the original
windows or doors.
❑ 11. Reconstruction, substantially similar in
exterior design, of a building, damaged or
destroyed by fire, storm or other disaster,
provided such reconstruction is begun
within one year thereafter.
MSV NCDC Page 1 Current Chair Uz Fennessy, 77 Elm Street, lizettafennessv0vahoo.com, 978-68&2915
R,
°� ygRTt1 �
Town of North Andover
s * Machine Shop Wage Neighborhood Conservation District Commission
1600 Osgood Street North Andover MA 01845
Application For EXCLUSION From Certificate to Alter
For terns 9,10 or 11, provide the following documentation:
Photos/drawings of existing doors, windows or siding, as applicable
__Description/Catalog Cuts of proposed materials to be used for doors, windows or siding
__,Alan and elevation of reconstruction forItem 11
Determination:
This project is determined to be
e empt
❑ not exempt
from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects
that are not exempt must complete the Application for Certifccate to Alter, available from the Building
Department and be reviewed by the Commission.
Determination made by:
Sig ure
Neighborhood Conservation District ommWion
Date
MSV NCDC Page 2 Current Chair: Liz Fennessy, 77 Elm Street, lizettafennessv@yahoo.com, 978-688-2915
ti
OMS Ver. 0002.03.00 (Current) BAKER, Kathy
Product availability and pricing subject to change. Ultrex Replacements
Quote Number: HL6LVJK
Architectural Profile Number:
LINE ITEM QUOTES
The following is a schedule of the windows and doors for this project. For additional unit details, please see Line Item
Quotes. Additional charges, tax or Terms and Conditions may apply. Detail pricing is per unit.
Line #1
Mark Unit: Son's Room
Net Price:
874,87
Qty: 1
53.40
Ext. Net Price:
USD 874,87
Line #2Mark
Qty: 2
Stone White Exterior
Net Price:
Ext. Net Price: USD
White Interior
53.40
* •�� e� .
Integrity Traditional Insert Double Hung
654.15
&, u oerrznt
Wood-Ultrex
wiacar..Pe w...
Integrity Traditional Insert Double Hung
Inside Opening 33 3/4" X 68 3/4"
B°e
Wood-Ultrex
8 Degree Frame Bevel
Inside Opening 27 3/4" X 68 3/4"
Top Sash
8 Degree Frame Bevel
I IG
{ Top Sash
Low E2 w/Argon
IG
7/8" SDI-- With Spacer Bar
43.61
Low E2 w/Argon
Rectangular2W11-1
I
7/8" SDL- With Spacer Bar
I Stone white Ext - White Int
A;Y--;IP=Tx
I Bottom Sash
'ar
IG
AS %Ww" rnm..
Entered As: 10
Low E2 w/Argon
n:ese—
FS 33 3/8" X 691/8"
; 7/8"SDL- With Spacer Bar
43.61
10 33 3/4" X 68 3/4"
Rectangular 2W1H
FS 27 3/8' X 691/8"
Egress Information
Stone White Ext- White Int
10 27 3/4" X 68 3/4'
Width: 29 23/32" Height: 29 3/8'
1 Oil Rubbed Bronze Sash Lock
47.17
Net Gear opening: 6.06 SgFt
Exterior Aluminum Screen
32.93
Performance Information
Stone White Surround
Net Clear Opening: 4.84 SgFt
U -Factor: 0.28
Charcoal Fiberglass Mesh
Processed on: 7/28/201511:53:17 AM
ENERGY STAR: N, NC
*"Screen/Combo Ship Loose
131/4"
Solar Heat Gain Coefficient: 0.28
Jambs
Condensation Resistance: 56
I Thru lamb Installation
Visible Light Transmittance: 0.47
Existing Sill Angle 10
CPD Number: MAR -N-424-002104)0001
I ***Note: Divided lite cut alignment may not be accurately represented in the OMS drawing. Please consult
Performance Grade
your local representative for exact specifications.
Licensee #1123
AAMA/WDMA/CSA/101/ I.S.2/A440-08
LC PG401076X2146 mm (_42X84 in)
LC-PG40 OP +40%40
FL 6525
i
Line #2Mark
Qty: 2
Unit: Master
Net Price:
Ext. Net Price: USD
863.30
1,726.60
"
Stone White Exterior
White Interior
53.40
wiacar..Pe w...
Integrity Traditional Insert Double Hung
642.58
B°e
Wood-Ultrex
Inside Opening 27 3/4" X 68 3/4"
8 Degree Frame Bevel
{ Top Sash
IG
Low E2 w/Argon
7/8" SDL- With Spacer Bar
43.61
Rectangular 2W1H
Stone White Ext - White Int
AS %Ww" rnm..
Bottom Sash
n:ese—
IG
lxrtered A5: 10 `
I
Low E2 w/Argon
FS 27 3/8' X 691/8"
7/8" SDL - With Spacer Bar
43.61
10 27 3/4" X 68 3/4'
Rectangular 2W1H
Egress Information
Stone White Ext - White Int
Width: 2323/32' Height: 293/8'
1 Oil Rubbed Bronze Sash Lock
47.17
Net Clear Opening: 4.84 SgFt
Exterior Aluminum Screen
32.93
Processed on: 7/28/201511:53:17 AM
Page 3 of 5
OMS Ver. 0002.03.00 (Current)
t!
OMS Ver. 0002.03.00 (Current) BAKER, Kathy
Product availability and pricing subject to change. Uitrex Replacements
Quote Number: HL6LVJK\
Architectural Profile Number:
Performance Information
Stone White Surround
6 -Factor: 0.28
Charcoal Fiberglass Mesh
ENERGY STAR: N, NC
***Screen/Combo Ship Loose
Solar Heat Gain Coefficient: 0.28
31/4" lambs
Condensation Resistance: 56
I Thru lamb installation
Visible Light Transmittance: 0.47
Existing Sill Angle 10
CPD Number: MAR -N-424-00210-00001
j ***Note: Divided lite cut alignment may not be accurately represented In the OMS drawing. Please consult
Performance Grade
•, your local representative for exact specifications.
Licensee 111123
AAMA/WDMA/CSA/101/ I.S.2/A440-08
Top Sash
LC-PG401076X2146 mm (42X84 in)
LC-PG40 DP +40/-40
FL 6525
Low E2 w/Argon
Line #3 Mark Unit: Daughter's Room
Net Price:
874.87
Qty: 2
Ext. Net Price:
USD
1,749.74
Project Subtotal Net Price: USD 4,351.21
6.250% Sales Tax: USD 271.95
Project Total Net Price: USD 4,623.16
OMS Ver. 0002.03.00 (Current) Processed on: 7/28/2015 11:53:17 AM Page 4 of 5
Stone White Exterior
....,.
White Interior
53.40
.......... o....
Integrity Traditional Insert Double Hung
654.15
Built to perio.
Wood-Ultrex
Inside Opening 33 3/4" X 68 3/4"
8 Degree Frame Bevel
Top Sash
IG
Low E2 w/Argon
7/8" SDL - With Spacer Bar
43.61
Rectangular 2W1H
Stone White Ext- White Int
re.Hext�Fiom Tt
I Bottom Sash
Ece�or
IG
Entered As:10
i
Low E2 w/Argon
FS 33 3/8" X 691/8"
7/8" SDL - With Spacer Bar
43.61
1033 3/4"•X 68 3/4"
Rectangular 2W1H
Egress Information
Stone White Ext - White Int
Width:2923/32" Height:293/8"
1Oil Rubbed Bronze Sash Lock
47.17
Net Clear Opening: 6.06 SgFt
Exterior Aluminum Screen
32.93
Performance Information
°• Stone White Surround
LI -Factor., 0.28
Charcoal Fiberglass Mesh
ENERGY STAR: N, NC
1 ***Screen/Combo Ship Loose
Solar Heat Gain Coefficient: 0.28
31/4" lambs
Condensation Resistance: 56
Thru Jamb Installation
Visible Light Transmittance: 0.47
Existing Sill Angle 10
CPD Number: MAR -N-424-00210-00001
***Note: Divided lite cut alignment may not be accurately represented in the OMS drawing. Please consult
Performance Grade
I your local representative for exact specifications.
Licensee #1123
AAMA/WDMA/CSA/101/ 1.S.2/A440-08
LC-PG401076X2146 mm (42X84 in)
LC-PG40 DP +40/-40
FL 6525
Project Subtotal Net Price: USD 4,351.21
6.250% Sales Tax: USD 271.95
Project Total Net Price: USD 4,623.16
OMS Ver. 0002.03.00 (Current) Processed on: 7/28/2015 11:53:17 AM Page 4 of 5
LL
*N
1111t Tommanwealtll of Masstttllusetts Office Use Only
Department of Public Safety
Permit No. c�g %
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00` !�U (/!1
Occupancy &Fee Checked
3/90 (leave blank)
APPLICATION NFOR ork to be �PEIRMITeMassachusetts
in with the TO PERFORM ELECTRICAL WORK
Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INF09MATION)
City or Town of /V," IP /I M ri (%0 Ve /
The undersigned applies for a permit to perform the electrical
Location (Street & Number)
Owner or Tenant
oeiow.
