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2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an
electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shall-be limited as to the time of ongoing construction activity,and may be-deemed-by the lnspector_of_Wires abandoned.and.invalidlflre—_. ._
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written
application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
• "in effect or existence"during the qualifying period beginning on August 15,2008 and extending-through August 15,2012.
ule 8-Permit/Date Closed: /�- — /;� **Note:Reapply for new permit'
rmit Extension Act-Permit/Date Closed:/ ���
.a
Date.......: .2 . -.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4 ,,.o
,SSACMUSE�
1
This certifies thatC—
has permission to perform .......... ....`..:`..yS.1- ...................................................
wiring in the building of.....................
3 � lh .. .... ........... ,North Andover,Mass.
° _av
Fee.. ............. Lic.No—MR.-5-1-..4.............. .�.�
ELECTRICAL INSPECTOR /
Check # b 7/
28210
`_��
-.-••....W.rwCa,c.ar yr MassachUSetts official Use only
V`
Department of Fire Sere�ices Permit No. Z Z 0
BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked
[Rev. 1/071 (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
All work to be performed in accordance with the Massachusetts Electrical Code WORK
(PLEASE PRINT IVINK OR TYPE ALL WFOR11 ),s27 cMx 12.00
I14TION). Date:
City or Town of: NORTH ANDOVER
By this application the undersigned gives notice of his or her intention to perform the el trick W Wires
below.
Location(Street&Number)
A..v 1 /1�.
Owner or Tenant C(A—A t
Owner's Address :SA.,44 Telephone No.U(7
Is this permit in conjunction with a building permit? Yes
Purpose of Building N° ❑ (Check Appropriate Boa)
Utility Authorization No.
Eaisfing Service Amps / Volts
Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts
Overhead❑ Undg-rd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
_�" ( n,E Sttli�ttiGt�6�r (�Q�l
Y
~ Com letion of the ollowin table
No,of Recessed Luminaires No.of Cei1-Sus No.of�'be waived by the Inspector of Wires.
p.(Paddle)Fans Total
No.of Luminaire OutletsTransformers ISA
No,of Hot Tabs Generators KVA
No.of Luminaires Swimming Pool Above �_
o.o mergency
No.of Receptacle Outlets a. ft d. Batte units
_ No.of Oil Burners FIRE ALARMS :No. of Zones
No.of Switches No. of Gas Bnr'ners o, of etection and
No.of Rangesotal Initis Devices
No.of Air Conti.
Tons No. of Alerting Devices
-,t No.of Waste Disposers eat mber Tons o. of Self:Contained
Totals:.' �' Detection/Alertin Devices
% No.of Dishwashers Space/Aren Heating KW Local❑ Municipal
` No.of Dryers Connection ❑Other
i 5' Heating Appliances KW Security Systems:*
No.of Watero.of No.of Devices or E uivalent
Heaters ' No, of .Data Whin .
Si!,us Ballasts.
No.Hydromassage Bathtubs No.of Devices or E uivaient
No.of Motors Total HP Telecommunications
OTHER: No.of Devices or E v alent
Aaach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value o Ele 'cal Work: �1Dd
e Work to Start (When required by municipal policy.)
O Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C GE: Unless waived by the owner,no
the licensee provides proof of liabilityPermit for the performance of electrical work may issue unless
insurance including completed operation"coverage or its substantial equivalent The
undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office..
CHECK ONE: INSURANCE BOND E] OTHER
I certify, ains o
p p fPe17at1',that thunder the and enal&es [3 (Specify.)
e inf
FIRM NAME: ormation on this application is true and complete.
1� Lt11 S t 6 V C
Licensee:�ICU4EL LIC.NO.: "I
✓�'{�t G(�1.��et i 1 ) Siguatare LIC.NO: _
(If applicable en r"exempt"in the lic a number line.) d'Q
Address: (�-c_S 6y Sti �� 1�� Bus.TeL No.: �p
*Per M.G.L c 147,s 57 61, curity work requires D �6 S t
epartamem of PubIlc Safety"S erase: Alt LicL No
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance
cerise:
required by law. By my signature below,I hereby waive this re
Owner/Agent oquirement I am the(check one) covernge normally
❑owner's agent
Signature Telephone No. PERMIT FEE.$
9478
Date..... ..- �1`::z�.
l
NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSACMUSE�
This certifies that .......RmeL!..-F
has permission to perform .......... � L-
..... e....................................................
wiring in the building of.............!qun/—..eA............................................
at.. .-' 4......94............... .... . .North Andover,Mass.
Fee.� --ted
`�...'-"":... Lic.No.V L N i
RELECTRICAL INSPECTOR
4 Check # /32�—
Department of Fire Services Permit No. Iq Zgl
r Occupancy and Fee Checked
� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: —
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) G 5
Owner or Tenant o f e l" Telephone No.
Owner's Address LQc,
Is this permit in conjunction with a building permit? Yes ®,-- No ❑ (Check Appropriate Box)
Purpose of Building Pee
j Utility Authorization No.
Existing Service c)(J'l) Amps IDLIO Volts Overhead [e— 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:
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above - ❑ o.o Emergency Lighting
rnd. rnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
InitiatinIZ Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons g
No.of Waste Disposers Heat Pump I.N!l I Tons KW No.of Self-Contained
.. . ............................... .......................
Totals: Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: 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:)
I certify,under the ins and pe allies of perjury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.: :_&q 7-13
Licensee: IC PZ ?4—0 Signature LIC.NO.:
(If applicable, nter "exempt"in the license number line.) Bus.Tel.No.: !JX 3,'a ,$)9
Address: !� Ka.vc-Sa1t� 4 LZ •dt� rit 14 o! Alt.Tel.No.:
*Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I 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
Owner/Agent PERMIT FEE: $
Signature Telephone No.
.�,�
5
Y
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
5� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): jo �/,f72`74Az
Address: 15-
City/State/Zip: JV 14 6 (F3 Phone #: -5-
Are
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. [1 I am a general contractor and I 6. ❑New construction
em ees(full and/or part-time).* have hired the sub-contractors
2. am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling
{
ship and have no employees
These sub-contractors have 8. E]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.F-1 Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.] t employees. [No workers'
comp.insurance required.] 13.❑ Other
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
t 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach 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
fine 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
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
sign e: f'9 —7� Date:
Phone#: ��� 3 4 5x'33
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
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#:
IL DI "TEg : Ti{�i �j.,►1 { ueK�fw+rl�l ,s daT
PI7T1.1. -e,c Z
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AS BUILT PLAN
�St11 %R%CE DISPOSAL SYSTEM
LOCATED IN
ti,lo�ftl a,1JDBy�fz, MAy,. �4�j G�wt�!-�5'1"IcK C�ofa�
AS
PREPARED FOR
GATE: 0-16•off
*GALE: I"_�. TL 1 i ' •" _ a
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
ea PARR STRW a+DOVEL MAUACHMM 01830 • tEL Ia177 475-W3,373.5"1
Official Use Only
'0-0
Permit No. �
i7e�antrx�rd e��a6lte Sa °�
Occupancy&Fee Checked
am.. ,._
wl Ab RD OF FIRE PRE1t'rPITI0t-RI�GkJLATIONS 527 CMR 12500 y f.,
►/1 j \! i,F � ; _1 : ,, y...l�...:
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK i
`All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Pleast?�Nr131inkell„Np1je%n&fpo%lation)` 1,'•+'i. �”.g 1� �• +�"„*, f s� Hate• ^•c:i
To the Inspector of`N'Ires:
VR sawn ofi` North Andover
The undersigned applies for a permit to perform the electrical work described below. ,
Location(Street&Number t( 3 l_ a-v� Q IZL vy:
Owner or Tenant 47L "Ky' s
Owner's Address
Is this permit in conjunction with a building permit Yes a No (Check Appropriate Box)
Pu of Building Utility Authorization No.
�ce 9 �Y
Existing Service Amps Volts Overhead a Undgmd 0 No.of Meters
New Service Amps Voits Overhead 0 Undgmd 0 No.of Meters
Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical Work 0- SALLA-rW—
Total
No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA
Above if In a
�.of Lighting Fixtures Swimming Pool gmd D gmd a Generators KVA
No.of Emergency Lighting
No.of Receptacles Outlets No.of Oil Burners Battery Units
No.of Switch Outlets No of Gas Bumers ' FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Ranges No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Diposal No. Pumps Tons KW No.of Sounding Devices
NoJ of Self Contained
No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices
a Municipal a Other
No.of Dryers Heating Devices, KW Local Connection
No.of No.of Low voltage
No.of Water Heaters KW Signs Bailases wiring
No.Hydro Massage Tuft No.of Motors Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremenfits of Massachusetts General Laws
I have a current Liability Insurance Policy inclplated Operations Coverage or its substantial equ' EYES)NO�ave sub valid proof of same to the YES NO - If you have checked YES please indicate the
by checking the appropriate
INSURAN BOND - OTHER (Please Specify)
pF (Expiration Date)
imated Value of.Electrical Work$ IC 5-8 0
Work to Start I- Z_y S` inspection Date Resquested Rough Final
Signed under a PeCra s of perju
FIRM NAhAE� /w l l ) e-q_
q_ n_✓ k t. LIC.NO.
Licensee/l C h /� �/b Signature , LIC.NO. ��v�� Z-
n " ( (� Bus.Tel No. 7 SI If 2 -DS�OS
•-'dress�U Ot O V P-Kr `V 1 I.,�►�e�UA[1 Mt Tei.No._F
JER'S INSURANCE WAIVER: I am aware that the Licen es does not have the insurance coverage or its substantial equivalent as required by Massachusetts
_merai Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
(Signature of Owner or Agent) Telephone No. PERMIT FEE
NEED
- 5961
ti Date....
.............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4L
-This certifies that .......9"-Ial..........
................ .............. ..............................................
-�ias permission to perform -j-
wiring in the building of... ............................................
....... . ....... ...... .. 'North Andover,Mass.
Fee.:/:.?.... ... Lic.No ........ ......
4 .
ELECTRICAL INSPEcrOR
Check #
Official Use Only
- �!/
/ Permit No.
Dy&au+x«rt o�?�uClie Sa�ety �` d/
Occupancy&Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 12:00
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) Date
the iijf W-
.0uoas:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number 3
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit Yes a No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Voits Overhead a Undgmd a No.of Meters
New Service Amps Voits Overhead a Undgmd a No.of Meters
Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical Work %z tE W isy✓�� )�v tom• _n e.tz��
Total
h .of L!ghting LightingOutlets No.of Hot fuse No.of Transformers KVA
1 Above a In a
' o.of Lighting Fixtures SvWmminq Pool gmd a gmd a Generators KVA
No.of Emergency Lighting
No.of Receptacles Outlets No.of Oil Burners Battery Units
No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Ranges No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Diposal No. Pumps Tons KW No.of Sounding Devices
Nol of Self Contained
No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices
No.ODryers Heating Devices a Municipal a Other
_ KW L.oca! Connection
No.of No.of Low Voltage
No.of Water Heaters KW Signs Bailases Wiring
No.Fid ro Massage Tuds No.of Motors Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy incl u Co pleted Operations Coverage or its substantial equ' YES NO
ave sub valid proof of same to the OtTi YES NO a If you have checked YES please indicatethe ype coverage by checking the appropriate box.
INSURAN o BOND OTHER (Please Specify)
(Expiration Date)
imated Value of.Electrical Work$ K 1 $-'D e)
Work to Start T—Z—0 S— Inspection Date Resquested Rough Final
Signed under t e PetP�a 'es of perjury `
FIRM NAME (4-r,.Ll � "t_
UC.NO.
Licensee P,Chi�� Signature _ LIC.NO. Z-
/J n Bus.Tel No. 7
"200 �$'HOL
Address
Q p V e_!L KJ ` 1x rr,04 Alt Tel.No. J,`7$ d C7 —9:,2 —
OWNER'S INSURANCE WAIVER: 1 am aware that the Lice es 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 $
(Signature of Owner or Agent)
I
it
s 2s z = od -~i N �
w w n
o O o 0 0 0 0 o
a -��
= t
T v�
O WATER CLOSETS }
KITCHEN SINKS � H
1 LA,YATORi[S
RATHTNNS
SHOWER STALLS
o
S
DISHWASHERS
❑
wAs �
i DSSPOSERS
LAUNDRY TRAYS
WASH. MAC". CONN. y n
HOT WATER TANKS
TANKLESS Z
s ar o SLOP SINKS
FLOOR DRAINS
OAS TRAPS
D ❑ URINALS
[] DRINKINO FOUNTAIN
O AREA DRAIN
O P WATER PIPING '0
' ROOP DRAINS � S
S ❑ BACKFLOW PREV.
