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HomeMy WebLinkAboutMiscellaneous - 53 FRENCH FARM ROAD 4/30/2018 (2) 53 FRENCH FARM ROAD 210/035.0-0092-0000.0 Office Use Only • 1'j � �Wmwfdt of Massar4aft Permit No. • ltp tritntt of f ablit fafttjl Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 iso peays blank) f APPLICATION FOR PERMIT T0, PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date - 0* or Town of NORTH ANDOVER To the Inspector of Wires: The uderftned Applies for a permit to perform the electrical work described below. Location (Stribt & Number) c�{ (tit -- r Owner at Tenant M k c,+.c A [ iZa n Nt ftp '+ Owner's Address 7S Is this permit In conjunction with a building permit: Yes Cd No ❑ (Check Appropriate Box) purpose V Building i� s���� =---- Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters W Number of Feeders and Ampacity ,.• Locllttlori and Nriiture of Proposed Electrical Work No. of Lighting Outlets "� No. of Hot TLbs No.of 1Fanetormers lbtel KVA No.of Lighting Swimming Pool Above In- Fixtures - gmd. ❑ gmd. ❑ Generators KVA ( No.of Emergency Lighting No.of Reciaptatle Outlets )o No. of Oil Burner Battery Units ' No.of Switch Outlets LQ No.of Gas Burners FIRE ALARMS No.of zonas i No.of Ranges ' No.of Alr Cored. Tbtal No. of Detection and tons initiating Devices i Heat Total Total No. of die posale No.of Pumps Tons KW No. of Sounding Devices No.of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices No.Of D Heating Devices KW Local Municipal Other r"hil g 3 ❑ Connection ❑ No. of No. of Low Voltage i No.of Water Heaters KW Signs Ballasts � Wiring No. Hydro Massage Tubs No.of Motors Tbtal HP I OTHER: — i INSURANCE COVERAGE: Pursuant to the requirement*of Massachusetts general Laws _ i 1 have a Current Liability Insurance Policy Including Complet peratlons Coverage or Its substantial equivalent. YES ANO = I have submitted valid proof of same to the Office. YES T,/NO Z If you have checked YES. please Indicate the type of coverage by checking thea ste box. •r INSURANCE BOND C CrrH� G (Please Specity) ,.• J� (Expiration Date) Estimated Value of Stec I Work S zoCSO, -9^97 Work to start Inspection Oats Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME •�.M ma c:-1tic S��c/� UC. NO.Af J. I " I� C�i 4 f2 f"- /�'L ftc r v�4 t 2 7 f-6 LiCenaN�_` Signature LIC. NO. Ails.Tal. No. 3_3£�2^Z O Address L N C O ' r ^1 DW n I{ 3 a L Alt.Tel. No. °i OWNER'S INSUR NCE WAIVER: I am aware that the Licensee does not have the insurance coverage or Its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit applicsition waives this requirement. Owner Agent (Planes check one) Telephone No. PERMIT FEE S `u': (Stgnatuts of Owner or Agent) x5685 � r *� Date.... .'.1.'.(. .......1...7. f NpR71�1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSES � This certifies that •�h L �+� .......................... ............................... .....5....................... has permission to perform ...... wiring in the building of. !.�.. ..�{ 1� ../..�.�a��.r .�............. at.J.3... �C:(.��_.. .. ...er r.. ......... ,North Andover,Mass. �7 . Fee....��...�..... Lic.N/—c)..... . ........ ................. .. ...... !qA It!—"f/ ELECTRICAL NSPECTOR /x%/09/97 13:27 75.00 PAID WHITE:Applicant CANARY Building Dept. PINK:Treasurer Location , No.' Date NORTh TOWN OF NORTH ANDOVEIJ ,•',•y000 A Certificate of Occupancy $ 41 Building/Frame Permit Fee $ 8 MUs<� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ 93 Water Connection Fee $ f TOTAL $ ' Building Inspector 1� Div. Public Works k x _ �.s.• * -*`- ,.�'t ^y. ,:� th 'r'" s _.r«tr .. . `''S.•'`S ^"-:. '`.....,e.,.r` .-,�"r of z :y -»^Y..�-:'1 xrr No. _ . AFKICATU M FOR ►ERMIT To SURD— NORTH ANDOVER, MASS: r - `-PAGE o MAP X10. LOT NOS Z- RECORD Or OWNERSHIP' DATE o00K PAGE ZONE SUa DIV. LOT NO. RRA ION �. PURPOSE OF BWLDINa � _ OWNER'S HAMS l f �� •,• NO. OP STORIES. size OWNER'S ADDRESS " 0 ��- Q BASEMENT OR SLAP ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST A(V ND 3RD BUILDER'S NAME SPAN a{ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS .� t C( _ l DISTANCE FROM STREET t o , POSTS (� + DISTANCE FROM,LOT LINES—SIDES CCC• (� REAR /eG GIRDERS tt(c L( �c AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS li—'U'L DING NEW k(6 SIZE OF FOOTING x IS BUILDING ADDITION NO MATERIAL OF CHIMNEY IS BUILDING ALTERATION 18 BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 18 BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST ' SEE BOTH SIDES EST. BLDG. COST Y� PAGE I FILL OUT sECVIONS 1 - 3 EST. BLDG. COST PER SQ. PAGE Z FILL OUT SECTIONS I - 12 EST. SLOG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC MET[Pf MUST B[ON OUTSIDE OF BUILDING' SEPTIC APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED fY BUILDING INSPECTOR DATE FILED lam BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT y F E E �- 6 � OWNER TEL I PERMIT GRANTED '' L66� CONTR.TEL I ? �_ 19 CONTR.UC.I ' JUN 61997 H.I.C.I 12-52 -3 -7 �. ;� �. _ _.� "c:'�.;'if'�-L•'lr..1r���-`:'.iXF�►'. _ s .. e -� �ft�' - Cl _ '1 BUILDING RECORD t OCCUPANCY IZ. 1 AMIt 'O 1 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LTI- FAMILY OFFICES LOT LINES IIID EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- A►ARtMENT3 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION ES INTERIOR FINIS" RETE 1 2 � CONCRETE BUK. FINE BRICK OR STONE NARDW O _ PIERS PLASTER _ DRY WALL _ UNFIN. 9 RASEMENT AREA FULL I FIN. S'M'T• AREA _ FIN. ATTIC AREA _ No R M T FIRE /LACES iIEI►D ROOM MODERN KITCHEN 4 WALLS I FLOORS w00ARDS R / 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW'O _ ASOESTOS SIDING COMMON _ VERT. SIDING ASPH.TILE stucco ON MASONRY STUCCO ON FRAME ATTIC SIRS.i FLOOR I_ {RICK ON FRAME OR CINDER SPK. TONE ON MASONRY WIRING STONE ON FRAME a SUPERIOR POOR ADIOUATE NONE ROOF 10 FLUMEING [ GAKE HIP BATH 13 FIX.1 t AM!!El MANSARD TOILET RM. 12 FIX.1 FLAT 1SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY '\ INGES KITCHEN SINK NO PLUMBING 4, TAR i GRAVEL STALL SHOWER ItOtt ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 0 FRAMING 11 HEATING WOOD JOIST PIPELESS F RNAr FORCED HOT AIR RN. ` T TIMER R LMS.i COLS. TEAM STEEL LMS, i COLS. NOT W'T•R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT N'T'G UNIT.HEATERS 7 p0. OF ROOMS GAS A IC I ELECTRIC lot NO HEATING • t • HOW IMOMENT COMTRKTOR i R"isttat w 103231 Ty" • IM MDUAk E�tpf�atlo� 07107199 OWES H. FOSTER, 16! Maxpatt-Rd. r/tol•,r-W Aedovet WO1940 AMCASTRAM s� ✓�ie L�aararrarrccrea`C�i a��-`ta:kucc�rure�ta . c�.�•�► �r� cHaR"s s :cs"se iE9 ''� 6AT3 RD N AU-0738, N0. '31345 JUN ra 1997 OR d Town of Andover No. 2 8 (� * _ dower Mass. Mass.,— .19 MICNEWICK "?,4,r-?E 0 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System NBUILDING INSPECTOR THISCERTIFIES THAT..................................................................... . .. ................................................................................. Foundation has permission ........ buildings on .........: ,5........ -!r�v- ...................... Rough to be occupied as...................................... ........... ............................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS, ELECTRICAL INSPECTOR Rough ........................... . ....... .............. .... ................................................ Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Ro Display in a Conspicuous Place on the Premises — Do Not Remove Fina No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. O/L TF1"K f 7. FVRNA�E I j + i YhP C Oj + + , r + + At 14, 1 , + • Location—s'--,S —7 No. Date A NpRTM TOWN OF NORTH ANDOVER " p Certificate of Occupancy $ C Building/Frame Permit Fee $ Foundation Permit Fee $ ss�causE Other Permit Fe -j) $ Sewer Connection Fee $ _fir Water Connection Fee $ TOTAL Building Inspector f*�n Div. Public Works PER111T NO. � APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP iqO. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. �I I 1 LOCATION SSS �� �.r S r (f� PURPOSE OF BUILDING 2R-QVl0Xt 566-kTy� (n ,�N7-Dot) ISE.. (.� T 1�-t/V !'7(�. /Gti I/Vf71�„ OWNER'S NAME �p,�r/ /' I^n�) C NO. OF STORIES SIZE OWNER'S ADDRESS S�5 f_o(LC-C s,�• K BASEMENT OR SLAB -- ARCHITECT'S NAME I"Si12 :r1J n SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME /I E�"`•` ,/1����C/Cr r SPAN DISTANCE TO NEAREST BUILDING V DIMENSIONS OF SILLS llCrTANCE FROM STREET C POSTS f I DISTANCE FROM LOT LINES-SIDES REAR ' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ✓WILL BUILDING CONFORM TO REQUIREMENTS OF CODE (� IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY i./0 IS BUILDING CONNECTED TO TOWN SEWER /Y V IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ST. BLDG. COST � (+ 0110 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGe 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILLED/AND APPROVED BY BUILDING INSPECTOR DATE FILED ��J�L�qs rm BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORI O AGENT rr,' FEE �� OWNER TEL.1/ �Qg 47r S3 `CS PERMIT GRANTED V CONTR.TEL.#S©8 `1'ba cl, 19 � CONTR.LIC.# 0 +-7-1 • H.I.C.M L dW SSI AUG 3 BUILDING RECORD 1 OCCUPANCY 12 " SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. , CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE 81.K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/. 1/2 '/. FIN. ATTIC AREA _ NO 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR 1. 1 POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING 40 GABLE HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT ASHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G , UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd_(^, NO HEATING + �, of NORT . own of 4Andover .1' L No 4 3 ", ..--�1��_ '-ort, over, Mass., (20-gr 19 T O It. LAKE coc HlcHEw Cc �� AO�ATED PPS\ �C E BOARD OF HEAI TH Food/Kitchen PERMIT T D Septic System �a t F}R,V S S 0BUILDING INSPECTOR THISCERTIFIESTHAT. .?Q ........................................................................................................................................... Foundation has permission to ereet-..h.X9P. ..I T?......... buildings on ..�5F...F A� e' . .................................. Rough .............. to be occupied as.�_.�r.1��►'�dt�.. ........5.X.5....... ..... .! .�.IE., �i'°�cL3A.C_.;�....................... c:bil„ney provided that the person accepting this permit shall In every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXP 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSCv ;-```"`�' Rough .............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final • No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT $�Cofo Ale C DEPARTMENT OF PUBLIC SAFETY "� 9 r o ONE ASHBURTON PLACE, y BOSTON, MA 021013-161E313O1 JUN (15 tori; C CONSTRUCTION SUPERVISOR LICENSE �-----�— -� Number: Expires= Birthdate: P. CS O47781 06/09/1997 0£3/09/1951 - Restricted To: 1G C DERMOT D BRAY Detach bottom, fold , sign on 42 HALE ST back, and laminate license card. NEWBURYPORT . MA 01950 Keep top for receipt and change of address notification. 4 4, :r Restricted To: 1G DEPARTMENT OF PUBLIC SAFETY I*rll�r.h NoNu�o+rrw�1 Mo..00Ao•.tts1)N1M��1f�1►f� CONSTRUCTION SUPERVISOR LICENSE 00 - None tooa.s+rorrowee«los 0. Nosber: Expires: Birthdate: lA - Masonry only at thin 1160890- CS 011181 08/09/1991 08/09/1951 1G - 1 1 2 Fasily Hoses Restricted To: 1G Q \� DERMOT 0 BRAY 12 HALE ST t NENBURYPORT, HA 01950 r I A �-.., �� s i exe'�-Z� 0/p�& 01'0�Da&c� ',4 �tczC�aczXcG�� `J czncL�O�Cz�u�zx u� WILLIAM F.WELD �/�7jjp STANLEY SHUMAN. Governor w i 02'OC) Chairman THOMAS C.RAPONE THOMAS L.ROG Secretary TEL: (617)727-3200 FAX: (617) 227-1754 Administrator Home improvement Contractor Registration Program Dear Registered Contractor; Enclosed please find your payment(s) received with your Home Improvement Contractor Registration Renewal Application. No payment was required for your renewal for the following reason(s): You are exempt from the Registration Fee since you possess a current Construction Supervisor License. The number of employees listed did not put you into a new—X grouping for the Guaranty Fund contribution, therefore, no additional Fund payment is required at this time. Your new registration card is enclosed. Sincerely, Home Improvement Contractor Registration Program STATE BOARD OF BUILDLNIG REGULATIONS AND STANDARDS sd `t 32, C D X i i i' it `-1 X 4 Q�� ,�?hCG 2L-D �T m AS o,<149 41, AW3 � y APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 0702 I>A(,E ONE OF PAGE PROJECT: ARCHITECT: (name, address) ARCHITECT'S PROJECT NO: TO (Owner) CONTRACTOR: CONTRACT FOR: APPLICATION DATE: APPLICATION NO: AT T N: PERIOD FROM: TO CHANGE ORDER SUMMARY Application is made for Payment, as shown below, in connection with the Contract. Change Orders approved ADDITIONS $ DEDUCTIONS $ Continuation Sheet,AIA Document G702A, is attached. in previous months by The present status of the account for this Contract is as follows: Owner— TOTAL Subsequent Change Orders ORIGINAL CONTRACT SUM . . . . . .. . . . . . . . . . . . . . . .$ Number Approved (date) Net change by Change Orders . . .. . . . . . . . . . . . . . . . CONTRACT SUM TO DATE . .. . . .. . . . . . . . . . . . . . . . .$ TOTAL COMPLETED & STORED TO DATE . . . . . . . . _ (Column G on G702A) TOTALS RETAINAGE % $ Net change by Change Orders $ or as noted in ColumnI on G702A State of County of: TOTAL EARNED LESS RETAINAGE . ... . . . . . . . . . . . . . .$ The undersigned Contractor certifies that the Work covered by this Appli- LESS PREVIOUS CERTIFICATES FOR PAYMENT . . . . . . . .$_ cation for Payment has been completed in accordance with the Contract — Documents, that all amounts have been paid by him for Work for which previous Certificates for Payment were issued and payments received from CURRENT PAYMENT DUE the Owner, and that the current payment shown heroin is now due. $ -- Contractor: subscribed and sworn to before me this day of 19 Notary Public: By: Date: My Commission expires: in accordance with the Contract and this Application for Payment the Contractor is entitled to payment in the amount shown above. ❑ OWNER Architect: ❑ ARCHITECT ❑ CONTRACTOR By: ' This Certificate is not negotiable. It is payable only to the payee named herein and its issuance, payment and acceptance are without prejudice to any rights of the Owner or Contractor under their C-ontra:t. AIA DOCUMENT G702 • AI'1'IICATION AND CERTIHCATL FOR PAYMENT • MARCH 1971 EDITION • AIA® ` 1ri71 • THE AMERICAN IN',TITUTr OF ARCHITECTS, 1735 NEW YORK AVE., N.W.,WASHINGTON,D.C20006 **'��+ r� urrrrvnm At'Pt.1GAT10N FOR PERMIT TO DD PLUMaiNt3 IPtlni or Type) NORTH ANDOVER, Mass, 08442 2_2718 Building3 Permit it- 3 3 9 9 Location Owner's- Name ��Fi New Q Renovation Q Replacement [z Plans Submitted: Yes❑ No.❑ FIXTUAEB » s W < y » •»+ 1" 0 S s M r w C = » < i R 31 ~ = 0 w w w tr u w w w ,� : s v = • a=i r s �' awl s ass ► v s = s s w r r �wr w at >• w es w s w • woa *a I. y c 3c Y st s{ a ar s AL a ss06 aua—SSYT. - - SASaYSMT 1ST FLOOR SRO FLOOR $RD FLOOR 4TNFLOOR - I-TN FLOOR OTM FLOOR TTM FLOOR STN FLOOR Check one: Certificale Installing Company Name���l h o� �1� ❑ . Address0 DZPsrtn�wp O /Co _ . .. .�.. ._. . Business Telephone :�QF O .Name d U tensed Plumber INSURANCE COVERAGE: ec one I have a current Ilabltty Insurance pdicy or No substantlal equlvalenL Yes one ❑ It you have checked yU, please Wlcate the type coverage by checking the appropriate box A .� . . ,.. ..ila_b_l..ty Insurance- --p-o-tt..d.y ---- _Other--typed triemriY Bond Q. .�'..- OWNER'S INSURANCE WAIVER: 1 am-aware that the Ilcenies does not have the Insurance coverage required by'^ Chapter 142 of the Masa. General Laws, and that my signature on this permit appltcaUon_waives.thla cegutreraant.-,_.�_ Check one: - Signatuts o Owner Q Agent. et.of H s- en� .� .. 1 hereby eerlify that aA of the detaBs and Information I have wbmttted Im entered)ti above appfkaUon are hua.and_aowrata b tha:bes4o{, Inowiedge and that all plumbing wwk and Inslaltatlons p wn*d under the pem-A Jawed a lhla tkxt ate, b w{I be.In Aa my=_ perUnen1 provisions of the Massachusetts Stale Plumbkq Code and Chaptat 112 (3en w t compliance with aN tritebigna urs of Ucansed Plumber 1 Clty/To%" license Number l `7 f Af f'110VED(OFFlCE USE ONLY) Type of Plumbing Ucense: Master [ ^ Journeyman ❑ 1 yy { COMMONWEALTH OF MASSACHUSE • AND GASF ITT ER BS 14 PLUMBERS �► SMLP ,T TO L U LICENS &k§ 15 M MALONSON SCOTT 60 PELHAM RD NH 03051--441 HUDSON 156 11875658 05/01/98 1. Date. . y. rr� r� .' Ltiyi J TOWN OF NORTH ANDOVER g PERMIT FOR PLUMBING g b 'O,,n°�^•�17 ,SSACMUS� i This certifies that f • • • • • • • • • • • • • • • • • • • • has permission to perform . . . .P U .�. r (... . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . ` +-' ?,:7.,r . . . . . . . . . . . . . . . . . . at. . 3. C.C .�—�i���t.'. . . . ., North Andover, Mass. o Fee. ��v�. . .Lic. No../. >>. . . . . . . . . . . .CTO LUMBING IN ER WHITE:Applicant CANARY: Building Dept. PINK:Treasurer