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Miscellaneous - 34 SARGENT STREET 4/30/2018
♦t Air (603) 894-6465 (800) 621-1189 (603) 894-7044 FAX June 6, 2014 23 Hall Farm Road Atkinson, NH 03811 North Andover Health Department 146 Main Street North Andover, MA 01845 Dear Sir: Asbestos Removal Residential -Commercial -Industrial AirQualityExperts@AQENH.com RECEIVED JUN 12 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Enclosed please find a copy of notification sent to the state for an Asbestos Abatement Project. The job will take place on June 21, 2014. Project: Theresa Paris 34 Sargent Street Any questions concerning this matter should be directed to my attention. Sincerely, Christopher Thompson President Commonwealth of Massachusetts Asbestos Notification Form ANF -001 k A. Asbestos Abatement Description 1. Facility Location: THERESA PARIS 34 SARGENT STREET Name of Facility NORTHANDOVERj MA City/Town State THERESA PARIS Facility Contact Person Name Worksite Location: 2. Is the facility occupied?1✓ Yes F No Street Address 01845 9786836285 Zip Code Telephone OWNER Facility Contact Person Title BASEMENT 100200831 Asbestos Project # F Project Revision JUN 12 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMI=nrr Building Name, Wing, Floor, Room, etc. Instructions 1.. All sections of this form 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility, or must be completed in owner -occupied residential property of four units or less)? 171 Yes F No order to comply with MassDEP notification 4. Blanket Permit Project Approval, if applicable: requirements of 310 CMR 7.15 and Approval ID # Department of Labor Standards (DLS) 5. Non -Traditional Asbestos Abatement Work Practice notification Approval, if applicable: Approval ID # requirements of 453 CMR 6.12 6. Asbestos Contractor: AIR QUALITY EXPERTS INC 23 HALL FARM ROAD 2. Submit Original Form To: Commonwealth of Massachusetts Asbestos Program P.O. Box 120087 Boston, MA 02112- 0087 Name ATKINSON City/Town AC000167 DLS License # 7. JOSUE NAZARIO Name of Contractors On -Site Supervisor/Foreman 8. Name of Project Monitor 9. Name of Asbestos Analytical Lab 10. 6/21/2014 Project Start Date (MM/DD/YYYY) miler NH State Address 03811 6038946465 Zip Code Telephone Contract Type: 17 Written F Verbal AS001124 DLS Certification # N/A DLS Certification # N/A DLS Certification # 6/21/2014 End Date (MM/DD/YYYY) -WA -1 _SPM Work Hours - Monday Through Friday Work Hours - Saturday & Sunday 11. What type of project is this? F Demolition W Renovation F Repair F Other - Please Specify: Revised: 11/13/2013 Page 1 of Commonwealth of Massachusetts � 002o0ai' Asbestos Notification Form ANF -001 E Asbestos Project # F Project Revision (— Project Cancellation A. Asbestos Abatement Description: (cont.) 12. Abatement procedures (check all that apply): I✓ Glove Bag I— Encapsulation F Enclosure 1— Disposal Only F Cleanup F Full Containment F- Other - Please Specify: 13. Job is being conducted: % Indoors F Outdoors 14. Total amount of each type of asbestos Containing materials (ACM) to be removed, enclosed, or encapsulated: 8 0 Linear Feet (Lin. Ft.) Square Feet (Sq. Ft.) Boiler, Breaching, Duct, Transite Pipe Tank Surface Coatings Lin. Ft. Sq. Ft. Lin. Ft. Sq. Ft Pipe Insulation 8 Transite Shingles Lin. Ft. Sq. Ft Lin. Ft Sq. Ft. Spray -On Fireproofing Transite Panels Lin. Ft. Sq. Ft Lin. Ft Sq. Ft. Cloths, Woven Fabrics Other - Please Specify: Lin. Ft. Sq. Ft. Insulating Cement Lin. Ft. Sq. Ft Lin. Ft Sq. Ft 15. Describe the decontamination system(s) to be used: GLOVE BAG PROCEDURES 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): WET 2 PLY POLY 17. For Emergency Asbestos Operations, the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Title of MassDEP Official Date of Authorization (MM/DD/YYYY) Waiver # Name of DLS Official Title of DLS Official Date of Authorization (MM/DD/YYYY) Waiver # 18. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this f Yes i✓ No project? Revised: 11/13/2013 Page 2 of 4' Commonwealth of Massachusetts 100200831 4 Asbestos Notification Form ANF -001 Asbestos Project # F Project Revision F Project Cancellation B. Facility Description 1. Current or prior use of facility: RESIDENTIAL 2. Is the facility owner -occupied residential with 4 units or less? F Yes F No 3. THERESA PARIS 34 SARGENT STREET Facility Owner Name AdNORTH ANDOVER MA 01845 9786836285 City/Town State Zip Code Telephone 4. THERESA PARIS 23 SARGENT STREET Name of Facility Owner's On -Site Manager AdNORTHANDOVER City/Town 5, AIR QUALITY EXPERTS INC. Name of General Contractor AdATKINSON City/Town N/A Contractor's Worker's Compensation Insurer MA State 01845 9786836285. Zip Code Telephone 23 HALL FARM ROAD NH 03811 6038946465 State Zip Code Telephone N/A 1/1/2015 Policy # Expiration Date (MM/DD/YYYY) Note: Temporary 6. What is the size of this facility? 0 0 storage of Asbestos containing waste material is only Square Feet # of Floors allowed at the place C. Asbestos Transportation & Disposal of business of a DLS licensed Asbestos 1. Transporter of asbestos -containing waste material from site of generation: contractor or a transfer p g station that is permitted by F Directly to Landfill or F To Temporary Storage Location/Transfer Station MassDEP and operated in AIR QUALITY EXPERTS, INC. 23 HALL FARM ROAD compliance with Solid Waste Regulations Name of Transporter Address 310 CMR 19.000 ATKINSON NH 03811 6038946465 City/Town State Zip Code Telephone 2. If a temporary storage location/transfer station is used, list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: SERVICE TRANSPORT GROUP, INC. Name of Transporter BRISTOL City/Town PO BOX 2132 Address PA 19007 State Zip Code 8779999559 Telephone Revised: 11/13/2013 Page 3 of 4 Note: Contractor must sign this form for DLS notification purposes Commonwealth of Massachusetts j 100200831 Asbestos Notification Form ANF -001 Asbestos Project # r- Project Revision F Project Cancellation C. Asbestos Transportation & Disposal: (cont.) 3. Name and address of temporary storage location/transfer station for the asbestos containing waste material: SERVICE TRANSPORT GROUP, INC. Temporary Storage Location Name WOONSOCKET City/Town 28 PRIVILEGE STREET Address R 02895 State Zip Code 4. Name and location of final disposal site (asbestos landfill): MINERVA LANDFILL N/A Final Disposal Site Name 9000 MINERVA ROAD Address WAYNESBURG City/Town A Certification "I certify that I have personally examined the foregoing and am familiar with the information contained in this document and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including possible fines and imprisonment. The undersigned hereby states, under the penalties of perjury, that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 4017661824 Telephone Final Disposal Site Owner Name CH 44688 State Zip Code CHRISTOPHERTHOMPSON Name PRESIDENT Position/ Title 6038946465 Telephone 23 HALL FARM ROAD Address Ni State 3308663435 Telephone CHRISTOPHERTHOMPSON Authorized Signature 6/6/2014 Date (MM/DD/YYYY) AIR QUALITY EXPERTS, INC. Representing ATKINSON City/Town 03811 Zip Code Page 4 of 4 Date .V-.klo ........... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies thal�. has permission to perform ....... ......... t .... plumbing in the buildings of. -16,!466 .................................................... at .... ....... ........ North Andover, Mass. 'AclM Fee ..... Lic. No. 2 ..........-1 ...........0 ..........4-r .............................................................. PLUMBING INSPECTOR Check # 2- `- -cx MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - _ CITY .. �` SS1-°"i - - _ _ _I MA DATE �-�.i') • PERMIT # JOBSITE ADDRESS y._ �f_A_. . __._. OWNER'S NAME OWNER ADDRESS - - !J A -f _ - - --- _ _ . TEL - i FAX i TYPE OR OCCUPANCY TYPE COMMERCIAL F-3 ED ATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT: _I PLANS SUBMITTED: YES F--j NO[] FIXTURES 7 FLOOR-4 Bsm 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB __. J i —. __ _:_ _____ .....,...! _ ___ _ _ I ___-- .-------- _._. -CROSS CROSSCONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM I DEDICATED GREASE SYSTEM - -J DEDICATED DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM __-! DISHWASHER._..___J DRINKING FOUNTAIN _ ' - - - - - .... - - - - - -� - - - - FOOD DISPOSER FLOORIAREADRAIN INTERCEPTOR INTERIOR KITCHEN SINK' - ----J --- - --I LAVATORY ROOF DRAIN SHOWER STALL I SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES tt WATER PIPING ' I I -- ---- ` ---I — - OTHER .._....._............-_...