OTHER fIXTNRES: C
Q
0ELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS S!<ET�CNES_ me
PROGRESS INS►ICTIONS
as
APPLICATION FOR PERMIT TO DO PLUMBING ,
NAZI!i TYPE OR BINLOIOINO
LOCATION OP BUILDING
PLlIII�R
v
PERMIT GRANTED
DATE 10
FLUMINNO R UPECTOR
Date. .
*z= 3670
4,0 TOWN OF NORTH ANDOVER
3? ���. .....•s 0
PERMIT FOR PLUMBING
'SSCN„S�
0
This certifies that . . . G. . . . . . . . . . . . . .
has permission to perform !%v
. . . . . . . . . . . . . . . . . . . . . . . . . . . $
plumbing in the buildings of . . �i-. �?�?,/? �f��. . . . . . . . . . . . . . . .
at. LI-3 . e-0-7 c r ! 41. . A �. . . . . ., North Andover, Mass.
Feed(,�. Lic. No.57� . . . . .`. . . . . . . . . . . . . . . . . . . . . . . . . . . . w
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO ASFITTING 0►
(Print or Type)
10 T t+ Dmef Mass. Date 19Permit * PY-3(,,
Building Location '-f3a Alb 1-CLS g(Glc, �r') Owner's Name 1XIC kJ A lep JiR A 10a
tYtA Type of Occupancy_ eSI 7e.�N Ti 01-
New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ Nocc
❑
to
y W N
Y z Q pl
yy V CC
y ¢ U) Q O O y = F-
W W Q 0 0 m t = S/1
0
J y W r
z 0 W r < C z 0 O r
m 0 r y W0 d ¢ W
10
0: 0 0 W = Z F. sA O W
W z W Q W r r z
W W M J < 4: 0 Q W W V
(7 r z J_ t' _ ►� W W r J
z < W < C F t- 0 m W Z O Z W O N Z
W Z. < W. < < O O W O W r
cc '= xO 10 S u. 3 c 0 J 0O
SUB—BSMT.
BASEMENT
1 ST FLOOR
2ND FLOOR 1
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name "i CjA=(Z T :-'AM MAT yl r 0 Check one: Certificate
Address 30 0o A C H 1h 14 n) i-fI. ❑ Corporation
M r 7 H U E (J Al ra U ( k ❑ Partnership
Business Telephone "1 ( 2--Firm/Co.
Name of Licensed Plumber or Gas Fitter �i (�niE T A- 5AMM I9 AIer�
INSURANCE COVERAGE:
I have a current Obility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes lid' No ❑
If you have checkedrtes, 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.
Check one:
_
Signature of Owner or Owner's Agent 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 the pe i ed for this application be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws.
BY T of License: C�
Plumber n ure of cen u or Gas Fitter
Title tte< X333
er License Number
City/Town O IC L Journeyman
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
C
I
NAME d TYPE OF BUILDING
LOCATION OF BUILDING ---
PLUMBER OR OASFITTER
LIC. NO,
PERMIT GRANTED
DATE 19.--
OAS INSPECTOR
ry�1
r
1
�.� 8 3 6 Date..//i/ .�.......
NORTH TOWN OF NORTH ANDOVER
' F�Oya�,.ao ,s,ti009
PERMIT FOR GAS INSTALLATION
t �
SACHUSES(
O
[L
This certifies that . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . .P/1 P .r. r . . . . . . . . . . . . .
in the buildings of . .� .1�,�?�'.r s
c.
at . . ��3. l �.�' :. . . . . . . . . . . . .. North Andover, Mai.
Fee. . . :. . . Lic. No..�.).;? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer