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HomeMy WebLinkAboutMiscellaneous - 43 JETWOOD STREET 4/30/2018 / 43 JETWOOD STREET \ 2101011.0-0039-0000.0 Date.... L) j TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that &Y1j,3e ...................... has permission to p6rform......... )V* ....) .4...... ..... ......................................................plumbing in the buildings of...... ............I.L,.L.A .................................................. at......Y,-5..... .................................(.J., North Andover, Mass. Fee.0J.....rDLic. No. /4-6..........................................!........................ PLUMBING INSPECTOR Check 4t Date.......17.1.. 1 . ..................... NonrN or' �, TOWN OF NORTH ANDOVER F � 9 iiW ' PERMIT FOR GAS INSTALLATION 8s+cmug�� This certifies that��?- ?5..... {.... .. .. ..�#--,�,�?'W ........ has permission for gas installation i t.4K. ...' 1Q: .f in the buildings of.......... ..�'`::C..�. ........................................................................ v at......... .3..... - Tca ............................... ... North Andover, Mass. Lic. No. . .y��. ..,. ........................... / GAS INSPECTO�t Check# S � (/ � Jr ir5 i w 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITYMA DATE ol I PERMIT#__ JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS TEL -- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW: 01 RENOVATION:® REPLACEMENT:Da PLANS SUBMITTED: YES Q NO Ell FIXTURES I FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM 1 j E I � __71 DEDICATED GRAY WATER SYSTEM t - i _ � _ = ___„_ _.____( _ -j { DEDICATED WATER RECYCLE SYSTEM I J J j _..-_� -V (E= ____I F-7-D _..i ----j1 I DISHWASHER --AL-2 _[ DRINKING FOUNTAIN I ..--__.j I I .___.._I _ _( _-_--_1 __.-_-__I .____.1 .. ..._( ......._� ._ ._-j _...._� _______I FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _ _( _—_i ROOF DRAIN I SHOWER STALL SERVICE/MOP SINK TOILET-' ___._l I .�__ j I .___ l I __ I URINAL __ I j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER __ _ I LIII 1=1 _.I INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY® OTHER TYPE OF INDEMNITY Q BOND 0-j- 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 Q AGENT �© SIGNATURE OF OWNER OR AGENT I 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 incom nce 'h ertinent provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME L Uygw c/ LICENSE# .06NATURE Mpg JP® CORPORATION®# z(, _PARTNERSHIP 01 COMPANY NAME - �ADDRESS CITY 7 STATE y �� ZIP p 3StTEL p FAX )� � CELL �fz3„S�rag� EMAIL J t Z- -C .Foe Ro *..J—5V , Lm• 7 — -- — ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPEC O TES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r • I ' The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print LeLyibly'' Name(Business/Organization/Individual): J or ,Coy E'SO s `1 1151 t- 144.4 Address: 131 -chiJ City/State/Zip: Phone#: to 0 3 .33 ,-),- '37o O Are you an employer?Check the appropriate box: Type of project(required): , 1.[ I am a employer with 7 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• [3 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 10.❑Electrical repairs or additions required.] officers have exercised their -3.0 I am a homeowner doing all work right of exemption per MGL 11.❑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' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 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:. ��f"'( /' l J / 5• G� Policy#or Self-ins.Lic.#: 1NM'a 8110 57.1 go i Z I q Expiration Date: /O 401 5� Job Site Address: 7i '�o sr City/State/Zip: A�Ai do vc-t— 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 rine 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. Ido hereby certo under thepains an enalties ofperjury that the information provided above is true and correct. Simature: Date: L2i1,AY Phone#: 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#: I Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for they 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,employingem to However employees.p Y r 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 buildingappurtenant thereto shall p ll not because ,, P 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 ofpublic 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 maybe submitted to the Department of Industrial Accidents for confi oration of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should J 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 Uvestigatirous 600 Washington.Street Boston,MA.02111 TO,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.Mass,goV/dia •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYjv� yMA DATE / PERMIT# JOBSITE ADDRESS !OWNER'SNAME GOWNER ADDRESS TEL.F—_� jFAX TYPE OR OCCUPANCY TYPE COMMERCIAL� EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:Fj RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOD APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BOILER BOOSTER - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ -,-! 1 DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT I OVEN _. � POOL-HEATER ROOM/SPACE HEATER ROOFTOP UNITTEST- UNIT EST'UNIT HEATER UNVENTED ROOM HEATER WATER HEATER �- -dT—HE R f INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ONO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L] OTHER TYPE INDEMNITY ® BOND (-] 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 0 AGENT SIGNATURE OF OWNER OR AGENT I 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 complianc with all PertineA provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME J .z _ �c � LICENSE# )R9-f i SIG URE MP MGF JP Ej JGF LPGIj CORPORATION[A#��PARTN RSHIP[j#=LLC E]# COMPANY NAME: a qyJ f / ADDRESS le � CITY %A-1 _ STATE /�� ZIP p $6 STEL ` FAX (_ z CELL EMAIL ° C-0- bbd �` 17 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPE TION NO S Yes No .S. THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES . c l The Commonwealth of Massachusetts - - DepartmintoflndlustricclAceldints Office oflnvestigations 600 Washington Street Boston,MA 02111 -www.mass.gov1d1a Workers' Compensation Insurance Affidavit:SupdersfContractor8LElectiriciansfflliiinbers Anplieant Information Please Pir nt Le0bZy _l Name(Businesslorganization&dividual): Address--__,Z / tkC�VVt ((e_ City/State/Zip: lr��Gt�6�d �/�D3�1ovPhone#:(��3 3 S z 970 0 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. [J New construction employees(fall and/or part time).* have nod the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.x `7. remodeling ship and•have no.employees These sub-contractors have 8. ❑Demolition working for me is any capacity. workers'comp,insurance. g, El Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 1011 Electrical repairs or additions required.] officers have exereised.their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself LEO workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurancerequired.]t employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that cheeks box#1 must also fillout the section below showingtheir workers'compensation policy information. t Ifo neowners who submit this affidavit indicatingthey ere doing all work and then hire outside contractors must submit anew affidavit indicating such: tContractors that check this box must attached as gdditional sheet shows agthe,name ofthe sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'com,peisation insurance for my employees Below 1s the policy and job site infarmadon. Insurance Company Name: I /' V 6t n 4 Co Policy#or self ins.Lic.#: W/�'1 Z ge o 5-7 l $0 l ZO/�( Expiration Date: f�l��I SS' I J'� r �w©0 Job Site Address: ?✓ City/state/Zip-NBd oor r" pt Attach a copy of the workers'compensation-poliey declaration page(showing the policy number and expiration crate). Failure to secure ooverage.as reguiredunder section 25A ofMGL o.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 DTA for insurance coverage verification. I do Hereby cert olid liepain penalties o fperjury that the information provided above is true and correct. - Simature- Date: Phone#: Official use only. Do not write in this area,to he completed by city or town official City or Town: Permif/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#: 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 tri the service of another underany contract ofhire, express or implied,oral or written." An employer is defiined as"an individual,partnership,association,corporation or other legal entity,or any two oxmore Of the foregoing engaged in a joint enterprise,and including the legal-representatives of xdeceased employer,or the receiver or fni' of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having notmore 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 employes." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or p ermit to op erate 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 ofpublic 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)andphonenumber(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the members or partners,are notrequired to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 applicatim for thepermit 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*orkers' 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 andprinted legibly. The Department has provided a space at the bottom Of the affidavit for you to fiU 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 submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)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-lion 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 ox permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves eta)said person is NOT required to complete this affidavit. The Office of Investigations would Eke to thank you in advance for your cooperation and shpuld you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho CQMJ?amwealt�o as�achusct�s epa ueut Of Industrial.A.ccidenta Of Roe QUAVOdtxga-00mg 6.04 Wasbiugtoa Sftee�t Bwton,MA021lX tel##RM-27,4.900 0A 496 or 1.877.:M m _ Revised 5-26-05 10/22/2014 15:30 9786833147 PAGE 01/01 OhTEt►�+DDfNWY) CERTIFICATE OF LIABILITY INSURANCE 10/22/204 THIS CERTIFICATE iS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RKiKM UPON THE CERTIFICATE HOLDER.THIS AMEND, EXTEND OR ALTER THE COVERAGE AFFORD BELOW, TI413 CERTTFICATE OfED BY THE POLICIIES M INSURANCE EDOER NOT LY OR YGONSTfTlJT1E AA GONTRACT BE WEEN THE F331AN© 1N$URER(SI, AUTHORtMO REPRESENTATIVE Olt PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: M the CertlticM tinkht IS an ADDITIONAL INSURED,the 1S01i�l�te$F rtlL�t be� If SUBR06AT1CN IS WADED,evb)oGt to the twms and cond4hins of the policy,certain Policies may mobe An o0 mffneltt. A s&ornerlt an this 00MCI to does not Md—elgIft tQ the cergiowe holder In h3u of such endorseme,htisl• PRODUCER p978)683-31Q7 M P ROBERTS INS AGCY INC N ,, . 1978)683-8073 1060 Osgood StreAt ADDREss: aLulaftpFebertuilisurance.com North ASdovibr, 14L 01845 MURIM) Apt=MG C0IV 0E euuc. INSURER A: TS INSt1RAZTCE GROUP INSURED ,Tp$ P.DY 6 SONS pU MBING ANI? INSURER 0: CFtAi�T 'S'T MCE G ig 13EA.TING, INC. INSURER G-D�'.RCl3PIl1�'�S INSURANCE 31 WSTVILLE RD. UNIT 1 INs❑RERo; 114 MTtJAL INS CO i PLAISTOW, NN 03865 INSURER E: � 603-3B2-8700 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLTCIE$OF INSURANCE LISTED BELOW HAVE BER94 ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOiW14STANDING ANY REOLAREMENT,TERM OR CONDITION OF ANY CONTf#ACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MNY MVE BEEN,REDUCECI BY PAID CLAIMS. TYPE Or INSURANCE yyyp POLICY NUMBER flf<t PUL Y I.1MIT5 I.TM EACH OCCURRENCE x 1 000 000 2E COMMEROAI.DEMSPAL WM+Lnr j CLarons Iu.sDE OCCUR PREMISES ,Ea�r►ence s 108 000 09/ B/1A 05/26/1B IDEXP nvonuPereonl i 15 000 SOPI0 4 9141 PERSONAL&ADV(N)URY >i 1 r 0'D 0 000 A GENERAL AeMEGATE s 2,000,000 GEML AGGREGATE LIMIT APPLIES PEFt 2,000,000 PRODUCts-COMPIOP AGG S POLICY❑1�RC LOC g OTHER: s000,000 AUTOMOBILE LIABILITY alN* f ANYAUTO BODILY INJURY'(Per 0'r—) s ALLOWNLD SWEOULED PIOSSs�4 12/ 2/1312/22/14 BODILYINJURY(Per wcldent) S AUTOS AUTOSNON-OWNED Ptre axitient � X 141RED AUTOS AUTOS 1t; UMBRELLA!ALIS ' OCCUR CXTPg142510 fi$ 28/3.4 05/28/15 SACH OCCURRENCE It 1r000'000 C EXCESS LIAR CL41M16!!n! AG IREGATE S 1,000,000 DED RETENTIONS 1 O 0 00 & WORItERS CONIPEN ATION R &TATiriE £R AND EMPLOYERS'IIABILITY vru MOSO05718012014 4/06114 x0/06/15 E;L,EActjACCIDFw s_ 500,0AW PR0NIU0RW'"NM*XS0UTTW 1A ElDlSeltSE-Eh EMPLOYE s 500,0001 4111mb tory in NID If yes,deeatbwurder E.LOISAASE-POLICYLS S 500 000 DESCRIPTION OF pPefRATIONS bM- DESCRIPTION OF OPERA.TIONS I LOCATIONS I VEHICLES (ACORD,101,Addi om[Rw WM S&edule,may be edeahed it mare SPM it roquired) CERTIFICATE HOLDER CANCELLATION t1,R .,I�.HOtT3$ I11v$,IGNC SHOULD ANY OF THE.ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 31 ;POOLE h S IME ACCORDANCE WITH THE POLICY PROVISIONS. ROCXPORT MA 01966 --Ito AUTWAizEO REPRES6NTA. t"8-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014101) The ACORD name and logo are registeredmocks of ACORD Date.... ............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION g$ACHU This certifies that ...... .RN�. ...�........ .` ................................................ has permission for gas installation ..... . ., r ........................................... oV L tAt, .............................. m the buildings of........ g.............................................................. at........Lf.3.......j ...�R...... �.................... North AndVver,Fee�--...v............ Lic. No.LA..�5�..... �� ...� � AS- INSPECTOR i Check# % 4( S� . :3 -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY _ MA DATE .S Zo(�PERMIT#-� JOBSITE ADDRESS —II OWNER'S NAME GOWNER ADDRESS _ TEL__� FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL ® RESIDENTIAL CLEARLY NEW:[j RENOVATION:® REPLACEMENT: — PLANS SUBMITTED: YES FJ-1 NO[- I APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ - , _ 1 DRYER J FIREPLACE FRYOLATOR FURNACE --j=_r E:—Q! - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _ ROOM/SPACE HEATER _ ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER ..g WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YESJ2NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND ( 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 © AGENT 0 SIGNATURE OF OWNER OR AGENT 1 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 complia with all P i provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME A�tG �o_c�(^ r_ LICENSE# �o?�l _YI SIG URE MP MGF®I JP 0 JGF 0 LPGI 0 CORPORATION M#E=PARTNERSHIP # LLC[3#= COMPANY NAME: ,lo� ID p f G ADDRESS ,, ,L_�i.L� y;► L c uaZ 1 CITY f w _) STATE /U(-F ZIP — —FAX lai(�g—`C�� CELL Z?S/d;EMAIL _ �pc_-Cot, AVC- ROUGH GAS"INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No © '/2--13 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth ofMassachusetts - Department of.�ndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit:Builders/ContractorslElectricians/Plumbers Applicant Information Please PrintLegibly Name(Business/Organization/Tndividual): Pe /t 5 Address:_ZZ �v ' C n t7'L / City/State/Zip: Phone#: 663 Are ou an employer?Check the appropriate boa: Type of project(required): 1.Yl am a employer with 3 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.x 7• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• El Building addition [No workers'comp.insurance 5. El We are a corporation and its ME]Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑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'. comp.insurance required] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they 2're doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X 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 S elf-ins.Lie.#: 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 maybe forwarded to the Office sof Investigations of the DIA for insurance coverage verification. X[lo hereby certify under tl ains andpeiml' fperfury that the information provided above is true and correct. - Simature: Date: T /Zd1-3 Phone#: 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 ane): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: P Information and ffnst actio 's 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 orimphed,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 certificates)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 anLLC or LLP does have employees,apolicy is required. De advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation ofmsurauce 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 riotedlegiliY: The De ar6nerit has rovided a sace of ffie boom --- 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 whichwill 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. Anew affidavit must be filled out each year.Where a homeowner 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: Tho Cox.monwe�altbL 0 f M ssarl?usPtts Dapaztnaea ofZndustxlal Accidents Offioe of 11RVest1gatio.nS. 60GWasbingtoa Street Boston,MA,02111 TO,#61.7-72,7-4900 at 406 or 1:-877,MASSAFB Revised 5-26-05 NO 61.7"727.7749 10143 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . ��VA.-Aw , .�? . has permission to perform . .1�.=.(? plumbing in the buildings of. . . �q ! . . , o.u. }.� at . . . ` 3. e -�wa 9.Q„ . . North Andover Mass. Fee U . Lic. No. 1 a`�5`j„ 7M . . . . PLUMBING INSPECTOR Check# 9ill (� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY -I r I MA DATE'r PERMIT# d� JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS TEL — FAX _ TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:� REPLACEMENT: Ug' PLANS SUBMITTED: YES® NO[] FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I ( f 1 1 _._ 1 —J. DEDICATED GREASE SYSTEM __--.-___€ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEMH E DISHWASHER { __ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK i - -_-_-I .---_ E ( I ._._.__J i _1 ._._.._! LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK __.-_._E ____-_j __--—11= ----.1 TOILET I E —_ _ _-_i _1 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 i .__-_-€ I WATER PIPING OTHER amwmp ==F IF ( INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY []j BOND D 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 0 AGENT I SIGNATURE OF OWNER OR AGENT 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 comp' ce wit P i nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME cJ ,e LICENSE# SIG URE MIX JP E-( CORPORATION W# ]PARTNERSHIP J# j LLC COMPANY NAME ADDRESS 3 6.1cg --,` (edk „ CITY / -77]STATE ZIP D 3 10 5- 11 TEL ,FAX 8 l Z € CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations kvi 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): ✓ v�c �" �' oks f 7G T Address: LJ65 v 4'< <e Kc Ott City/State/Zip: o 34 to S_ Phone © 7 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with f _ 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# 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.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑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.MOther ���� *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they afire 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:. G' ' Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: y� cJ e City/State/Zip:_Ajt4n�Duc r 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. Ido hereby cert and the pains and enalties ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: 6 D 3 3 (s g 7oD 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#: 1\ q 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 ofhire, express or implied,oral or written." An employeiis 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 bum 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 6.00 Washington Street Boston}MA,02111 Tel.#617-72?-4900 ext 406 or 1-877.MASSAFE Revised 5-26-05 Fax#617727-7749 wWw-mass,gov/dia Location No. —JZ,,413 Date "1¢' ,ORT" TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ Building/Frame Permit Fee $ ; . c►+uSEt Foundation Permit Fee $ Other-Permit Eee�. "y' $ Sewer'C6Yrriecion dee $ '-+ Water Connection Fee $ _ rT TAL $ s' J�1 N 1`4 1993 , Building I actor i16 Div. Public Works Location No. Date NORTH TOWN OF NORTH ANDOVER 0� 1,6o 6,+ O? 6 ON F - 9 Certificate of Occupancy $ Building/Frame Permit Fee $ • off". .. '� Foundation Permit Fee $ ?^GNUS q Pther,Permit Fee $ Sew�4Ugnnection Fee $ Water Conr3ection Fee $ TOTAL $ g _7 99,3 Building Inspector =_ ` Div. Public Works AtM T NO. �2� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK ;PAGE — ZONE SUB DIV. LOT NO. . I i LOCATION cc b Sr' -" PURPOSE OF BUILDING S�wlQlt `tq OWNER'S NAME 'T��� (.f t NO. OF STORIES 1r SIZE OWNER'S ADDRESS l 2 NO ���e( BASEMENT OR SLAB ARCHITECT'S NAME 1rJ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEWS SIZE OF FOOTING X IS BUILDING ADDITION �D MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Ye's IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY YY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST QJ PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER&Q. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 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 INSPECTOR DATE FILED b f-3 BOARD OF HEALTH SIGNATURE OF OWNER 1 UTHORIZED AGE&T pqr F E E PLANNING BOARD PERMIT GRANTED OWNER TEL.#M-01IO CONTR.TEL. 19 CONTR.LIC.#.9s8 23$ BOARD OF SELECTMEN BUILDING INSPECTOR yr BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE �_ 3 1 2 13 CONCRETE BL'K. PINE HAR BRICK OR STONE DRY W L PIERS PLASTER _ DRV WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 '/t 1/. FIN. ATTIC AREA _ N_O 8 M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 f 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD",/'D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR 11 ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE _ HIP BATH (3 FIX.( _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROIL ROOFING MODERN FIXTURES _ TILE FLOOR a TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE r/ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS IL O B'M'T 2nd _ ELECTRIC 1st 13rd 11 NO HEATING v `mss NORTH Town of And O i.FY;y��NM41 y�r 13 (J o ~- A dower, Mass. W�� 19 1 g� ;►3 -/ �ADRATED P'OL �C, '9S H 5�� BOARD.OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............................ 0 ...... .......................................................... Foundation do has permission to w W.....ORC ....... buildings on . ta !;F���h...... .........�... ..... Rough to be occupied as h �d� .......�� row0�......���Z.���� .... Chimney provided that the person accepting this permits all in every respect conform to the terms of the application on file in 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION T ELECTRICAL INSPECTOR Rough �............ .. .. ... ..... ...``................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough p Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. .,FkA1PP iINATFR FINAL DRIVEWAY ENTRY PERMIT