-------_-__.._.._----- - - -= --= -- -- - - - - . _ -------. I F-71. .. INSURANCE COVERAGE: I have a current Iiability nsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES, PLEASE INDICATE T TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY -_I OTHER TYPE OF INDEMNITY 0 BOND Q OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massach etts Gen ral Laws, and that my signature on this permit application waives this requirement. 11 1 CHECK ONE ONLY: OWNER [3 AGENT [] SIGNATURE OF OWNER OR AGENT I hereby Ortily that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. PLUMBER'S NAME .-.- _. ___......_ . _.. - ___._ -i LICENSE# `fa7..__ SIGNATURE MPEI JP - I CORPORATION E0141 PARTNERSHIPEI# _ _.._......_...___' LLC Eb COMPANY NAME ADDRESS CITY - 0'J" -- STATE ZIP ©3©3��-.._._..__.._ TEL FAX W CELL S �+`'l EMAIL 0 v,� AV? ` - The Commonwealth of Massachuseifs �J Departm nt of jndustr!g1 Acddiiks office of Investigations 600 Washington Street Boston, MA 02111 wimmass govldia Worker$' Compensation bsuranceAfridavit: Buffdens/Cony°actors/.EXectlLiciansfPlumbers •o*f-- no 'nw;,,-• T .pMhY, N'am.e (Businesslorgani'zation&dividual):^_�, A sa ,,. Q 7:)—. �5 1/`�\. City/State/Zip: V\6k-ro , ~I Phone #: 62D3 Are you an employer? Check the appropriate box: 4. ❑ I am a general, contractor and I 1, I a employer with �(_ m to ees full and/orpart-time).have hired the sub -contractors 2. I am a sole proprietor or pazaer- listed on the attached sheet. r These sub -contractors have ship and'have no employees working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their required.] 3. 1 am a homeowner doing all work right of exemption per MGL myself. [No workers comp. c. 152, §1(A•), andwe have no employees. To workers' P insurance required.] i comp. insurance required.] ()S - DIS Type of project (required): 6. [] New construction F 'i. ❑ Remodeling 8. ❑ Demolition 9. [] Building addition 10.❑ Vectdc,al repairs or additions 11. Plumbing rep airs or additions 12,E] Roof repairs 13.❑ Other ,Any applicant that checks boxil must also fill outthe section below shov>heir workers' compensation. policy information. i -Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. rContractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. _ram cue employer that is pr oviding woMers' compensation insurance for my emTkees:.Se%w is the policy anti joh site information. Insurance Company Name:. Policy # or Self ins. Lic. #: ExpirationDate Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil: penalties in the form of a STOP WORK ORDER. and a fine ofup to $250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office -of Investigations of the DIA for insurance coverage verification. X do Iiereby c ti uncle pains aytcl penalties ofpePjury that the information provided above is e and correct Date: Z// _QianafiirE:` . Phone #: V (V O Official use only. Do not write in this area, to be completed by city or town official. City orTa Town: Permit/License # Issuing Authority (circle one): 1. Board, of Health 2. Building Department S. City/Town Clerk �• Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person' Phone M. Informa%on and Instructions ` Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as ",..every person in the service of another under any contract of hire, express orimplied, oral or -mitten." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two ormore of the foregoing engaged in a joint enterprise, and including the legal representatives of a -deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than tree apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not b ecause of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local Heensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its poliiicalsub divisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and Phone number(s) along with their certiacate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If au LLC or LLP does have employees, apolicy isrequired. Be advised that this affidavit maybe submitted tothe Department of Industrial Accidents fol con5niation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumedto the city or town that the application for thepermit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town. Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the, bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number, In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if nocessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid aifzdavit is on file for kture permits or licenses. A new affidavit must be fillgd out each year. Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The OfEce of Investigations would like to thank you in advance for your cooperation and shQuld you have any questions, please do not hesitate to give us a call, The Department's address, telephone aind fax number: Tho Commonwealth ofM:assarhwottq DepartmeAt dkdmWal Aacidenta Qf co oflnveaiigatxona 60 WaM w B eet Boston. SIA 02111 Tel # 617-7.27n4900 eyt 406 or. 1 -$77 -;MAMBA E Revised 5-26-05 Fax # 617"727"7749 wwwmm-.gex/dia. l � L t 1� s 1% 1) ,��� Date ... . ..... . .......... I ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatt Int iVQ/1 n1 ...................... .................... —Q .0-. .. U, . S . 4 ........................................ ... ........ .... .... .... has permission to perform ........ ....... r-e..Yy ... '�.Ip . ....................... --7 . ... ... ... Lk Q ........ wiring in the building of ...... at ......... ............................................ -gNorth Andover, .......... ss... Fee............ Lic. No... .. .... .... BLEINSPECTOR Check, `�7 h 12 97 0 6P4 t510-V� iv Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Z� Occupancy and Fee Checked [Rev. 1107]. . (leaveblank APPLICATION FOR PERMIT TO PERFORM .ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL )7FORMATION) . Date: City or Town of: NORTH ANDOVER .' To the Inspector of Wires: - By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 4 -S onc4 e/* & k Owner or Tenant 6 f"I'Ck Owner's Address Is this permit in conjunction with a permit? Yes ❑ No ❑ Telephone No. ?�,'3 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: J'A n4-4, I rY4IQ Kr i64 -P/7 Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Com letion o th Il bl b OR No. of Recessed Luminaires e o owin No. of Ceil: Susp. (Paddle) Fans to a ma a waived b the Ins ector o Wrres. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o mergency ig mg rnd. rnd. BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number Tons KW........... No. of Self -Contained Totals: Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Devices No. of Water No. 0.0 or Equivalent KW Si Bal as Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs f No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Atracn additional detail f desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: I QYQ (When required by municipal policy.) Work to Start: f C, N Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAG : 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 undersigned certifies that such co erage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 3 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and pe alties ofperjury, that the information on this application is true and coriptete. FIRM NAME: l �(�-t,t(� c t LIC. NO.: -• jP Licensee: Signature LIC. NO.: (If applicable, nt r "exeir�t" in the license number lin .) Bus. Tel. No.•�IO^�� *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ -- • FI EcCMCAL PERI ffT NO. E rEL.LML-C-L INSPECTOR — — I. P10 CTION; Passed ] E+"ailed--[ ] �e-inspectzon xegauXecT($50A0) � j � inspectors' co wits: " 11 A _ y • 5. (Xuspectors igna a -no mitrals) _ Date 2. �xrrr�Jrr�PJ1 Txoz�; - - PasseaL() J+ailed—j ] Reluspectimrequired ($50.00)-[ f luspectors' co eats: pectors' gna r •-no in:ztials) Jute 3. TMERGROD JNSPECTION.' Passed--(] Faued--j ] ReAuspectiou.required ($50.00)-j ] Xnspeetors' co=ents: (Inspectors} Signature -• no initials) Date I) O OR. TAG,5 ARE TOBE MUD OUT AND LUT ON RME W THE A.PXA- TO BE INSTECTED IS NOT A.CCEMBLE AND .ARE 3USPECTION OF M50.00 18 TO BE CHARGED. *. /� .The Commonwealth of Massachusetts - Department o,fIndostriglAcczdents 0.2 Office of Investigaidons 600 Washington Sheet Boston, MA 02111 k1i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractoxs/EX PleasePrintumb r ,Applicant Xnformation Name (Businesslorganization&dividual): ,A.ddress: I � �' /4( Y/if� s� City/Sia�elZip: /1,7 /,1- Phone #•�� �� �� ��! Are you an employer? Check the appropriate box: 1. ❑ I am a employer with -________ 4. I am a general contractor and I have, Nixed the sub -contractors employees 0u11 and/or part-time)-* listed on the attached sheet. 2.I am sole proprietor or partner ship and have, no employees These sub -contractors have working forme in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. ansirauce officers have exercised their required.] 