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HomeMy WebLinkAboutMiscellaneous - 428 WINTER STREET 4/30/2018Location / � 8 a/ � No. 3 8,V/- Date a ��- TOWN OF NORTH ANDOVER o ; . Certificate of Occupancy $ Building/Frame Permit Fee $-S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -1/s 9 15 3 �'4- 3 / Building Inspector JLC L i iu V i- Nim PgFORMAI ION 1.1 Property Address: - 1.2 Assessors Map and Parcel Number: 7-dz2 ST. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service-: Signature Telephone 2.2 Owner of Record: / C3 Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address .� Expiration D to Sifnature i Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name / /-L E Registration Number Address ^/ Expiratio Date Si riature Telephone A r a C r i_4 a r r a i L- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a• ?..� _� . BUILDING PcRMIT NUMBER: DATE ISSUED: a SIGNATURE: �C Building Commissioner/I for of Buildings Date JLC L i iu V i- Nim PgFORMAI ION 1.1 Property Address: - 1.2 Assessors Map and Parcel Number: 7-dz2 ST. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service-: Signature Telephone 2.2 Owner of Record: / C3 Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address .� Expiration D to Sifnature i Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name / /-L E Registration Number Address ^/ Expiratio Date Si riature Telephone A r a C r i_4 a r r a i L- 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 applicable) New Construction ❑ Existing Building 0 Repair(s) Alterations(s) K Addition 0 Accessory Bldg. 0 Demolition ❑ Other )y Specify 00 — f► "M' yr Brief Description of Proposed Work: nw I crrTTnv ,< _ T QTTM A TFT IYIN4Q1R7Tf T1nN C CTC I Item Estimated Cost (Dollar) to be Completed by permit applicant E {) biSlNtl.Yns I. Building (a) Building Permit Fee Multiplier 2 Electrical L v (b) Estimated Total Cost of Construction 3 Plumbing D Building Permit fee (a) X (b) G� �- 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 as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I ,as Owner/Authorized Agent of subject property Herebv 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 ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 t 1 JJ16 iC4HiWfO7ftf7Mt[R, �✓ilt7tSSOtf4(st9l!' I i NOME IMPROVEMENT GONTRWOR € i " Registratiaa: 1221$9 Expiratior 1126102 X2pe: Private Lorporatio T.J. EOVAROS I SONS, TNG Thous Mardi, Sr $ G'•� 9 UNION STREET 1ADMMTRAIOR OERRI � :, . • NN 03038 _. `7k f s imons<. lJe c 6 [P � t fu. e BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR : Number. CS 073018 Birthdate: 0 413011 96 3, Expires: 0413012002Tr. no: 73018 Restricted To: 00 THOMAS J EDWARDS 12 UNIOWSTREET # BERRY; NH 03038 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: CityPhone aam a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity �I am an employer providing workers' compensation for my employees working on this job. Address % `7 City: moo, -Sem AJAI 6.),3,16& Phone* Insurance Co. A'i6E7�rt/ �%urllA(, ��.GrtfJ Policy #GlJC', `1-3%S_-33/c�0 3—D i Company name: Address City: Phone #• Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties.of a fine up to $1,501).00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine 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. l do herby certify, timer the pains and pen" of perjury that the information provided above is true and correct Print Official use only do not write in this area to be completed by city or town official' ❑Check if immediate response is required Building Dept Contact person: Phone #: FORM WORKMAN'S COMPENSATION ❑ Building Dept ❑ licensing Board ❑ Selectman's Office ❑ Health Department ❑ Other C/) m C/) 0 m a: C2 CD CO) CD 0 a) O CA 00 51 O CA loJ CD a CD CO) 0 0 0 CD I c n O C O z cn b n C c I*= o m = 0 E ti o VJ ERS � I V! co Cc) S -1 m Z yma2 ?•p VJ 0 �,► rd-► O y T orn co O m s p y H M o?m' m = > >� o �� 7 to t o o H Com! CD w SLK ra o CD m �M y CO d N h � CK C — c• tta C.m _ m Er o y Cos =m OC Z 0 0 �o m Piny � t ' 0= so o CL M Cl) C2 • . CA _CD s. . z Q )Mq 0 9 0x d o w 7 �' ��� n N ►� r °^ o. C a tz z O C CD ►s T.J. Edwards & Sons, Inc. Noposd No. F0116 General Contracting .1 mrn77 I,ondonde 'Turn ike Shed No.1 of I F� p Hooksett, NH 03106 Date January 169 2002 ; h.603-622-6068 A.603-622-1735 MC 9: 122159 License #: CS -073018 Proposal Submitted To: Work Site: Renee A Ford 428 Winter Street 428 Winter Street N.Andover, MA 01845 N.Andover, MA 01845. Phone: 978-974-9989 Phone: 978-974-9989 Installation of a Majestic DVRT36 (propane gas), fan; ceramic brick liner and venting kit to be flush with the interior wall. The exterior of the gas fireplace unit to be enclosed in a 'dog house' that we will construct on site. The 'dog house' to have the same siding as the house. The gas fireplace to be mechanically installed to manufacturer's specifications. We will construct a pine mantel surrounding the fireplace. We will apply tile surrounding the gas fireplace. The tile and grout to be supplied by the customer and have ready at their home. We will patch in the floor with flooring materials that the customer already has at their home. The customer has a certain amount of flooring materials if we run out of those materials we will install the rest of the area with file (as supplied by the customer) to make a hearth. Purchase and installation of (2) Anderson casement permashield windows with screens, wood on the interior and vinyl on the exterior. The windows will be installed on either side of the gas fireplace. While in this construction we will be removing the board and batton siding and either fix or replace due to water and pest damage. We will not know the extent of this damage until the area has been exposed. If there is extensive damage there would be an extra charge which is not included in this contract price* If there will be an additional charge we will alert the customer before proceeding. This price is for labor and materials. This price excludes any electrical, gas connections (plumbing), interior/exterior paint/staining and permits. We will not know the cost of the ,permit until we pull it with the town. All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and/or verbal specifications as submitted for the above work and completed in a substantial workmanlike manner for the sum of e, �G1 1, G, o ©. oo / J 7 /-aa �-- Dollars $7,177.00* With payments to be made as follows: $1,600.00 down payment to order the windows and the gas fireplace. $2,788.50 due on the 1st day of the job. $2,788.50 due upon our completion of the work as stated in this contract. We are not to be held responsible for delays resulting from other sub -contractors or Town Officials. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. Zero Clearance Fireplaces, Free -Standing Stoves, Fireplace Inserts, venting/pipe components purchased are covered under the terms of the manufacturer's warranty. Mail in all warranty cards. We cover a 1 year warranty on our labor and parts. We are not responsible for any delays in our jobs or defects resulting from 'acts of God', weather conditions, customer misuse etc. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Public Liability Insurance on above work to be taken out by T.J. Edwards & Sons, Inc/.prough American States Insurance. Respectfully. Submitted VNote - this proposal may be withdrawn by us if not accepted within 30 days. Acceptance of Proposal The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Do not sign thisscontract if there are any blank spaces. Accepted � i�7e4e �% to C� rrmt ivame e,n/1 ign ame J Date. . ... . It N° 4UO47 4, TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING ,SSACMusE� ..� This certifies that , ., .... ............. . G .......... has permission to perform .: ,�^�- -�-.` .^ ! : ,• plumbing in the buildings of ......... • . • • • • • at .. • • • • • . North Andover, Mass. Fee ...... Lic. No...., • , ............. ......... PLUMBI14 '61NSPECTOR � U Check # 11/` o r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING fPrint or Type) � 6` 1 �LP % II %V N ©01;1C Mass. Date / 19 Permit # Building New ❑ !d 9 cV /A) T't--A ST Renovation j SEWER# Replacement [ FIXTURES Owner's Typ!.10�ccupancy AG Plans Submitted: Yes ❑ No ❑ SEPTIC# Installing. Company Name iiaO�IPV fi k 91-10 �- Address �� n o R ll-Ylj - '9NDGv13'1,1Lt0lS _C,IS-/ Check one: ❑ Corporation (� Partnership Certificate # (// P Business Telephone ri?9 tf �� 3'� C Firm/Co. Name of Licensed PlumberzSoS� joo u'' T,-,FrC1,9A-, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142- Yes 42Yes No ❑ If you have c ecked yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy Er 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 ❑ or 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. BY Signature 9R Ucensed Plumber True Type of License: Master Journeyman ❑ CrtYRown 3 8 APPFO/ED (OPICE USE ONLY) License Number _ z. m � N N y O Z >a W Y J N E V H 4 h 14 O Z N N W d Q F� U W N Y - a O W ? d :. 3 ui E >C V = rt y in N X N WQ H N N z O < N C7 Q a C Q O -4 Cry C� 4 W O d N Q Q W H Q J? p c .j JJ H V d > S t- 3 o Z v► L us z= N F- 5C z a. o 0 01-- Z Z d W W F- LL o Y o 4J Z a < ? H< d = d d O x c7 Q 3 q < ]t J m v7 ® O J 3 H a) U. O a a m p V SUB—BsMT. BASEMENT % IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing. Company Name iiaO�IPV fi k 91-10 �- Address �� n o R ll-Ylj - '9NDGv13'1,1Lt0lS _C,IS-/ Check one: ❑ Corporation (� Partnership Certificate # (// P Business Telephone ri?9 tf �� 3'� C Firm/Co. Name of Licensed PlumberzSoS� joo u'' T,-,FrC1,9A-, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142- Yes 42Yes No ❑ If you have c ecked yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy Er 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 ❑ or 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. BY Signature 9R Ucensed Plumber True Type of License: Master Journeyman ❑ CrtYRown 3 8 APPFO/ED (OPICE USE ONLY) License Number Date%.:3'�/ 10 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING his certifies that ....t...... ?�'. 'Vas permission to perform .. 7.—: � ........ plumbing in the buildings of .. ........................... at . f-� .............. , North Andover, Mass. Fee .''... Lic. No.........�PLU�4G ......... . SPECTOii Check # 4972 .. t • MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING -�. (Print or Type) Mass. Data Permit # /"mop** Building Location I—f kZj h 4Q1>,1— - Owher's Name %C Cid ir� Type of Occupancy Residential New ❑ Renovation ❑ �' Replacement Plans Submitted: Yes ❑ No ❑ ' FIXTURES i r 4 " � s " Iristalling Company Nameertage Htg +`lYIo1 g • Co • F 'Check one; Certificate t i j CX Corporation _ 71.4_ - - -Address— et` Stoiet�am, `Ma 0 0 (j Partnership 21.8 f eusmess Telephiin ' #781 4 3 8- 7 7 7 Cl Firm/Co. Gordon Switzer Name ot:Ucer;set `PluMber' r ' q � flt, INSURANCE Cr�VE0AG15 I have;'a cutrenl-liabllity Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. 