C
Date - � --1 7
To the Inspector of Wires:
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building
Existing Service
New Service
Number of Feeders and Ampacity
Amps
Amps /
Location and Nature of Proposed Electrical Work
Volts
Volts
Jtility Authorization No. _
Overhead ❑ Undgrd•❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
No. of Lighting Outlets
�
No. of Hot Tubs
TOTAL
No. of Transformers KVA
No. of Li htin Fixtures
_
Above
Swimmin Pool rnd.
In -
1:1 rnd. —1Generators
KVA
No. of Receptacle Outlets
��
No. of Oil Burners
No. o Emergency Lig ting
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones—_
No. of Detection and
Devices
Devices.
No. of SoundinNo. of Self Contained
Detection/Sounding Devices
Municipal
Local❑• Connection ❑Other
No. of Ranges
Total
No. of Air Conditioners Tons
No. of Disposals
Heat Total Total --.Initiating
No. of Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters
KW
No. of No. of
Signs Ballasts
Low Voltage
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
'r r
- —,
INSURANCE COVERAGE: Pursuant to t requirements of Massachusttes General Laws
I have a current Liability Insurance Po 'cy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ 1 have submitted valid proof
of same to this office. YES ❑ NO
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify)
Estimated Value of //Electrical Work $
g po (Expiration Date)
Work to Start CP – S ` / Inspection Date Requested: Rough Final
Signed under the pe alties of perjury:
FIRM NAME P LIC. NO.
Licensee Signature
LIC. rvo. 3 3 97.;2 f7 -
Address �� J �►7F A� /v/ P f! U�.�J / (a< Bus. Tel. No. l 6
Alt. Tel. No.
OWNER'S INSURANCE WAWER: I am are that the Licensee does not have the insurance coverage or its substantial equivalent as required assachusetts
General Laws, and jhat mysignatur n this.pecrrrirapplication waives this requirement.. Owner Agent (Please check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
987
Or NOR7H 1ti
• o
9
�,SSACNuSEt
Date........................ .
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
_Q
This certifies that
has permission to perform ......... !' er!/...--..... /! .....
wiring in the building of ....... .... :......:/t"., ..................................
at ... .,5. �..... . ... . t .. .. .:................... . North d ver, Mass. CU
N
mA—
Fe 4.;70... . Lic. No. . /.7,? C.... ...... w
ELECTRICAL INSPECTOR
c�
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Location
No. -G-qz -G-qDate
NaRT� TOWN OF NORTH ANDOVER
n Certificate of Occupancy $
J
° ,; Building/Frame Permit Fee $ �r
Foundation Permit Fee $
s�CHU
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
riiiding-tnspe or
`� 06!17/97 09:'20 30.00 PAID
Location
No. -
Date
%ORTq
TOWN OF NORTH ANDOVER
Of ��ae .a 1N
•• 4 •a OOAi
O?
Certificate of Occupancy $
*
.e
#
Building/Frame Permit Fee $ i
�'� s'•^°'''��'
,+cst
Mu
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
B ' dirrgTnsp`e6tor
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9
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TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
Sewer Connection Fee
Water Connection Fee
TOTAL
1082" Y0:20 . 00
PAID
Building Inspector
Div. Public Works
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MASdACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINC
(Print or Type)
NORTH ANDOVER ,Mass. Date
building Location_ S /nom,;,, c: Permit # .?Y3 o,3
' A. A,h4oylr--,O'L 41.4 t Owners Name�,'LL
New 77 Renovation n Replacement El Plans Submitted
FIXT lRF
I
(Print or Type) Check one: Certificate
Installing Company Named Q Corp.
Address - L .-�.�,4 _qj-• SACS CZ.yc e-71-1 Q A r} 7 9 Partner.
Firm/Co.
Business Telephone: ('()3
Name of Licensed Plumber or Gas Fitter �% L,�,S Ao Q e,,-
Insui-anca Coverage: Indicate the type of insurance coverage by chegking the
appropriate box:
Liability insurance policy M Other type of indemnity Q Bond Ej
InsuranceW iv �do�esnotI, the undersigned, have been made aware that the licensee of
this ap i have any one of the above three insurance coverages.