3. ❑ Z am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no employees. [No workers' insurance required.] comp. insurance required.] Type o£project (required): 6. [] New construction F 7. [] Remodeling S. ❑ Demolition 9. [] Building addition lo.❑ Electrical repairs or additions ILL] Plumbing.repairs or additions 12.[] Roofrepairs 13.❑ Other 'Any applicant that checks box#i must also fill outthe section bel6w showingtheir workers' compensation policy information. T Homeowners who submit flys affidavit indicatingthey ace doing all work and then hire outside contractors must submit anew affidavit indicating such. J tcontraaors that eheekthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information- In am an employer that isproviding workers' compensation insurance for my employees: Below is the policy a`tti job site information. Insurance Company Name: Policy # or Self ins. Lic. #: Expiration Date: Job Site Address: SG!(- — City/State/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one7-year imprisonment, as well -as civil- penalties in the form of a STOP WORK ORDER. and a fine ofup to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. • 1,10 Hereby certo under flims and penalties ofperjury that the information provided above is true and correct, - !f M official use only. Do not write in tliis area, to be completed by city or town official. Permit/License # City or Town. Issuing Authority (circle one): 1. Board of Health 2.. BuiidingDepartment 3. City/Towo Clerk 4. Electrical Inspector 5. Plrrmbinglnspector 6. Other. r Contact Person: Phone 0: Information and Instructions ' 1 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, - express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other Iegal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a•deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having riot more than three apartments and who resides therein, or the occupant ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings is the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill, out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addresses) and phone numb or(S) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LL C or LLP does have employees, apolicyis required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fog confvmation of insurance coverage. Also be sure to sign and date the affidavit. 'he affidavit should be returnedto the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Departmenthas provided a space atthe bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number whichwill be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) and under "fob Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone anal fax number: The Commonwealth of1V_ra=9,dhvsPt Departmut cfh?ftWal AAceldwta office ofIni. cAigatio u'a • 604 WWWoa fted BmtQn, 02111 Tel, # 617-`-27_4900 at 406 ox I-&7`-MASSAFF, Revised 5-26-05 Fax # 617-727-7749 MONWEALTH OF Date. TOWN OF NORTH ANDOVER s PERMIT FOR GAS INSTALLATION This certifies that f imp ... ........ ........... . has permission for gas installation f-eplera ..66ie......... . in the buildin s of ... P/.k2 t .............................. . at .. ... ✓�! . 4.......... , North Ando er, ass. Fee 0:..... Lic. No. '�.N ... Mo `GAS INSPECTOR Check # I T7 8218 FRYOLATOR if FURNACE GENERATOR __jj GRILLE - - - - - - ..... INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT L.-.- JA A OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT L TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER E�--- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES 12NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY E] BOND Fil OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E] AGENT DJ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are t nd ac urate to the best of rxy knowledge ill be in 'r'p- r and that all plumbing work and installations performed under the permit issued for this application %h c i a- �nnn) e all Perti nt Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME j-; f, e,4--, &oL� -e LICENSE #=fd& I MONATURE IMP EJ MGF 0 JP 0 JGF LPGI CORPORATION 2# PARTNERSHIP [:]# LLC [3#= COMPANY NAME19 11 ADDRESS I _o__/3_® CITY STATE Fea-41 z I P[ �TEL 0 FAX C 33 MAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYPERMIT MA DATE # JOBSITE ADDRESS VL OWNER'S NAME GOWNER ADDRESS j TEL TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL CLEARLY I NEW: [1 RENOVATION: 0 REPLACEMENT: PLANS SUBMITTED: YESF—]NOD APPLIANCES I FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER =11 _____J DRYER FIREPLACE FRYOLATOR if FURNACE GENERATOR __jj GRILLE - - - - - - ..... INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT L.