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HomeMy WebLinkAboutMiscellaneous - 33 HIGH WOOD WAY 4/30/2018N r' • NORTH ANDOVER, Mass. Dole AU ' �/ • •.Ig ` L- �' Bonding Permit tY3 Locatlon_3 3 N/o�, q KW D V g y < `x Ownees ' Nems New 0 Renovation Q �Ye—�eMTo eAefiKfiNt IST FLOOR &NO FLOOR t)110 FLOOR 4TNPLOOR IT" FLOOR PeTN FLOOR ITN FLOOR eTN FLOOR Replacement 0 Plans Submitted: Yes 0 . No. p FBXTUPE3.....-... ai « « ,, « o Is }• J« b, u K M N Y r O s« 44! az Qhi «= o o s low, 1• s x av i it N. p, :i s Y s j k« s K O• ai 1: .030 10 a a Is IL s• r. ., Installing Company Name—A </ , I� Check one: Certklcale O Address C/Ap CWp, �,v� . ! �� 0 Partnership 116 1 k1 M A l�irm/CO. 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 `-------------- Journeyman, ❑ j jainseail :NNld Ida(] 66i.pp9 :J.HVNVO luebllddV :311HM U0103dSNl ONISVY , ........0, ON �iZ:. `saa3 ss�y� `ianopud WON ... ...... .a�.� 3o s5uip�i.nq ay; ui 2u gwnjd wio3jad Or uoiss►w.iad seq ql N a r W `,.�y�✓nM�Yss`� ,$ S + f t � f JNlgwnld b0:J llWU3d 8 113A00NV H1dON d0 NMOl�°tip ;,laoN' a � ��?r.x"^ �-.wear..e...s.Y•�..a9'-a`�sr..�....J'i;'e—�.44s' u.'��fs :A e"�' �.s"'v�'�'rr" �!,-�t,'�-�£.h'9'ytah:•�d.�"O�ia� 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 r� u (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 ■MENEM IN ME MEN EM MMIMER, MMIMMENNOU •• rrrrrrrrrrrrrrrrrrrrr�rrrr . ... ■rrrrrrrrrrrrrrnrrrrrrrrr .. .. _ rrrrrrrrrrrrrrrrrrrrrrrrrr� ... ■rrrrrrrrrrrrrrrrrrrrrrrrr ... ■rrrrrrrrrrrrrrrrnrrrrrrr • • •- rrrrrrrrrrrrrrrrrrrrrrrrrr .. MONSOON r: ML ... ■rrrrrrrrrrrrrrrrrrrrrrrr■ (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 ..n 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 E- 7 HI 1( . Ll ..ti 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 .