HomeMy WebLinkAboutMiscellaneous - 33 HIGH WOOD WAY 4/30/2018N
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• NORTH ANDOVER, Mass. Dole AU ' �/ • •.Ig ` L- �'
Bonding Permit tY3
Locatlon_3 3 N/o�, q KW D V g y < `x
Ownees '
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New 0 Renovation Q
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IST FLOOR
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t)110 FLOOR
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IT" FLOOR
PeTN FLOOR
ITN FLOOR
eTN FLOOR
Replacement 0 Plans Submitted: Yes 0 . No. p
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Installing Company Name—A </ , I� Check one: Certklcale
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Address C/Ap CWp,
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. ! �� 0 Partnership
116 1 k1 M A
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Business Telephone Lfy•,�
Name of Ucensed PlumberT G 4141�&,4
INSURANCE COVERAGE:
1 have a current IIabN Insurance cy ec one
NY poll or No substsnIW equlvalenL Yes 0 No 0
If you have checked M, please Indicate the
type coverage by checking the appropriate box
4 A IIabINy Insurance pdtcy Other type of Indemnity C] Bond Q
OWNER'S INSURANCE WAIVER: I im aware that the 1lceni
Chapter 142 ee does not have the Inaurince coverage ^required by
d the Mass. General and that my algnalure on this
perynit ap Wectt o e�• es
Ch n
a ore o K. « area an Owner 0 Agw*, 0.
hereby evilty that IN of the detaAa and Inlormatlon I have eubmltiAd lot enlNed) ti above
Irwwfed�e and that aN plumbing wak and InsloNattona parformdd under the penM lewd bin ate bua.aadaexKatalaWabEea4ot:p�y►_
pertlnen provlsbns of the Mauachuratta Slat. Plum aDPNcatbn wiN be.h aompRana with aN
Plumbing cod. and Chapter t12 of VW G"ai�ALA".
Title no We
dtylTown Uanse Number 19-d •'t J�
M bWD (OFFICE USE ONLY) Type of Plumbing Uanse: Hasler
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Journeyman, ❑
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t
(Print or Type)
C NORTH ANDOVER Mass. Date
building Location _33 /yIk-O l 6W) W4 L Permit # 2 U
• Owners Name ,5/<
• = New 77 Renovation Replacement Plans Submitted D
FIXTURES
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(Print or Type) - Check one: Certificate
Installing Company Name, Pot 41, V- y 7-6� Corp.
Address 5:3 r/y Partner.
rm/Co.
Business Telephone: SBS
Name of Licensed Plumber or Gas Fitter ®��{/ f`%, /r'it� jfz99A/T"af.�1
Insurance Coverage: Indicate the type of insurance coverage by checking the
app opriate box:
Liability insurance policy �ther type of indemnity Q 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 coverages.
Signature of owner/agent of property Owner F� Agent M
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 fo: this application will -be In compliance with all pertinent
Provisions of tho Massachusetts State Cas Code and ChApter 142 of tho General Laws.
By
Title
City/Town:
APPROVED (oFFicE USE ONLY)
TYPE LICENSE:��—
Plumber z I j 9-, 67�
Gasfitter Signature of Licensed
aster Plumber or Gasfitter
Journeyman kd-11 S'^
License Number
Y
Y
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MMIMER,
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(Print or Type) - Check one: Certificate
Installing Company Name, Pot 41, V- y 7-6� Corp.
Address 5:3 r/y Partner.
rm/Co.
Business Telephone: SBS
Name of Licensed Plumber or Gas Fitter ®��{/ f`%, /r'it� jfz99A/T"af.�1
Insurance Coverage: Indicate the type of insurance coverage by checking the
app opriate box:
Liability insurance policy �ther type of indemnity Q 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 coverages.
Signature of owner/agent of property Owner F� Agent M
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 fo: this application will -be In compliance with all pertinent
Provisions of tho Massachusetts State Cas Code and ChApter 142 of tho General Laws.
By
Title
City/Town:
APPROVED (oFFicE USE ONLY)
TYPE LICENSE:��—
Plumber z I j 9-, 67�
Gasfitter Signature of Licensed
aster Plumber or Gasfitter
Journeyman kd-11 S'^
License Number
04Date .. r�,/���,�'..7........ .
A
HORTM TOWN OF NORTH ANDOVER
pF4ao ,e,'t'O
° `p PERMIT FOR GAS INSTALLATIONui
�9SSACHUSEt M �.
N
CU
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This certifies that .. A• j(?� ti. P G• • •
o
has permission for gas installation .� i? H'.�!. c • •-. !! • • • • • o
in the buildings of ............................ .
at ... 33 AY?. N�h Andover, Mass.
Fee.. ? .... Lic. No J. �.) ... .. , ..... �� ...... .
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
L -T
lz�l
1�7
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HI
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No
17911111mmi
4
NOpTIy
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15.354
OF .THE STATE ENVIRONMENTAL CODE, TITLE V
TEL. 682-6483
Ext 23
This form must be submitted to the Board of Health no less than
five (5) days prior -to date of abandonment and be accompanied with
a copy of the sewer connection permit.
Name Phone
Address zz: CAI- U j oo d Walz
Contractor hired for work:
Name Phone
O
Address-e-lLCJaT t 5�--
Date for scheduled abandonment
Method of septic tank abandonment (check one).
( ) removal ( ) sandfill crush
Other
( ),other (describe
below)
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
pe ting Agent Date
Comments
Na 1094
APPLICATION FOR SEWER SERVICE CONNECTION
`�
North Andover, Mass. i� f 19 l�
j�
Application by the undersigned is hereby made to connect with the town sewer main inCGt tt>�X%l C Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. Cf it, ci Street
or subdivision lot no. J
Owner Address .
Contractor Address
i
Applica o s Signatu
i3.
OFI� fel
J �
C-.,) AZ49�?✓,4ToA-i
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
By
See back for rules and regulations
Street
Division of Public Works .