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Miscellaneous - 50 MAIN STREET 4/30/2018 (4)
J50 �y�� �G� � .,/y Da�.� �•. Date oa; 0�9 TOWN OF NORTH ANDOVER „ PERMIT FOR WIRING This certifies that ...!�, f !e ^�.... v .�,e-�— .... ............................................................ has permission to perform ......... U — . lj....... '< . ...................... wiring in the building of....T........... ✓.:, t,.., [.ti at .....;0.............. ..... ! j...............................,No h Andover,Mass. Fee..J.tn....✓..........Lic.No. 1IlO ' "1.......'.............. . �: ELECTRICAL INSPECTOR ` Check# (f—o l7 11427 Commonwealth of Massachusetts Official Use Only o Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 Geaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Codep',527 MR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORW TIOII9 Date: City or Town of: NORTH ANDOVER To the Insp� for o 01wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) '� / - Owner or Tenant PV _ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps /90/ POR Volts.3Overhead❑ Undgrd[INo.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number ofa de and m aci • I F e rs AP ty Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell: TransSusp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ JNO.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No.of Gas Burgers No.of Detection and -Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons • Heat Pump Number Tons KW No.of Self-Contained \ No. of Waste Disposers ............................................_... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent Heaters KW Ballasts Data Wiring: Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. d Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides roof of liability insurance including operation"Coverage or its substantial equivalent.ent. The � undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. c� ' CHECK-ONE: INSURANCE-�<BOND ❑ OTHER ❑ (Specify:) rcertify,under the gins andpenalties ofperjury,that the information his appl' nom and complete. !. FIRM NAME: p LIC.NO.: Licensee: Signature LTC.NO.: 6 (Ifapplicable,ent "exem t"in the license number line.) Bus.Tel.No.• Address: -6 (>t001,29k Alt.Tel.No.: 726 R— *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. i i ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, § 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the 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 IM Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed❑' Re-Inspection Required($.)❑ Inspectors Comments: �1 Inspectors Signature: Date: ROUGH SPECTION: Pass ' Failed Re-Inspection Required($.) ❑ Inspectors Commen • Inspectors Signature: Date: r FINAL,INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ v Inspectors Comments: 4 d4r Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com .� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Uf 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): &104- �4(" ac Address:— & 13 D )L City/State/Zip:127 5!07 kz 4!?4 Z!2�q�Phone#: 2 ��'—�/ 26.E Are you an employer?Check the appropriate box: Type of project(required): 1.KI am a employer with_J 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.1 7.ARemodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. El We are a corporation and its. required.] officers have exercised their 10.0 Electrical repairs or additions 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.]t employees.[No workers' comp.insurance required.] 13.[i Other *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 their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. -t Insurance Company Name:. X kJe ny/,r Policy#or Self-ins.Lic.#: Vit/��-2 AQ ��© Expiration Date: Job Site Address:_3 D D2 A//Z City/State/Zip: i l 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 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 insura coverage verification. I do hereby certify e p ns penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: !72 Op-Yz Offccial 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 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-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 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 permittlicense 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 Massachusietts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston?MA.02111 Tel,#617-727_4900 ext 406 or 1-877, MASSAFE Revised 5-26-05 Fax##617-727-7749 WWW-Mass,govfdia q i t Yi f ' r COMMONWEALTH OF MASSACHUSETTS ELECTRiC1ANS R GISTERED�MASTER ELECTRI ISSUESOT k�B�3V Ll 7a , r 'BRIAN LA�VO.IE ;L, x 4 TH YER 'STS 01.844-261 METHVEN r , - 4 ..07Y31/1 'x88747 11648 A r ONWEALTH OF MASSACHUSETTSELECTRICIANS REG'JOURNEYMAN ELECT CIA ISSUES,THE' 0406 SENE tLAVOIEAYEEZSTI' UEN v'�f,a .Y r MAS 01844 `26I7 28664 •E ` ' ,`07431/13 x =887474 I 09804 E Date . . 1 I �. . . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . has permission to perform . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . plumbing in theuildings o`—4eP �.C-tJ !!C�^�t . . . . . . . . . . . . a ��� y, t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , North Andover, Mass. Fee .lG"') ?. . Lic. No.3.�1A?- PLUMBING INSPECTOR Check# �5 l i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY v ►�Z/ MA DATE a ( 0>3 _I PERMIT# JOBSITE ADDRESS &4^ S>'• = OWNER'S NAME - POWNER ADDRESS S r^"^ _. TELF JIFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: ©# RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES , NODI FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I { .__� I i ( __. I ! ___.} _ __( F __I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I _ ( I (. _ I ' I _ ! _ j I --1 i .-_._ I i DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN ___I .-__-_-( _.___i ._..___-_► __-� 1 ___..__i __J _._._-} ._-___j .__-___j —_.__ r_ j ._.._._j FOOD DISPOSER I FLOOR I AREA DRAIN .._----- INTERCEPTOR --.INTERCEPTOR(INTERIOR) KITCHEN SINK .pr-n-J, __...._. ! LAVATORY ROOF DRAIN SHOWER STALL SERVICE MOP SINK -_( -____JJ TOILET URINAL I _ _ _ j WASHING MACHINE CONNECTION I ( -_. } } i __..-.j -__ _ ) ____j _.__J _. ._. WATER HEATER ALL TYPESP WA'$ER PIPING !OTHER ----.._.. _ _( INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESM NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY,g OTHER TYPE OF INDEMNITY D BOND ❑.1 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 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are e a 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 co lian with a inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ___-_ cy _-F-Vr�, -_-- LICENSE# 3)l 9), 1 SIGNATURE NIP JPg CORPORATION Fjl# PARTNERSHIP _[# — LLC COMPANY NAME weI s;dk ��,,,bry d i ADDRESSCITY i STATE ���". 'f._ �� ZIP E TEL 7 '�-- )IoCIL - -- V FAX CELL EMAIL I .......... 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 k J The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street quo Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly �( c Name(Business/Organization/Individual): (�) Address: City/State/Zip: �v,,J Phone Are you an employer?Check the appropriate box: Type of project(required): 12, ❑ I am a employer with 4. ❑ I am a general contractor and Iemployees(full and/or part-time).* have hired the sub-contractors6 ❑New construction ❑ I am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition I working for me in any capacity. workers'comp.insurance. g• ❑13uilding addition I [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 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.]f employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they ace 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 em information. ployees. Below is the policy and job site Insurance Company Name:. 11�er-4-I • Policy#or Self-ins.Lic.P Expiration Date: Job Site Address: Sp m w,\ sa . City/State/Zip:_ -PIw SLv w �/k G,�X 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. 