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Home My WebLink AboutMiscellaneous - 53 HEPATICA DRIVE 4/30/2018 53 HEPATICA DRIVE BUILDING FILE t f TIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER 49 7 9 0 Date; 'December 18, 02 07_ Building permit Number � THIS CERTIFIES THAT THE BUILDING LOCATED ON 53 He Drive N MAY BE OCCUPIED AS Sin leFamFly ssACHUSE'I"t's STATE BUILDING ACCORDANCE WrM THE PROVISIONS O CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Kev Lime Inc 10 Heyatic Drive N rth An gYer MA 01'845 Buildin spector _4. 9 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 49(7/19007) Date; December 18, 2007 THIS CERTIFIES THAT i THE BUILDING LOCATED ON 53 Hepatica Drive MAY BE OCCUPIED AS _Single Famil_v_Dwelliner _ IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Key Lime Inc 10 Hepatic Drive North Andover MA 01845 Buildin spector i i i I OORTM 0 '1SS�CHU APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit# �I ADDRESS/LOCATION OF PROPERTY : / Map Parcel Lot Number �� ' ` 14 'n SUBDIVISION ®�� e V • �� G -- DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: Le-V Address '-pe, Vv 4 w ode e-` w bF . SIGNED C v ROUTING, OUT N CONSERVATION PLANNING - L,P FYI ly/h DPW -WATER METER ® i 11ag6� SEWERIWATER CONNECTION ® It f ZdO7 NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW V)Aa' LaI16 Signature Fife: Application for OC form revised Jan 2007 XORTH 6i Town of Andover 0 too No. 0 , dover, Mass., �• O �= LAKE COCMICKEWICK %S RATED BOARD OF HEALTH s Food/Kitchen Septic System PERMIT T D BUILDING INSPECTr :°IIS CERTIFIES THAT �'" �/� ..........1..F................................................................................................ ....................................... u ,�c " �` ... �G� v� €--is permission to erect........................................ buildings on .. ... ...,�... �ough A. # be occupied as.................` �-,�......./ �1 '.f .:. .... y...hcation on file m y c r.ovided that the person accepting this permit shall in every respect conform to the terms of the application i Final, V its office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of r lldings in the Town of North Andover. PLUMI PECTOR ' :OLATION of the Zoning or Building Regulations Voids this Permit. Rough F& I/ d� PERMIT EXPIRES IN 6 MONTHS -' ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS oui� �} . .. .............................. Service DINOR Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No- Lathing or Dry Wall To Be Done FI E DEP Until Inspected and Approved by the Building Inspector. Burner ' Street No. 0 C w SEE REVERSE SIDE Smoke Det. V40RTM Town,: of No. 9 0 o , dower, Mass., - 0 LAKE 1� C.00MIC EwICK Ids RATED O'Pa,�� 7 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic Sysfe �1- x I le— A G SP TOR, THIS CERTIFIES THAT Foundation � has permission to erect.......:.................... buildings on ..., .. . .. ... ` . �c..t9........ . .............................. to be occupied as........................ ..; .. ..... °a..: �a m. . ................................................. .... ....... ey provided that the person accepting this permit shall in every respect confpfm to the terms of the application on file in ina 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. h / ` PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO t ,STARTqCIL S f0 0, ...........•.It...... ....... .. .... ......................... �.+.o.e+.•*� BUILDING INSPECTOR Final �, Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - Do Not Remove Rough No Lathing or Dry Wall To Bw Done FIRE DEPARTMENT Until Inspected and .Approved by the Building Inspector. Burner �i Street No. ��w D Sm ke Det.' SEE REVERSE SIDES 1 .S �i ,,, �•r� I/zV.r 7 NORTH TONM of No. CO' o . '� dover, Mass., COCHI C HE W ICK y1• 7�SoR4 TED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System UILDING INSPECT THIS CERTIFIES THAT �. �• 1;V: tion has permission to erect........................................ buildings on ,.--f.. .. &,� `1...C. a..... -'Rough .... . .... .... ..................................... to be occupied as.:...........:... ....../../.. . t'/"¢ ......� .��.�:1:...r., �.�:. . ....� �,.�,,�a. ................... c provided 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 Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUM SPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit.. Rough F�� C 44 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS ou ,4, Service .......................... ..... ................... :.... .... ...................................... DIN R 1Q 1 7 Occupancy Permit Required to OcL-upy Building GAS INSPECTOR Rough Display in a Conspicuous Place.on the -Premises- = -Do Not Remove Final r - /I/ No- Lathing or Dry Wall To Be Done FI EP - Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 603 Salem Street Nantucket, MA 02554 Wakefield, MA 01880 Tel: (508) 228-7909 Tel: (781)246-2800 NOA-0064 Hayes Engineering, Inc. Fax: (781)246-7596 Refer to File# December 10, 2007 Lincoln Daley, Town Planner Town of North Andover Office of the Planning Department Community Development and Services Division 400 Osgood Street North Andover, MA 01845 RE: Occupancy of Unit#25 Old Salem Village, Rte#114, North Andover Dear Mr. Daley: Unit#25 and the foundation, walks and drives shown on "'Old Salem Village of North Andover Condominium' Condominium Site Plan in No. Andover, Mass.", dated December 5, 2007 by Hayes Engineering, Inc., have been completed substantially in accordance with the Old Salem Village Site Plan titled "Site Plan in No. Andover, Mass", dated October 4, 2004, revised through March 1, 2006, as amended by the plan titled "Layout Plan in No. Andover, Mass", dated April 19, 2004, revised through June 15, 2007. Very truly yours, aka-- 13r K,5; Peter J. Ogren, P.E., P.L.S. President PJO/mas cc: Key-Lime, Inc. z Date...,l'....r�- .. .� NORTI� °`'"`° '•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that .................J) Smiell...... has permission to perform ..............r!v,,�LL/..''(. r.. ......................... wiring in the building of...........k.'e y 4"/z`''R........ .!............. S 3i9�Pi9 at.............................................................. ............... .North Andover,Mass. Fee.S�LIc.NoAg..� .. .............../. - ..!......... j ELECTRICAL INSPECTOR Check # 7666 Official Use Only Commonwealth of Massachusetts Y Department of Fire Services Permit No. 7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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 IN INK OR TYPE ALL INFORMATION) Date: � , Z 5 ti l City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intendan to perform the electrical work described below. Location(Street&Number) •j 1 -6� Owner or Tenant Ar Telephone No.6 11( - Owner's Address Is this permit in conjunction with Auilding permit? Yes No ❑ (Check Appropriate Box) Purpose iof Building / Utility Authorization No.�3?Z J—y" Existing Service mps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service 2 e e Amps /2v/2 ya Volts Overhead❑ Und rd g No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: i Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 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 R No.of Ranges No.of Air Cond. ons TotNo.of Alerting Devices No.of Waste Disposers Heat Pum Number Tons W No.of Self-Contained Totals .... . .. . ........ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal 11 Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.of KW Data Wiring. Heaters Signs Ballasts No.of Dvices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: .i Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: —2s a7 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 proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage 's in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Icertify,under the pains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: c v IC.NO.: A-9S 33 Licensee: Signature LIg2C.�p�N^--O.: /J-9 y 3� (If app licable, enter 'exempt"in the license number line.) Rus.T�LTCGo.: 4,E7-01 Address: S - Alt.Tel. No.: *Per M.G.f 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 Signature Telephone No. PERMIT FEE. $ 4 �� 2�� r r C Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street M Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AM licant Information Please Print Legibly Name(Business/Organization/individual): 2. Z le- Address: City/State/Zip: 4/- e� Phone#: Are you a, !oyer?Check the appropriate box: 1•Uram a employer with 4. 0 I am a general contractor and I Type o[project(required):. employees(full and/or part-time).* have hired the sub-contractors 6. w construction 2.❑ I am'a sole proprietor or partner_ listed on the'attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have working for me in any capacity, employees and have workers' 8' 0 Demolition o , v�+orkers (N comp.insurance comp.insurance.#' 9• ❑Building addition 3.0 required.] 5. (] We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised.their myself. 11.❑Plumbing repairs or additions [No workers comp. right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees.[No workers' 13.E]Other comp.insurance required] *My applicant that checks box#1 must also fill out the section below showing their workers,co t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors policy information. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether oar not affidavit th se entities esuch ve employees. If the subcontractors have employees,they must provide their workers comp,policy number. I am an employer that is providing workerscompensation insuran information. ce for my employees: Below is thepoUcy and job site Insurance Company Name: ,¢ o G Policy#or Self-ins.Lic.#: a/-Y 4"�L 6/e/;, � � _ Expiration Date:_ % — z c o y— Job Site Address: �1 � c City/State/Zip: N ��, Attach a copy of the workeicy declaration page(showing the policy number and expiratio d e 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 ' risotunen unp as well a 6 s civil� ! enalti of u to$250;00 a da P es in the form of a STOP WORK ORDER P y against the violator. Be advised that a copy of this statement may be forwarded to the Office f d a fine investigations of the DIA for insurance coveratze verification. I do hereby certify under the pains and pen s o ury that the information provided above is true and correct Si ature• Phone#: _ y Zl o 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 Z.Building Department 3.City/Town Clerk 4.Electrical Inspector 5 6.Other .Plumbing Inspector Contact Person: Phone#: i i LAWRENCE H. OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 fax 978—352-2858 pager 978-502-5921 September 28, 2007 Mr. Benjamin Osgood fax to 978-685-1099 Key Lime Inc. 1538 Turnpike Street North Andover,MA. 01845 RE: Unit"E' Alt.,Lot 25 O.1.d-Salem Village,North Andover Dear Mr. Osgood As you requested I visited the above project to review the Engineered Lumber used in the framing as shown on plans prepared by O'Sullivan Architects dated 7-23-07. The Engineered lumber is installed as shown on the drawings and field modification sketches as prepared by me. I therefore certify that the use and installation is acceptable and will support the loads as required by the Massachusetts State Building Code 6`h Edition. Should you have any questions please call. Yours truly I(lawrence'H. Ogden P.E. �tH of,y��y 9 LAWRENCE G HA LD A o N H 5� IS FSS Ai ENG�O i LAWRENCE.H. OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978–352-2858 pager 978-502-5921 September 28, 2007 Mr. Benjamin Osgood fax to 978-685-1099 Key Lime Inc. 1538 Turnpike Street North Andover,MA. 01845 1 RE: Unit"E"Alt.,Lot 25 Old Salem Village,North Andover Dear Mr. Osgood As you requested I visited the above project to review the Engineered Lumber used in thelframing as shown on plans prepared by O'Sullivan Architects dated 7-23-07. The Engineered lumber is installed as shown on the drawings and field modification sketches as prepared by me. I therefore certify that the use and installation is acceptable and will support the loads as required by the Massachusetts State Building Code 6t'Edition. i Should you have any questions please call. Yours truly /�I'-71 v,, I V awrence H. Ogden P.E. N of M LAWRENCE 9CyG HA LD m N COO .o 'A 77 5 �G�F C'IS SSS AL v.3 ��t1Jo�iC-c.wc/ I ' Date.. .r,15 l"Q.7.. . . . .. . j� .e f ,40RTM 1 o? ' TOWN OIL ORTH ANDOVER " PERMIT FOR GAS INSTALLATION s �a ,SSACHUSEt 6'"This certifies that . . . has permission for gas installation�. . . . . . . . . .' . . . . . . . . in the buildings of . . .G „/in?.!'. . . .'.,/,�C-. . . . . . . . . . . . . at . . . . ..5� . . . .�!/ ` %'. . . .-�. . . . . . . . ., North Andover, Mass. Fee. 20 . . . Lic. No..%!r. :'. r�17 f!0,N. . . . . . . . . . . GASINSPECTOR Check# 6108 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITI'ING --� (Print or Type) } � Mass. Date 7 Permit # 0,,5 BuildingLocation 3 l7 C C ' Owner's Name l lw p- C�-L � �� ti �u� n ~� Type of Occupancy -ice New ( Renovation ❑ Replacement ❑ Pians Submthed: Yes❑ No❑ N a N W t11 Y z Q N N N U ¢ s W JX N ¢ O N = y� W ¢ O t7 ¢ Z p u .4 < ¢ Za W Q O N F- W W O Q ¢ < 9 ¢ N 0 W W = Z f U) O O W V UA y 0 m Z •O Z W O 2 < W < ¢ < C[ < O O U, a O til P SUB—BSMT. BASEMENT I ST FLOOR '2ND FLOOR 3RD FLOOR ATH FLOOR I STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name ct�,!16 YEN u ah v� ; 1 �&, Check one: Certificate I Address Q ( ❑ Corporation l ( 7-3 ` ❑. Partnership Business Telephone_!i2 - 32 V q 3 0 Firm/Co. C Name of Licensed Plumber or.Gas Fitter i— C"P11-i s-, 6�` INSURANCE COVERAGE: I have a currelt,iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes t' No ❑ If you have checked yes. please indicate the type coverage by checking the appropriate box. A liability insurance policy Mll� Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: owner[-) Agent ❑ Signature of Owner or Owners Agent I hereby certify that ail of the details and information I have submitted(or entered)in above pli 'one and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issue o 1 tion will Vin compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gener s $Y T be Sig Lure of Licensed Plumber or Gas otter Title �1 fitter ster License Number City)lawn f^,un,eyT.a. ( e Date. ! .( 1..?. . ; .. MORTM f ref of �` �p TOWN OF NORTH ANDOVER PERMIT FOR GALS INSTALLATION S^CMUSES This certifies that . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . '�C. . .,g!�?!./!'-. . . . . . . . . in the buildings of . :. 7 ;-4!.. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . ��. 1h. .'.`.G9 . . . . . . . . . . . .. North Andover, Mass. Lic. No..�7t,.?. . . . . . . . . . . . . . . . . . . . . . �AS INSPECTOR Check# Date. .,52:.1./.0. .7. . � r k NORTH o?�.,<��°„•.',�oo� TOWN jOF RTH ANDOVER PERMIT FOR PLUMBING SACHUS r This certifies that 64. )�.i . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . j.%f�. . . . . . . . . . . . . . . . f � f plumbing in the buildings of . . . . . . .' . . �tn!t . . . . . . C-. . . . , at. . . . . 5- 3. . :. . . . //./� .>:qIS . . . . . ., North Andover, Mass. ' Fe�� ,u�.Lic. No. l� 4. ?t . . . . . . . . . .I)•f`�,A, 4.�?. . . . . . . . �J PLUMBING INSPECTOR Check # / d 482 o MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUIUBINO V �/� ` (Type or print) (`t a 6-Y SCS-_ r r MASSACHUSETTS Date � Building Locations �3 cam) c Permit #_ Amount' Owner's Name .-V12=1 �l w'-� L L c- I New Renovation ® Replacement ® Plans Submitted ri FIXTURES rn ra v, va w F l�" Pro F A �n En SLB4ME IR FUM -z- 2N11 2M1 FLC(R Z 2- MH MH R m M1 Rfm 7M 110M SII FUM (Print or type) Check one: Certificate Installing Company Name G a l i n s k y P 1 u m b i n Q & H gni n e v Corp. 1 9 n Address P.O.Box 1701 Partner. HavPrhi i l MMA n Ri1 LJ Business Telephone 978-374-1743 �! ❑ Firm/Co. i Name of Licensed Plumber: Stephen C. G a l i n s k y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Bond Insurance Waiver: I,thel undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance I Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entere )in above application are true and accurate to the best of my knowledge and that all plumbing work and installations perfo ed der ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State in d Chapter 142 of the General Laws. By: Ti—gnature'or LOSEum er Type of Plumbing License Title �� City/Town Lice'11..s, um er Master Journeyman APPROVED(OFFICE USE ONLY MASSACHUSETTS ::FORM APPLICATION FOR PERMIT TO DO GASFITTING $ ' Gy � c (Print or Type) , Mass. Date (P 200 Permit# 2 L Building Location s j4 7-it-44 Owner's Name 4 2. Telephone R3 3143 Type of Occupancy NewED Renovation Replacement Plans Submitted: YesEl NoPA 0. 4) m � N � N N 0 0 0 7 = d y � � N d V m C £ = L w to _ '` G > J d d N C 0 L a) C� N $_ > C 4) > R E = O N c O c L O W 2 0 = W D O a J U W m D 11L 1-' O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR ' 6TH FLOOR 7TH FLOOR `a 8TH FLOOR Installing Company Name EnergyUSA Propane,Inc. Check one: Certificate Address 100 Myles Standish Blvd.,Suite 101 X❑ Corporation 132 C Taunton,MA 02780 Partnership Business Telephone (800)822-1300 X8055 Rick Rousseau C(603)231-2702 Firm/Co. Name of Licensed Plumber or Gasfitter William Kent Corson(800)822-1300 X8051 Cell(508)294-6660 INSURANCE COVERAGE: EnergyUSA Propane,Inc. has a current liability insurance policy or its substantial equivalent,which meets the requirements of MGL Ch.142. Yes V No ri If you have checked rimes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy X❑ Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Owner � Agent Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code and Chapter 142 of the General Laws. Type of License: By Plumber Title X❑Gasfitter Signature of Licensed Plumber or Gasfitter City/Town R Master APPROVED(OFFICE USE ONLY) Miourneyman License Number 3707 BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GAS INSPECTOR t