Loading...
HomeMy WebLinkAboutMiscellaneous - 40 HOLLY RIDGE ROAD 4/30/2018 40 HOLLY RIDGE ROAD 210/038.0-0248-0000.0 Date. . .' HORTM �'<. •� .�ti TOWN OF NORTH AN40 DOVER p PERMIT FOR,,PLUMBING f • o� • I ACHUSE� This certifies that . . . . . . . . . has permission to perform . . . . . . . plumbing in the buildings of . . vti . Y1 at . ... . . . . . .. North Andover, Mass. Fee. �Lic. No.. . 1��6 G . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # _t�.l�l 79 8369 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS i� � / Date �® /TO// R496C Owners Name /�O vpI Permit# ' _ Building Location y n '--- Amount Type of Occupancy New Renovation Replacement ® Plans Submitted Yes No FIXTURES z Cn o � � H P4 Cn a x E~ �4 O A sx SIME iSIC H-OOR l 2ND�nc�i 1 3MFLOCR 41H FLOOR srxFuO siF H-OC t 7IaFLOCR SMFLan (Print or type) J Chec ne: Certificate Installing Company Name &Q Marto C c Plt fm�;I + qeC !] Corp. Address P® vy &q& El Partner. �+4 t 0, I JrF O T $!o Firm/Co. Business Telephone_ 06 3 3 7e–O® ?.O --- — - Name of Licensed Plumber: � 's lyd4�►2C�cl a Insurance Coverage: Indicate the type of insurance coverage by checking the box: Liability insurance policy � Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one ofthe above threeinsurance Signature K, Owner Agent I hereby certify that all ofthe details and information I have submitted(or enfered)iAab e application are.true andaccurate to the best of my laiowledge and that all plumbing work and installa' s erformed undet Issued for this application will be in compliance with all pertinent provisions of the Massachus a Plumbing C d Chapter 142 ofthe General Laws. By: Nignqw o s um ype lumbing7i se Title l Sa6 City/Town icense um er Master Journeyman APPROVED(OFFICE USE ONLY ('.�.w'vYT Location ` T 6_ t No. - ( r Date ZZ rik 01 kOR H .4 TOWN OF NORTH ANDOVER A Certificate of Occupancy $ r * + Building/Frame Permit Fee $ S� 73 a; ,>• Too Foundation Permit Fee $ y Other Permit Fee $ N Sewer Connection Fee Water Connection Fee $ TOTAL $ 4 r a �j (&Buildin ector 9 Inspector 1,554-00 PAID Div. Public Works .�.�,.-vw,. �-�Ay..,..,.�.,•,,..+(;.r+--c-.:+......,�..•.r.4.`�w►uv •,_ ... v«-.«.. ((yam: —:— - "'—"•� s.. t Locatio n- Ab Z06rr- r No A- (,Q Date ! of 14O"' -1 TOWN OF NORTH ANDOVER p Certificate of Occupancy $ * t Building/Frame Permit Fee $ Foundation Permit Fee $ 0a ' sACMUs . `^ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ . TOTAL $ SIZ) l, Building Inspector 1��, 09/211/95 14:35 150.00 RAID ^ S 8814, Div. Public Works v 5= Location- No. ocation No Date NaRT� TOWN OF NORTH ANDOVER Y4 3?c:',�•o �hooL Certificate of Occupancy $ . ; Building/Frame Permit Fee $ s ��s'^••°'SE�� Foundation Permit Fee $ ACHU „ Other Permit Fee $ Sewer Connection Fee 19 Water Connection Fee TOTAL $ "�------ ildi g Ins ctor, 8:. . :� Div. a is Works PER111T Na. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. / PAGE 1 MAP 4v LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE YSUB DIV. LOT NO. .LOCATION PURPOSE OF BUILDING e OWNER'S NAME ./ NO. OF STORIES SIZE OWNER'S ADDRESS 1. �i t /J� EMENT OR SLAB L 9 lCg..l ^��n ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST,:q v1 �cOlr3RKJ G�IU BUILDER'S NAME G SPAN QC,/tc p� N DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS --- DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES–SIDES/ REAR GIRDERS AREA OF LOT 51 L ✓1 t < �Z/FRONTAGEJ Z HEIGHT OF FOUNDATION /i / THICKNESS IS BUILDING NEW CJ � SIZE OF FOOTING 71 X IS BUILDING ADDITION D MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND �� G 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 9 PROPERTY IN ORMATION PERMIT FOR FOUNDATION ONLY LAND COST SEE BOTH SIDES REGULATED BY PARA. i1Tn1.Y-S. B.C. EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT 1�C1/70 K ['�'c PAGE 2 FILL OUT SECTIONS i - 12 DATE .417 EST. BLDG. COST PER ROOM FEE PAID��,� SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS- , PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECrw MIT FOR FRAME/BUILDING DATE FILED /4� ATE: EE PAID' BOARD OF HEALTH SIGN E OF O R OR U ORIZED AGENT FEE PLANNING BOARD PERMIT GRANTED l CSO—+ 19 BOARD OF SELECTMEN W4- LM F GO BUILDING INSPECTOR �t u QUb.ou), r BUILDING RECORD 1 ' 'OCCUPANCY 12 SINGLE FAMILY'' SoRIEs - THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES I 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 d 1I3 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WADI UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/. 1/1 '/. FIN. ATTIC AREA NO B M FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS 1 2 3 DROP SIDING CONCRETE —��— WOOD SHINGLES EARTH ASPHALT SIDING- HARMU'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. 8 FLOOR I_ t�.Lt .,�„-7' r ;� ,•�€ 1 .w�,4y t1 -I� _ IrD"} ---- - BRICK ON FRAME CONC. OR CINDER BLK:' STONE ON MASONRY WIRING STONE ON FRAME • , SUPERIOR POOR Ij ADEQUATE NONE " 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) ' GAMBREL MANSARD TOILET RM. 12 FI X.€ •; �, -- r•I- {,,;p—- t FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING >~— - •,..t-� .t t �, TAR 8 GRAVEL STALL SHOWER __ „mak +, • - "I ROLL ROOFING MODERN FIXTURE + TILE FLOOR - - - TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'.R OR VAPOR WOOD RAFTERS AIR CONDITIONING 1 RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL' B'M'T 2nd _ .ELECTRIC y 1 st 1-3'dI ''NO HEATING - .T '-d�Ct m ti ' VAORTH T0 of 6 Andover N . �s l>F 0 c� O -- o ndover, Mass., � - ZS 19'�s- � "I IL � t AORATED PPS\ '\� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...(3A.K.......` 4a..5►..t.................................................................................................. ....... Foundation has permission to erect..U��....Q�PQMP—buildings on .4 0......I�4 .�4,`.�'1' ,0.(..F...... ........... . `.13 trough to be occupied as.g4.6t ,..:. !M1.� u�.1�1. . .1�.�a....l�Ul....Z..C49--ro. Q4.61r..................... chimney provided that the erso accepting this ermit shall in ever respect confirm to the terms of the application on file in P P � P g P Y P PP Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough PERMIT EXPIRES IN 6 MOFEEPAID Final . UNLESS CONS T T - ELECTRICAL INSPECTOR Rough „I .............. Service B LDING I ECTOR ' Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises _ Do Not Reggo FOR R*Vt LDItAG Final No Lathing or Dry Wall To Be Done VU OU FIRE DEPARTMENT Until Inspected and Approved by the Building InspectobpIE:1A' Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT f' FORM U - IAT 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: Un C, Phone LOCATION: Assessor's Map Number b Parcel �15 Subdivision Lots) _ f3 Street St. Number ************************Official Use Only************************ RECOMKENDATIOj OF A S 7. Date ADoroved Conservation Administrator Date Rejected Comments QI; (A2L LTC QQ Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected .,-7 Date Approved Sel5t1c4fnspector-Health Date Rejected Comments c S�- Public Works - sewer/water connections � ,tJ (9-Z15 45 - driveway permit l�-✓ l�J --ZS — ,P0 wi 41 s `� id� e ( (0 3 re Departments Received by Building Inspector Date Ir I / \ LOT 11 Oft i i \ 56.7' 49.3' Cn EXISTING V FOUNDATION TOP OF FOUNDATION LOT 12 \ ELEV.= 104 £µENS '9O: / 1 / - `1o. 286' Lor 13 i V , i • � • STREET NSON / jo FOUNDATION LOCATION PLAN THE HTOTHE RIZONTALSETBACKA REOUIREMENTS OFRY STRUCTURE THE WN RMS TO TH£ LOCAL APPLICABLE ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRIC77ONS SUCH AS COVENANTS,WETLANDS,EASEMENTS, CLIENT.• COOLIDGE CONSTRUCTION ORDERS OF CONDITIONSETC.) THIS.DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY THIS CERTIFICATION /S MADE AND LIMITED PURPOSE OTHER THAN THAT OUTUNED ABOVE,EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. TO THE ABOVE CLIENT. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED.CHR/STIANSEN & SERGI TAKES NO RESPONSIBILITY . FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR— MAT1ON CONTAINED HEREON. LOCATION: LOT 13 HOLLY RIDGE ROAD w of g MICH SCALE: 1" = 100' DATE.' NOVEMBER 13, 1995 RGI a o� Na 191 Al R CHRISTIANSEN h SERGI PROFESSIONAL SURVEYORS 160 SUMMER ST. HAVERHILL,MA. 01830 TEL 508-373-0310 ©1995 BY CHRISTIANSEN& SERGI INC. DRAWING No. 92008001 q��= 4(v0 AND - SEWER SERVICE 2 \ } 6" PVC'SEWER SERVICE 4. <; EXISTINC RIM = INV = c �Q �� �� / � iii a':. ':.'�• .i�,OO \\ \ \ �WATE� SERV CEi /� \ 120' WIDE DRjkEWA ASM Ti TFL. ELEC \ 45° BEND / ACL UT \ �\ LIMIT OF 100' B FFER ZONE01 32 / PRdPOSE HOUSE \ TOP FND. - 106.5 % 56 I `r 50' NO N T TION LINE FND: DRAIN IN = 96.5 v 48' 25' NO CUT LINE o rn \ 52' i 96 B-1 121 _ 9A 9A LOT � 2 9 I / 53 � 100 YEAR FLOOD ELEV. (94.5) IA-7 / / B-3 i `10 DRAINAGE �^ B-9 , -4 EASEMENT d gk/ B-5 285 94 A 5 B-6 'A-1 �. A-4 B-7 — EDGE OF BORDERING VEGETATED WETLAND LOT 13 r „r AREA .= 83,950 S.F. f 1 466.04' Location IJo Date ? � TOWN OF NORTH /ANDOVER -f NORT1y., 03 •.. O� 'A Certificate of Occupancy $ 4.'. Building/Frame Permit Fee $ tMUFoundation Permit Fee $ SAS t , F Permit Fee Sewer Connection Fee $ a Water Connection Fee $ TOTAL $ F" Building Inspector � O Div. Public Works wII pf L?0 Maier Ste!. OI345 ILS .H.r=��ELso` �_� _ --:._: _rTp -- _ •; (saa) sae-6� D ""°' = �• NORTH_ ANDOVER BVILOING COsSc�:aTtO\ HEaLT.H PLANNING g; CON31UN- = DEVELORNMN- T CqlwN= APPT.TCATTON A"" - , _T� _a7-q PERM oW 3 LC TION 4/0 ' fool% l2►��e OIV;N E=' c NI AMZ. Cl'lU�i�d9 $L T_:rte`..R' S Nc..:'�v •S�1// SON ' S ;1n��:. 1�N5,2I1- - C M- T yj3- res -3 s' -:LRS "2`S ,+ , - c NTIR. LIc. = 6z 9/ZS AT, Ci L..Z V. -CE / INN RP.:•L��v THIS 3. DISPT_s�'j=0 Gii T::L PRZ!7SSS C� >.....r�.^�a1^ve!�tAe."w-.arx,^a.�r�...,...urn c. - _ - - •. __ ,.- - COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF ONE ASHBORTON PLACE MASSACHUS€TTS - BOSTON,MA 02108 Of rnr: -I rZ��C- L I C E N S f: CAUTION EXPIRATION DATE C.0 NS f k. a U P L it V I.S 0 R FOR PROTECTION AGAINST 10/2.5/199 S EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB RESTRICTIONS PRINT IN APPROPRIATE NONE06/30/1993 z12 s o a PLACID() D STEFANt! 5 =�� " {{ r �� ° 1 7-1 4 ATK1NSON RU !BLASTI G�PERA7 RS SS 4 014-54-9020 Z SALT-�M 41 ()3F,179 m I�Il1ST itvCt=t7f1€'PfiIQTO t; r }a . I' , PHOTO(H OPR ONLY) F n )t e 13 I ti'��.1 t.i`t•U o NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED-OR-SIGNATURE OF THE COMMISSIONER HEIGHT: DOB: 10/25/1955 THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF WA . THE HOLDER WHEN EN- ' OTHER SPRINT GAGED IN THIS OCCUPATION. J COMMISSIONER CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number _w _ Date c, THIS CERTIFIES T AT THE BUILDING LOCATED ON � � P( n MAY BE OCCUPIED AS / wCTt` IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 1 M°RTM a °° ;•1"o CERTIFICATE ISSUED TO ° ------('-% �_ ADDRESS $A HUS Building Inspector i AM �©RTFi :.. . ► w iTown of 6 Andover 0 "I", - '�" �y 'P Ol� L A 0� " dover, Mass., 19 / s pA co:M'C E-I(�\` �A 0RATEo PP ��� 1 S L BOARD OF HEALTH PERMIT T DFood/Kitchen Se_ is,Systerrl C � BUILDING INSPECTOR THIS CERTIFIES THAT........0.1?-.1<....... ............................ .................. Foundation has permission to erect. L(�G. .. 4'>'!�- Uildings on ... v..... ..��`�........:J ..1.4: ..0 c.....!S...d..... .. -f 3 0U to be occupied as.... ...k-1:4, AL-LI provided that the person accepting this permit shl in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. / , 4_%--1' PERMIT E_XPES IN 6 MO S "FEE PAID ELECTR L INSP ^T FERMI UNLESS CONSTRUCTION ST S r 0 _ oug T FOR FRAME/BUILDING ic, u.... ... ....... . ......1 .. 1.�-� 44 : - . ` sere $-1 �l � DATE: FEE PAID' I BUILDING INSPECTOR ina 5 Occupancy Permit Required to Occupy Building GAS INSPEC_ y:)R Display in a Conspicuous Place on the Premises — Do Not Remove Y No Lathing or Dry Wall To Be Done FIRE Inspected and Approved by the Building Inspector FIRE DE7PA'RTN` N { Burnerlot PLANNING '(ft SIAL CONSERVATION Street No. 'n IV Smoke Det. SEWER/WATERT'0_ tfi' ►. . FINAL DRIVF'"JAY ENTRY PERMIT 1 v --.� office use on` Gf t \r5BI2tIliIIIIIU1Can of sadF 33 Permit No. JEPr=2= Ed ,$, uhiYt —Aafrtg C=pancy&Fee Checked ig$ am (leave blank) BOARD OF FRE PREIEMON REuJLATIONS c�7 C.'SR 1200 Sa y APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in ac,rrdance with the Massacnusetts Eiec:ricai Cade, 527,C�1R,) 01 a (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �� J MQ or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned appfies for a�.pjermit to perform the eiec--ricai wcric described below. LCcation (Street & Number) e I�`+ q ` �� 1-n Cwner or Tenant CJ Ic Cwner's AdCress — O ' Is .`tis permit in ccnjurc:ion with buildir, pert- it Yes No ieck Apprcenate Box) t l Rur�cse cf °uiidinc S l ii1a12 a h Utili Authcrizatien No. Existing Sar�ic� Amps ' `/c's Cverre_d _ n _ e.ers Ne:v Semite 2: Amps lln,_r 'I L4(i volts Cver ea-Z - unC_rna No. of deters Nu^car of Faecers ara Arncacity L_caticn arc Nature :f rrcccsec No = '.cs I No. _. -anstormers No. _:gnang Cutlets al O ave-_ :`n- No. ct _:gm:ng =x:ores Generators KLA No. of Emergencygr.ttng Ne t "�zecectave Cut'et5 o NO -t "i1 = -ers ISaner., Units Vo of c�witcn Cutlets No. _. Gas 9_.-_._ FIRE ALARMS No. of Zones No. ct _etecnon anc No. v Ranges No. s c7 inrtaung �avices ea: No. _t Ciseosais No•Cr R•ut--s zns C• No. ct Stunting Z:evtces I v No. w Seit ContaineC i No. --t C isnwasners SCacetArea _ C:l I Cetec::=Souncing Devices Municioat --Cther C :(`;J _.:cat onnec::on No. of I-ryers ( NeanrcZevices I _ No. ct ?+o. or ( Lc%v Veitage No. atwater seaters K:1 sicns Ba:ias s .V,irnc No -svc c iassac u s ` No -t • -r5 - --• -= C E INSURANCE CVE=AGE. Pursuant:o`:he recuirements cr -'assacncse=s ;er.erai _aws .. .. I have a current uaaiity Insurance-Pciicy Inc:ucmg.Ccr..o:etec Cceraccns Coverage or ;ts sucstanual ecuivaier YE5Xt - NO i nave s _-mm ui[tee vatic.-rent of sae to the Ct'ice. `rES = NO = a ycu nave cnecxec YES. please neicate :ne typovarage cy crtecxing :ne accrocnate nox. INSURANCE = BONO = OTHER = tP!ease Saec:tvf (Excitation ]stet - Som Es::rratec ValueCt E°ecxtcaI 'NorK s W +' C g I I :•rcrK :o Star. .. 2� ��N-`�(>. Inscer_cn Ca-0 Reeues:ec =cub.n Fnai Slgnee anter-.114 Ps .antes t ertu 3 NA, C. C o �C. UC. No. +_censee (7 ) 5:yna:_retrl Q 1 Y 06 1140. ; --n—9-- �_�l t 11�C 1� 1 I tivR ) I ► /� � ) q .s 3 Sus. -et. No. `7 1 1�i�T Actress � Au. :et. No. CwNER•S INSURANCE wAIVER: I am aware that ate Lce^see^_ces :-et nave :ne insurance overage or its suostannat ecuiva[e t as ent e eturee oy massaenusects General Laws. are .tit --.2y sacrtazure cn =ermit aeotication waives this reouirement. Owner Ag ;Please cnecx ones e+ecnere No. PERMIT F=_= 3 iSignature of owner or,agent) <�=�� �� -� � � 2 ��Z � � � 3 ;.. . —+:.;� �_�-- -r .. ,,,,�;Fly ;M,wy-��}•:e7dvwy�.fr:�g�y�.tF --�. .-.r�.. ,� , tf // Date....... ....... .... .h TO 2833 p< NO oTM - 3? TOWN OF NORTH ANDOVER A PERMIT FOR WIRING SSACNus� 'Y7 This certifies that ......./. . . .f �.....!' f14 .rre: has permission to perform .......a . f1 .. .l! .!-... . ':. t'.........................a w wiring in the buildingof .......................... at.. ..!` rP � .. r1l ._. ... . .. ....���. ...... ,North Andover,Mass" Fee.3. Lic.No!.-.7,F/-3.......................................... ELECTRICAL INSPECTOR 5V 5 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG (Print or Type) Mass. Date 6 191,L Permlt # Building Location 4� 1 Owner's Name Type of Occupancy. 5 ccr v p New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ ' No ❑ N cc a N W N y N V . W W rL O aUJ 4 m N r, ;yr W a.O C Z V W = �, W ,. .a O in W > LL J C t' �- W N m 2 O H W0 !A 'u W cC W z. { rt < O O WE 0 h W Ct '= 0 O ...r U C Y O a F- O SUB—BS i BASEMENT I' l IST FLOOR ' l 2ND FLOOR �. 3110 FLOOR I 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name -0 4A /t,w y Check one: Certificate Address Pl o x 7_5``� ❑ Corporation V a e ,e l U CQ ❑ Partnership Business Telephone 2, 7— I Lt S 7 Firm/Co. Name of Licensed Plumber or Gas Fitter ILC. e--LAP eir r! v INSURANCE COVERAGE: i have a curren lablifty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes No ❑ ' If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy--tg"— 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: owner[] Agent ❑ Signature of Owner or Owner's Agent 1 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 the permit issued�Iow�r_lhl, pli on will be In compliance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the Geral By Type of Ucense: Plumber ignature ol UcensedPlumber or Gas dte Title sfilter eb Master Ucense Number Cityrrown Journeyman APrn(Nr .:+w.•' W` YaiW:}e-ii'�i"'--_.. _ .,sem. .. .. ti-...;dr�e-� ..Y.,.-' �y-.-,-=-w+=xlb---w.•.'.ur- "' -<,�k�,6�,b., r Date. . 2041 r: TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION SS,yCeMu ' TIS certifies that . 0 . . . . .4 . �"%' S ha?permission for gas.installation . .!11 t��t °''{'� : : a in'lhe buildings. of . . . . d k d } ` . .Hid. ,Y�?at . . + . . . . ., North Andover,_Mass. Fee kO.0..0 i w. No..IQ 11. . . . . . . . . . . . � - GAS INSPECTOR C x, WHITE:Ap cant 'CANARY:Building Dept. PINK:Treasurer` GOLD File .. >�za-;�...� ,s . '" ��rz.•--=<�s�..-+�s��rS� - w3�vs-��3-:�:�-->'=2:.av`��-.�' -'s:= _