Loading...
HomeMy WebLinkAboutMiscellaneous - 42 CROSSBOW LANE 4/30/2018 (3) 42 CROSSBOW LANE LJA 2101106._ 8-097'0000.0 1 I Date . ..7..��' ♦ y�q'!Ti:�Yby�� n, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . , 2t1c c. . . . .�� . . . . . . . . has permission to perform . . ?!/ 5an�Ao�'f4- wiring in the building of at .V Z- • • • • • • . • .A�rthAndover, M s. Fee 1 `•. . Lic. No 1. 77��,-� . . . . . . . ELECTRICAL INSPECTOR Check# 10946 Commonwealth of Massachusetts Official Use only Department of Fire Services permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC ,527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL I FO ?,4TION) Date: /j /Z City or Town of: /, yGY' To the Inspect r If Wires: By,this application the undersigned gives notice of is her intention to perform the electrical work described below. Location( Street&Number) S UInI L-e4t nA Owner or Tenant ' Telephone No. Owner's Address Is this permit in conjunction wit a.buildin ermit? Yes No ❑ (Check Appropriate Box) Purpose of Building t % Utility Authorization No. Existing Service_7jtr�U Amis /Z0/Z!Yolts Overhead ❑ Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a r t j C) !ra—tun ah �Y�Y ttr mar f4 Completion o the followin table may bewaived by the Inspector of NVires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.o Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o Detection and 6 InitiatingDevices No.of Ranges Total g � No.of Air Cond. Totts No.of Alerting Devices No.of Waste Disposers eat Pum um, er ons o.oSelf-Contained Totals "..' . " '" '' " ' ' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local[:] Municipa ❑ Other Connection No.of Dryers Heating Appliances KW Security stems: No.of Water No.of Devices or Equivalent Heaters KW o.o o.o Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent � • OTHER: Attach additional detail ifdesired,or as required by the Inspector of 11'ires. Estimated Value of -lee rical Work: (When required by municipal policy.) Work to Start: -711111-L Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVLf RAGE: 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) /cern ft,under the pains and enalties ofperjurj7,that the information on this aP !ic ation is true and complete. FIRM NAME: Tnr_ LIC.NO.: 17238A Licensee: Richard J. Arel Signature LIC.NO.: 27514E (lfapplic•able,enter "ezeinpt••in the license niunber line.J Bus.Tel.No.:978-372-1601 _eet Address: MA Alt.Tel.No.:97R—'109-9187 *Security System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: 1 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 agent. . Owner/Agent Signature Telephone No. [PERMIT FEE: $ r9 J- Date. ��S,l! Z 9540 TOWN OF NORTH ANDOVER € PERMIT FOR PLUMBING ,SSACMUSE� This certifies that . . . . .�1`fY"'e... . g . .�S . . . . . . . . . . . . . . . has permission to perform . . . .�� /7. ��?r-�. . . . . . . . . . . . . . . plumbing in the buildings o . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . Tz. . &v'SA� . . . Andove .Mass. Fee� Lic. No. �o?& " 7�. . . . . . PLUMBING INSPECTOR Check c` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ t-Gc��� d MA DATE ,��/y�/ ( PERMIT# JOBSITE ADDRESS L 4/ Cra v s Saw v OWNER'S NAME P OWNER ADDRESS 2 l TEL JIFAX __['I TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL Di RESIDENTIAL EV– PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES I NO© FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM E 1 I ( I ...___..I ( .___. I __.__..._.! _ I _..__..� .......J=== DEDICATED GAS/OIL/SAND SYSTEM f w._I 1 ._ ( ( _. __..I _f . _..M l ___....__1 —1 I--_f. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I ! ( I __.... _I f _�..._. I _-. _I DEDICATED WATER RECYCLE SYSTEM I ....._.._.1[-.._._� 1 ..._v._ _1 .._.._._.I �I _...._...._f .__.__l DISHWASHER — _I _....__..._I 1 f .---.__-_! l ! l ._.._...J ._.........I _._.___-' .._.....ri I DRINKING FOUNTAINf FOOD DISPOSER -J .._._._.__( .__._..._._I ._..._..1 ......_.._I ( _.--__..l FLOOR/AREA DRAIN I _.._...___.I __._.-. _._.f .__..___.; I I J [ f ......___I _... INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN _I _._..__ 1 _....___i .....__.t ._^( __...._1 SHOWERSTALL SERVICE(MOP SINK TOILET URINAL .__-.-...( .._._..__.i WASHING MACHINE CONNECTION =71(._.... .! __.r_ ... ...1 l . ... _-. A WATER HEATER ALL TYPES —1 -_ ` --�-f r 1 �1[_- [_--I .__ WATER PIPING OTHER 77– INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L4W NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY l BOND I 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 JEO SIGNATURE OF OWNER OR AGENT B hereby certify 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 c mpliance withnaertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ,7'A�` S �"-CA i76/l S _ 'LICENSE# .1 7 _I SIGNATURE M40" JP CORPORATIONS!# j PARTNERSHIP 0# -_ .__ LLC COMPANY NAME l4 ,s �7`l� ; ADDRESS _7 ANYc4�l�s �? CITY; P1�+if 1'd4-/ _ j STATE ZIP TEL�Cso--� FAX -.. tI CELL 16,.1 C2yd EMAIL CL C. G,,Af / , e..�, ---]ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 9 s`iz FEE: $ PERMIT# PLAN REVIEW NOTES r . j t a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgations 600 Washington Street Boston,MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):. "�"� Address: 77vi-Ac/re., �M City/State/Zip: 1 s 4 1V H o a k6 r Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 1311 Other comp.insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 'am an employer that is providing workers'compensation insatrance for my employees. Below is the policy and job site nformation. nsurance Company Name: i 'olicy#or Self-ins.Lic.#: Expiration Date: ob Site Address: City/State/Zip: kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 ,f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certify tinder the pa�enalties of perjury that the information provided above is true and correct. i ature: .��— Date: 'If / hone#: a3 -3 J?Z— YG'l 2 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# i 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#: r L� 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 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),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 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 and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-7274900 ext 406 or 1-877-MASSAFE .evised 5-26-05 Fax#617-727-7749 www,mass.gov/dia FORM U - LOT RELEASE FORM ­--­ INSTRUCTION IS-: 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 _ theapplicant and/or landowner from compliance I la nce w�th any applicable or requirements. ul rements. *******APPLICANT FILLS OUT THIS APPLICANT L A�g L a2C-� PHONE Ct1ls 69,'S �9�5 i LOCATION: Assessors Map Number IIIA PARCEL 9 1 SUBDIVISION LOT (S) ZO ST. NUMBER_L 2 OFrICIAL USE RECOMMENDATIONS OF TOWN AGENTS: zW-, U, CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS �" Vy 1 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS i FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED XSEIITIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS i DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY BUILDING INSPECTOR � DATE Revised 9197 im �_J 9 ` A= 431566 S•f- M LOT 2IV, ' '' LOT 19 t � iu - j 26,CD O O O 1 N O � 2 .00 t� 27i� 12Pc � Ede No. 42 _ r •0 O a 2 STY-WOOD' j cu 1 • ��--- 150.00 S U e42-e% CROSSBOW LAN E location NORTH ANDOVER_, MA. C L M. Date 5- 6- 1995 Scale: 1 inch , 5_..._feet REDAtOND .. No. 31342 Deed.and Plan Reference: a t uMo 9438 -OF 1984 i?eed Book�6.Pape 17.3_Pian Certification is hereby made to: 10A 2AnMW4 that the existing structures as shown are siWated on the lot Commonwealth Engineering designated and are in compliance with the applicable Building and Associates, inc. Zoning By-taws of the m#dpaffty when constructed. 16 Old Post Road E.Walpole, MA 02032 Certification is hereby made that the structure shown on this plan IS located within a Special Flood f•la=ard Area as delineated Phone: (508) 66&5136 on the FIRM map of Comm<urityY Number 2 50 0 9 8 0 012 C Facslae: (508) 660.1457 Date..6- 2 -19 9 3 i 1 Date...:. , N2 : 5 0 ..... ...... NOR711 , °fs"'° '•'"a TOWN OF NORTH ANDOVER r PERMIT FOR WIRING u �,sS^CMUSE� This certifies that °..:!:.:-;-.`.................................... ................ has permission to perform ...................................... r ,.T. ... t wiring in the building of ....�:...... 4- 1?:-.:�..a.r2' "`�.. ,North Andover,Mass. ..... Fee .�5................. Lic.No. .............. . �................................................ G, ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer i TB'COVfffONUE4LTHOFAI9&�401USEI7S Office Use only DEP4REYEVT0FPUB0CSAF= Permit No. 49 i3OARDOFFMPRET,=OIVREGU A77ONS527C,,M] 00 Occupancy&Fees Checked iirZ= APPLI( ATTONFORPERAIRT TOPERFORM==(�'AL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IIs(INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of W ices: The undersigned applies for a pen-nit to perform the electrical work described below. IMAP PARCEL Location(Street&.Number) Owner or Tenant J rA l? j $ Owner's Address ����-` ��� iA�Y� Is this permit in conjunction with a building permit: - Yes No (Check Appropriate Box) Purpose of Building `tee lL' PA/It /Y 11"'L-1 J1 NV~ Utility Authorization No. Existing Service � 6 Q Amps `- /2Q Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Owlets /' No.of Hot Tubs No.of Transformers Total KVA No.of LightingFi== ry Swimming Pool Above- Below Generators KVA !iground ffound No.of Receptacle Outlets No.of Oil Bumen No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burner No.of kanges No.of Air Cond. Total I-IRE ALARMS No.of Zones Tons No.oc sals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwasher Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Sia_ns Bailasis i.Hydro Massage Tubs No.of Motors Total HP �OTHER- hsutarlceCo�aage Asst.Ianttali�regmana�sofNla�Ya>sEfisC�allaws Iba,&aczo=Lmb&ybsLz Pc iL YES NO Ilmest>1mikdvalidpr(dcfs=tDtbeOfce YES No Yyxil echa�YFS,*Lmmd;caIL-t re Fofmcaaq lbyd=krgttr INSURANCE F7 BOND OlE (Please Spey) L .13 lel U �2, ��\�V, -Z-:? Esti�Vahr lWcrk$ �dl d Wc�ctosw !0 i1 Irn�f)atRe`�d Ra# �=� F1iinal --i /l 0,4 Sigrrd,mder�ieAma�of N,��,� n �1) - I eNo f ,tBLE=ssTeLNo. l r n ��C j . AIL Td Na OWNER'SINSURANCEWAIVEP Iarnawatedntt1mLomsedoesrnthAwd-,emsL=ce crit a±sta�iegritiaia'asqmedbyMa sad C-,,a a Laws atxitlBtmysigr><ahaecnthis�ntapp�tialwdi�st�s�mtYr�art /� (Please check one) Owne Agent U/e? �' �� PERMIT FEES �^ Telephone No.of Jlimature of u7ner or ALI= N° 2 •I 4' Date...... ....... ...�'-)... NORTI{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSAcHuSEt Thiscertifies that ............................................................................................. has permission to perform / .�...... ..................... wiring in the building of..!..... ,. .............................................................. at� .?... !�-r--¢�/�, .-• .....ee--............................ .North Andover,Mass. Fee?6 Lic.No. .. 45 .............. ."i...:. ..:..:..................... ELECTRICAL INSPECTOR WHITE:: Applicant CANARY: Building Dept. PINK:Treasurer Rough Service Final 04t Goinmvnwralt4 Of MSSSnr4twetto Office Use Only Department of Public Safety permit No. P BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy 6 Pee Checked/,S"`= 3/W (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL,,INFORMATION) Dat C3 v City or Town of f� ice! �7 '1 t�C�Jy/� To the Inspector of Wires) The undersigned applies for a permit to perform'the .electrical work described below. Location (Street & Number) /ZOSSI Uv�.J I�y1 f Owner or Tenant Owner's Address �- Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work :LQ/Liz C 14 4✓1 C � TOTAL No.of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above No. of Lighting Fixtures Swimming Pool gmd. 9rnd. ❑ Generators KVA No. of Emergency Lighting No.of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones °� No.of Detection and No. of Ranges No. of Air Conditioners Tons Initiating Devices Heat Total TOtaT No.of SoundingDevices. No.of Disposals No. of Pum Tons KW No. of Sell Contained No. of Dishwashers S ce/Area Heating KW Detection/Sounding Devices * Municipal No.ref Dryers Heating Devices KW Local❑• Connection ❑Other No.at No.of Low Voltage N9,of Water Heaters KW I Signs Ballasts I Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES 0 NO 01 have submitted valid proof of same to this office. YES U NO U If you have check YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Final Signed under tT,hi,,40 Itiesof perjury: ^^�/�� FIRM NAME t`'d J35 E A" ����1� �C LIC. NO. Licensee l Signature LIC. NO.�LG7 Address yy��ui2.� / d !F i Slac J l/1/tf O"•j�'�S� Bus. Tel. No. 663 Alt. Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) Date. . . 02 • 40RT"-1 TOWN OF NORTH ANDOVER 3: � w .,, .• aL PERMIT FOR PLUMBING ,SSACHUS� This certifies that has permission to perform . . . '. . . .�. ... . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .� . .'f. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . ,,North Andover, Mass. Fee. i . . .Lic. No.. . 2!.?.? . . . . . . . 1: . `.�. . . . . . . . . . . ( PLUMBING INSPECTOR WHITE: Applicant 'CANARY: Building Dept. PINK:Treasurer i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ( \ 1 (Print or Type) "94k, y Mass. Date �— D D Permit # _ Building Location facyo, CdttJ �h Owner's Named e.. r 0%tnr !h 1✓+ec ` t 14s i C�.Il Type of Occ ancy 1510— a wrx(t,t New Renovation Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES I Z Z Z to 0 11 V z tH Z W W W Y < y QQ x U ccQZ_ 0 Z_ Z_ 1D. OZ y to to x } c< P y �L OL a V 66 Z L cW O DW to C 3 66 W to W Z G Q661 9' Q N � Q = Op = a D Q O Z C C a oc m < 141 li 3 Y 3 m cc 3x l_ to 16c < 3 cc mo� SUB-BSMT. BASEMENT VV 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR (� 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name CLIMATE DESIGN Check one: Certificate Address 7 Stewart Street C Corporation averhill, MA 01830 (978) 372-9999 C Partnership I Ic. Plumber: Michael H.NOM Business Tel C Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes O, No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity a 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 I hereby certify that all of the details and information I have submitted(or entered)in the above application are true and accurate to the Vst i knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all perti t pr Bions he Stt Plumbing and Chapter 142 of the General Laws. S By Signature of Licensed Plumber Title Type of License:Masters❑ Journeyman CitylrownLicense Number APPROVED(OFFICE USE ONLY), I FINAL INSPECTION SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME & TYPE OF BUILDING -- LOCATION OF BUILDING PLUMBER -- PERMIT GRANTED Date 19 U.G. Insp. Rough Insp. Final Insp. 1 1 Plumbing Inspector /