HomeMy WebLinkAboutMiscellaneous - 445 CHESTNUT STREET 4/30/2018 r445 CHESTNUT STREET
2101098.0-0085-0000.0
110&4
TOWN OF NORTH ANDOVER
a PERMIT FOR PLUMBING
{� ��This certifies that..........................
has permission to perform...... .......f P4`r`u \. ......:.........
..� �..................
plumbingin the buildings of.................... ..................................
�} 11
at........ l� 4-?V-4...�::........ ..........North Andover, Mass.
Fee .�. ....Lic. No. ��.IZ` :....
.................................................................................
PLUMBING INSPECTOR
Check# 3 `1
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY North Andover MA DATE 1 03-20-15 PERMIT# D
JOBSITE ADDRESS 445 Chestnut St. OWNER'S NAME Loretta Taylor
POWNER ADDRESS 1 445 Chestnut St.North Andover,MA 01845 TELI 603 891-9124 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL D
PRINT
CLEARLY NEW:® RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES[] NOM
FIXTURES-1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM �J _
DISHWASHER
DRINKING FOUNTAIN J T
FOOD DISPOSER
FLOOR I AREA DRAIN T�
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE I MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION j
WATER HEATER ALL TYPES
WATER PIPING
OTHER
Job Costs:$1550. �� J
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES® NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY® OTHER TYPE OF INDEMNITY E] 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
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 compliance with all Pertinentprovisionof the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
I
PLUMBER'S NAME Michael Bell LICENSE#F 12124_ SIGNATURE j
i,
MP� JP®
CORPORATION 2814 PARTNERSHIP®#O LLC[J#
COMPANY NAME I John's Sewer and Pipe Cleaning, Inc. ADDRESSI 4 Breed Ave.
CITY Woburn STATE MA ZIP = 01801 = TELI 781-569-6695
FAX F-78-1--569--669-41 CELL 617-755-4112 EMAIL info@johnsewer.com
�1
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): John's Sewer and Pipe Cleaning,Inc.
Address: 4 Breed Ave.
City/State/Zip: Woburn,MA 01801 Phone#: 781-569-6695
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 44 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp.insurance.$
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp, insurance required.]
*Any applicant that checks box#1 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.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Arbella Insurance
Policy#or Self-ins. Lic.#: 9103301209 Expiration Date: December 9, 2015
Job Site Address: 445 Chestnut St. City/State/Zip: North Andover,MA 01845
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 certify underth�e1/pains and penalties of perjury that the information provided above is true and correct
Signature: Lf/GGGGCt>l'11.�� Date: 03-20-2015
Phone#: 781-569-6695
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#:
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IMPORTANT
cuate*
If your license is lost, -d,am,.a,,g�ed' or, ,dest,roye,di, is inac roir
needs to be corrected, vi',s,i,,t our web site at mla,ssmgov/dpl for
a
instructions to ensure the proper mailing of your Re:,new,
Application and any other corresporildence.,
This, licen.seis su�b-ect and
jto, Massachusefts Generaws
-
regulations. Your license is a privi"lega, and cann.,ot- Abe Wnt ar
A 4 Keep t'his,
aSS,jgrned to any, person or jeritifty under 1penalty of laW
icense! onad/or
'your personorposted asreqUired by 1 aw n
S'll
regulatin, "o
t Date.......7...........
,
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
CHUS�t ell)
This certifies that......................1�. 11 .1. ......... 1 4v...... ....;r
has permission to perform ...., .��cx: — -s'--,........ �f.........................................
wiringin the building of...............................................................................................................
at ......7........—'...... ""../................ orth Andover,Mass.
Fee ����ic.Nq5...�/,/'.7..............................,L! .��....... ....,. ..(� ...
ELI�TRICAL INSPECTOR
Check#
4+i
� Commonwealth of Massachusetts Official Use Only
Permit No.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j (leave blank
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 WINK OR TYPE ALL INFORMATION) Date: a I�
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her inten'on to perform the electrical work described below.
Location(Street&Number) LS C�� AUT ,71
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with aVilding erm. Yes ❑ No r"5"No Appropriate Box)
Purpose of Building S N G L{ !Jty4 &j C L-i'N 6 Utility Authorization No.
- Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ,?,Q� l5 �. Q fjdT L F5 ��?�"f9 'L'' �Y S7-e7c•
Completion of thefollowing table may be waived by the Inspector of Wires. Z
No.of Total
No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators IVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
rnd. rnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
^ ,
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices v
No.of Waste Disposers HeatPump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other lzz �
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water K,W No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent It
r� No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: Q
No.of Devices or Equivalent .�{v
OTHER:
Attach additional detail if desired,or as required by the Inspector of Kres. —J
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: �'a S -)LI Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERA E: 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: INSURA-NCE ° BOND ❑ OTHER ❑ (Specify:)
I certify,cinder trains and penja)lties of perjury,lJtat the information on this application is true and complete.
FIRM NAME:\)Jtm e—S �OIOYQU� SAN FI E G�.�C, -.4AJ LIC.NO.:�cSkS/�
Licensee: OV760h-�',-;IOy S e , C.NO.:
(If applicable,e to e empt"in the h se numj qr li Bus.Tel,No.! 8l'�G�so�fol;
Address: Z��(ILv- X DV'KC Ald—�V4 AV- 0,113eS11t/ 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 agent.
Owner/Agent PERMIT FEE:$
Signature Telephone No.
❑ 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.GL.c.143,§3L. C
Permits shalt-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he
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
purpose 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.
❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑
❑Permit Extension Act—Permit/Date Closed:
Trench Inspection
Pass 0 Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
SERVICE INSPECTION:
Pass Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass 0 Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
ROUGH INSPECTION:
Pass N Failed Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
FINAL INSPECTION:
Pass Failed❑' Re-Inspection Required($.)❑
Inspectors Co ments:
Inspectors Signature Date:
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
r
Y The Commonwealth of Massachusetts
Department of IndustdqlAceWnts
Office of Investigations
600 Washington Street
.Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/ContractorslElectricians/Plumbers
Applicant Information Please Print Ledbly
Name(Business/Organizationllndividual).' ti ES Yo U Y'o v"—?AN
Address:-es-
ddress: t7s- � eLj_ ko
City/State/Zip: fy Rao"-,t6 rk-01X6 � Phone#: �64 J6Zt2
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.El am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling
ship and'haveno employees These sub-contractors have 8. ❑Demolition
working for mein any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised they 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.❑Roofrepairs
insurance required.] employees.[No workers'
q ] 13.❑Other
comp.insurance required.]
*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 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.
I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job sife
information.
Insurance Company Name:.
Policy#or Self-ins.Lie.#: Expiration Date:
lob Site Address: City/State/Zip:
1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder 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
o£up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DTA for insurance coverage verification.
Ido hereby cer ' rrrlerft� ' sandpenalties ofperjury tliat the information providle�d above is true andcorrect.
Si afore: Date: / a S_
Phone#• l f
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#:
Information and Instructions `y
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who.has not produced.acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political,subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if `
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of t
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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be retained 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 t
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 Co ozawealthofMassachusetts
Department of ladustrzal,Accidents
4face ofIavestigatio"
600 Washington Street
Boston,ASA.02 111
Tel.##617-727-4900 aYt 406 or 1-877-MASS.AFE
Revised 5-26-05 Fax#617-727-7740
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Date....../. . .... ../ ......
TOWN OF NORTH ANDOVER
s PERMIT FOR WIRING
sSACHUS�
I
This certifies that .....................
......................
has permission to perform ......�. (..P...R4 ..........................................
wiring in the building of..�-.. . �.�0`R.
at ..... .....Q, 5��!�. ...
..... ... North Andover,Mass.
Aq-,+��.
........................ . ..
1~ee...... .......Lic.No.
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Check# 1L0= )--------- LECTRICAL INS
CT
132Fr Wo- i? Ur,- 2f�� 1� �"
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. (32
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00
(PLEASE PRINT INMK OR TYPE ALL INFORMATION) Date: �Ll 2 /S
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned Ives notice oaf/his or hN251�u�
intention toperform the electrical work described below.
Location(Street&N mber) 4 /,�`,f � 5
Owner or Tenant Telephone No. o�
Owner's Address
Is this permit in conju ion with a building permit? Yes No ❑ (Check Appropriate Box) C
Purpose of Building m c (Q_ Utility Authorization No.
- Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ;:-
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires l No.of Cell:Susp.(Paddle)Fans IQNo.of Total
Transformers KVA
No.of Luminaire Outlets Q No.of Hot Tubs Generators 'A
No.of Luminaires d Swimming Pool Above ❑ In- 1V0—.0T mergency ig ting
rnd. rnd. Battery Units
r No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges '" No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: T.. "'""" " " Detection/Alerting Devices
No.of Dishwashers , Space/Area Heating KW Local❑ Municipal ❑ other
Connection
No.of Dryers Heating Appliances KW Security Systems:Y
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:
1 Attach additional detail if desired,or as regzdred by the Inspector of Wires.
Estimated Valueof El e tr' 1 Work: 00 0 (When required by municipal policy.)
