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HomeMy WebLinkAboutMiscellaneous - 33 SHERWOOD DRIVE 4/30/2018N J 0 W � w o Cn = (7 m o J o 0 0 - p O o O < o m AMERICAN CLAIMS SERVICE MULTI -LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 Insured: Nguyen Address: 33 Sherwood Drive North Andover Policy: PHO 0100 62 41 35 Loss Date: April 15, 2015 Loss Type: Ice dams ACS File: 32010 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Ned Grady Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 04/17/15 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 / FAX (781) 245-1077 E-MAIL — daims.acs@verizon.net APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 15. MAP h� LOT NO. I + 2 ` RECORD OF OWNERSHIP DATEBOOK 'PAGE ZONE R` SUB DIV. LOT NO. A 'fmi5i'���/ 84,0S. Iga(,p I3Z!Rq LOCATION 3a !a �p �C� �RtuP - 1 PURPOSE OF BUILDING t] Ci f`F� �JY2��j � OWNER'S NAME NO. OF STORIES "7 !_ SIZE , "r OWNER'S ADDRESS \ - �X �Ua N 1�� BASEMENT OR SLAB f10Seylr�el-j j ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST ax 2ND 3RD BUILDER'S NAME T �, ^ SPAN DISTANCE TO NEAREST BUILDING 1 DIMENSIONS OFFT'SILLS a J e DISTANCE FROM STREET o� �' POSTS 3.IT DISTANCE FROM LOT LINES - SIDES 3-�, Co2 / REAR f/0! GIRDERS 1 ^ S AREA OF LOT coo RX SQ pr FRONTAGE 3TJU / HEIGHT OF FOUNDATION O / THICKNESS IV IS BUILDING NEW 7_�l�Ov SIZE OF FOOTING O /O X `2 1 IS BUILDING ADDITION N MATERIAL OF CHIMNEY m . \ IS BUILDING ALTERATION ' \ IS BUILDING ON SOLID OR FILLED LAND 30L, 1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER" IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CON ORM TO STATE FIRE REGULATIONS PLANS MUST BE FIL P Y B ING INSPECT R s DATE 7 " / SIGNA4trRE O R D AGENT FEE PERMIT GRANTED to O MAY 1 51997 3 PROPERTY INFORMATION LAND COST EST. BLDG. COSTEST. BLDG. COST EST. BLDG. COST PER SQ. FT. CD -2 - EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # CONTR. TEL. # -SS3 CONTR. LIC. # 20 a 42 H.I.C. # t P BUILDING RECORD I 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJALL I UNFIN. 3 BASEMENT_, AREA FULL FIN. B'M'TAREA _ 'h 1/2 % FIN. ATTIC AREA _ N_O BM'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDSB 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I I POOR ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK T' SLATE NO PLUMBING 4" TAR & GRAVEL STALL SHOWER`.."I rr� ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING .� WOOD JOIST A, PIPELESS FURNACE - FORCED HOT AIR FURN. rim TIMBER BMS. 8 COLS. STEAM E r� STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H' UNIT HEATERS . 7 NO. OF ROOMS OI L .. .. r . ­1ci crTDlr 1st 13rd I 11 NO HEATING I I _ FORM U - LOT RELEASE FORM 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. ****************Applicant fills out this section***************** APPLICANT: _COB,F)e/ V ,4/iusz Phone 373- 753 LOCATION: Assessor's Map Number Parcel J� Subdivision J A P E0 1 Lot (s) I q StreetJle-P-U) OO I�RipF St. Number ************************Official Use Only************************ NDATI� S OF OWN AGENTS: d � onservation Administrator Comments To Planner Comments f� Food Inspector -Health pt'c nspe ,or -Health i Comments Date Approved 5/ 1 - ! V Date Rejected Date Approved` Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections ,T� 7 )9 7_ - driveway permit _1216 S 7 27 Fire Department Received by Building Inspector Date MAY 199T- q ` W_ �� 0 0 z O — �NOQ y GOam = C O oEsmo m CI • o O cop N —• z y �.m H 'D =r a n m C � m �O m y O � O OO d o CO) C7 o y' •m O ,� d c H Z y A r a mCL om 06O c7•C-12 . ra o =r. C ^ c CL C• = y n yam : C m N � � C CpD o _ a c o _ ^ � m `a p.p io m Q CD •w "\P _a CD O CD c dv _ oON % .� s cir e! CD CL 0 y ►-� 'o o �s �j y y , 4 ^� _ CD Z.+cn m 9x CD CD 0 CCD CD c o ►'3 J y 0 f� G. O C CD a* Cf) N J y 0 f� G. O C CD N0 722 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 19 Application by the undersigned is hereby made to connect with the town water main in >>Vl e✓��1� �� Street, subject to the rules and regulations of the Division of Public Works. f The premises are known as No. -�:3.3 or subdivision lot no. / 0.17 0 :5 Owner Contractor g ,373-- 753 ArMrocc PERMIT TO CONNECT WITH WATER MAIN l� The Board of Public Works hereby grants permission to ��/ N h S 7 to make a connection with the water main at 154rP1—u11-19G( l J2 Street subject to the rules and regulations of the Division of Public Works. Inspected by Date B rd of Public Works By See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the. Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. !.'-Service connections shall be V type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall 'be' installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug type cover.` � 1. 1/ i Q � � x B t KC2 0 0 7j , ; -477 GO 2S �S5 2-92- S All C ,4.1 kms. �J ' zz r- Y" , t CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 255 Date November 6, 1997 THIS CERTIFIES THAT THE BUILDING LOCATED ON 33 Sherwood Drive MAYBE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Timberland Builders PO Box 907 No. Andover MA 01845 ADDRESS Building I ctor 0 IA Lm . N • o 7 CL, E 9E Me N N C CM 0 cm v m O O) C CD TQC N t w O 2 O 0 4 a Z � CL O h � C I cm CO) o� m m I0 .c CD 16L C O 0 O O d' CL Ir cmQ C 0 � ev 'Q O C Z � O d c C c h :•m C CL C MCC i.: m C J: O R CA 4Z D YO N ' O O _ O O m C oo CD 4/ ECO m m` o Nm� �_� ® c O N ' dC� m O H V .� CL H m H O = 00 a.*' t - '" N H y W CO 4D.2 ��_ MSLL. AIS •� . .. v a�v03 y_ C m� O� a4.3ca E 9E Me N N C CM 0 cm v m O O) C CD TQC N t w O 2 O 0 4 a Z � CL O h � C I cm CO) o� m m I0 .c CD 16L C O 0 O O d' CL Ir cmQ C 0 � ev 'Q O C Z � O d c C c h �' -- Office Use Only 014t &MManwettlo of Maosar4ustas Permit No. 'f z 19epartment of public §tfetg Occupancy & Fee Checked l • u BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 .also (leave blank) t, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK,s All work to be performed in accordance with the Massachusetts Electrical Code, 527; CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date�� (X& or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electricalworkdescribed belo ry L �(—thT �-d' G C Location (Street & NumberL')I � Owner or Tenant Owner's Address �J/r �' `�� �✓ jyP� /�� 0 Is this permit in conjunction with $ building permit: Yes ❑ No ❑ (Check Appropriate ^ Purpose of Building t /� Utility Authorization!�_��S Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets 9 9 No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA __7No. No. of Emergency Lighting No. of Receptacle Outlets of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of ,Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal Other ❑ Connection ❑ No. of Dryers ^1 Heating Devices KW g No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES L' NO C I have submitted valid proof of same to the Office. YES = NO Z If you have checked YES, please indicate the type of. coverage by checking the appropriate box.�� INSURANCE C BOND C OTHER G (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ _ Work to Start Signed under the Penalties of perjury: Inspection Date Requested: 2 Final FIRM NAME LIC. NO. Licensee ew I w Signature LIC. NO. 13Y�'Z r / Bus. Tel. No. y -2 S - Z3-6 Address J AllTel. No. � J/�/o OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insuran a coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Ownqr. Agent (Please check one) ` ,l Telephone No. PERMIT FEE 5 (� (Signature of 0wner or Agent) x-6565 �• sr.4 Date..... + 1673 NORTH °f<'`°.;•�"° -. .. TOWN OF NORTH ANDOVER.05' ' • - PERMIT FOR WIRING A 5 ,SSACNUS� S This certifies that ......... b.Y1........�.................................................. ...t:..:..:. has permission to perform .......&I,P ....!I' �'. p'1. �{.`.! wiring in the building of .. .......f.. .:..,� :`.. ri at .1 - i...1 ........ ...................... . North Andover, Mass. m /1 w, c.� jj �`..: ruu Fee Lic. No. l....�Y.. .........................:......... ......... C ELECTRICAL INSPECTOR' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date.A .... -7 N2 1915 ........2............. NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 7SgACHU This certifies that ...... has permission to perform wiring in the building of ......1........................................... K .1 ....... .............. . North Andover, Mass. at,.%3? ..... V.J.� ...... Fee"Z:RL::-:� ......... Lic. No/'??./!... . ......... �7 — *— EL� A**L* 1* N**S' P*'E* C—T, 0**R"' 10/12/99 12:24 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer !L-� X( • Olke use Only _. , ahc (401nmonwtalt of MUSUC411atts Permit No. 1 !a/-6 19tyariment of Vublic %fttg Occupancy 8 Fee Checked BOARD OF FIRS PREVENTION REGULATIONS 527 CMR 12:00 �J90 peeve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 9/29/99 City or Town of NORTH ANDOVER To the inspector of Wires: The uderelgned applies for a permit to perform the electrl'cal work described below. Location (Street b Number) 33 SHERWOOD DRIVE Owner or Tenant THAN NGUYEN Owner's Address (978) 974-9202 Is this permit In conjunction with 4 building permit: Yes ❑ No ® (Check Appropriate Boit) Puzgose of Building - Utility Authorization No. Existing Servk;e Am Volts Overhead ❑ Undgmd ❑ No. of Meters Amps _. J htew Service • /imps _,_! Wits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Antpacity Location and Nature of Proposed Electrical Work No. of hu Outlets No. of M T1,bs No. of ltunforrnen Ibis! o Lighting . - No. of Lighting Fixtures Swimming Pool A�qrnd,e❑ � ❑ Oensrators KVA No. of Emmency Lighting No. of Receptacle Outwits No. of ON Burners • Baum Ur" No. of Switch Outlets No. of Das Burners FIRE ALARMS No. of Zones No. of Air 'ond. 15W No. of Detection and 7No. of Ranges tons Inidau" Devices No. of Disposals No.d TOW � Tions KW No. of Sounding Dsdces - No. of Self Contained No. of Dishwashers, SpecefArw Heating KW Do c-lorV3ounding Device* Municipal No. of Dryers Heatkq Devices KW Local ❑ Connection ❑ounr No. of No. of LOW lbltape No. of Water Heaters KW 819 Waste vnp BURGLAR ALARM No. Hydro Massage 'Ribs No. of Motors TOW HP OTHER: .INSURANCE COVERAGE.• Pursuant to the requir*msnts of Massachusetts generN Laws - 1 have a current Uabiflty bwxsnoa Paley kwkx tnp Completed Operations Cove"* or its substantial equivalent. YES O NO O 1 haw submitted valid proof of same to the Office. YES O NO O If you haw c wd" YES. please Indleate the type of coverage by ehoddng the appropriate boot. INSURANCE 0; BOND. O OTHER Q (Pleas* SP6d1yi -- - � (Expiration Oats) . � Estimated Value of 214.00 Work s 10/1/99 Wbrk to Start 9/28/99 • Inspection Date Requested: Rough Final Signed under the Penalties of perjury: 1 t r FIRM NAME UC. NO. Ucensee Donald A- Arnnlcrt Signature uc. No.. 123u' Bus. W. No. Address 111 Mora& Street Norwood, MA AII. W. No. OWNER'S INSURANCE WAIVER: 1 am aware that the License+ doe* net have tin Insurmw4 *overage or Me substantial equivalent as re• qulred by Massachusetts General Laws. and that my sipnature onth►— s perno application waives this requkertnnl. owner AO" (hers* chock one) .. Tolephon No. �_ PERMIT FEE t _35.0 _ r3lenuur•_d Owna._or AaoM1 •.ntltS %MASSACHUSETTS UNIFORMAPPLICATION 'PLUME1 IT JD0 (Type or Print) NORTH ANDOVER Mass. Date: ­ Building Locations 3 S4eOLj'oo fD. Permit V.,V-7/i Owners Name 'r(/ 79e4PP-D New Q Renovation Replacement Plans Submitted 9, 7`- F T UREq ip (Print or Type) Check one: icate" 7- p - Installing Company Name kli& 1Y ror M Cor Address 31 Partner. 11,0_14t ag Firm/Co. Business Telephone Name of Licensed Plumber: z - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy `--t-'Other type of indemnity Bond 0 Insurance Waiver: 1, the undersigned, have been made aware that the licensee of 1"! this application does not have any one of the above three insuronce coverages. Signature of owner/agent of property Owner E] Agent"ti,.o I hereby certify that all of die details and information I have subiniticd (or entered) in atmove application are true and 4rugatc to thc best of Inv knowledge and that all plumbing work and installations lictformcd under reentit ksucd for this application will be in costoptiance with all pcglinefit rsa.,4 witiOns of the Massachusetts State Plumbing Code and chapter 142 of die General Laws, B Title. Signature of Licensed Plumber4. CitTown: �2 16C)<(Xype of Plumbing License �je Y/ f.LAPPROVED TOFFICE USE ONLY) License Number ❑ Master Journeyman z X Zz 0 a Z -C z IIA 44 54 Z cc 0 a. CC 0 A W ;i to X Z- CC 0 t2 a cc 93 4 tt W >- < ja All Z CC a 0. .4 03 cc 9L w. 0 -8 6 cc ILI W X W 03 0 0 x. 0) cc 1- j 93 X .11- 40 0ai CL W X X CL 0 0 Q 0 W0 0 < o A J a cc cc 1%; 0 4 40 U. 0 = 0 SUB— q3smT. 1 T - BASEMENT to 1ST FLOOR 2ND FLOOR L3 A 31113 FLOOR 4TH FLOOR 77 7 STH FLOOR 6TH FLOOR 7TH FLOOR 13TH FLOOR'l—n (Print or Type) Check one: icate" 7- p - Installing Company Name kli& 1Y ror M Cor Address 31 Partner. 11,0_14t ag Firm/Co. Business Telephone Name of Licensed Plumber: z - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy `--t-'Other type of indemnity Bond 0 Insurance Waiver: 1, the undersigned, have been made aware that the licensee of 1"! this application does not have any one of the above three insuronce coverages. Signature of owner/agent of property Owner E] Agent"ti,.o I hereby certify that all of die details and information I have subiniticd (or entered) in atmove application are true and 4rugatc to thc best of Inv knowledge and that all plumbing work and installations lictformcd under reentit ksucd for this application will be in costoptiance with all pcglinefit rsa.,4 witiOns of the Massachusetts State Plumbing Code and chapter 142 of die General Laws, B Title. Signature of Licensed Plumber4. CitTown: �2 16C)<(Xype of Plumbing License �je Y/ f.LAPPROVED TOFFICE USE ONLY) License Number ❑ Master Journeyman - 3471 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . 1A,, f.'.( <. F. - ... (i 4� .c. !'� ?�j'' ......... g has permission to perform .../A, f .. (`r� !�'^ �........... . . . � plumbing in the buildings of ......... . . at. . 135.� e%:: t, -s-.4 x�,. c ............. , rth Andover, Mass. Fee -'/0...- .. Lic. No.d. !. U .`% . vi r. PLUMBING INSPECTOR g' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer (Print of Type) " ^` "'�` rvry 1 -VH PERMIT TO DO QASFITTINQ NORTH ANDOVER c� .Mass. Date g Locatlo, Permit # Locatin ��� c S� �i��d o � Owner's Name T7 -')Li 3 7D eq New Renovation p Replacement t7 Plana Submitted:. Yes Q No Q sun—ssMT. • •ASEM,kNT 1sT FLOOR irrO.FLOOR 311 FLOOR ITH FLOOR STH FL0011 4TH FLOOR 7TH FLOOR STH FLOOR '. Installing Company Name G✓f1/� A� �J ye�jt�/ � dco Check one: Certificate Address 21 P/,Tre o (3i Q Corp' d Partnership p Firm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE:Check one 1 have a current liability Insurance policy or its substantial equivalent. Yes O If you have checked yea, please Indicate the type coverage by checking the appropriate boxNo O A liability Insurance policy `` Other type of Indemnity D Bond D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hay® the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature on this permit applicallon waives this requirement. Check one: Signature of Owner or Owner's Agent Owner D Agent D I hereby certify that aq 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 Installallons performed under the pewi pertinent provisions of the Massachusetts Slate Gas Gbd nd of enrmit Issued for this application 11 be M oom Ilan wl eY Title Clty/Tgwn IIPPr1 mo (OFFICE USE ONLY) e a Chapter 112 the Geral LAWS. p a lh all T of License: PPlumber GasOtler gna uta o cense um er or aseI r Master Journeyman Lkense Number 2i0 0 bi tl K J h h W ! O >< p V to p �' Z M Z Z N p tl« p M Z < W a• M _ h .. _ 0 s >< h et ' M 01�- id r J x F '. N tl O yam, MM U J .Z 1 's o d o v 0 w� s��„ sun—ssMT. • •ASEM,kNT 1sT FLOOR irrO.FLOOR 311 FLOOR ITH FLOOR STH FL0011 4TH FLOOR 7TH FLOOR STH FLOOR '. Installing Company Name G✓f1/� A� �J ye�jt�/ � dco Check one: Certificate Address 21 P/,Tre o (3i Q Corp' d Partnership p Firm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE:Check one 1 have a current liability Insurance policy or its substantial equivalent. Yes O If you have checked yea, please Indicate the type coverage by checking the appropriate boxNo O A liability Insurance policy `` Other type of Indemnity D Bond D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hay® the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature on this permit applicallon waives this requirement. Check one: Signature of Owner or Owner's Agent Owner D Agent D I hereby certify that aq 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 Installallons performed under the pewi pertinent provisions of the Massachusetts Slate Gas Gbd nd of enrmit Issued for this application 11 be M oom Ilan wl eY Title Clty/Tgwn IIPPr1 mo (OFFICE USE ONLY) e a Chapter 112 the Geral LAWS. p a lh all T of License: PPlumber GasOtler gna uta o cense um er or aseI r Master Journeyman Lkense Number 2i0 0 149633 Date.. � . �..�.. f NORTH 1 TOWN OF NORTH ANDOVER py`,.to ,e tiOL p PERMIT FOR GAS INSTALLATION 9SSAcmUSE f` This certifies that 1 �-2 r:...D�4 ........... . has permission for gas installation ...! e ...0 .... in the buildings of .................�. at �. S1f.` �Z .�. G �........... , North Andover, M.. Fee.. j, Lic. No..'.�`f..b....... . AS -INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 48 f ✓'V / Date. ......... ...... _.: ,�pRTM TOWN OF NORTH ANDOVER r3: ' PERMIT FOR GAS INSTALLATION W /' • °oma _, . 7 `/.. . �� V ` � This certifies that ..1`:. f ................ r _ S has permission for gas installation .f- " . ........... . in the buildings of :.0 r> ..................... tv " at North/Andover, Mass. Feed .`.. Lic. No��7G ..... ...... GAS INSPECTOR . WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MAP Z � �� j ��� • � � D� _ 74:2 4ASSA CATON FOR PERNQT TO DO GAS FMING or print) Date 19 1vUKIH ANDOVER, MASSACHUSETTS Building Locations ��-1Z�.xx"� K� V` Permit #� Owner's Name New ❑ Renovation ❑ Replacement ❑ Amount S Plans Submitted ❑ (Print or type) Name Name of Licensed Plumber or Gas Fitter R - . Check one: Certificate Installing Company ❑ Corp. armer. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ 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: Signature of Owner or Owner's Agent `�` Owner ❑ A2ent ❑ I hereby certify that all of the details and information l have submitted (or entered) i • ab e application are true and accurate to the best of my knowledge and that all plumbing work and installat' F%rme n�e.DPe it Issued for this application will be in compliance with all pertinent provisions of the Ivlassachus s Stat as a II at) r 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Li`:c`� ed Plumber Or, Gas Fitter Plumber. l VAP 'i fEl-Gas Fitter License i umoer Master Journeyman