-.- JA A OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT L TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER E�--- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES 12NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY E] BOND Fil OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E] AGENT DJ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are t nd ac urate to the best of rxy knowledge ill be in 'r'p- r and that all plumbing work and installations performed under the permit issued for this application %h c i a- �nnn) e all Perti nt Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME j-; f, e,4--, &oL� -e LICENSE #=fd& I MONATURE IMP EJ MGF 0 JP 0 JGF LPGI CORPORATION 2# PARTNERSHIP [:]# LLC [3#= COMPANY NAME19 11 ADDRESS I _o__/3_® CITY STATE Fea-41 z I P[ �TEL 0 FAX C 33 MAIL O z z 0 H U a rA 4 '41w - 0 Fl z. O yT d rA ~ w a ftZ w ~ a w X � Kul ri) a W 55W LLI �+ w N a o a a a rte,,, U Ei a a to a � LLI s w H O z 0 H U w a tA c�7 C�7 - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IV 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp, c.152, § 1(4), and we have no insurance required.] f employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:, Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if I supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, # 61.7-727-4900 ext 406 or 1.-877 M'ASSA.FE Revised 5-26-05 Fax # 617-727-7749 'c�ww�mtass,govf�ia Date. TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that .`. !� ..................... has permission to perform ... (<.. (?L .......................... . plumbing in the buildings of .. .)........................ at .... -`.......... North Andover, Mass. Fee.. ' ..... Lic. No..� . .... I�......... PLUMBING INSPECTOR Check # I ) j 5773 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS �� Date Building Location /9�S%Owners Name Permit # J� � Type of Occupancy Pc— L of r� Amount New1:1 Renovation Replacement �' Plans Submitted Yes 1 No FXT.SRES ----------------------- (Print or type) Installing Company Name U /?1- 7- l y o Name of Licensed Plumber: LJ Insurance Coverage: Indicate the type c Liability insurance policy S%— Check one: Corp. Partner. Firm/Co. C - insurance coverage by ch cking the appropriate box: Other type of indemnity ❑ Bond EI Certificate Insurance Waiver: I, the undersigned, have been madd aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent F1 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 inst a ' s perfo ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach tt ate PI b' g Code and Chapter 142 of the General Laws. By: ign ense Tun—mer T e Plumbing License Title � City/Town icense um er Master ❑ Journeyman APPROVED (OFFICE USE ONLY 4 DateA-!:1 . .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that �/ ............. has permission for gas installation ... .................... in the buildings of ............................. at ... ? ......... -North Andover, Mass. Fee. Lic. No... GAS INSPECTOR Check # 4487 vIASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS,G or print) Date (' tvvnTH ANDOVER, MASS JAiCHUSETTS`� Building Locations 3 ,�! /�G 5 %y 1 Permit � Amount Owner's Name PA / (`) S New ❑ Renovation ❑ Replacement Plans Submitted ❑ (Print or type)r Check one: Certifica In aIli Company Name C�6L L,/a 1�/iiv A--,P-CGs-I') 'f' j+r6 P. Address `' Business Telephone Name of Licensed Plumber or Gas Fitter To C G%4(,(,%--f41U ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D--- No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Q"� 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. Signature of Owner or Owner's Agent Check one: 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 best of my knowledge and that all plumbing work and installatio s performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts state Gas Coe and Chaffer 142A,f th/General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Si ature of Licensed Plumber Or Gas Fitter ❑ P tuber . L/ 13—Cas Fitter 7777 17-5=7 umber ❑—Master ❑ Journeyman ::l i— w Gz -orW i ^�' W Z C -t C C W Cn SUB-BASEM ENT BASEM ENT IST. FLOG R 2ND. FLOGR 3RD. FLOOR 4T H. F L O O R 57 11 _ F L O O R 6T If . F L O O R 7T 11. FLOGR 8TH. FLOOR (Print or type)r Check one: Certifica In aIli Company Name C�6L L,/a 1�/iiv A--,P-CGs-I') 'f' j+r6 P. Address `' Business Telephone Name of Licensed Plumber or Gas Fitter To C G%4(,(,%--f41U ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D--- No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Q"� 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. Signature of Owner or Owner's Agent Check one: 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 best of my knowledge and that all plumbing work and installatio s performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts state Gas Coe and Chaffer 142A,f th/General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Si ature of Licensed Plumber Or Gas Fitter ❑ P tuber . L/ 13—Cas Fitter 7777 17-5=7 umber ❑—Master ❑ Journeyman ` ocation �s moi! Date MCR*h Ott�o TOWN OF NORTH ANDOVER ,�h O? • O0' p Certificate of Occupa� *,.)r , +�99�� Building/Frame ,SSACHU Foundation Permit Fee $ Otheri0ermit Fee $ €oC ,_,._._._ Sewer Connection Fe Water Connection Fee $ TOTAL Building Inspector Div. 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C ++ = oc •E CL=LLJ E E N Z CD ao Q COD _ C. m .5 0:0 OM= Cm {Np = ai co O co 0 o � z °' CL O y C � I o cm C C CO2 p 'O O .CO2 CD E m m L O O CL ++ COco O i M0 Q a cma CO2 cc o cc v J� O C z CD O O. V CO) O CL CO2 D J z_ LL L1J CL C:) z LL } Q LU w C/) Z C 0 W C3 z z cc Z LL W a_U) ►SSACHUSETTS UNIFORM APPLICATION.:.FOR. PERMIT;-TO.DO°PLU 61NG (Type or Print) ;..:•,•.,. , NORTH ANDOVER ,Mass.-; Date: Building Location Permit co ` ..,7,;. Owners Name --�41) >• New D Renovation Replacement (] Plans Submitted FI TURE (Print or Type) // Check one: Certificate Installing Company Name S�,cp",eaf P Corp. Address's )3U)( Fv YJ S I Partner. 72o 4 --1- o / ff'11 Firm/Co. Business Telephone Zv Name of Licensed Plumber: 9A0 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond 0 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 Agene}: I hereby certify that all of die details and Worms tion I have submi(Icd (or en (coed) in alxo.e applicalion are Irue 284 41irrale to die best of our knowledge and that all plumbing work and insullatinns lverfncared under Permit issued for (his application will be in compliance with all peslineat pto••4 wisiona of the Massachusetts State Plumbing Code and Clupter 142 of (lie (:metal Laws. 144 By Title. City/Town: APPROVED 1OFFICE USE ONLY) signatu a of Licensed Plumber Type of Plumbing License i 1U 3 (-- License Numbet�r Master ❑ Journeyman x � • < N 03 O Z 2 .. W W x of a¢ fC S N = a o= (d x to r- WN I O — w' ys 1-- W Q! t.. U W Crf of Y a {a. 4. x X V Z' ¢ c °' v=, W >' < l.- sn = G a as x ¢ o- t* o u. o' 'C W o a to a W' lrl � AG ~ J a ¢ a j k oC F- v a > r r o x a z �. N Y 2 a o 0 p os x _ x < W0 W IL Y v W Z 3 a t- < a x "-' (n a a o< -i J a W Er W a o < I- da sue—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) // Check one: Certificate Installing Company Name S�,cp",eaf P Corp. Address's )3U)( Fv YJ S I Partner. 72o 4 --1- o / ff'11 Firm/Co. Business Telephone Zv Name of Licensed Plumber: 9A0 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond 0 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 Agene}: I hereby certify that all of die details and Worms tion I have submi(Icd (or en (coed) in alxo.e applicalion are Irue 284 41irrale to die best of our knowledge and that all plumbing work and insullatinns lverfncared under Permit issued for (his application will be in compliance with all peslineat pto••4 wisiona of the Massachusetts State Plumbing Code and Clupter 142 of (lie (:metal Laws. 144 By Title. City/Town: APPROVED 1OFFICE USE ONLY) signatu a of Licensed Plumber Type of Plumbing License i 1U 3 (-- License Numbet�r Master ❑ Journeyman t ^a Date. . N2 3660 NORM TOWN OF NORTH ANDOVER • 3e ••' r, ' O '. Ot PERMIT FOR PLUMBING •�r�o ,SSACNusii / This certifies that ........................ has permission to perform ... ....�............ . plumbing in the buildings of at �.... . f..... ......... , North Andover, Mass. Fee. n. ... Lic. No—&,V .. ............................. . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer