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HomeMy WebLinkAboutMiscellaneous - 416 CHESTNUT STREET 4/30/2018 416 CHESTNUT STREET 2101098.C-0110-0D00.0 I Location No. Date -. 3 Ot "O^TM TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ ;CM„5� '-Foundatto ,Perrnjt Fee $ . �+gal;..:j 7iiF4DOC'� tgnit F� ' $ ,O r Sewer Connection Fee $ `Water.CDDnection Fee $ ------- MAY 93 $ 15, a 0 Building`Inspector 6 u 2 6 Div. Public Works J Location - o. Date pGeTh TOWN OF NORTH ANDOVER samaA& p Certificate of Occupancy $ Building/Frame Permit Fee $ MuS t� FoundaUu�Permit Fee $ Ot Fee ��, ,onnection Fee $ �,,; ;,ter Connecti� Fee $ TOTAL- $ ti� $ (2 1,C U � ��M ///"" f � • , ,�- Building Inspector Div. Public Works Location �No. 72- Date 4, TOWN OF NORTH ANDOVER p Certificate of Occupancy $ • _ �. �,J Building/Frame Permit Fee $ / � l a. • • '+s ACMUs ES Foundatiqq Permit Fee $ ! 2 s Other Perfft $ x`75 Swer Gpectio ee $ � Hill S W ®q�onnectltiree ' $ 31,q 4JV g� c TOTAL VP6) i� C , ONOX �. .:Building Inspector Div. Public Works Location NcO z/ 7? Date A, "ORT" TOWN OF NORTH ANDOVER % Certificate of Occupancy $ U Building/Free Permit Fee $ 1ACMus F I00 Permit Fee $ !/3 t; emit Fee $ �c�4lrer Corim 'on Fee $ Q Water ction Fee $ A 01&L $ /, v Building Inspector Div. Public Works i , Ll �/L I Location .2A �� iNo. ? Date M�"T'+ TOWN OF NORTH ANDOVER 3?C. �tiQOL p Certificate of Occupancy $ Building/Frame Permit Fee $ ass^CMUsEt�' Foundation Permit Fee $ ( Other Permit Fee $ � , �`757 Sewer Connection Fee $ x/189 Water Connection Fee $rk�'l �� TOTAL $ Building Inspector Na Div. Public Works Ptm T Zvo. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP 430. � 1 LOT NO. Vf 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE J SUB DIV. L T NO. I — LOCATION LA PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES '7 SIZE OWNER'S ADDRE 5 BASEMENT OR SLAB C•_ ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST =/y/��/2ND�.6�`,��%3RD BUILDER'S NAME - SPAN �1 DISTANCE TO NEAREST BUILDING + / DIMENSIONS OF SILLS 25// DISTANCE FROM STREET cy POSTS DISTANCE FROM LOT LINES—SIDES REAR / / GIRDERS AREA OF LOT FRONTAGE 17 HEIGHT OF FOUNDATION THICKNESS LJ Jill IS BUILDING NEW /i✓�Z SIZE OF FOOTING / x / 'A IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND i 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 LIONFE e INSTRUCTIONS - �trQ� � ' � I,o 0 3 PROPERTY INFORMATION ,^ 6r■ �fQLAND COST BaO SEE 130TH SIDES i I� .r . U 0 �p� PERM EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 -3 '� �Q( DM MME"ER"--� EST. BLDG.COST PER BQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 I EST. BLDG.COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE,OF'BUILDING-T; i I 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS .t PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED f � BOARD OF HEALTH SIGNATURE OF OR ORIZED AGENT OWNER TEL.# • F E E Z,3 c5 o C) CONTR.TEL,# CONTR.LIC. PLANNING BOARD .t • PERMIT GRANTED� BOARD OF SELECTMEN a a ovl INo INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S�ORIEs THIS SECTION MUSTSHOW EXACT DIMENSIONSOF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ -LOT LINES AND EXACT DIMENSIONS,OF BUILDINGS:. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN., CONSTRUCTION ` 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d il 2 I3 • i1.CONCRETE BL'K. EBRICK OR STONE PL/ TER PIERS PLASTERDRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M'TAREA _ 1/ 1/3 1/ FIN. ATTIC AREA N_O 8 MT FIRE PLACES _ 1 HEAD ROOM _ MODERN KITCHEN _ i 4 WALLS I J FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE _ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS COMICN VERT. SIDINIGING — AS HATILE -- t ..� • STUCCO ON MASONRY 'STUCCO ON FRAME—__, ma o-W,yyt z-,y:.to+ sea:.•r.� r>.�' tar+T� .a+...a ei BRICK ON MASONRY _4 ATTIC STRS.& FLOOR _ \ �. .�•„My- "I ri47 ,Rg1�f BRICK ON FRAME I •,,.,A..,..:..:.«,••.+-_... fa.••_..,..A n{..,`•r:`.„ .f i,r ti CONC.OR CINDER BLK. . s STONE ON MASONRY WIRING L STONE ON FRAME SUPERIOR I­1 2tR7 _ ADEQUATE S ROOF 10 PLUMBING GABLE I I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ I FLAT SHED WATER CLOSET _ f ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK 1 t � SLATE NO PLUMBING _ y TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR \ TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS.6 COLS. STEAM I 3 STEEL BMS. 6 COLS. HOT W T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd - \ ELECTRIC N Ift 13rd ,I\ NO HEATING -� . f COMMONWEALTH DEPARTMENT OF PUBUC SAFETY � OF 1010 COMMONWEALTH AVE. MASSACHUSETTS BOSTON,MASS.02215w L.IC ENSIc EXPIRATION DATE Z O I S T A• 0-95/3111993 O EFFECTIVE DATE LIC-NO. RESTRICTIONS ° NONE "s 09/0111990 C-544%; m KERRY M 000NAELL 115 Acasp iNl- RD SS 6 .015.52-4n54 AADOVI' MA f,'181' PHOTO IBLA$T1N0 OPA VNLY) FEE: SFA. n 00 HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY - = STAMPED OR SM.NATURE OF��Slt)Nll DOB: 08/3 119tt THIS DOCUMENT MUST BE I NATURE OTTICtftEi CARRIED ON THE PERSON OF ' •" �i,$..;= THE HOLDER WHEN ENGAG- E 0 NGAGED IN THIS OCCUPATION. MISSIONER 20OM-2.87-81429 iZh 40pt t. yh - ... r AA Y F t y-iA�d�IM11°}mssRIFT { - r • ti ' X U } - own 25 i r IBL- , l 310 � J3t0 310 .P. W/ agoST.rS 1105E lti7 r► 274� ---- - mss► *'+ - - `oS. ��.. i•.,v.: - .i� �'y _ SEL:IER �o.a�t.n�- wn' t' r•} '+•s. ::� ,. �' ft - - y.�.'�.. gyp,, � �� .iF•G. 1 � f CE C COLLOPY ENGINEERING CONSULTANTS 65 AYER STREET METHUEN, MA 01844 ti FRANCIS H.COLLOPY REG.PROFESSIONAL ENGINEER _ Residence:(508)685.7969 Office:(508)685-8069 CIVIL STRUCTURAL DYNAMICS September 24, 1992 Building Inspector's Office Town of North Andover North Andover, MA 01845 Dear Building Inspector: The purpose of this letter is to provide your office with a design change to the Plans for the residence being built on Lot 4, Chestnut Street in No. Andover by Broadview Developlment Corp. The original plans were prepared by a firm referred to as Guy Messier Residential Design. Mr. Berry O'Donnell of Broadview Development requested me to modify the framing above the Garage area(first floor framing) from the steel beam, as shown in the original drawing, to a wood framing member including appropriate footings . I am enclosing a copy of two engineering design sketches which provide that information for your office. If you have any questions concerning this matter, please do not hesitate to call this office. ���t80RNq�f Sincerely, ��! s COLLOPY ENGINEERING CONSULTANTS FRANCIS H. �► COLLOPY "'i 2017 Francis H. Col lopy, P.E. Structural Engineer Enclosure SJOB I-c>r 41 CNG S 7_Vu7- 5T., /lo. 19iyP-dL/L COLLOPY SHEET NO. /`T—IOFL , _ ENGINEERING CONSULTANTS p 65 Ayer Street CALCULATED BY__ FH G DATE_ B L METHUEN, MASSACHUSETTS 01844 CHECKED BY.- DATE (508) 685-8069 SCALE— �/0 i I I .......i ......... ..... ........�............................' , t ................._........:...............................................................I..............,.....1...........1.........�....... ....s .5. ...... ........... ! ....... , niJ �.. 1 I ..........; . L...... p..........�. ... ....._........... ..... i i ............ 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Flk5 r i... ...........................».1...».........................;................................»................................}..........;...........;...........;... I t ...... . ' .. .... , }...... .............:...........:........ ...... .�/ i.... .. L.....................L. ........i........ I .......I......... I I I ; I4 PHOMW2054f 1_Gmtm Yut 01171.To ONxPHONE TOLL FREE 144215-M , JOB— L,,-r LQ c-Hf-STNT 6?; � /leo h�N�✓ yi COLLOPY ENGINEERING CONSULTANTS SHEET NO. /"/ — �" OF pZ' p CALCULATED BY�9 65 Ayer Street DATE METHUEN, MASSACHUSETTS 01844 CHECKED BY--- DATE (508) 685-8069 SCALE M.775 ` .......... .. ...e............... :. ...................... .................i..,, t ........... .... -. ,...._ ................ ...... a.....................J. -- .... .. ... .... ... ..... .... .... .. ..i.........:............. ...�..,... ...,..... i : j ............... ..... .. .......... .... ... .. .. ... .... .. .... .. 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PRODUCT „Groton,Mast 01471.To Order PHONE TOLL TREE 1.000.225-M tix 01 FORM U - LOT RELEASE FORM t ` 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: Phone r LOCATION: ' Assessor's Map Number Parcel Subdivision Lots) Street C� W2Z 2:k St. Number ************************Official Use Only************************ RECOMMENDATIONS -.OF TOWN AGENTS: l COY Date Approved 2 Conservation Administrator Date Rejected Comments �Y`oSCor� c-� ea�rl dtPlddlil Date Approved G( ?7 '� - Town P1 ner Date Rejected Comments C� Date Approved Health Agen Date Rejected Comments 10- f'd Nei Public Works - sewer/water connectionsl-vvmitssuj9 �( ; ivewaYpermit Fire Department V ��G�.�c� U17''' •'� G�-P.� .•• 0 "1% Received bOy,Building Inspector Date Q ' _ 6 199? i 1 �a CERTIFIED PLO's PIAN n 19.01' Lnr- �- 2s, �oq s � a M a � r CX Is FuNDA77ON — I I N I � I � I i 1 , 7N 7- .5719EE7- NOV 1 31992 DEED REFERENCE.• 373Z-37 SCALE: / = 30 PLAN REfE"RENCF- /1/09 DATA lI I la /9 2 1 GLRTIFY ro THE No_AI\o,,vr e 6,to& Agr-RT THAT THE FooNs�Anant IS tOCATFO OW Ill£tor AS SHOW AND THAT lT DoLes CONF61RM WTH THE Iowa Gig No. A•NaavcQ ZON/NG REGUI-A710NS H Oy qs REGARD/NC SEmms fROM S1N££T UNES AND tor LINES / FURTHER nLRTIFY THAT THE DN£LL/NG /S NOT LOCATED IN A fEDERAL ROOD HAZARD AREA AS WOM L3N fZOAD INSURANCE RA TF i N MAP DATFD: 6--6- 8 q 3 9 � ME13NER LAND .SURVEY CO. ®� [J/ A/A/N STREET • SALEM, NEW HAMPSHIRE 03079 t Gov s93-3301 FINAL. PLANNING - �FINA SEW /WATER _ FINAL Town of � =c nctover ® ar a f R4;s�"' r" FW�AY ENTRY PFRNMT _ K�r� o, er Mass. 1 RIVE 4! tl / � ■ � �MF WICK � � ��T�� �. O R� Eru PERMIT TW or I LD BOARD OF HEALTH THISCERTIFIES THAT. ,.... l.. 0.. . ...................... has permission to erec 0U .. uildings on �. �! . .�1i�t..�T• RoughUILDING INSPECTOR to be occupied as1�AJAIt.A".4140AWAI.I�.�jv.em i�joeiiwit Chimney """ Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,A'PMMbTt%R FID W(dNLY Rough Buildings in the Town of North Andover. REGUUITED BY PARA, 1x&& k Final VIOLATION of the Zoning or Building Regulations Voids this Permit. NTWE 7 9 FEEP D d © o d PERMIT EXPIRES IN 6 M 0 115" � � ELECTRICAL INSPECTOR II Rough PERMIT FOR FRAME/BUILDIN�LESS CONSTRUCTION STARTS Service .� . .. 204� ..... Final DATE: FEE PAID' Zt J BUILDING INSPECTOR GAS INSPECTOR Occupancy, Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner �o Lat ing to Be Done Until Inspected and Approved by Smoke Det. p- Building Inspector `�� ,� d g P c)I FICE11;ur. Tt)4V l t � rrr t) \I'I'I ALS 1) I ! lil•III.IIIN(i ,'• ;�/,'• hirititi:n lni'a•II' i�lt4•I! • C:UNtiIa(Vi�'17ON I JIVIN11 INtW 11-*AI:l'I I"LANNIN(' 1'LANN1N(i & (;O111f111fN1'1'ti' U1:V1:1.OI'A1LN'1' • 1, , (::�I;I:f. 1 I,I', Nla.til )N, I )Iltl:(:I t)It CHIMNEY APPLICAI IOIJ ANO I'ERAf l' )A7'E 13 PLltru'r. # .00ATION WNER'S NAME: UILDER'S NAME: ASON'S NAME: ASON'S ADDRESS: ),J J d'� et> z y !ASON'S TELEPHONE: y— 27-�"7 ATERIAL OF CHIMNEY: INTERIOR CHIMNEY: L'Xl LRIOR CIIIMfJEY. JIMER AND SIZE OF FLUES: HICKNESS OF HEARTH: ____.-----_-•_.'_ . . ___... U chbi bin ate. (�epCaee ealtf anal to aIle. hl?.I�u.ihetnen.t:1 or the code d"d ft(lvc�, -ltcCC alt(( •c egu,eat oio been received: _-- _-- 4TE: f 3 IGNATURE OF MASON: ERMIT GRANTED: C) )BERT NICETTA .lILDING INSPECTOR — JSPECTEO: -- --MARKS: SOLID BLOCK NEQUIItED 5��� THIS PERMIT MUSF GE DISPLAYED ON JHE I'RLAIISES I, {{ 11 � 11\: l..rf �Y �.1�1�� •�t 1 /�a t 'I�� ��. j V I��1 � ��. t.��T_I.���, �},�. L 1 f'li'rt •' I i,n .:aa4l..c.i trl_'t 'I. I .J f . rS it it] Chef,(_T l ] r;is;ti:' UII i C j,:.L`I't:r�Y li' n A i ;ipo-ids3 napir'-g a 3 1n!- L't+ ' :^ I1C iniil 4 .;L7,' 1 -tr.,� . j hF,k• 51!-1 i rccPivci: dit i ! 1o;-, !l inq for _ 8:>r ,l tC_. .. c']".. C'Gf jJ L?LQ l:il:? WOrk isrn,-1"''r'Jf'3 Kc, atcorn �,- fo'-, tn= :;r.;... Tr 1 'ves „lig; L;ncilun;tancdiry tl; t}1 it �I "Clu_s, 1 01-1 rt r CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 472 (1992) Date MAY 5, 1992 THIS CERTIFIES THAT THE BUILDING LOCATED ON Lot #4, Chestnut S t. (#416) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGEIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. e*;�ao CERTIFICATE ISSUED TO Kerry M. O'Donnell o:�•`" � P.O. Box 331 ADDRESS Andover. MA Buit Ing Inspector 'Flow$Eli 'AlIuN_ - /O TIAL 6 � fir: -- PLANNING l FINAL SEW MATER, ��, INAL Town . of O' rth' . ,,,An over No. A'I a a Y, �-� � �P ��-d �� :North: °Andover,C Mass., 1 RIVEWAY E s^ �• BOARD OF HEALTH ER...M .IT. I LD P T . Blu • II°. .. THIS CERTIFIES THA .... .! .:............. . ., � BUILDINGINSPECTOR , • &&Vtuildin - �(•. 7, has per to ere.0 - g •••••• •• � c,� � f� .t Chimneyy, to be occupied as Final J-f� �� j "fed that the erson accepting this 4mit.shall in ever respect conform to the terms of the application ort file in Oro� P r P g P Y P PP PLUMBING INSPECTOR this oftice,.and to the,provisions of`the Codes and By-Laws relating to the Inspection,AIMMMFOR fGNNW N(PQY Rough f REGULATED BY PARA 1144.& &a B jltiings in the Town of North Ahdoler. , 04 ViULATION of the Zoning•ot Building Regulations Voids this Permit. DATE/.7,` �. FEE% J :r . .^ • f �; a n� 1 �:%o ? ' ,� a ;! l s`•.i ( � ( FLl .,) ��� EI.ECTR AL INSPECTOR Rough o f_ :.`� t Service r.PRMIT.FOR f,R/�IUIE/BUILDING • Final DATE;�.�..;FEE PAID: . BUILDING INSPECTOR GAS INSPECTOR Rough .. � , Y .�ii;, 7 '•r7t�i !.•- ( r'Jlrft'll lig ? ( 1` 1 /. . ' ^ - Final Display in-a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove But ier No Lat in to Be Done Until Inspected and Approved b � � S P PP Y Smoke Det. �� `.� �'a Building Inspector 1—Lj 6 U L' LA U 4'-6 d U- U'j NORT�f Town o n over 0 No. we'��1 40101*pl� MIVEWAY ENTRY PERNAIT AA 'Nor�h�EA er., Mass ox? BOARD OF HEALTH 4wt4 PERMITT 4/0Z 1601A 4ASA01 THIS CERTIFIES THA TAA0W.W.0;Off. . . . ......... LDING INSPECT AP20A Am& (V has permission to Idingson AgLM.OX f..f b &57j RougBhu'/"—:,— Chimney Final as.. ..... to be occupied ... provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in 14 MN N S 0 this office,and to the provisions of the Codes and By-Laws relating to the inspection,Alteration and Construction of ugh Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY Final REGULATED BY PARA: 112.7 S.B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. DATE:-FEE PAID: ELECTRICAL IN&PECTOR PERMIT EXPIRES 1�4 MONTHS 0 lk�r Rough UNLESS CON4UC N. TARTS Service PERMIT FOR FRAME/81AD1146 &0 Alf- Final ,DATE-ZAU FEE PAID: 7S' HUI DING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Bui1jkWMMff FUS. 72_T-, d_V Rough 1J3M FEE cy"4 5' Final Display in a Conspicuous Place on the p?gMjVFsPERmrr .2 ;,-z- o%;7 FIRE DEPT. Do Not Remove Burner No Lathing to Be . Done Until Inspected and Approved by Smoke Det. 0 X, Building Inspector !-fid d r e s s Title of File Page of Date File Open: Date file dosed: Cloc Document/Action Title Date of action Refer to other PurP.ose of t}ocumernt/Action and notes IW u m. Document/ document/ Action Department Board of Appeals – Board of Health Plannin•g.Board _ Conseruatiion Commission - Building Departm, en;t --'�— Date./? 1 .? . . . "O°T:.'�o TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING 'SS.cmus This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . ?V�nk.7. . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . ?�!� ` at. . . .� �.� C.4. P. `^. `. . . .n. . . ., North Andover, Mass. Fee. . . : Lic. No..�.?`!. . . . . . . . . .`J'. ��-��--�. . . . . . . . . PLUMBING INSPECTOR Check # 6727 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Location Date 1- 14 -05. Building `fI(oChEsrdtAT ST Owners Name KATE MARe.orlT- Permit# Amount ;3C. Type of Occupancy New Renovation 0 Replacement I�' Plans Submitted Yes No E] FIXTURES SLB.lM &LglvlHl�u' M HDM M IT" �FIDCit 4M H-" 5M Hi" 6M HfM 7M H-OCR 8MHIM (Print or type) .— Check one: Certificate Installing Company Name S A V A Lx r(u Mto I N L.3 +4Q ntl N Cr— Corp. Address -- .o' BOX 391 Partner. SA 1►E M A/ N 030-79 Business Te ep one 979 — g oq_ 115 p Firm/Co. Name of Licensed Plumber: R-N A 1 d St 1/Pis 6 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond E 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 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 in s performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac u s Stat I mbie a hapter 142 of the General Laws. By: rgna ure ofl-icenseu riumon Title Type �pe of. g Plumbing License � CitylTown rcense um er Master 1✓f/Journeyman ❑ APPROVED(OFFICE USE ONLYL_I FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Streets �� St. Number i ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments 0JLA Date Approved � - Town PlhKner Date Rejected Comments A:: A . Aiz , _ , Date Approved `+ Health Agen Date Rejected Comments d �v Public Works - sewer/water connectionsqsvml iveway permit Fire Department1v Received by Building Inspector Date