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HomeMy WebLinkAboutMiscellaneous - 53 MIDDLESEX STREET 4/30/2018 �I 53 MIDDLESEX STREET 210/031.0-0046-0000.0 i Date... o::.a::. Of NORTH,h0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0 ACHU5. This certifies that ........ ....................... has permission to perform .......... .,e/ ,2—=.............................. wiring in the building of...�.,5,4 ........................ ......................... at..... ......IF.;T'............. .North Andover,Mass. . . .1T......... Fee.,. .... Lic. ....... .... Check # L 8419 .y . { Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 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: /©-/7 o'S" City or Town of: NORTH ANDOVER To the Inspector.of Wires: 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 t I–arj N(–y Telephone No. Owner's Address 541 �+ Is this permit in conjunction with a building permit? Yes ❑ No,-M (Check Appropriate Boa) Purpose of Building 1 Utility Authorization No. r Existing Service 1W Amps /L0 ! 71JO Volts Overhead-K Undgrd❑ No.of Meters / New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: C(AWIUC w G Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil: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.ot Emergency Lighting rnd. grnd. 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 —InitiatingDevices Tons g No.of Ranges No.of Air Cond. TotalNo.of Alerting Devices No.of Waste Disposers HeatPum– Tons IKW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers g S ace/Area Heating Municipal p b KW Local❑ Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: sud (When required by municipal policy.) Work to Start: .�V/,P elf 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 is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Of LIC.NO.: Licensee: J?XAaMJ Lf4CL04(Z ) Signature LIC.NO.: 0 SCI (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 02 1��-d _G X7, <5"61Et, P-lb 011"11 Alt.Tel.No.: 22L;-/S Y/Lfo *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"9"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: r $ The Commonwealth of Massachusetts 67 Department of Industrial Accidents Office of Investigations 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): Address: City/State/Zip: Phone #: ' Are you an employer? Check the appropriate Vox: r Type of project(required): 'V 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11 .❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 41 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. :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 employees. Below is the policy and job site 3 information. Insurance Company Name: Policy# or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 Inv 'Q estibztians of the)IA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Sip-nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town offtciaL 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#• w f aftice Ura QNy Of fffis��Zttra 01 41 (EMMna= Permit No f � t of V1161k 101 p- a«vr a�. .. - -•. Taxpk r.. BOARD OF FIRE PREVE�J?ION REGULATIONS 52?CdA 1290 �0 (lea"bilitti.114 . .. APPLICATION FOR PERMIT T0. PERFORM ELECTRICAL WORK AI! work to be" performed in at=rdance with the Massac:tusetts Electrical Code,SZ7 CMR 1100 (PLEASE PRINT IN.INK OR TYPE ALL INFORMATION) Oate •:C 7 a* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perfor-,nm thep electrical work described below. Location (Street & Number) V-3 M 7 /J �L- Owner or Tenant m 4- 14 a Owner's Address Is ;his permit in ceniunc:ion with a builcing ::errnit: Yes _ No (Check Appropriate Sax) Purccse of Suildir.g Utility Auti'criZation No. tloits Overread '� Uncgrna 1 No. of Meters Existing SarAce Amps _I r- New Service Amps _ / Volts Cvemead r Uncgmd Q No. of Meters Numaer of Feeders and Ampacity Location and Nature of Proposed E:ec:nc.zl 'NcrK ' Tota1 i i No. at ranstormer5 No. of L.:.;n;ing Curets Na. zi -_. '.cs KVA n �+_. aav8� No. or Lgnrng =xtures C a«�r--5 gr—c. _ _-c. _ i Generatcrs KVA I No. at i'mergenc/ i.�gnting No. at Recectac:e Cutlets IL No. at Cil Surners j 3arery Units No. at Switch C No. ar ^-as 3_rr.ers FIRE ALARMS No. of Zones � 'otai No. at Cetection ana j No. at Ranges i No. at Air Gr.C. _rs I Initiating Cavitas I mea: c;at .a:ai No. at Ciscosats Near=_,,-as :ors CJ No. at Sounaing Devices No. i a: Satf Cantainec Ca!e No. at Cisnwasners SaacelArea -__ ;,g, . c.:anrSouncing Dawcss Muric:oai Ctner No. at Crvers -ea^ng 2ev:ces SCJ =poet _ Canner:on i No. at No. at I Law ':citage No. or Water Heaters KW i Signs Sa:tas:s Wirnc i No. Hycro Massage Tubs No. at Motors -oral i;P I !NS�PANC= CCVEPAGE. Pursuant to : e roc::rer..er.:s a :!assacn_ r. sers ger Laws _ I rave a current Lianiiity Insurance Pais/ inc_c:rg _.. .. _.etec Ccera^ens Coverage or .:s sues.antial ecwvaient.YES NC — nave sucmtrtea vatic proof of same :o :t•.e C'tcs. `!__' = Nc — t -.;cu nave cnec-ee `!_S. -tease incicate *me ypo of coverage ay anecxing trio accdata pox. INSURANCE P SCNO = OTHEa = ,Please S=ec-!*.) (Expiration Datei 'csamatea Value of Vectr+cat�w'oorrk 5 Worx to Stats Z zr-!7 L_ insaec-_cni Ca:a Racues:ee: Rcugn S;gnea uncer-no Penalties of penury: r �iRM NAME 01- A E 9 7- C 114C uC. NO. L censea �� .Sr S gratt:re UC. NO. LrZ �Vr- Sus. aI. No. AeCress,e// L T X E h h Alt. -at. NO. CWNEP•S iNSURANCE WAIVER: I am aware :nal a L:cer•see Sees ret 'lave ,rte insurance coverage or its suostantial eeutvalent as :e- cuirea ay Massachusetts General Laws. ana trial -ty s:sra:ure on ;rts aerr:it accacation 'waives in's reautrernent. Owner Agent (Please cnecx one) :eieorone No. PS_RMIT FE=S (signature of Qwner Cr Agent) :--3563 N2- 1 343 Date../?... ... 0� N�STH 1,y Ci TOWN OF NORTH ANDOVER a PERMIT FOR WIRING ,SUCNUS� r This certifies that-...— . ,_ _ , has permission to perform wiring in the building of....�. c...... .� "-�... J."� .................... tL at.... ��1 ...1 ....,�.�'�,-. . � :� ..-.:...., orth Andover,Mass:" ;:... Fee-4............... Lic.Nok .41„ .9.......................................................... ELECTRICAL INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer APPLICATION FOR PERMIT TO BUILD — NNRIM ANOUVER, vwf►ab. MAP NcyLOT NO- Z RECORD OF OWNERSHIP JDATE BOOK iPAGE ZONE SUB DIV. LOT NO. I I LOCATION - 1 D PURPOSE OF BUILDING D7,7 OWNERS NAME \ , -t 1 NO. of STORIES size OWNER'S ADDRESS e�-T ` BASENENT OR BLAS ARCHITECT'S NAME J SIZE OF FLOOR TIMBERS IST 2ND SRD BUILDER'S NAME � \/ 2 ._ j SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET - POSTS -•- DISTANCE FROM LOT LINES SIDES REAR - GIRDERS AREA OF LOT /RONTAG[ HEIGHT OF FOUNDATION THICKNESS Is BUILDING NEW - SIZE OF FOOTING x IS BUILDING ADDITION MATER:AL OF CHIMNE♦ ' IS BUILDING ALTERATIONn IS BUILDING ON SOLID OR FILLED LAND ' S � WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANT IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS S PROPERTY INFORMATION LAND COST 11 SEE BOTH SIDES EST. BLDG. COST `L� PAGE 1 FILL OUT SECTIONS 1 S EST. BLDG. COST PER sQ. FT, i EST. BLDG. COST PER ROOM PAGE Z FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. • ELECTRIC METEPS MUST BE ON OUTBID[ OF BUILDING A APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APP OVED BY SUILDING INSPECTOR . 1 DAT! II �� v 1 ma 11tSr'EC'TOR SIGNATURE OF OWNER O# AUTNORI AGENT Owners Tel # E Contrac� Tel�,E t+E1aMIT tiRA1fTE0 - s. Contra. Lic # (yrn • _ HIC # i T40R Town of _ 4 _ over No. SRI over, Mass., _19?� LAXE 0 ICHEW I CH I C K E16) BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THISCERTIFIES THAT............................................7� .......................................................................... Foundation has permission to elect-:.. .... buildings on ...... . .............. ............... Rough to be occupied as............................ ...­­­**­* ...0.W.-Z.............-P..(. .. Chimney .(X 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 MONTHS UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR 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 Street No. Smoke ke Det. � New toilet in some location New pedistal lav in some location 3'-6 3/4"X 3'-0" 3'-6 V X 3'-0" <i UOU I —6 3/4" Bead board 1/2 wall around HO C:)) perimeter S-4 '/8" Tile floor i co 7 Replace existing door unit with a prehung solid jamb 2'-6"x6'-6" 3'-4 2'-6" Pine six panel door.Client will provide hardware to match existing. Replace shower with new shower We are to approximate existing moldings Thornley as built bathroom base and Corion walls Thornley proposed NONE !NPROVEAENT :'ONTRAC'OR Registration 106877 Tree -. PRIVATE CORPORATION Lkense • ExPiratioe 07/18/48Use oT kion•valid forual. • returnm:Ocie Ash�b radon dam � - � BLACK006 MUM. INC �t0n M&02108 �n Pie If 1301 �.,.r.Dualvid K. Bryan AM&WTRfiM-- '�—ltelly Rd, No. Sales NH 33079 :41: �^ : i 119196 Restricted To: 18 OEPARTNENT Of POOL It SAFETY t I ;, •. . ;. ` 11 - None CONSTIUOT-Iii,SUPERVISOR.lItENSE; . , l IA — Masonry onlyExpir.0, 'Birth, family Nous -_ 18�31i196R•: Failure to possess a current edition of the � ' , `' Rti :! xe4 !t : i 16 Nassachusetts State Building Code is cause for revocation of this license. � N,iDAVIQ K:i Ar�N.,: t 6 KEI�Y N0,12 �� _ SAIEN. NH 03079 ` = The Commonwealth of Massachusetts - - -- Department of Industrial Accidents' v 0/flceol/oyestl9adons •• = 600 Washington Street Boston,Mass 02111 Workers' Compensation Insurance Affidavit Im name, ailwea location- cilx IeW, ghone jV9 030 ❑ I am a homeowner performing all work myself• ❑ I am a sole proprietor and have no one working in any capacity ( 1 am an employer providing workers' compepsation for my employees working on this job. company na on : .. insurance co. �t°� f'fs �St/l�AG'C - nolicv# � -- _ � - '�`�` - _rsa.ane�c.ssi'�ctrdwna�.sc3a»•wr._.._.n.�.�•,,..,9 ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comoanv name• address: city .. "!Phone* ::.:.. • :..::::::.� ::.: :::•.:.:................v....:.:::..:�:::<•:}..%•::}:•+:::6!(•:r::::iAw i:::'+.RO.ri.`:::r::v'::•:v:::•n•:4;....: ::•.;.....:.,v:v'vi: insurance co.,:... .::..:...:. .. company , .. name. ':,.....,. ._ adds :. .:•;{:h.:iiii ... .. + .... .. plane N! insnranceco. :.::.:.. . : .. ;;:..;;:;:.: i o a c Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerd under the pat and penal!es ry!flat thein ornlatlon provided above is true and correez a �� signature / 2 �_ ace $ Print name l ore/ G•ll�Y,�rS�l! c hone# 03 S' ove official use only "do not write in this area to be•completed by city or town official, _ _.... .. ._ ... _ .. city or town: permit/license# riBuilding Department C3 Licensing Board Q check if immediate response is required - 0Selectmen's Office ❑Ileaith Department contact person: phone#; n0ther (twirl7/93 PIA) No 3 ,- 50 Date... .......... r NORTIy TOWN OF NORTH ANDOVER FO A PERMIT FOR WIRING 4g ,SS^GHUSE� , i r This certifies that... !................................. � �--�^---Y �- x has permission to perform ............................................................................... i wiring in the building of......... ..�...��'. �.:r . �:. ................................... 67 .....................................�............../,North Andover,Mass. Fee ................. Lic.No.............. ......... ��............ .r�............................. ELECTRICAL INSPECTOR Check # 17 Li WHITE:Applicant CANARY: Building Dept. PINK:Treasurer UZrA!(JA=V1UPFUfM(,MPPJY Permit No. ��f BOARD 0FFMPREVEW0NREGUTAT10AN5270 R12:Q0 , VA Occupancy&Fees CheckedPPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL.INFORMATION) Date®?-® ®/ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 7- Owner or Tenant p >7 C r,r Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. j Existing Service Amps Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1,21 17 t: l�i G,4 S E4 D/L T-A No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.ofLighting Fixtures Swimming Pool Above Below Generators KVA ground_ oarid No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones .......� Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained .�..� Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Othe' Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER ImstrarreCmaag�PtrtsUat>rbthetegtmametisafh�adus�Ga>IaalLaws a Ihareeaanot Liabi JimrarxePoky erh&tgCorr# e C Axageoritsst *Valat YES Iha%estbtniltedmMptofofselttetothe0ffi=YES Ifj mfoedvdWYES pi=eediralethetypecfcotaagebydaimgthe bmc. INSURANCE BOND OILIH32 (PleaseSptxiiy) F dvahrdEkelicalWak$ -� OD WodcbStat � D* Final FIRMNAME i'V l V 15�.. I Y1 / _ lioaiseNa Lioatse�t',4 LiteNTo /� Btsit=TeLNa - AltTel.Na 97,*,kQ V 6 8 OWNER'SIIgRAZANCEWAIVMlamamm battheI doesnotlx $teit ta'mneoot orGss>bs lec�riva?eltasl�ttrta�byMa Idt tsGataalLaws a4d tl�atmys> •olihss pslm�t�l�iat�this re�tmetna>t. (Please check one) Owner a Agent a ,/!�v Telephone No. PERMIT FEE$ A5 `Type or Print) IV ,•, i. , i. , ;1 , ; ; ,. NORTH ANDOVER ,Mass. ',�r4:•. ` . Oates' •% •� 1 Building Location _3 a Permlt I Y11) Owners Nam New j] Renovation Replacement Plans Sylbmitted FIXTURFS 'w _z t,y z4 < p O O z N O J O V { z +� W ld !- U yaj of �[ < W d X bC V Z CC p yal I- < F- h x O 4 O x n: s► or G• k .- a: r+ 0 ° w Q a' c < _W, 91 ¢ a o o A : • f- : 0 le AL 0 V Y H O x a 7 to f' z O G 47 z z W O V T. • ;:;; ,C M- < Q x h N Q Q O Q A ,j Q cc QC 0 < O < I- ll c 6a O . SUB—IBSMT. ' BASEMENT t 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 4 STH FLOOR 6TH FLOOR >' ?TH FLOOR BTH FLOOR (Print or Type) Check one: Certifica Installing Company Namep /� Address //� �a`d - Partner. Co. Business Telephone © to Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity a 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 wyorages. Signature of ownerlagent of property Owner Agent�% I beabr ceftify tbal all of dic dclaila and infolnlalion I lla•c aut/lllillcd(of cnlcicdl in abo:c application ifc lilt&1Z mo to L%4 6461 so'" ...- k mwkdge and that all plumbing walk and installations loWnimcd undca Pctlllit nuc of this applicali"wool b4 w bowlpWnp4 Mi11t all pool"PW 10 •biam of lbs Masacllwclu State Plumboad Codc and Qlaplcf 642 of IIIc Ccnaa w � I Title • S' ture of 4censed Plumber City/Town: Type of Plumbing License ' ' a. I J1pDRnVF11 TAFFICF USE ONLY) License . Number ❑ Mastsr Q Journey - Y _ ,. - _, _. _r.+- iat-'-fit- --..�„y'"v".,.,;....ti-„�.,..�. e-:-�.._._..4...._ . .-•*.- y Date. V-1`0` . 3557 t ro`.�c°T•�hOO oMiMCAM& T TOWN OF NORTH ANDOVER � , 9 • PERMIT FOR PLUMBING g • ' "5zr a ,SSACHUS This certifies that . . , ,�.��.r. :. . .�. . w' has permission to perform . . .RQ. . . . . . . . . . . . . . . . . . . . . a D d�v plumbing in the buildings of . .�� ./. . .�.Py. . . . . . . . . . . . . . . at. . . . . . . . . . . . Orth Andover, Mass.. Fee. �!t� - . .Lic. No.. . C?�.Y t . . . . . . . . . . . LUMBING INSP C R a WHITE: Applicant CANARY: Building Dept. PINK:Treasurer --