1 do hereby cern n er the pains and penalties ofperjury that the information provided above is true and correct - Si ature: �} Date: D111 Phone#- q7S'�4�- a9c� Official use only. Do not write in this area,to be completed by cify or town offrcial. City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PEmbingInspector 6.Other - Contact Person• Phone#• r 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 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 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 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 Investigations 600 Washington Street Boston,MA.02111 Tel,#617-7274900 0A.406 or 1-877:MASSAFE Revised 5-26-05 Fax#617-727-7749 wwwanass.govfdia Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ........................................................................................................................................................................................................................................................................................ Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency LICENSEE More... Name:CORY J. ST PIERRE j REFERENCES& H"ERHILL,MA ; RELATED INFO d Disclaimer Regarding "This Licensee has additional Licenses,click here to view them."" Website License Searches I Enforcement Process Glossary Licensing Board: PLUMBERS 8 GASFITTERS Glossary of License Status License Type: JOURNEYMAN PLUMBER Codes License Number: 32182 - More... Status: CURRENT Expiration Date: 5/1/2014 . i Issue Date: 9/18/2010 Exam Date: 9/18/2010 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday,February 11,2013 at 10:07:15 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/pubLic/pubLicenseQ.asp?board_code=PL&type class=_J&li... 2/11/2013 Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION F g This certifies that . �J has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of- . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . .North Andover, Mass. Fee . --7. . Lic. No. -32-1.U... 1`A . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# 8595 1` y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA MA DATE PERMIT# JOBSITE ADDRESS - -�f / '_- OWNER'S NAME GOWNER ADDRESS TE � �FAX��� TPYPPENOT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL i RESIDENTIAL CLEARLY NEW:F.1 RENOVATION:9 REPLACEMENT:[.�.1 PLANS SUBMITTED: YESIR NO APPLIANCES 7 FLOORS- BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE . I[ DIRECT VENT HEATER DRYERI FIREPLACE FRYOLATOR - = . — -- ! FURNACE _-- 1 L_=: 1- - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN Lonl/Cc . 1...- _ .1=L - -.1 I. . _.L__-_ L_T=--1.= L� I . 1 POOL HEATER ROOM/SPACE HEATER � --_- ' ROOF TOP UNIT TEST I I _ ! .1 j.___ UNIT HEATER I !---- 1 --I - I— f _- I _ r.-.�-- J-- :-.I E.___. ,-s.-_ _ UNVENTED ROOM HEATER WATER HEATER _ I _! - I I-___.�(-- I L ! I I J 1_ _ _�_ IL - - -�L_ I i.__I L.=. (� -I(—f f _I L----I-1_ J i�_-1 INSURANCE COVERAGE shave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ONO [I] 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY PI 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 ,(D AGENT tJ 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME L =--! f�______�LICENSE#_ SIGNATURE MP 0 MGF�i JP JGF[] LPGIE] CORPORATION[]# PARTNERSHIP 0#=LLC[ (# � COMPANY NAME:C }__:__---___.__=ADDRESS CITYJ1 STATE /U/f ZIP[V SJTEL -. --- -.- , FAX CELL % f _ / EMAIL _: _ _.._ - ---- ------- ------- --- -- T--_. -- -._-. ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ L FEE: $ PERMIT# PLAN REVIEW NOTES d - The Commonwealth ofMassachusetts kqjpDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02.11-1 'Workers' Compensation Insurance Affidavit: Bui ders/Contractors/E A licant Information lectricians/Plumbers Please Print Le ibl Nam�(Rc ness/Organizatiorvindividual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1.01 .❑ I am a employer with___ 4. ❑ I am a general contractor and I Type of project(required): 2.❑ employees(full and/or part-time).* have hired the sub-contractorsI I am a sole proprietor or partner- listed on the attached sheet.t 7. E]New construction E]Remodeling ship and'have no employees sub These -contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. G [No workers'comp.,insurance 5. ❑ We area corporation d it9. El Building addition r required.] ansofficers have exercised their 10.El Electrical repairs or additions 3.E] I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing g re or ' ' Myself[No workers'comp. c. 152,§1(4),and we have no p ditions insurance required.]t c. 152, employees.[No workers' comp,insurance required.] 13•❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they ai a doing all work and then hire outside contractors must submit anew affidavit#Contractors that check this box mast attached an additional sheet showing the name ofthesub-contractors and their workers'comp.Policyinformation. vrt indicating such. 'am an employer that is providing workers'compensation insurance for in employees Below is thePolicy a D information. y � b site Insurance Company Name:. Policy#or Self-ins.Lic.#: Job Site Address: Expiration Date: Attach a copy of the workers'compensation policy declaration page(Showing the aolicip Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition bof criminal expirationer and Penaltiesdate). fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER a Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the of a Investigations of the DIA for insurance coverage verification. and a fine Office of 'do hereby cert6 under the pains and penalties ofperjury that the information provided above is true - I Signature: and correct. Phone#: Date: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Issuing Authority(circle one): Permit/License# 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M R c 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." 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 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 j 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 Cone onwealth of MassachvsPtts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Tel,#617-7274900 ext 406 or 1-877-MASS.AFB Revised 5-26-05 Fax#617-727-7749 www.mass,govfdia Division of Professional Licensure: License Search Page 1 of 1 .a The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure -Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ................................................................................................................................................................................................................................................................... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency } LICENSEE More... Name:CORY J. ST PIERRE REFERENCES& tHAAVEE--R��--HILL��MA RELATED INFO J Disclaimer Regarding **This Licensee has additional Licenses,click here to view them.** Website License Searches Enforcement Process Glossary Licensing Board: PLUMBERS Et GASFITTERS Glossary of License Status License Type: JOURNEYMAN PLUMBER Codes License Number: 32182 More... Status: CURRENT - Expiration Date: 5/1/2014 Issue Date: 9/18/2010 Exam Date: 9/18/2010 i School: 1 This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday, February 11,2013 at 10:07:15 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/pubLic/pubLicenseQ.asp?board_code=PL&type_Class=_J&li... 2/11/2013 190 Date. `�. . .� . .. .. 4 ! I E NORTH TOWN OF NORTH ANDOVER pF •�ao ,,,'YO . PERMIT FOR MECHANICAL INSTALLATION p 9 • o� C �9SSACHUSE t I This certifies that �.1!0 . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t p nical installation . .T . ./ ..� . . . . . has permission for mecha/ ' ' ' ' in the buildings of North Andover Mass. at Fee/S- . . . Lic. No.. . . . ,� . . . . GA . . . . . GAS INSPECTOR I WHITE:Applicant CANARY:Building Dept. PINK:Treasurer r ,t Commonwealth of Massachusetts Sheet Metal Permit Date : 3 - ,;Z 7 — 13 Permit# Estimated Job Cost: Permit Fee: $ ��(J Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License#—5 3 H 5 Business Information: Property Owner/Job Location Information: Name: L W6/V r10C4J Ia�� �' Name: WzAvelity I✓®/ L ( S Street: 7 1 J cJ M PY Street: �� ✓ J�l City/Town: e f#U e.� I jVy4 City/Town: o r-07L l9it) QC�'Vzr Telephone: 'I 76- b cb —35C)O Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail X Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. K over 35,000 cu. ft. Sheet metal work to be completed: New Work:-1-- Renovation: HVAC,!� Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: q 5(-y PP l� A-� d Jti 5Jrhrl �� s r-������s u-) 1/-), C (D/pe_ 0 r7j - I � b� INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch..112 Yes pr No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 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 Owner's Agent < By checking this boxN,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 sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments Type of License: By Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# 3 L� ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval I i AbbrWatio f ns W Lege � u, C�u L O- I ^. 0 U v; n >ra- o d �' ill. n i ! II ,ld�Ii'i I �� �Coiling systeMS LL-j 0 �— (:F,T n, C1H k 1 4 i#'lvJp .. 0., rm,-Fflt'xY Ease r �r II II Ili! I Q ! T �I III Light EiXtur9¢ LL IWtlltl EITL>2 v I LYI� - k = F°w 3 l mIY 1 Fr...rl1'.Y n:.r -reR:J FT 7 tl- .. � a Pcr k trc°ex, as p ,rfea rs- -11 Heating,AC.Ventilation at Ceilings H.1.•, tv k I � � <1 N t M` "'N IF M1I ih.:r�:,;nrbr ® 71 A9 L&Z P,,I tfi'kC1 f If-n7 I li qq ® '7 � FII'a Alarm ov LA IV I ! II �I II M >`cul.Fs trt:r<9•� llvr ' O wY:"ArY't f)tt� 1 ct I R, <IFcw d nlrl K� I Protecticn Elrargenc Id= v-In rauL -1;I.r P6$ Fe 14 `IJFd vmr shnYl t -H Proposed Ceiling Plan IJ ��r[Y.Fy.:`!iba wry LI � =rhil�a'hl �L Interior Finish Materials Schedule TT FtF r, tiT � .r. ti(1 LrxFy- . � Vin' G'CI'cr. Ju*(J lY H]I MF �vT p. .ol,xlrvY. LI.'fi kX+r �0� r .. Iw \hbr 1 61 t` £ /u^T lev t L i -V TF i(T'i ( n 1;. II�� 'll 'I Firl '-J''oyJ ufN. E a T G fe 1etr l ya I,IT F 1'�.II 0.1'>M 1 T t r H I -i aD n AFF m h A r IAF &:� ��, Ili, lir UO 2a tt� >`_r� 45 /c t. �;�.3' I Poi I /Y.i f ttLG' Ff+Y= 6 i/c F 8.:;rFt �r.-+ �+s `• ,¢'� u \ .... __F , R� ,,y;T 9., A s' .�Q) Fl:J i•> 4, .. a.al.rry \r_ An t-N ;>;>t11 1,ltn?cn r`]-.rF. � rA \KN Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license V All sheet metal work being performed with proper JourneyPerson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during / fire alarm testing) V/ Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) ZSmoke/atrium exhaust systems installed and operation verified i (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required)and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts.Proper clea;`ances,fire rated enclosures and pressure testing required. , __ Sei �:�ic es,�. ints installFd ixrti .re required'on equipment and du.t.v.);rk Duct penetrations in fie'ratc- Vvallz and floors sealed Metal roofing systems installed watertight using proper materials and fasteners VFlexible duct runs installed 6 -0" maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight JDuctwork insulated by means of external covering or internal lining JVolume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) r 1. Sheet Metal Residential Guidelines/Inspection Ch ecklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean-properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-off) • I k _ � t a ciCOMMONWEALTH ASSA HUSETTS � SHEET METAL WORKERS r 4� -_ S A MASTER—UNRESTRICTED 1 SE TO ISSUE.,THE ABOVE LICENSE � u � { RUSS� L A BOISVERT t G.. °E.VEN t SOW HVAC :, UKFY .LN METWUEP! MA 01844-.1321. I, 534"i ,1-05./28/14 6073T_ i Fold,Then Detach Along All Perforations I f Q COMMONWEALTH OF MASSACHUSETTS ; - - ISHEET METAL WORKERS. _. AS A MASTER-UNRESTRICTED' ' I�SU�S't�IE'A��51%�'L'14'EAtSE T(3: - ' RUSSELLAf�'BOISVERT y EVEN FLOW -HVAC I27 BUMPY: `L'N 'METHUEN o,r MA.. 01844-1321 j ` 5345 05/28/12 959364 t Y 1 J .. Location 4K, y 00, No. 2 J Date -� + TOWN OF NORTH ANDOVER • ��yt►�r�rr x96` . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Feg TOTAL $ Check o �Z 26213 Building Inspector 1 14ORT-! r �� 56``+` Y s,•t6 O0 ® TOWN OF NORTH ANDOVER D wxo A C9 SIGN PERMIT �DRAT6D t'PA`y� cAus� DATE: March 20, 2013 PERMIT: 5024-2013 THIS CERTIFIES THAT Heavenly Donuts has permission to erect three signs . on-50 Main Street Front Heavnly Donuts 15 Ft. by 31 Ft, Left Side Parking in Rear 12 x 33 and Right Side Heavnly Donuts .Park 29 x 90. provide that the person accepting this Permit shall.in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and,By-Laws relating to the Sign Regulations in the Town of North Andover. 4 Violation of the Zoning of Sign Regulations, Section #6, Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings Ampunt paia:6o.00 ;- Check 3�Q SIGN IZER IT APP LWATI ON 1600 ®Sgood Street Bunfllld kg 20, Sante 2-36 07POI[S'I H AlkTDOVE1R'i Date: Name of applicant who is purchasing the sign A+f `7 p Q,pU 7 Site OwnerCA�t�t�an m i v� �'LoP��-1-t Phone#of applicant who is purchasing the sign_CO l 7 G y 3 Site Address_ `T � • )"'�I�-�� - �—�Z� �� ��CQ�- ame of sign coman N G -� compan Cc-,k � Phone#moi 723-372- _y� Map b L-I IF—creel Size of proposed.Sagas HOW attached: a)Against the gall ��DS ! Mumination: 0 Not•i.l.luminated b)Roof b)Internally illuminated c)LFxteicnally illuminated c�Ground . d)Other Materials: Y, �i V4 v Proposed Colors: Background Lettering ]order u113_ Cost of Si a 61 60 IL�eapnnfin°ed AffaeDnunnegnts° 1`�®4e: N®permanent/temporary . ,,-,Photographs of building sign shall be erected, or enlarged until an „Material sample application on the appropriate forge finniched by the Sign Office has been filed Color sample with the Sign Of icer containing such information including photographs,plans Site or Plot Plaii(required for.all free-standing signs) and scale.drawings,as he may require,and a permit for such erection, alteration, or enlargement has been issua d by him. Such permit shall be issued only of the • .Drawings of proposed sign Sign Officer determines that the sign Other,specify complies or will comply with all applicable provisions,of the By-Law. Will sign overhang any public road or walkway Yes ( ) No If Yes,Name of Agency who will provide liability insurance: - AN IQgCr E A]PPLICATION WILL NOT BE ACC]EPT"]EIl� _ DATE IFILI ED: Receipt# Check# Revised 10 1.2®®6Form Sign Permit Application SIGNATURE OF APPLICANT I 1 1 1 �a P � momm � j II six ITT jjmmm� ON r w,. I l; • s 1 1 1 i •, ' ►v 1� ' ��� ` ' 1 f ����r �1 4.4 �'C�►�.t s-r p"' N�l CLD'PTi5 " oN 12V�N MUFFINS*BAGELWASTRIESHEAV T ,�r 33" PARKING IN REAR � 55" rL ok7- CVT Oor tom[ 15-TUID t j OJ t,-IT W/A'DkE-S l%,Le HE"DIMLY Of ti A RDONUT K IN MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTiHG (Print or Type) NORTH ANDOVER Mass. Date kuilding Location Permit # y Owners Name ,5/ Xe- e A-). • New '1 Renovation D Replacement FIXTUR-s Plans Submitted D /'✓� 9 N tr cc ILI Ot t; O U W d us 03 0) f' W UJ 0 — O O W t– M W F. y) C6 tr y 4 9)) cc Q7 W Z Q LU o) W V3 0 4 t7: p > W O H x J H 2 H W W t7 O ? ti d d O O W a W F- z o O U. o Sua—aSTMT. i BASEMENT IST FLOOR 2KD FLOOR I 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTHFLOOR 8TH FLOOR – —�± (Print or Type) Check one: Certificate Installing Company NameW/y//0/wt/� Q Corp. Address / 3 C !i e S?" S `j , 4-�e 44- Partner. OL*Gt.J Firm/Co. Business Telephone: Cl he 0) Name of Licensed Plumber or Gas Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy �ther type of indemnity Q Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Q Agent Q I hueby certify that all of the details and information I have submitted (or entered)in above application are true and accutate to the best of my knowledge and that at! plumbing worts and Installations performed under-Permit iueed for this appUcatioo will-be In eomplianea with all pertinent provisions of tho Massachusetts State Cas Code and chapter I4:of the General Laws. By PE LICENSE: Plumber Title Gasfitter- Signature of Licensed M ter Plumber or Gasfitter City/Town: ,,-Journeyman % S 1 a APPROVED (OFFICE USE ONLY) License Number .�. NO 2264 Date. �.... ,,pRTH TOWN OF NORTH ANDOVER 3�pye,�Eo L o p PERMIT FOR GAS INSTALLATION$ �9SSACNUSEt - r O This certifies that AAA' . . . . . . . . . . . . . . . . . . . . . .. p has permission for gas installation . . L4- .//. . . . . . . . . . . . . . . . d in the buildings of . . 'kr. .�.�'.!. ' . . . . . . . . . . . . . . . . . . . . . . .� at . . .q.ex 5-:"•:. . . . . . . . ., North Andover, Mass. Fee.):0,,. . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File