Signature o owner agent of property Owner 2r Agent ED
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 Installations performed under' Permit issued for this application will-bein compliance with all patlnent
provisions of the 1Kanaehusetts Slate Cas lode and Qsaptes 142 of the General laws-
4
By TYPE LICENSE:
f" .. Plumber ,
title Gasfitter Signature of Licensed
City/down: Master Plumber or Gasfitter
Journeyman
APPROVtD (OFFICE use ONLY) I License number
-.�. _. V-. �' `... r,.. •..+^'s ' ice.. � .....-..�...�,^ -
TO) 2573
NORM TOWN OF NORTH ANDOVER
Oft ,e,�O
to PERMIT FOR GAS INSTALLATION
P
. . . . . . . .
This certifies that ............ �----:--' . .
has permission for gas installation .. .
atC25in the buildinV.-
...
17. , North Andover, Mal.
Fee... Lic. N .U. M
,. � $ GAS INSPECTOR
WHITE: Appli nt ANARY: Building Dept. PINK: Treasurer GOLD: File
I / 9
•�••v�+r• �..► uvsirVrlm Arr"LA%,A66Un rVM f r-nMsd lu NV C16.u4v61W44ty
(Print w TWel
NORTH ANDOVER, , Maes. Oats
building Permit
Locatlon . S 7 S 7-
Owner's (,GL
,tj 4g4or�TdL �.¢�s <<.� _ Name AILC- gvg,�L
New ❑ Renovatlon M Replacement J$ Plans Submitted: Yes ❑ No. ®.
FIXTUAEg ......_.
Check one: CertNlcite
installing Company Nsme,L„hr_❑.
Address 11.7 er— C,,q C --"e,- Alp? O Partnership
❑ Firm/Co.
business Telephone Q3 e 9,6- z� 4
Name d Ucensed Plumber
I have a current liability Insurance L'necx one
sill policy or Its substantial equivalent. - Yes 0 No EL
N you have checked yam, please Indicate the type coverage by checking the appropriate box.
A liability Insurance"Cy ❑ Other typed Inder;,Nty, 0 Bond ❑
OWNER'$ INS AN ANEB: I am aware that the licensee des not have the insurance coverage required by
Chapter 14 he e. Dene am
Chapter that my signature on this permit application wolves this requirement.
7 Check one:
signstuts of oNnstar Owners Mani Owner J@ Agent ❑
hereby carlity that all of the details and Information I have submitted (or entecedl In above t
I and that at binq work and Inslatatlons apOflca.son are true and $ousts to the best of my
deAlneni I ani Cha of the Massachusetts Slate Plum Famed under the pewit Issued for tills Qpkailon will be (n complance with ill
bkV Code end ChapterIi 2 o1 al Lwx
1!l► '
nor urs ucansod Plumber
A44INE 0 (OFFICE. USE ONLY)
lkensa Number '2 `/ 6.3
TWO of Plumbing License: Master ❑
Journeyman
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Check one: CertNlcite
installing Company Nsme,L„hr_❑.
Address 11.7 er— C,,q C --"e,- Alp? O Partnership
❑ Firm/Co.
business Telephone Q3 e 9,6- z� 4
Name d Ucensed Plumber
I have a current liability Insurance L'necx one
sill policy or Its substantial equivalent. - Yes 0 No EL
N you have checked yam, please Indicate the type coverage by checking the appropriate box.
A liability Insurance"Cy ❑ Other typed Inder;,Nty, 0 Bond ❑
OWNER'$ INS AN ANEB: I am aware that the licensee des not have the insurance coverage required by
Chapter 14 he e. Dene am
Chapter that my signature on this permit application wolves this requirement.
7 Check one:
signstuts of oNnstar Owners Mani Owner J@ Agent ❑
hereby carlity that all of the details and Information I have submitted (or entecedl In above t
I and that at binq work and Inslatatlons apOflca.son are true and $ousts to the best of my
deAlneni I ani Cha of the Massachusetts Slate Plum Famed under the pewit Issued for tills Qpkailon will be (n complance with ill
bkV Code end ChapterIi 2 o1 al Lwx
1!l► '
nor urs ucansod Plumber
A44INE 0 (OFFICE. USE ONLY)
lkensa Number '2 `/ 6.3
TWO of Plumbing License: Master ❑
Journeyman
3372
Date .. 6.'. // + 7
NORTIy
.... ..'"vow TOWN OF NORTH ANDOVER
CL
PERMIT FOR PLUMBING
,SSACHUS�
This certifies that . .�. , .
has permission to perform .. �!'I ,?!L.r-1T`..}�.�(L_
plumbing in the building f .../f... r..C°r,........
y% m
at .,) 7..,%1 7 t..... ............. . North Andover, Mass.
a,o
Feed . ,!.. Lic. No(�5.. ............................. .
PLUMBING INSPECTOR
3vS
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer