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HomeMy WebLinkAboutMiscellaneous - 32 ACADEMY ROAD 4/30/2018 / 32 ACADEMY ROAD J 2101 32 J I, S North Andover Board of Assessors Public Access Page I of 1 pORTM North Andover Board of Assessors Click Seal To Retum �Zroperty Record Card Parcel ID:210/058.0-0020-0000.0 FY:2013 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge P Search for Parcels Search for Sales Summary Residence Detached Structure Condo 32 ACADEMY ROAD Commercial Location: 32 ACADEMY ROAD Owner Name: MACLAREN,ALAN MACLAREN,ROWAN Owner Address: 32 ACADEMY ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:7-7 Land Area: 1.00 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3104 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 558,300 505,100 Building Value: 323,000 279,500 Land Value: 235,300 225,600 �Market Land Value: 235,300 Chapter Land Value: LATEST SALE Sale Price: 780,000 Sale Date: 03/22/2004 Arms Length Sale Code: Y-YES-VALID Grantor: TREVOR GOWDY Cert Doc: Book: 8639 Page: _11 3 http://csc-ma.us/PROPAPP/display.do?linkld=2253724&town=NandoverPubAcc 3/19/2013 Residential Property Record Card PARCEL ID:210/058.0-0020-0000.0 MAP:058.0 BLOCK:0020 LOT:0000.0 PARCEL ADDRESS:32 ACADEMY ROAD FY:2013 PARCEL INFORMATION Use-Code: 101 Sale Price: 780,000 Book: 86391 RoadyType: T Inspect Date: 05/19/2011 Owner: Tax Class: T Sale Date: 03/22/04 Page: 213_ Rd Condition P Meas Date: 05/19/2011 .- _ Tot Fm Area 3104 Sale T e P Cert/Doo: Traffic � M '-'—'Entrance: _ C MACLAREN,ALAN _ MACLAREN,ROWAN Tot Land Area. 1.00 Sale Valid: Y m Water: Collect Id RRC Grantor. ; TREVOR GOWDY T Sewer: -InspecfR6as: C Address: - - _ _ 32 ACADEMY ROAD Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CIL Tot Rooms: 9 Main Fn Area: 1984 Attic; Y NBHD CODE: 7 NBHD CLASS: 7 ZONE: R4 �.. ... � ... _-_.,.- mr Story Height: 2.35 Bedrooms: 4 Up Fn Area: 1120_ Bsmt Area: 1984 Seg Type Code Method Sq-Ft Acres Influ-Y%N Value Class _ll Bath Fu - Fn Bsmt Area. - 1 P 101 S 43560 1`.000 235,254 Roof: G s: 2 • -Add Fn Area: l Ext Wall: FB 'Half Baths. 1 Unfin Area: 694 Bsmt Gracie: Tot Fin Area: 104 VALUATION INFORMATION Masonry`Trim: Ezf Bath Fiz:4W 0 3. "� Foundation: _CN Bath Qual. T RCNLD_�" 322987— Current Total: 558,300 Bldg: 323,000 Land: 235,300 MktLnd: 235,300 -- Prior Total: 505,100 Bldg: 279,500 Land: 225,600 MktLnd: 225,600 Kitcti Qual T Eff Yr Built � 1970 Mkf Adj � mm HeatType'_ HW ExtKitch: Year Built: 19511 Sound Value: Fuel Type: O Grade: G - Cost Bldg:' 323;000 Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val 1: C66tFai AC: N' Bsmt Gar SF:'_ Pct'Complete: Att Str Val2 Att Gar SF: 576 /oGood P/F/E/R: /100/100/78 Porch Tyne Porch Area Porch Grade Factor P 25 E 224 SKETCH PHOTO 24 77 10 f, . pp �33SS S U819t�8 14 2 4 %FtSCl6 S 32 F�� U g 32 FUJFML F42_ 16 24 .35 _ l 4 27 35 W11 AK ,1 r 1 1.' r'.:$."!"°'• �- ' ;iy,; ' v 32 ACADEMY ROAD Parcel ID:210/056.0-0020-0000.0 as of 3/19/13 Page 1 of 1 Date... '40 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ti This certifies that t . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of .14 . c ..... . . . . . . . . . . . . . . . . . . . . at I:q.C..4 . . . . . . North Andover, Mass. Fee. . . . . . Lic. No.. . . . . .. . . . . . . . . . . . . . . . . . . . II'S INSPECTOR Check# 53 '18 MASSACHUSETTS UNTIMRM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUS TTS Buildingod �G� �rn Locations Permit# S 31 l_ Amount$ �- K-`i'�— Owner's Name lel IrC�/,O New Renovation ❑ Replacement ❑ Plans Submitted ❑ x d x H o � a o � a A O z O d a � A a0. F O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD . FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH . FLOOR Name or type)(PrintLA """' L Corp.Certificate ir► aCompany Address ` Partner. 1"t.— Business ttBusiness Telephone �. ❑ Finn/Co. Name of Licensed Plumber or Gas Fitter W)Y) �ee�yre— J� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No[:] Ifyou have checked M,please indi a type coverage by checking the appropriate box. Liability insurance policy Other type Cif iruer .ity ❑ Rond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owne Agent ❑ i hereby certify that all ofthe details and information I have su 'tt r ent a application are true and accurate to the best of my knowledge and that all plumbing work and ins ta tions orined er P it Issued for this application will be in compliance with all pertinent provisions ofthe Massachu tts S t e nd Cha er 142 ofthe General Laws. By: >ignature of Licensed Plu Fitter Title Plumber City/Town ❑ Gas F' er Licee Number aster APPROVED(OFFICE USE ONLY) Journeyman VER. M/CJS/�C1II `ql � yr• H 1�,•..•'•� JUN 4 c5 MJ e.9 .SCNui tt 5'.cultlC DI.STRIC1' CUt1M1:SS:COt1 F Ateplication rot �ertiL.tcate_ of np�r�riateress Applicatiorl is hereby made for the1' ^_suanc APPROPRIATENESS under Chapter .IOC for e of a CF'RTIFIC,\TE OF and on 9 plans, ;drawirl s► or proposed work as described below Photographs accompanying this application . CHECIC CA'PEGORIES '1'IIAT Allpj,Y : 1 • Lxter.ior Bu.ilCiillg con;l:ruction: ( ) Add i.ti0n Type Of •puilding (`Vlj A].teration • (`v1 home ( ) C"r-,lge ( ) COMmercial ( ) Other 2 • Uel"Oliti011 or Removal of: 3 • Signs or Billboards : ( ) L•':c.isting Sign ( ) Other `i • Structure: ( ) I'rtlr:r? ( ) Other ('type or print legibly) Address of Proposed caggk; ' c (e;���I►'l(, �� Owne2' ' )C'f t car r 1C_ `f- - rl Date TelephoneS .) AgentIiome Address (if different from above) : �~ Agent or Contractor: 1V — _ Address : 1 Assessor's ljap '--3—f Lot ,y Q i I r .`t VDetailed Description of Proposed Work: Give all particulars of wor,v, to be - doge (see 90 below) , including materials to be used, 11"" specifications do not accompany plans . , locations of existing signs and ` I11 case of signs, give (attach additional street- if rlecessaryr)posed locations of new signs. 411 Co cYc�L: �lk C'S' tJ 11 ) a � 1 �. � 1 ll C.•-/ � (' �•�/,��>���✓ 1, `r Xx I;, � � t" �' iJ/C' L'`%C ,�. / / (C ��/ ` l r�— _1 _ L�[• (' �7 ' i (it/L�CG L / i/r.��'G%'tT! t'✓ /t r r Lf (> I C-/` r Ownet Agent, Cor factor) DO NO•I' WRITE BELOW THIS LINE RECEIVED FOR HISTORIC DISTIRCI' Cot-U-1ISSIOtd: TIME: DATE: BY APPLICATION # : THIS APPLICA'T'ION FOR CER'.U.LF.CCA•T'E OF APPROPIUA•T'E11PSS : ( ) APPROVED ( ) DISAPPROVED Reason for Disapt)r:oval : ( ) NO CERTIFICATE OF APPROPRIA'T'ENESS ItEQUIRI.,t) A CERTIFICATE OR APPROPRIATENESS is in the application above an a - -ach documents , for wort. described Chairman: /D< Secretary: s� vice Chairman: e• Location 3c> CA cleof y ICC �Y No. 02 3 cf Date /a � ��^rM TOWN OF NORTH ANDOVER F? • • ow A s ; Certificate of Occupancy $ Building/Frame Permit Fee $ VVV`t ACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4, rY I 7 b 9 U `~ Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 77 77= BMDING PERMIT NUMBER: c/ DATE ISSUED: f ` D SIGNATURE: Building Commissioder/IngWor of Buildings Date SECTION 1-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / . Map Number Parcel Number No SYN �►v ykat L�j 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infonmtion: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zane 0 Municipal ❑ On Site D' 1 System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT i 1-'i"I,r!^i: Y" j jr) M 2. Owner of Record Q Name(Print) Address for Service: -70) 8lP-a5-o3 Signature Telephone 2.2 Owner of Record: 0 Naos Print Address for Service: z i M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES (-4.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: Cd q 6 7 3 9 �> �v License Number A Addres I a 41-7/ -5—/ Expiration Date O Si ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M i Registration Number r Address z Si mature Telephone Expiration Date TOWN OF NORTH ANDOVER MASSACHUSETTS NORTH ANDOVER OLD CENTER HISTORIC DISTRICT COMMISSION VIA FACSIMILE 978 6889542 Building Inspection Town of North Andover North Andover, MA 01845 TO WHOM IT MIGHT CONCERN: Please be advised that renovations at 32 Academy Road do not need approval of the Historical District Commission. The renovations are in the rear of the property and therefore do not need approval from the Olde Center Historical District Commission. Any questions please call me at 978 685 5000. Sincerely, George H. Schruender, Jr. Chairman North Andover Historical District Commission North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with therovision of MGL c 4 p O 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 c 11, S 150 A. The debris will be disposed of in: I�Ioi2T��T 1Ji5PDsAz. � �i��l;.�it�� (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTiq 0 Of over No. ;3q oo dover, Mass., /� QA COCMICMEWICK\y %d RATED P`P���S IT G i• BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System N *A CIa N� BUILDING INSPECTOR THIS CERTIFIES THAT..... 41,4 ............... .................. .................. .....................G1....................................• ...:............... Foundation has permission to erect... �r . buildings on •,k y /G ......... ......�.�.......... ...... Rough .. .. .. ....... to be occupied as...�t..... ...........................................OZ 4�'Lis $............................................'jfA �/t� ..............y'..1C#W14fV46 Chimney ..fit provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration nd Construction of Buildings in the Town of North Andover. Air ei r. A ft h for% FNW&jk a,& An.. . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. /L p Rough PEREXPIRES IN 6 MONTHS Final MIT UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 000 C"'C4 .................... ....... .. Service ............................................. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: &NOWA-i,dN Est. Cost20 �©p Address of Work 3�L &A,09Mv ROA-b Owner Name: % AN M&,c_M07g Date of Permit Application: 10 1D I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied _Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner'Name Date... ,,ORT" 0 TOWN OF NORTH ANDOVER 0 I- PERMIT FOR WIRING 4L ,SSA CHU ,> This certifies that .... ...... ...............k� ......................... has permission to perform r ....a-2 qh ........................................ Ile wiring in the building of A.. ............... .............R'2'-... North Andover,Mass. `Fee.��.2.:�.. Lic.No.A... .......�Jv� .heck 4 ELECTRICAL IN%�Ecroi L. 5478 Official Use Commonwealth of Msssacllus Us / Permit No. Department of Fire Se s Occupancy and Fee Checked i BOARD Of FIRE PREVENTION RE LATIONS v. 11199) 1eM APPLICATION FOR PERMI O PEf ZFORM ELECTRICAL WORK All work to be pofommal is socotdtsce wi t Mussohusetts Electrical Code(MBC),527 CMR 12,00 (PLEASE PRINT IN INK OR TYPE ALL ORMA N) Dater 3 I City or Torn of: To the Ins�of Wires: By this application the undersigned ves notice,4 his or he ' tention to petfo the elec 'cal work described below. Location(Street&•Num Owner or Tenant Telephone Owner's Address Is this permit is con�anMioa with a bWing permit? Yes fa No ❑ (C+eik Appropriate Bax) Purpose.of Building > Utility Authorization No. Eldsting Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters NO&Service Amps Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: h • Z Complefiono the olloxdn table bewni 6 thel oro Wires. o.of uta No.of Recessed Fixtures No.of Ce1L-Susp.(Paddle)Fans Transformers Kv No.of Lighting On" No.of Hot Tubs Generators KVA o.o noergency. g. . Na.of Lighting Futures. Swimming Pool d e n-d., ❑ gaffe Unita No.of Receptacle'Outlets No.of OR Burners FIRE ALARMS 140,of Zones ��7 o.o og,ah ' No.of Switches. I No:of Gas Burners Initlati '.De No.of Air Coad. Total No.of Alerting Devices No.of Ranges Tons Heat Pump. umiber JTous ..IKW of. ntained No.of Waste Disposers Totals• Det oN e n Devices No.of Dishwashers Space/Area Heating KW Local 0.�aninection❑ Other Heating Appliances ICW Security yysstems: No.of Dryers t; No..of Devices or uivalent No.of WaterNo.a o.o Data Wiring Ballasts No:of Devi Heaters Signs ces r E uivalent e common cations ing: No.Hydromassage Dathtubs No.of Motors Total HP No.of Devices or vivalan OTHER: �.c p Attach addittoaal det di tfdesirted.oras required by the 1h*wdor of Wtrea. i 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 . Y undersigned certifies that such coverage is in force,and has exhibited proof'ofsanke to the permit issuing office.• 2 CHECK ONE: INSURANCE 21 BOND ❑ OTHER ❑ (Specify ` :teflon to Estimated Value of Electrical Work .� (When required by municipal policy.) Work to Start 12-1 1310 4 lnspections to be requested in-accordance with.MEC Rule 10,and upas completion. I cert fy,under the ins 6dpenafties ofperju ,that the information on this appllcatinn is true and complete.' b FIRM NAME: LIG NO. Licensee: A tlu 1=—X Signature-, LTC:NO.: S store�6'h'1 �--� ('applicable, ter"emrertrpt"in a license a reline) s.Tel.No.• Address: UP Alt:Tel.No.: OWNER' INSURANCE WA R: IBM aware that the Licensee does not have the liability insurance coverage normally . required by law. Bymy signature below,I hereby waive this requirement. lam the(check one ❑owner• 0 owner's agent. Owner/Agent LPERMITFRE.Ilk $ Signature Telephone No. ACORD CERTIFICATE OF LIABILITY INSURANCEOP ID $ DATE(MM/DDIYYYY) CANNE-1 07/28/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Landmark Insurance Agency, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 198 Massachusetts Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, North Andover MA 01845-4190 Phone: 978-688-8829 Fax:978-975-3987 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual 14788 INSURER B: Canney Electric Thomas P. Canney INSURER C: P.O. BOX 118 INSURER D: Methuen MA 01844 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DDIYY DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERALLIABILITY MPP93743 02/10/04 02/10/05 PREMISMAGES(E RENTED $ 500000 CLAIMS MADE ❑OCCUR MED EXP(Anyone person) $ X Business Owners MPP93743 02/10/04 02/10/05 PERSONAL BADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2000000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITSTH EMPLOYERS'LIABILITY I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ If yes,describe under --- SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Electrical Wiring CERTIFICATE HOLDER CANCELLATION NORTAN2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sutton Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover MA 01845 REPRESENTATIVES. AU ORI REP SENTATIVE h:ORD 25 (2001/08) ©ACORD CORPORATION 1 r Date. „ORT1y TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING SS US This certifies that./-` . . . . . . . . .C',� . . . . . . . . . . . . . . . has permission to perform--l. . . _ �-r ' : .; !� 'plumbingin the / buildings of _-` _ . . . . . . . . . . at. .Z . . �-�`-- !�: v . ., North-Andover, Mass. s,0 --- Fee., .,,,. Lic. No.13. W.. ����<. *ICT�R . . . . . . . . . PLUMBIN Check � �����<r 6256 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or ORTH AIp t). N6ER,MASSACHUSETTS ` ate Building Location -ACAOwners ame /IqbAll I 'd U,q"" Permit Amount Type of Occup y New Renovation Replacement Plans Submitted Yes . No FIXTURES SiB33�4V1C ]ST kLlOC�I2 `.� I♦I1Jf�Ct I 4II�) 9w"M (Print or type) 1 r :Check one: r2 Certificate Installing Company Name A(� (�7/ � 5,64) 1 kc M Corp. 'J Z0 Address24 0 Partner. usftiess Te ep oneq 1 g --ty��t� fpga Firm/Co. -- ►� Name of Licensed.Plumber: t 0'^-%ik3 ku-O-CZ Insurance Coverage: Indicatethe type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnityL-iBondEl Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance .Signature Owner 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 belt 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 Massachusetts State P aybing Code and Chapter42 of General Laws._- BW. Signature oI'l Ices n�P um r Type of Plumbing License Title 0 ' '5-- City/Town (cense UmDer Master F Journeyman 0 APPROVED(OFFICE USE ONLY