1; No ❑ .` k IC youthave checkk'.ki pleaseilndicate the type coverage, by checking the appropriate box11. A Ilabllity,insuPance policy M Other type of Indemnity C3'Bond ,:,. ty i ' a vWIN&"S tNSUWl E,INAIVER( I am aware that the licensee does not have the insurance coverage required by. V , r; . .CliapteF 142 ,of` the M sS:'!Gendai Laws. and that my signature on this,permit application waives this requirement. 'Check one: Owner. ❑ Agent ❑ ' '+ _c,,,.�titm of (lwn inr-(.wttiAt's'Atlent :t:, - ' � i�tiereb� ceHify that all of fl r knowi6dge',and that afi pfu pfiitlneht piovfsions;of the .. Title s " Cit /Town'' �P�f i `co> C S ,i � t d6tails afid information I have submitted (or entered) in above application are true and accurate to the best of my Ding woikaiid installations periorified undat the permit issued for irks application will ba in compliance with all . a5�achusett9,Sta'te Plumbing Code and Chapter 14 of the General Laws. $; S ature o icens PI m er .Type of License, Master [X Journeyman Ej IL k License Number 8322 1, 'L i z ?N'`f r U1 i ! { p Z .nth h +LLJ D l7 S � 0 ' O J tN W , e W N cc W S: ;p: ' {tU W ; tr A - N G. V' '1 ` - } U !Y m N W }- d ¢W 1- 0 Z � � Q ,. N X cc d rt M w U 0 Q. 7 w }i d r rn ,tQ . X 'Q j r x N a.' O tL" N J— X X p W W 0 W X >`I i -f '{ t-1 Q .4 I N iU) ;Q ',d i0 Q J .J a Q 'oC OC Q O Lt Q m 3 04 3{n 3 suA-0SMT. ;` : 'ASLMENT, + i 5T -'P LOON 2Nb'Fi.00R t 3AI),OL009. 41rH'IFt.00R ATH FLOOR' + t . ,R'H'FLOOq p. � 9TH-FLOoR' " Iristalling Company Nameertage Htg +`lYIo1 g • Co • F 'Check one; Certificate t i j CX Corporation _ 71.4_ - - -Address— et` Stoiet�am, `Ma 0 0 (j Partnership 21.8 f eusmess Telephiin ' #781 4 3 8- 7 7 7 Cl Firm/Co. Gordon Switzer Name ot:Ucer;set `PluMber' r ' q � flt, INSURANCE Cr�VE0AG15 I have;'a cutrenl-liabllity Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. 1; No ❑ .` k IC youthave checkk'.ki pleaseilndicate the type coverage, by checking the appropriate box11. A Ilabllity,insuPance policy M Other type of Indemnity C3'Bond ,:,. ty i ' a vWIN&"S tNSUWl E,INAIVER( I am aware that the licensee does not have the insurance coverage required by. V , r; . .CliapteF 142 ,of` the M sS:'!Gendai Laws. and that my signature on this,permit application waives this requirement. 'Check one: Owner. ❑ Agent ❑ ' '+ _c,,,.�titm of (lwn inr-(.wttiAt's'Atlent :t:, - ' � i�tiereb� ceHify that all of fl r knowi6dge',and that afi pfu pfiitlneht piovfsions;of the .. Title s " Cit /Town'' �P�f i `co> C S ,i � t d6tails afid information I have submitted (or entered) in above application are true and accurate to the best of my Ding woikaiid installations periorified undat the permit issued for irks application will ba in compliance with all . a5�achusett9,Sta'te Plumbing Code and Chapter 14 of the General Laws. $; S ature o icens PI m er .Type of License, Master [X Journeyman Ej IL k License Number 8322 1, 'L "iz ti �* 4 �• t ai � inky t. � t r. .. . s J _ W yy N tU F I° arr , Q a a t � 5 ` �. '.M1�.,.q �. m � f 4{•sw sr 1uy. ay, K' . Q �' �1 ws. LL r A LL LL LL < i' ,+' �i 2 :r�y J .➢ •z`'t a F'�� ��hrt... i,�it YM,' aF. ,t •.°- , t .. . 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NORT►� of <• 0. ;•. 40 FAT 0 9 �SSAGMUSEt TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..........Zt ............................... .......................4z P.� has permission to perform............................................................................. wiring in the building of C.g.�.j ..................................................... at .............` �� 6T- s� ..... , North/Andover Fee.... :../'... Lic. No..`...7.... .... .........,1 ELECTRICAL NSPECTOR Check # J ' THEC0A0fflNWE4LTH0FM4MCHUSE7TS offiee Use o/,yam' DFpARTA1FVTOFPUBMCS4FElY Permit No. BOARDOFMEPREVF. MONREGULAT1OA83r(W ]Z*M Occupancy & Fees Checked APPLICATION FOR PERW 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 6 Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes ® No u (Check Appropriate Box) Purpose of Building /-)0//-)0//Z ,, 'a -5X6V & Utility Authorization No, Existing Service Amps / Volts Overhead Underground 1:3 No. of Meters Iew Service Amps �� Volts Overhead Underground [:3 No. of Meters Number of Feeders and Ampacity 11,ocation and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above groundg1:1round Below Generators KVA 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 Detection and Initiating Devices No. of Sounding Devices No. of Self Contained No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Heat Total Total Pumps Totts KW No. of Dishwashers Space Area Heating KW Detection/Sounding Devices Local M Municipal Connections Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Si Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHEIR' InstrareCo�aage Ptttsttantbthetegtmartal���� Iha caaxmtliabd'dyham=Pcbcy dACCarq> * YES NO 1.hme%hniWdvalidptoo'ofsa e1otheOlfioe YES 0 NO F)mhareci>IeiWYES,pleasecdc*thetMxofwmwbydakirgthe INSURANCE M BOND OYL•&R M ftmSpe* Expa'anonDra6e /& ^ e E9i maad Vahte�ecUiml Wak $ WcrkiDSwt �,�` 6 P, MTec icnD*Regtlesled Rco* _ � � � FmW �Y �R ' n ei� �i'isLfl//x-71 /_—`/ cit,` _ X502 FIRMNAME P�D .�.,��.�. � .� L�seN0. S ff ` / Lioet>SeNo 7�5 Lioamee_ Pb b c'1- ��t✓2 tUr? 6 Sigt�Ixe ✓ Bt6nessTel.Na Ar im,, /�� C/�,�t_ / L'rg �,�co r �e ��%�a'1 �-I O) A 3 AltTelNa 3� , b. OWNER'SDVSURANCEWAIVER;IamawatetlnttheLioero d rotlme$leiu m amVa�snbstalfialepyakitascegtmedbyN4mo tBoCatdLam ard�atmysigtiataernit>�pat�appFt�onwai�ilbs tec�arla�. (Please check one) Owner Agent ❑ < �. V Telephone No. PERMIT FEE �/ ' COMMONWEALTH OF MASSgCNUSETTS BOAR]).� A; OF ELECT AS A REG RICIANS ,.JdURNE" YMANr. } T YPE . i �SSUES�tTh11S LICENSE To EC TRIC IA ?.; \' �� ,, ROBERT"` C✓ :' RIVIEREss _E 18 CARL IDA ROAD GROVELAND heti ' 387481 d O 1834- 1745 37452 E SMA 07r31/o4.- 387481 WMMM Fold, Then DetaO Along All Peno,tion® ;privet's License 04-03=63 04-03-06 M 608"";'. DM 022465610 D,ts or Nth' Exon . sex Cuss LARIVIERE . ROBERT H ^ s -1., oc 18 CARUDA RD� GROVELAND. 01834.1745 AV 4 Date? ../�.... s ' TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. Y.��x 0Zclv. ...... . has permission for gas installation >�fr:. . in the buildings of .... / %U , . --.. .................... . at 4a"' .. �! !`? ��-... -<;�........ North Andover, Mass. Lic. No. GAS INSPECTOR Check #' 6 3 ? 3;37 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type (/ 4 e^'"&A Date 2 � 20e ZRecelpt# � Permit# Building Location Owners Name/✓ J2, r Map:_ el New ❑ Lot: Renovation can Al Zone: 6' No Installing Company NamecJ Address EstimateValueof Work: BusinessTelephone=�����T Name of Licensed Plumber or Gas Fitter Checkone: Certificate Corporation d� E3. Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability 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 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. Checkone: Owner Agent❑ Signature of Owner or Owner's Agent f. 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 the permitissued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. gY TYPe of License: Plumber Signature of Licensed Plumber or Gas Fitter Tide Gasfitter Master License Number City/Town Journeyman APPROVED (OFFICE USE ONLY) Revised C5/IM