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NORTH TOWN OF NORTH ANDOVER
Of �.•o ,•1yQ
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Certificate of Occupancy $
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'�s' •° •'<�' Building/Frame Permit Fee $
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Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 1311-0
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Certificate of Occupancy $
Building/Frame Permit Fee $
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Foundation Permit Fee $
Other Permit Fee 6.-Z7 $ f
TOTAL $ /
Check # 13,519
Date 12-
TOWN OF NORTH ANDOVER
19884
Qk4,
V Building Inspector
TOWN OFNORTH ANDOVER
1600 OSGOOD ST
APPLICATION FOR CERTIFICATE OF INSPECTION.
Date O Fee Required (Amount)----- Q O --__----
No Fee Required
Accordance with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby apply for Certi f icat,
Inspection for the helow-named premises located at the following address:
Street and Number W f �1 JA)—_— 17
--- --------------
Name of Premises ------� � -----------------------------------
Purpose for which Premises is
Used------ -------------------------------------------------------------
Licer>nses (s) or Permit (s) Required for the Premises by Other Governmental Agencies:
License or Permit
Certificate to he issued to �--�
Address—_5 _StZ -- �------------------------------- Telephone d �7� 3 3
Owner of Record of Building _
Address ---W613'---- --- —�� C� ——`e�— --
���---------------------------
%Name of Present Holder of Certificate__�-�----------------------------
Name
Name of Agency, if any ------------------------------------------- ------------------------------
SIGNATURE OF PERSONS TO WHOM CERTIFICATE TITLE
IS ISSUED OR HIS AUTHOIRIZED .AGENT ������Q�_-----
DATE
INSTR UCTIONS.•
1) Make check payable to: Town of North Andover ------------------
2) Return this application with your check to. BuAhd w Dept.
1600 Osgood ST, North Andover MA 01845
PLEASE NOTE:
,Application form with nccompanyin,c FEEmust be submitted for each building or structure or part thereof to be certifies{.
3) Application and fee must he received before the certificate will he issued.
4) The hitilding officittls slrctil. he notified i.rithin tcn (10) clays of ariy chcinge in the above information. _
CERTIFICATE # E.YPIRATION DATE.
• _
CLIx'TIFICATE of INSFECTION WORKSHEET
REVISED 3.200( jnu
NORTH ANDOVER HEALTH DEPARTMENT
Z_7 64ar-fes• North Andover, MA 01845
Telephone (
Housing Inspection
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COMPLAINT #� !
COMPLAINANT
ADDRESS OF PREMISES �� L� ��� �' ��i�:
OCCUPANT
OWNER ef / 1e-
4e -
OWNER'S ADDRESS --
DATE OF INSPECTION Arjp HOUR
ROOMS/VIOLATION:
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#HIR -1 Action Press 885-7000
INSPECTOR
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