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HomeMy WebLinkAboutMiscellaneous - 38 MILTON STREET 4/30/20186196 Date ... ��.-...:?.. IW °e<``° :•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ... t has permission to perform r �. ,:.. K wiring in the building of ... ...... ........................... r .......... -- ......... , North Andover, Mass. � Fee ..:...... Lic. No/�/ %l. ,.� ................... : .....:�z.�.......... ELECTRICAL INSPFECTOR Check # J 1* :�••�rf r' y f �r i .r..r r rr� permit Na Occapoicy R Fee• Checked "PUCATIONFOR PERMITTO PERFORM ELECTRICAL !07ALL WORKTO BE PERFORMED INACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE. 527 CMR 12:0PE (PLEASE PRINT IN INK OR TYALL 1N1'aORMATTON) VJ Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street d Owner or Tenant Owner's Address To the Inspector of Wires: is this permit in conjunction with a building permit: purpose of Building , is Existing Service Amps Volts New Service AmW� Volts r No a (Check Appropriate Boa) Utility Authorization No. OverheadUnderground C3 No. of Meters Overhead Underground C3 No. of Meters Number of Feeders and Ampecity Location and Nature of Proposed Electrical Work 7c�' .✓ .Pe- 1'7el No. of L shft Oatlau Na of Hot Tube No. of Tnnearnoers Total KVA Na of Ligift Ritalee Swbnndng Poon Above VOWA Below Claterator• KVA No. of Receptacle Outlets No. of Oil Burnet• 0001W No. of Emergency Lighting Battery Units No. of Switcb Outlsn No. of Oars Bowers FIRE ALARMS No. of Zona No. of Range No. of Air Coed. Total Taos Na of Detection and No. of Disposal No. of Had Total Total Pam@ Toga KW Initialing Davk= No, of Sounding Devices No. of Dishwashers Space Am Hating KW Na of Sew Comained Dat ui— 000 ttg Device Laad Mmdcipd p No. of Dryers Heating Devices KW Connectiotn No. of Water Heaters KW Na Of Na of -SimsBailesl No. Hydro Massage Tube No of Motors Total HP inura CbvwF A--wmD9rw*i1i MdWt=dxiMCh=1Ls%@ Itztestt�rri�dvaidproddstme IodeOID� I los BCM 'Z-> WodrbSlat EMNINANS Will DoPlo� do YES L.J NO If}whstedsdedYEKPk=h* ffierAecf 01111111*11* r D EWWVailea Het" Wak S PZ* lied 1JaaeeNa cP B«leesTam AdckM ��S�Crr��y /�U.C�' i%9��15'11 AtTaLNa 9� %%/ 6©/i 0WI,R'SlNSLRAN1MWAMRI= w=dlatdlelJ=Wd=Wt bin =mewwWarisltgl" agivalaitaslequiledbj,Mele3 tuftGala'ILawe k l[. arddletrr>ysi@�ondlbpearitapplc�w�dile4imreet (Please check one) Owner [:3 ASM Telephone No, pgRMff FEE 12,-:5 f y' 'i h y I 41m,k37:4 bb Permit No. OMPancy Fees Checked T1ONFOR PERMIT PERFORM ERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSM MSCMICAL CODS, 527 CMB 12:00 " 0(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_ �'� A;� C Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street 3 Number) Owner or Tenant Owner's Address XL/'o To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes No [D • (Check Appropriate Bos) Purpose of Buildingi'(; icl��, f�?o�=' Utility Authorization No. Existing Service Ampa�. olts Overhead Underground New Service Amps Volta Overhead Underground Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work IC, %c. No. of Meters No. of Meters No. or ughfbig Outlets W of Hot Tuba M. of Trenafbsrners Total KVA Na or Lghdry PGftmee Swimndng Pool About♦Below rl Cksraett>te KVA No. of Receptacle Outlets No. of 00 Bursars No. of Emergency Lighting BMteq Uniti Na of Switch Outlets No. of Oss Burets ME ALARMS No. of Zam No. of Ranges No. of Air Cad. Told Taos Na of Dewcd= and No. of Disposale / No, of Haat ToW T" Pont*Ton KW Lddadng Dnk= No. of Sanding DltWoee No. of Dishwashers Space Arra HeWag KW No. of serf C "Ind DetecdowSoon ft Devkn Doer Mwddpd Other No. of Dryer Reefing Devices KW Comrecdow r=1 No. of Wader Hasten KW Na Of N0. of sisle Missile No. Hydro Message Tube Na of Movers Total HP iWMXeC WWV ABsstbbere�srtte�afMa CrareelLarte �ltvwsrhrftdvafdpoafcf=wlofa;0� M »arm D 0nm ED iVCdcbSW itrecsutDatRa}ssl�d VwundarTeptniasofPOW.RMNAME , G do Ir3nubatetibdedYH4,plaida1efre%Xc(mtrby rmllz* E�riebdVair dEbc" Wads s fav FM rl HiaaJw zmNn Aditso OaWI�R'SII�LAJRAI�WANII�IanawaedettheL+case A!'ll'1Na d,�,g�j�Iheirasaioeao�eigeor�a�b�rridet}ivatetatg:luiadby'I1�dsa�0alaadLaws arddietmysig)�ondibperrrdappk�fireQierrre�t c� t( (Please check one) owner C3 Agent a TeleSignature or Ow or Agm phone No, r»� turr FEB 0 Location •-' " 3-C�t'`r.--� No. �Is-/l Date y- %- '::' "'- TOWN OF NORTH ANDOVER O.'"•� :• 1ti0 Y o •, Certificate of Occupancy $ HUS Building/Frame Permit Fee $ /. G jDr Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #!�I U 15443 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: \6-71 DATE ISSUED: SIGNATURE: Building Commissioner/I Date.1�22tor of SECTION 1- SITE INFORMATION 1.1 Property Address: 3� - 3 �,,, Gov 1.2 Assessors Map ®3 ( Map Number and Parcel Number: �3 Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT V. Owner o d oL /N 0 %.S fl ' ) %ON71-141 t( 3G - 3 Fr lY'I !G Na a (Print) Address' s for Service /`7S- - 6�7r 157 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: �/2 -elyy n LS o Licensed Construction Supervisor: '5.,/ %�S� �� 7- c./' ./ Address "!2� 9 — / � �! 1! � (O � F 7� � Signature / V Telephone Not Applicable ❑ License Number ®� Expiration ate 3.2 Registered Home Improvement Contractor Not Applicable ❑ a%�y Company Name ,C , /Y f Registration Number ! S� f o Address r 2 J 7 Expirati n Da e i nature Telephone V M z O SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Se SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be feted by permit applicant flFFICIALUSE ONLY I. Building' �G ` D' l� (p U a g Petmit Fee () Building Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (n) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby_ authorize to act on My calf n a afters rel 've ark authorized by this building permit application. -Signature of Oviffer Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I; as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 3 SPAN DIIVIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHA4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 t }} -w _ .✓ize pV� oor�n2oru c�P,a�� o,/� ./�ac�ic�oel,�a € r g BOAR6 OF BUILDING REGULATIONS` I ry ob" -,License: CONSTRUCTION SUPERVISOR Number: CS' 022680,. a + Birthdate: 06/09/1939 ' Expires: 06/09/2002 T -Tr., ho 1.846 `Restricted To -.'.'60. ARTHUR J WALSH JR &_PLEASANT ST �_ N ANDOVER, MA 01845 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents office offnlrestiyations 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit I am whom lam a sole F1 Iamane proprietor and have no one working in any capacity ern providing workers' compensation for my employees working on this job. P/ 0 I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have one years' imprisommetnt as well as civil penalties in the form of a STOP WORK ORDER and a tine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certifp ander the pains and penallliies of perjury that the information provided above is true and correct Signature gy4zlQ Date 7 -11-6 Print name �/��%� —7�ir/�GS l� /2 Phone # Z r �7f' — 6 94-- x'737 official use only do not write in this area to be completed by city or town official city or town: permit/license tt nBuilding Department []Licensing Board ❑ check if immediate response is required ❑Selectmen's Office ❑Health Department contact person; phone #; nOther (revised 3195 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 section 25 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 produced acceptable evidence of compliance with the insurance coverage required. Additionally, 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and , supplying company names, address and phone numbers as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 r CI Z O z ok W a a Ou as V o w C n V) O z z A a C -n o w o n; v U co w a U W � a o rs; G x a 0 W � w ,� W o w U) coo w R. a z w G w W A aWG rr w v W O z cn Q o cn o m c CD ` C h O C Cc C3 C.) CLc ev m m c := o c ` Ea m c" ._ts � o n N E a N 0 N C O co 0 Q1 c m Q'. cm c .c N m _ O Z O CD F. �X T 9 0 O v cots O co O v Z O d O y D C O CM CD CD VO w r= W M Cc • O � CD CD w O O G O R O a a cma ca C 0 -6-0 C vcc -j .0 CL cl CD C Z tS co V h O C C C _cc C. COD 0 'U) vJ w w w U) O �. . V CD �. cm RE : N w mm CD N Of IND.- 3 m c c ' a m 5 a Cv .o = c N CO N CD d%OD N O m I, OQ C N O. O O C,mcc 210 Z CZ o CL ~ o y m c Q H O m 0 H W +' m r0.. g i .0 CD C �y M_ O H .m = C LU D ,toy cm CD y d O.O O:0 _ H lC .c O N O 42 C m E a N 0 N C O co 0 Q1 c m Q'. cm c .c N m _ O Z O CD F. �X T 9 0 O v cots O co O v Z O d O y D C O CM CD CD VO w r= W M Cc • O � CD CD w O O G O R O a a cma ca C 0 -6-0 C vcc -j .0 CL cl CD C Z tS co V h O C C C _cc C. COD 0 'U) vJ w w w U) D. Robert At;.cetta, .31diditti; Commissioner t'OWN OF NORTH ANDOVER Office of the :Building Department C ommlinity Development and Services 27 Charles Street No tb Anndover, Vassachusetts 01845 DEBRIS DISPOSAL FORM Telephonc (978) 688-9545 FAX (978) 688-9542 In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit # the debris resulting from the work shall be disposed. of in a properly licensed, solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of at / in: A s - C Signature of permit appy (Site locaAn) Date Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diozzi, Gas/Plumbing Inspector N2 160(4 Date ... "IT/ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ NZ.1.,6.0 ...... f AV v.. -(2 ....................................... has permission to perform ........ ............. K( .. .............. wiring in the building of ........"All.c.—k.(I............................................ it at ..... k/t...Jl 6 ........................ . North Andover Yas. Fee.. Lic. No-APW ...... ...... ....... E&i�Rl AL INSPECTOR 80. 00 PAID M411 t. Applicant CANARY: Building Dept. PINK: Treasurer Office Use 7 F00M10N�L7HoF'A:49,4CHL= onl . DEPARTt1�7'OFPUBLICS4= Permit No. BOARD 0FMEPREVLV70NREGUMT10AS5VCMR 12-00 Occupancy &Fees Checked Uul APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street B Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes No F ---J (Check Appropriate Box) Purpose of Building Utility Authorization No. , Existing Service ODOO� AmpJ00/ -V Volts Overhead Underground Q No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Local ion and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. ofTransfonners Total _ KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals Nb. of Heat Total Total Pumas Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local 1-7 Municipal Connections f-7 Other �No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis INo. Hydro Massage Tubs No. of Motors Total HP S UmsaroeCoyaage Pta$IttrY>altteta�tntarta�cfMassad�etrsCra�alLaws ' ('�j IheNeaa=tLiabdityhm m=PobcytraxkgCanFeb�CovaaWcriissksonfiale4ii%, l YES i NO Ihave ahmiuedvalid. ptoo(ofsamelotheOfoe YES r7 IfjcuhieclledcedYES ple3seetd&thetypecf`e bydxc�ttr WSIJRANCE BOND OTI 11 R F7 ftweSpaffy) Expand— Daffi Estinn&d value ctl3ectrical work S WodktaSwil hq)ecticnDakRe� Ra4gb Final 1/ C *19 Signeduoda�ie ofpt3jtay FRM L wNa � IRMNAME Sigiahae ` LicenseNt l 6 Business Td. Na '' ' Alt Tel Na 7 OWNER'S INSURANCE AVER;IamawatethattheLionot Mw dXicmranewwWrZ&ksb tiale#malrtasmr$>IIadbyM adn—tNGajcd1.ays and fat my fern � pem>ii appScetiai wanes this � (Please check one) Owner M Agent// Telephone No. PERMIT FEE A�-O— . �V s5ijoM oilgnd 'Al(] QIad 00'L22 0: TO 661, EjO' joloodsul 6uipling ��o $ Ivio1 $ aad uoiloauuoo aaleM • $ aad uoiloauu00 James _ $ aad IiwJad Jaylo $ aad Iiwaad uoelepunod ;SnH��rr $ ead IowJad 9wejd/6upin8 t . $ Aouednoop aleoi;ipao RIM o _ ;o a3AOa NVQ HIUON -AO NMOL _ r� 'GN / r 0b _ u01le001 G o n e 'r � r - !� W r l J w r w oy w o7 D m s ° O a D O O r O S 3 m z p z l J w r w oy w o7 D m ° a D O O r O S 3 m z a`n-i --ir g � z z z r m m m v� O t. o 1 b D Y n Oy '� O z 6 z D H � D m a m r y m m yr- m -a w m 11 O vr� � Co O O W m m Oz O � z y m O a O z c� d 'X m b r O Z M� o H z 0 in in cn cn ° ° N z O 'D N d R n A 0 0 o o 0 " 8 czi [o o o 0 o N o r g A o rn cn m Ln o °' C z e o H H tz O ° r -Ln O pp L7 l7 8 d m m yi � n ryy y zz-1i m r � W m z X 8 a C7 x m 5 � qq0 W -q W N C7 Rb x r� ,t j" S �Y • ^ ' � y:y N k 4 +� ter✓ 4w � a c '. `i x .r -"� � y < •� _ �? F' e ' .� s `• � � a.. ,� � r,,. a_. ;t .. '.� !t• s A Y .� ��. to .O CD z CD o wC wwr,, W W CL _. C2 o p CL Cr =� CD O o: O to CD CD CO! 10 CD C 0 O O CA n' c c CO) d n CD 0 �M CD CDa rA' CD CO) O O CD 0 CD 0 0 It C 0 a O CD 0 O C a to m cm C: O N C 0 a CO) CO) C ?� �. y O cr N d o C nm a m O m C'! m n Nm�� N ,.n COL 7 m nim O m N O W -� o m m m n o �% --� O N• Cy 1,0C/V :� �5� `� irCA CL do O O N ;� :• 1 O CD 6 D d N ' Cl. d C W d � C.CD m NQ .., O_ m W N: Cog CO Cl �m 00:7 O CD :0 C, CD I CD C .� N W O ' y C, CD n � o-,�� CA cl:— :+ cm o_. ._ c 0 0 "0 = ro P= Crl n Lcn wor-w PV � m wG : R. � rr C/A n �^ A � n n O z O W y 0 O C CD Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 NORTIj Of o ;. x 09 i OP -� �9SSACHU`-�t,h Fax(978)688-9542 In accordance with the provisions of MCL c 40 S 54, a condition of Building Permit Number /,3,5_- 91is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MCL c 11, S 150 A. The debris will be disposed of in: 13 3 fs Yo 7-01y' ST (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town -of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 0 .11 Bey I._ SS30 I Jw } P 3EwE< I „ AM 815 Iw15?0 gr5 I erl53o t f Ir Kitchen Designs Unlimited 270 Littleton Rd. Unit 16 Westford, MA 01886 Tel. (978) 392-0099 \ Fax (978) 392-0027 E pz�rrza �as�» The Commonwealth of Massachusetts Department of Industrial Accidents � - � -- lllflca lil/oYesUgaUons - 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit City nhone # I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity C] I am an employer providing workers' compensation for my employees working on this job. comoary ra net MacIsh Corp. - address: 1 Jefferson Dr. city: Londonderry, TSN 0305'1 nhone a- 603 425-2629 insn ra n t:e_ cv. Worcester Insurance Companvt.0 ttolicY a WC IE 23 45 l-7 I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: in]aran= CT). ro,;Cy.11, .. ... .. .. . Failure to secure coverage as required under Section 25A ofMGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of5100.00 a day against me. I understand that a copy of this statement may be forwarded to lope Office of Investigations of the DIA for coverage verification. I do hereby cer tr�gnder thf�ains ani/pifialties of perjury that the information provided above is true and correct Signature Print name Ronald W. , President 4/29/99 one# 603 425-2629 official use only do not write in this area to be completed by city or town official city or town: permit/license # r78uilding Department C]Licensing Board ❑ check if immediate response is required C]Seiectmen's Office [j Health Departmcnt contact person: phone #; r-IOther (1--1 )/95 PJA e 3178 Date.../j. �7... ca TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATIONS _ This certifies that .. ->--, -" ......... 1) .................. has permission for gas installation-. in the buildings of ..... • • • 0 at .�.`�. `'.'...`''`� ....., North Andover, Mass. Feel Win!. Lic. No``r �? ....;?cr-� o :>%i,� ,•c GAS INSPECTOR . WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING or print) ivvicIH ANDOVER, MASSACHUSETTS Date 5--13-19 9 ( j Building Locations -�?53; — `y�7 /�� % �� �� Permit 9, .L Amount $ Owner's Name n» A 124/nAr— !/N 24 New ❑ Renovation ❑ Replacement Z Plans Submitted (Print or type) Name of Licensed Plumber or Gas Fitter Check one: Certificate installing Company , ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® Nom If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy � Other tvpe 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 ❑ 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 installations erformed and Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StaGas Code a.qK Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber . 0 ❑ Gas Fitter License Number ❑ Master ❑ Journeyman c Cn Cn z C =c �. Cn y W C C y w z W z Uj W W �. C Z W C U 13-13A SEM ENT BA SEM EINT I S T. F L O O R 2 N D. F L O O R 3 R D. F L O O R 4TH. FLOOR STIi. FLOOR 6T It. FLOOR 17T-11 . F L O G R STH. FLOOR (Print or type) Name of Licensed Plumber or Gas Fitter Check one: Certificate installing Company , ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® Nom If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy � Other tvpe 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 ❑ 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 installations erformed and Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StaGas Code a.qK Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber . 0 ❑ Gas Fitter License Number ❑ Master ❑ Journeyman CSS {..ti.���"w._ _..- �-�.vK.,,,�i,.,�..af,.�,-v�-�.�.•--..��-- mss.?^' "`^,,�,�,s..ia"y:iti-:r3. �g-..�:y;S.,-^d".�a. Date. : �•,( NR - 4030 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that-7?�?-.l...... has permission to perform -,/`:c'?': ? 4 - plumbing in the buildings of . a. atd . ,NorthjAndover, Mass. Fe ..... Lic. Noa��... —)e . ,... PLUMBING IN E OR 05/17/99 14:15 53.00 RAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS . J Date — Building Location Owners Name 41,/y�'.iGg�2 Permit # �f03 Amount 03 ✓ Type of Occupancy Am, Z., 101, New ❑ Renovation Replacement 1:� Plans Submitted Yes No FIXTURES (Print or type)/ 1, Check one: Installing Company Name �� ��/.���JfJ> � fi�P - l— ❑ Corp. 11 Partner Firm/Co- Name of Licensed Plumber: c J 144S'A Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 13 Other type of indemnity 0 Bond Certificate 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 Signature Owner Agent El 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 for this application will be in compliance with all pertinent provisions of the Massachusetts 5Wte PlumbingCode and Chapter 142 of the General Laws. By: Signature of Licensea riumDer Type of Plumbing License Title City/Town icense Murnoer Master ❑ Journeyman (j(� APPROVED (OFFICE USE ONLY r