HomeMy WebLinkAboutMiscellaneous - 327 FOREST STREET 4/30/2018f, ASSACHUSc'i i S UNIFGFt1,4 ArrLiC;i i iGl i r GrS i=nl �l i TO GO r. ;�i ► ► ii:G ' J
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Building Location Owner's Name
Type of Occupancy
New Renovation 0 Replacement p Plans Submitted: Yesp No p
Installing Company Name r?.stern Pro -ane C•'. s .T. ;, C Check one: Certificate
Address
131 Wa t e?: Street A Corporation
Dative r n, ? f 01923 p Partnership
Business Telephone (50,0)) 4 —1930 0 F(iirrm/Co.
Name of Licensed Plumber or Gas Fitter e A V14— A 1y f T 1`C�
INSURANCE COVERAGE:
have a currknt liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No O
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability insurance policy A Other type of indemnity E3 Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
OwnerO Agent O
Signature of OA•ner or Owner's
1 hereby certiy that all of the details and i ormztion I have submitted (or entered) in above application are true and accurate to the best of my
kncw;edge and !`gat all plumbing work and insiaCations pe formed undsr the permit issued for this application will be in compliance with all
pertinenf provisions of the Massachusetts State Gas Code and Chapter 142 of the Gneral Lzws.
By
Tie ct Umnse: ,(C1l
';1Plu,-ber Signature of Ucens2d lumber or Gas Fitter
Title ,:��•Gasf tler
Master License Number
City/Town b Jour-,Ey^an
APP lora IC US ONL
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Installing Company Name r?.stern Pro -ane C•'. s .T. ;, C Check one: Certificate
Address
131 Wa t e?: Street A Corporation
Dative r n, ? f 01923 p Partnership
Business Telephone (50,0)) 4 —1930 0 F(iirrm/Co.
Name of Licensed Plumber or Gas Fitter e A V14— A 1y f T 1`C�
INSURANCE COVERAGE:
have a currknt liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No O
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability insurance policy A Other type of indemnity E3 Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
OwnerO Agent O
Signature of OA•ner or Owner's
1 hereby certiy that all of the details and i ormztion I have submitted (or entered) in above application are true and accurate to the best of my
kncw;edge and !`gat all plumbing work and insiaCations pe formed undsr the permit issued for this application will be in compliance with all
pertinenf provisions of the Massachusetts State Gas Code and Chapter 142 of the Gneral Lzws.
By
Tie ct Umnse: ,(C1l
';1Plu,-ber Signature of Ucens2d lumber or Gas Fitter
Title ,:��•Gasf tler
Master License Number
City/Town b Jour-,Ey^an
APP lora IC US ONL
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TOWN OF NORTH ANDOVER
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Certificate of Occupancy $ EE
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $- !P
Water Connection Fee $
TOTAL $
Building Inspector
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Div. Public Works
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FORM U - LOT RELEASE FORK
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.1/7-72
****************Applicant fills out this section*****************
V'APPLICANT:SLS l o AE Phone ,S'6(5- /2
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
,/Street ��� }- St. Number
******************Official Use Only************************
RECO DATIONS OF TOWN AGENTS:
✓conservation Administrator
Comments
Date Approved
Date Rejected
Date Approved
Town Planner Date Rejected
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
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