Work to Start: t r
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE O RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCEV BOND ❑ OTHER ❑ (Specify:)
I certify,undd the pains and enalties of perjury,that the informatio us a rue and complete.
F=censeeAlaQJ-0
NIC.NO.:
L : d i ur ' IC.NO.: 221
(Ifapplicab er" pt" n the li a Wim Mer ' e.) Bus.Tel.No -
Address: r J�— O�✓� I I O Alt.Tel.No."-.-?73
*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety" "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 agent.
Owner/Agent PERMIT FEE:$ —
SignatureturaTelephone No.
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the i
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 Inspector of Wires abandoned and invalid if he
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
purpose 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 exteriding through August 15,2012. .
❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑
❑Permit Extension Act—Permit/Date Closed:
Trench Inspection
Pass M Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
SERVICE INSPECTION:
Pass R Failed 0 Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass M Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
ROUGH INSPECTION:
Pass IN Failed Re-Inspection Required($.)❑
i
Inspectors Comments:
Inspectors Signature: Date:
FINAL INSPECTION:
Pass Failed 0 Re-Inspection Required($.)❑
Inspectors Comments.
IDA I-
Inspectors Signature: Date:
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
The Commonwealth of Massachusetts
Department oflndustrialAccidents
1 Congress Street, Suite 100
Boston,AM 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FII WITH THE PERMITTING AUTHORITY.
Applicant Information rV
Pleannse riot Legibly
Name(Business/Organization/Individual): a l�
Address: ( �
—2
City/State/Zip: p L\\
Are you an employer?Check the appropriate box: Type of project(required):
1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction
X2111'ain a sole proprietor or partnership and have no employees working for me in $. Remodeling
any capacity.[No workers'comp.insurance required.]
9/LJ Demolition
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F-1 Roof repairs
These sub-contractors have employees and have workers'comp.insurance3
6.❑we are a corporation and its officers have exercised their right of exemption per MGL C. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also 611 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.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificat'
I do here cer' er the s an a perjury t tion provide a!,7vetrue7and orrec4S' na Date: Z 3 15
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#:
Y
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
i '
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-contractor(s)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 cityor 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/lieense 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 Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE
Fax 4 617-727-7749
Revised 02-23-15 www.mass.gov/dia
g COMMONWEALTH OF MASSACHUSETTS
.. • * • • • •
' ELECTRICIANS f { �� �
ISSUES THE FOLLOWINGL-1CENSE
r } i
F AS A ::REt JOURNEYMAN 'ELECTRI`C`IA Z iI
AARON DEANGELO
N
-. 14 NEW
NAV�RNiLL=:,. MA 01830 4929
7698 Date.. .6.:-. ..... ..
NpF TM
,s1$p
32 TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SSAC,MUSES ?.
ti.
This certifies that . . . . .. . . . . . . . . . . . . . . . . .
has permission for gas installation . aA:« -\tv. -ikw-t. . . .. . . . . .
in the buildings of . . .(��.r.�
at .. . . . . . .. North Andover, Mass.
Fee. :?Qa,?. Lic. No.!2?:7v. . . ,/ -�-{,/.�� .....e'67 . .. . .
• GAS INSPECTOR
Check# (-S-7 4
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: o. , MA. Date: f Permit#
Building Location: J Owners Name:
Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional❑ Residential ❑
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑
FIXTURES
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Z fn -I Q m w O z 0 y 1= > Z 2
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SUB BSMT.
BASEMENT
15T FLOOR
2 Nu FLOOR
3RD FLOOR
4 THFLOOR
Fff FLOOR
6 TH FLOOR �?
7 FLOOR
8 FLOOR
Check One Only Certificate#
Installing Company Name: occ
❑Corporation
Address: ' M'tCity/Town: m >l c�_ State:
❑
. Partnership
Business Tel: 7 /o._� S'�-/��� Fax:
_ Firm/Company
Name of Licensed Plumber/Gas Fitter:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 Yes ] No❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
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
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Signature of Owner or Owner's A ent Owner [:1 Agent El
By checking this box i];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
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By
Type of License:
Plumber .
