HomeMy WebLinkAboutMiscellaneous - 440 OSGOOD STREET 4/30/2018 440 OSGOOD STREET \
210/102.0-0003-0000.0
Date............ . ........... ..
�'• NORTM
°tt :•'"� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSAC14USE�
This certifies that ....................Arv.,w t/ ��................ ... ....... . ..............................
has}permission to perform !154..`? 5 d
f V 'I
wirVig in the building of........ :Q.�.5........................................................
S North Ando erA'ass.
Fee.. ............ Lic.Noj .._. ?, ........ :... � .. ..............
q ELECTRICAL INSPECTOR
Check # C . 1
52253
ThE MWONHEILOIiSCSMS Office Use o2��
DEPARTAflM0FPUBLICSAFE7'Y Permit No." V
BOARD OFFREPREVEWONRYGULAHONS527 CM 12 VO
Occupancy&Fees Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,S'27 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yeso (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead Underground No.of Meters
New Service Amps / Volts Overhead Underground No. of Meters
Number of Feeders and Amp acity
Location and Nature of Proposed Electrical Work dtJf/2F 1rUA4e961" 10401770"
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
2-- KVA
No.of Lid hting Fixtures Swimming Pool Above Below Generators KVA
round eround
No.of hseceptacle Outlets Q No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets/
No.of Gas Burners
No.of Ranges No_of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No_of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW Ng.,of Sounding Devices
N6,oESelf Contained
Detebtion/Sounding Devices
No.of Dryers i Heating Devices KW Local Municipal Other
Connections
No.of Water 4eaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER'
histuuloeCovetage.PIRManttothe teqWM1ff1lsofMassacta>set1SCurd Laws
[have aamattLiability bmrancePolicy iw1udfflgComplete 0 p watiom Coverage or itsatstantialePYA it YES �NO
[bavt;akniiwdvandprcofofsmrtodrOffim YES F1 � i If you haw chadod YES,pkase xkak-the type ofcoverageby
'J ldng die box
NSURANCEBOND r7 UITIM (Plea--Spa*)
ExlmationDale
Esth1aWVahieofE dficalWodc$
Wolk to Start hispectiortDateRegt Rough Final
>ignedurd3ARnaliesofpetjut
,IRMNAME f � Li No.
/
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g>atiue �..
iceils� / � LicenspNo
BtlsitwssTel,No. q;r'�C&7Z C Z!> Z
! rlrtmcaG�,Lrr> �f 24 Ah Tel No.
)WN�'SINSURANCEWAIVFI2;IamawaredrattheLicedoesnothavetheinA.rmxmveiageoritsa zslanbalequivalttitasltxlxodbyMassachusettsGenerallaws
x1 diatmysigoahneon diispmot al#cadon waives this mgtmErrient ,`U
?lease check one) Owner ® Agent
Telephone No. PERMIT FEE$
igna ure ot Uwner or 7gent
W The Commonwealth of Massachusetts -
d Department of Industrial Accidents
Office of Investigations
Boston; Mass. 02111
1M s�
Workers'Compensation insurance Affidavit
Name Please Print
Name:
Location:
Clty Phone #
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
aI am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City: Phone#:
Insurance.Co. Policy#
Company name:
Address
City: Phone#•
Insurance Co. Policy#
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$1,500.00
and/or one years'imprisonment-as_well_as_civil.penal iesfntheformof-a..STOP WORK_ORDER..an4_a.fine_of_(.$1D0.00.)_adayagainst..me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date
Print name
Phone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensin
E] Building Dept
❑Check if immediate response is required E] Licensing Board
E] Selectman's Office
Contact persona Phone#: F-1 Health Department
Ei Other
Location 447—
No.
47—No. �S2' Date
i r
NpRTM TOWN OF NORTH ANDOVER
pt�«ao ,,SMO
A Certificate of Occupancy $
Building/Frame Permit Fee $
s
s�cMus"4cmu E Foundation Permit Fee $
� t
Other Permit Fee6�-114 $ w
Sewer Connection Fee $
` ,;Water,Connection Fee $
J
1 �9 TOTAL $
., ^t „ Building Inspector
Div. Public Works
PE&,mh ?ro. 1 �'�Y APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. 1/ PAGE 1
MAP Z40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE
ZONE I SUB DIV. LOT NO.
I
LOCATION Lf OSG'DO 5?' PURPOSE OF BUILDING s 6-pf1-/R FL,p�,E► fe �i�� 6 F /' p���
yJ41VT(71C�
OWNER'S NAME L- A-R,5 / NO. OF STORIES SIZE
OWNER'S ADDRESS '1 BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME Jot-f Aj 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 NEW SIZE OF FOOTING X
IS BUILDING ADDITION j MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
I
INSTRUCTIONS _ r 3 PROPERTY INFORMATION
a =�S ONr CI LAND COST
SEE BOTH SIDES --9--)2 1-F- ' -1 LLQd� I�,'��' EST. BLDG. COST�'�' Coo
PAGE 1 FILL OUT SECTIONS 1 - 3 �L• K 11/�!T r ��,�+ EST. BLDG. COST PER SQ. FT.
' '\ EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12 �A I\�O/v,
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 JU Af E 1R 1 l ( q/
i'
BOARD OF HEALTH
SIGNATURE OF OWNER OR AUTHORIZED AGENT OWNER TEL
Q a
eONTR.TEL.
F E E D -�� CONTR.LIC.I'#
PLANNING BOARD
PERMIT GRANTED
BOARD OF SELECTMEN
R BUILDING INSPECTOR
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
CONCRETEB 1 2 I3
CONCRETE BL'K. PINE
BRICK OR STONE PARDW LASTER —_ ——
PIERS PLASTER
_ DRY MALL
UNFIN.
3 BASEMENT I — -�--
AREA FULL FIN. B'M'T' AREA _
'I, 'h 'I, FIN. ATTIC AREA _
NO B M FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH
ASPHALT SIDING HARDVJ'D _
ASBESTOS SIDING _ COMMON
VERT. SIDING ASPH.TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR I_
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR POOR
EQUATE
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE I HIP BATH (3 FIX.)
GAMBRELMANSARD TOILET RM. 12 FIX.) _
FLAT A SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
_ 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
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
`Y
PE)RAtil NO. o ;.52 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
` MAP AO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE (BOOK ;PAGE
ZONE SUB DIV. LOT NO.
LOCATION L{L�O 6S y ooD ST- PURPOSE OF BUILDING �E �o F $h'ED
WNER'S NAME AKTIJOIZ. L 4 r-,SO^ ' NO. OF STORIES SIZE
✓OWNER'S ADDRESS .Jr �,M ,"1 BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
f ,ILDER'S NAME /p/1t/ C-,tRy 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 NEW ` SIZE OF FOOTING X
IS BUILDING ADDITION / MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
✓W ILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
OARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES EST. BLDG. COS ODO
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. 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
ANS MUST BE FILED AND APPROVED BY
BUILDING INSPECTOR
DyFErFIL V
BOARD OF HEALTH
SIGNATURE OF OWNER OR AUTHORIZED AGENT
OWNER TEL.0
F E Ey CONTR.TEL.b
WNTR.LIC.fY PLANNING BOARD
PERMIT GRANTED
t9 �
BOARD OF SELECTMEN
�r✓v
BUILDING INSPECTOR
I
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 8 INTERIOR FINISH
CONCRETE E 1 2 13
CONCRETE BL K. ---III PINE
BRICK OR STONE HL—AS D
PIERS PLASTER
_ DRY WALL _
UNFIN.
3 BASEMENT
AREA FULL FIN. E'M'TAREA _
y, '/l � FIN. ATTIC AREA _
N_O B M FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 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 _
SUPERIORI POOR
ADEQUATE NONE
rj ROOF 10 PLUMBING
GABLE I HIP BATH (3 FIX.) _
GAMBRELMANSARD TOILET RM. 12 FIX.) _
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK _
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
_ 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
GAS
7 NO. OF ROOMS OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
94
NORTfy 9
r. 6own of
O
No. LAndover
o �.,....rs;; n, �T,
r .Fr 4x,`� `I
,ANEWAY ENTRY PERMIT - - - -
" �K er, Klass.•• o 19 f/
G MI MEWICK
'
I
BOARD OF HEALTH
:S
THIS CERTIFIES THAT.............. .... .... .... �W
BUILDING INSPECTOR
Lhas permission to&M . . ......... buildings on ... .. ..... at .....ST. Rough
to be occupied as. .� ... • Chimney
... ...®�....................... ...... ........... Final
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in
PLUMBING INSPECTOR
this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough
Buildings in the Town of North Andover.
Final
VIOLATION of the Zoning or Building Regulations Voids this Permit.
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
Rough
UNLESS CONSTRU START Service
Final
... ... .. .................
BUILDING INSPE OR GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Final
Display in a Conspicuous Place on the Premises
Do Not Remove Burner FIRE DEPT.
No Lathing to Be Done Until Inspected and Approved by SMoke o°
Building Inspector
Town of North Andover ,
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE 01) �� y
JOB LOCATION 'IV(9 OSS OO-b G7-
Number
7Number Street Address Section of town
'►'HOMEOWNER" M Ae77{ A- L-P-2SOI J 6a -
Name Home Phone Work Phone
PRESENT MAILING ADDRESS S 4 6__
City Town State Zip code
The current exemption for "homeowners" was extended to include owner
, -occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license , provided
,t-hat the owner acts as supervisor. (State Building Code , Section 109 . 1 . 1)
DEFINITION OF HOMEOWNER:
' Person(s) who owns a parcel of land on which he/she resides or intends to
reside , on which there is , or is intended to be, a one to six family dwell-
ing , attached or detached structures accessory to such use and/or farm
,structures . A person who constructs more than one home in a two-year
period shall not be considered a homeowner . Such "homeowner" shall submit
. to the Building Official , on a form acceptable to the Buldi-ng Official ,
that he/she shall be responsible for all such work performed under the
'building permit . (Section 109 . 1 . 1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes , by-laws , rules and
'regulations .
The undersigned "homeowner" certifies that he/she understands the Town of
North Andover Building Department minimum inspection procedures and
requirements and that he/she will comply with said procedures and
requirements .
HOMEOWNER' S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
'Note : Three family dwellings 35 ,000 cubic feet , or larger , will be
required to comply with State Building Code Section 127 .0, Construction
Control .
Date.. . . ......G. .... ....
AORTM
TOWN OF NORTH ANDOVER
O � F
- PERMIT FOR GAS INSTALLATION
•'t s �a
SACNU`�ES
This certifies that . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . �.! '. : . . . . . . . . . . . . . . .
in the buildings of . . , I .,.�... . . . . . . . . . . . . . . . . . . . . . . . . . .
at /2 ccNorth Andover, Mass.
Fee. �l�i. . . Lic. No.. . `. .: .' . . . ... . .. . ^. . . . . . . . . .
GAS INSPECTOR
V
Check#
345
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FTWING
(Type or print) Date
NORTH ANDOVER,MASSACHUSETTS
Building Locations
Amount$ L
Owner's Name
New❑ Renovation ❑ Replacement ❑i Plans Submitted ❑
v� U
a�
z
O«moi
SUB-BASEM ENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
. 6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type) 7� CSC one: Certificate Installing Company
Name , "�+ i�!�7 /�� ❑ Corp.
Address 5b �� ��� '2 _ ❑ Partner.
t-D /�-,i✓e� d✓—arc-- '+; U I k�Y,l
Business Telephone (9 (� p �'Z V EFirm/Co.
Name of Licensed Plumber or Gas Fitter s Gj ��Gu
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ ' No❑
If you have checked yes,please indicate the type coverage by checking the appropriate box.
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 ane:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions ofthe Massachus' 'to Code nd Chapter 2 ofthe eral Laws.
By: Signature of Licensed Plumber Or Gas Fitter
Title Q'glumber �Z 3 6
City/Town ❑ Gas Fitter License Mim r
[ A aster
APPROVED(OFFICE USE ONLY) ❑ Journeyman
?J ?J L Date./-2...' ..... ..
NpaTM TOWN OF NORTH ANDOVER
pF
+ T
+
C. PERMIT FOR GAS INSTALLATION
f A
s •
L 4k.4
• a
SSACH USE
This certifies that . . '! r !?c .v«. . . . . . . . . .
has permission for gas installation . . ?. . . . . . . . . .
in the buildings of .G s;/.-F.� : . . . . . . . . . . . . . . . . . . .
at . . .lS.Gj. u . . . . . . ., North Andover, Mass.
Fee... � . . . Lic. . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
J�t
vjkt� Typ
MASSAt APP CATON FOR PERMIT TO DO GAS FITTING or print) PARCEL
Date 12/� 19
NORTH ANDO! / q
Building Locations L,7 V V"/j c� S'7 ` Permit 9
Amount S
Owner's Name
New❑ Renovation Replacement ❑ Plans Submitted ❑
A ri
L
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n
z =t %' z `_ °`� .'� n ^^ z C 7
S U B -BA S EM ENT
I3ASE .M ENT
is,r. FLOOR `
2N FLOU R
3 R D . FLOO R
4'r II . FLOOR
Tgli . FLOG R
6Tn . FLOOR
7'r ii . FLOOR
sill . Ft. 00R
(Print or type) Check one: Certificate Installing Company
Name ���..�.� ✓1 y fr� Y G�1 ❑ Corp.
Address 7 /'�°�'� S -�dJ�:H . DO ❑ Partner.
Business Telephone 7 L/ _ 1./�� j� ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter eg,
INSURANCE COVERAGE Check one:
1 have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked ves,please in ate the type coverage by checking the appropriate box.
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. ral a and that I
signature on this permit application waives this requirement.
Check one:
Signatue f Owner or Owner's Agent \ Owner ❑ Agent
i hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued For this application will be in
compliance with all pertinent provisions of the IvIassachuse s S ate Gas Code and pter, _ f the Genera aws.
Bv: S' na re of Licensed Plumber Or Gas Fitter
Title ❑ P ber /!� r
City/Town Gas Fitter License F umoer
taster
APPROVED(OFFICE USE ONLY) ❑ Journeyman
h��// h�°GL 9 to,� �����i'P �vy' O L'�/�t p�-c!� .
�" .S'C"�O�'�Tc' f'pr�e ���t'�'
� �.
t
. 3 0 1 2 Date Ll. . `- .9,r..........
E Na DTN �� TOWN OF NORTH ANDOVER
O � e
O
? o I
3 '
O PERMIT FOR GAS INSTALLATION
I_.;. 9
SACNUSEt�
This certifies that . /*j:!�t- .4. . . . . . . . . . . . .
has permission for gas installation . . C . . . . . . . . . . .
in the buildings of . . .�3 . . . . . . . . . . . . . . . . . . . . . . . .
at . �/ Q Oryoo 41 . . . . . . . . . . . . . . .. IyfaA,dov�er,cMass.
Fee. .;-, .,. Lic. No. ?.Z /. . . . . . . . . . . . .'�.✓. . . . . . . . .. . . .
GAS INSPECTOR
1 WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
1 >
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
ype or print) Date ��()V a�K 19 9 �'
NORTH ANDOVER, MASSACHUSETTS 2
Building Locations 4op CSS&oo& 4z (,r— Permit#
Amount S " y"
Y ) Owner's Name 1�� �j C,,-^ cr,
New�� Renovation ❑ Replacement ❑ Plans Submitted ❑
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