Title
L1 Gas Fitter
Master —Silynature of Licensed Plumber/Gas Fitter
Cit gown LlJourneyman License Number: .,/L . 6
APPROVED OFFICE USE ONLY El LP Installer
9001 Date.!6. .15,-11. . . .
,,oRTh TOWN OF NORTH ANDOVER
3+ .� o�
a s
PERMIT FOR PLUMBING
,S$�CMUSE�
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . "
has permission to perform . . . . . . . . .
plumbing in the buildings of . f.`! . . . . . . . . . . . . . .
at. �. . .0 h e Sfi v�-. ! . , North Andover, Mass.
Fe 3v.p?? .Lie. No.. .. . 7�? . . . . . . . . . . . . . . .
PLUMBING INSPECTSR
Check # �.% 76
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: /(f/�, MA, Date: f�®�/j Permit#
I!'
_ Building Location: Owners Name:
Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential K
New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No
FIXTURES
DEDICATED
wTX SYSTEMS
►-
Z N
> Y
Z y
H d C z U F W j O
a W W Z0 Ln F_ W Z F Z �Q C W
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LL z LLLU
3
w
m H i6n O 3 >Uj Z > LLI LU O
e U O L3wOO cI
a r—
SUB BSMT.
a c� 3
BASEMENT
1sT FLOOR
2ND FLOOR
3RD FLOOR
4T"FLOOR
5T"FLOOR
6T"FLOOR
7T"FLOOR
8T"FLOOR
'--
Installing Company NamCheck One Only Certificate#
e: "�:�/�J „� ��
Address: City Town: 5tate: • El corporation
❑Partnership
Business Tel: =�M Fax: - -�
,. irmlCompany
Name of Licensed Plumber:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes V1 No❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
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
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Si nature of Owner or Owner s A ent Owner ❑ Agent ❑
1 hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and instaiiations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General La
By
Type of License:
Title Plumber a re of Licensed lumber
City/Town AMaster
APPROVED OFFICE USE ONLY) []journeyman License Number. ,(/
Location h p���" 3'7�1
No. Date
NpR,M TOWN OF NORTH ANDOVER
1- 9
a Certificate of Occupancy $
���°'•^°•'',�' Building/Frame Permit Fee $
STAG NuSE
Building
/Frame
Permit Fee $
Other Permit Fee $
TOTAL $
Check # �(
150 U 3 Building Inspector
r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
`
11 .11
BUILDING PERMIT NUMBER: / //� DATE ISSUED: ! /v 4=0 m 17
X
SIGNATURE: /vt
Building CommissionerAETector of Buildings Date
SECTION 1-SITE INFORMATION 2
1.1 Prope ddress 1.2 Assessors Map and Parcel Number:
c79 � s
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage 00
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Require Provided Re red Provided
1.7 Water S 1.5_ Flood Zone Information:upplyM.G.L.C.40. 54) 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0
aa®
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name;(Print) U Address for Service:
b
r
Signature Telephone O
2.2 Owner of Record:
Name Print Address for Service:
p�
Signature Telephone 1�
SECTION 3-CONSTRUCTION SERVICES 94
3.1 Licensed Constructs Supervisor: Not Applicable ❑ a�
J
Licensed Construction Superv"so l
License Number
I
ess
�I
— z�z
Expirati n Date
t attire Telephone
r
r
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number
Address ra
a®
Expiration Date
Signature Telephone
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 0 Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑
Accessory Bldg. r❑ ,� . Demolition ❑ Other ❑ Specify
7% t. �- •� .,ti s
Bri scrip ion of Proposed Work: c y
C k e
SECTION 6-ESTIMATED CONSTRUCTION COSTS l
r Item Estimated Cost(Dollar)to be " 3� x Q r 714- 7,
C11 'N ;
Completed by permit applicant
„a
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)x(b)
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
I, as Owner/Authorized Agent of subject property
ell Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
' Signature of Owner Date
r
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Print_Name 7M�
14
Si ature of Owner/A ent Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS iST 1ST2ND 3RD
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
-- 0. ��. : 2fie CommomVeafth of 5lassachusetts
oepartmertt of zrndwtriaTAxidents
'r qffic0 ofinvatations
600Washington Street
Boston,-17�A 02111
Workers'Compensation Insurance Affidavit
APPLICANT LN-FORMATIO Please PRINT Legibly
2v Z'z--I�'
Name:
Location: ,/�
City: ,! C Telephone#: 5�e�3 L9 a
I am a homeowner performing all work myself.
I am sole proprietor and have no one working in my capacity
0 I am an ernpl er providing workers'co pensation for my employees working on this job
Company Name:
Address: c
City; Telephone#:
Insurance Company: Policy#: W C f.�i° 61?
I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following
workers' compensation policies:
Company Name:
Address:
City: Telephone#:
Insurance Company: . Policy#:
Company Name:
Address:
City; Telephone#:
Insurance Company: Policy#:
Attach additional sheet if necessary
Failure to secure coverage as required under, Section 25A of MGL 15B 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 penalises in the form of a STOP WORT:ORDER and a fine of S 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.
I do hereby certify under the ins and penalties of perjury that the information above is true and cor,`e>ct. ,y
Signature: Date:
Print Name: Phone# 9Z&fAfi4ze6
_
Official Use ONLY-Do not write in this area
o Building Department
City or Town: PermiVJcense#: o Licensing Board
o Selectmen's Office
o Health Department
❑Check if Immediate response is required o Other
i
o Castricone Roofing & Siding
n REPAIRS FREE ESTIMATES
Co Telephone(978)682-4266
MARIO CA TRI
�5 D S CONE
31 Court Street North Andover Mass. 01845
I/we,the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary
materials, labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and
conditions,on premises below de cr'
Owner's Name..... . ....................
Job Address........... ..�.... .. . ............................Ci� """'lam State
SPECIFICATIONS �79 c p 5
; .�..... .A. ... . ... .... -:�....� .. ..............j...... ........................
....,,.���.....�, ......0... .Z...... ...�- �........................� .... ........ ..................... ... ............. � .... ................. .............
................ ......... ................ ........ r.... .......................
,,� ..... .a - ...,. �r. ,. ,� C. .... - .. t..............................
... .... .... .... .... ..............................................................
..f
...................... .... .. .............
. ...................... ......... ...... .............. ....... Q ......................
.. ... ...
.......... .........�..- .... .... .... ., ...1......... .......... ........... ....................
.......... ..................... .. :.... ................ .. ...... .....................
...o........................................................,......................
f
.................................................................................................................................................................................................. ..........................................................
...................................................................... ............................................... . ............................................................
. . ....................
Materials and labor to cost$.. Payable...................... . and balance in............
... ............. ... . ...... on.....
monthly installments of$.........................................each,payable on........................................day of each and every month thereafter until paid
in full (..............%charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.
Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation and a
completion as requested by the contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid
immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s),all reasonable costs,attorney fees and expenses,in
addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith.
It is further agreed that this contract may be assigned by contractor;and also that the obligations hereof shall bind and apply to their heirs,successors or estates
of the parties.
The undersigned warrant(s)that he is(they are)the owner(s)of the above mentioned premises and that legal title thereto stands of record in his(their)name(s).
PROVISO:This contract shall be void and of no effort if credit approved of owner(s)is refused.
There are no representations,guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this
contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed
by all parties.
Cover attic storage cleaning not included.
Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and
the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and
understandings of said parties are contained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in operati
IN WITNESS WHEREOF,the parties have hereunto signed their names this............. .. ....... da of.. ....... .......... yltt...P."'....
Accepted: f I�
Signed........... . ........... . .............f./..!.........................
Owner
(OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT)
Signed......................................................................................
C�X-
1. Owner
Per.... .......... Signed............... ....................................................
Representative
tAORTiy
T® of E /
No. ° .�:,. . ,.. ®ver
N -
�AoCoCH,C 0, dover, Mass. 0/- i o —a oc, /
.9S RATED
H E
i BOARD OF HEALTH
PERMI Food/Kitchen
Septic System
THIS CERTIFIES THAT..... ..... n 1c 4
"'J" BUILDING
t7 Y /O ........................
has permission to erect. .. �I/V y I t ............................................................ INSPECTOR
buildings on......41`�� L' ,� Foundation
Y( /� V
�/ . ............................s............
to be occupied as...... i ti Rough
provided that the person accepting t s permit shall in ever` r�� """�? S ���+-..c
this office, and to the provisions of the Codes and By-Laws relating to th Inspection q 4.4--
this
Chimney
every aspect conform to the terms of the application on file in
Buildings in the Town of North Andover. Final
g C g Itera ion and Construction of
VIOLATION of the Zoning or Buildingul i S / PL
Re g atl
ons Voids this Permit. �d` UMBING INSPECTOR
PERMIT IT EXI' Rough
11 IRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS
ELECTRICAL INSPECTOR
141 IA( C Rough
Service
BUILDING INSPECTOR
Occupancy Permit Required to Occupy Building Final
Display in a Conspicuous Place on the Premises — GAS INSPECTOR
Do Not Remove Rough
No Lathing or Dry Wall To Be Done Final
Until Inspected and Approved by the Building f 9 Ins pector. FIRE DEPARTMENT
i
Burner
Street No.