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Home My WebLink AboutMiscellaneous - 55 BRADSTREET ROAD 4/30/2018 55 BRADSTREET ROAD 210/044.0-0003-0000.0 k i I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT T9 PERFORM GAS.FITTING WORK CITY _! _ l � MA DATE !� PERMIT# JOSSITE ADDRESS OWNER'S NAME _�� OWNER ADDRESS TE ' �5= TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONAL . _ RESIC?ENTIALU' PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: AO PLANS SUBMITTED: YES, r NO— APPLIANCES 7 FLOORS► esM 1 2 3 4 5 6 - 7 -8 9— 10 �� 12 13- 14 BOILER - BOOSTER _ > J. , CONVERSION,BURNER - COOK STOVE - -- DIRECT VENT HEATER I DRYER —_- _h FIREPLACE FRYOLATOR FURNACE. - GENERATOR GRILLE t ' - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER: ROOM/SPACE HEATERROOFTOP UNIT ! - TEST UNIT HEATER - � - UNVENTED ROOM HEATER j� WATER HEATER__ z OTHER } INSURANCE+ have a current Ila t insurance policy or its substantial equivalent w' [NO �,. { !IF YO!!CHECKED PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING I mr Apf Kurmpvj m ,jvA or.6vvr LIABILITY INSURANCE PO V -,. LILY .�,,- OTHER TYPE INDEMNITY -BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee do av the insurance coverage required by Chapter.142 of the Massachusetts General Laws,and-that my signature on this permit application wa_this requirement, SIGNATURE OF OWNER QR AGENT CHECK ONE ONLY: OWNER AGENT - - - - I hereby certify that all of the details and information I have submitted or entered regarding this application are a and accurafe f e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in m Ila wit Il P ant provision of e Massachusetts State Plumbing Cpd and Chapter 142 f the General Laws. . PLUMBER-GASFITTER NAME LICENSE;► /' _� ATURE P ✓ M MID , JP JGF LPGI CORPORATION PARTNERSHIP - #. LLC # COMPANY NAME' '�CITY .v h ham STA TE ZIP TEL ,. FAX , CELL .t+�h'1_ _ EAI '4 .aMa y` CJVD /� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM OAS.FITTING WORK CITY MATE PERMIT# _. - JOSSITE ADDRESS OWNER'S NAME ` OWNER ADDRESS /� TYPE OR TEI�j v AX PRINT OCCUPANCY TYPE COMMERCIAL. _ EDUCATIONAL RESIDENTIAL ' CLEARLY NEW. " RENOVATION: ma REPLACEMENT; PLANS SUBMITTED: YES NO— APPLIANCES"I FLOORS--o esM1 2 3 BOILER 5 6 7-- -$ 9_ 10 11 :12 13 14 _ - , BOOSTER l� J ERSIONBURNER STOVET VENT HEATER R — -- -LACEATORCERATORERED HEATERATORY COCKSP AIR UNIT POOL HEATER _ ROOM/SPACE HEATER ROOF TOP UNIT TEST I s UNIT HEATER - - UNVENTED ROOM HEATER WATER HEATER- OTHER -- - — - J INSURANCE CQVERAGE have a current Ila i insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142' YES INO I IF YOU CHECKED`tES,PLEAGE INDICATE THE TYPE OF 6OVERA13E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1/' OTHER TYPE INDEMNITY BAND OWNER'S INSURANCE WAIVER,I am aware that the licensee 422molla-vA the insurance coverage required by Chapter 142 of the Massachusetts General Laws,snd-t6t my signature on this permit application waivee this requirement. SIGNATURE OF OWNER OR AGENT - CHECK ONE ONLY; OWNER AGENT.® 1 hereby cerdilly that all of the details and Information I have submhted or entered reoardin this a licetion ar 9 PP @ e and accurate t e besi of my knowledge., and that all plumbing work and installations performed under the perrnit tssuad for this application will be in m Ila wit IIP ant provision of e Massachusetts State Plumbing Cod and Chapter 142 Qf the General Laws. PLUMBER-GASFITTER NAMEetr _ . . Y � LICENSE# ATU- E MP ✓ MGF JP JGF LPGI CORPORATION � "� — 13 PARTNERSHIP # LLC , # COMPANY NAME' r .�°.-�. •. r_ A � -raw rtH, DORESS CITYQ l I, IaY.I If STATE ; - J1LL ZIP TEL rAf FAX !'-__ CELL EAI dt=—r e v1 MASSACHUSETTSUNIFORM APPLICATION FOR A'PERMIT TO P�RF+DRM LUMBI WORK CITY MA DATE PERMIT -- JOSSITE ADDRESS, OWNER'S NAM r . : OWNER ADDRESS An, TEL AX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT _ _ . CLEARLY NEW, ._• RENOVATION: _ REPLACEMENT: PLANSSUBMITTED: YES NO IDEDICATED ES.I FLOOR-► BSM 1 2s a 9 6 7 8 Is 10 11 12 13 14 BATHTUB CONNECTION DEVICE i DEDICATED SPECIAL WASTE SYSTEM TED GAS/OIL/SAND SYSTEM TED GREASE SYSTEM .GRAY WATER SYSTEM # i I t TEDWATER RECYCLE SYSTEMSHER G FOUNTAIN I FOOD DISPOSER - FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN ; I, r i SHOWER STALL SERVICE I MOP SINKI TOILET E i t � t t , • URINAL WASHING MACHINE CONNECTION s WATER HEATER ALL TYPES s - WATER PIPING OTHER s ' s INSURANCE COVERAGE; 111NO II cur'ivrit Iia�insuranco policy or itis substantiai.equivalent which meets tho requiramonte of MOL Ch.942, YES:eNO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE SY CHECKING THE APPROPRIATA SOX I FLOW UABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY l30N® OWNER'S INSURANCE WAIVER,,I am aware that the licensee o a e the insurance coyotes® require by Chapter 142 of the Matachusetta General Laws,and that my signature on this permit appiicaticrl waives this requirement, - C SIGNATURE OF OWNER OR AGENT_ HECK ONE ONLY: OWNER AGENT I hereby certify that all of the dotails and information I have submitted or.entered regarding this application true and accu to the be of my know) gc and that all plumbing work and IngtaAations performed under the permit issued for this application will be lance lth I ertinent provisio f the Massachus®tte State 12 ing:Code and Ch ter 142 of the General Laws, PLUMBER'S NAME LICENSE# NATURE MS 17/ JP CORPORATION ° PAR T NERSHIP�# LLC / COMPANY NAM4DDRESS �� CITY Ll h4&-A STATE ZIPTEk FAX �_ CELL E®AI I nun e The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mzs gov1ft r " r ti'orkers'Compensation Insaralice Affidavit:Builders/Contractors/Ekeh iciana'Pigmbeix-, TO BE FRED WITH THE PERMITTING AUTHORITY. N=e(Business 04mization/Individual): Address: P M h raven city/state/zip:-, one 0:_/ A!j' Are you an employer?Check the appropriate`boxr; Type of project(required): LC3 I am a employer with • employees(full and/or part time). 7. []New consftodon 2.Q I ant a sole proprietor or partnership and have no employees working for me in atly oapaeity.(No workers'comp.insurance requiredg, Remodeling ] S. ❑Demolition 3,01 ant a homeowner doing all work myself.(No workers'comp.insumace required]' <3I sm a homeowner and will be hiring oontraotors to conduct all work oamy property. I will 10❑Building addition mm dW ail contraotors either have workers'compensation insurance or era sole 1 In Eleetzied repairs or additions proprWors with no employees. 12.[]Plumbing repeats or additions SC31 sm a genas!oontraotor and I have hired the subcontractors listed on the attached sheet 13f suboomnaotors have employees and have workers'comp.insursnoe,r . Roo �ah 6.G� e nee a moa and its offioers have exercised their right of exemption per MOL c. 14.[3 Other 15%§1(41 and we have no employees.(No workers'comp.insurance required] 'Atsy applicant that oheeke box 111 must also frill out the section below showing Weir workers'oompansedon policy Mrmation, t Fiomeownas who submit this affidavit indioating they a e doing all work and Wen hire outside conasctors must submit a new d ids*indioadng suds, tCoan000rs that check this box must attached an additions!sheet showing the name of the subcontractors and state whether or not those oWdee have amptoyoes, Ifthe suboontraotors have employees,they must provide their workers'comp.policy number.- Ion an mloyer that is providing workers'compensation insurance far JW employees Below is the policy and job site Insurance Company Name: . Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration Page(showing the Policy y number and aspiration date Failure to secure coveragg as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500,00 and/or one-year imprisonrietit,.as well as civil penalties in the form of a STOP WORK ORDER and a film of up to$2S0.00 a day against the violator.A'capy of this statement may be forwarded to the Office of Investigations of the DIA for insumnee ooveaageve�ific$ti0n. I do hereby c der t p andP19MOSof pedury fhat the i>'}/ormadon provided above is hue and cornea Phone ig Ojidd use only. Do not write In this area to be completed by city or town offleid City or Town: Permit/L,icense# Ironing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 3.Plumbing inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachuselts Department of Industrial Acelidents 1 Congress Sfree4 Suite 100 Boston,MA 02114-2017 www mass govldia Workers'Compensation Insarance Affidavit:Builders/Contractors/EketricianCP}gtmbei&•, TO BE FLIM WITH THE PERbUrrING AUTHORITY. Print Loadbly NMe(Busines &pnizadowbdividual): qTDbC Aj S60M4 M- il±I L Address: (s/_ �5 cf)1. n raye-- ,- 9ji city/stewzip: one#: ,S' Are you an employer?Cheek the approprtate'bem: ., Type of project(required): 1.Q I am s employer with employees(lull an&or part-time).* 7. ❑New consaueden 20 lam a sole proprietor or partnership and have no employees working for me in S. [3 Remodeling OW fir,iNo workers'comp.insurance required] 9. D Demolition 3,01 eat a homeowner doing su work myself[No workers'comp.insurance required]' 10 D Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will MW that all ooa notors either have workers'compensation insurance or are sole 11.Q Electrical repair's or additions pnope)stors with no employees. 12.D Plumbing repairs or additions S.Q I am a feral contractor and I have hired the sub-contractors listed on the attached sheet. 13.rlRoofrepaks sub-oowzactors have employees and have workers'comp;insurance.: 6 a cctpomtion and its offim have exercised their right of exemption per MaL a 14.[]Other 1JZ$101 and we have no employees.LNo workers'comp.insurance required.] 'fits applicant that checks boot#1 must also til out the section below showing their workers'compensation policy information, t Aomeowners who submit this affidavit indicatingthe are do all work and •y lug then hire outside contractors must submit a new ai'tidavtt indicating such, tecone rs that chwk this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those enddes have mWoyees. If tl a sub-oomractors have employees.they must provide their workers'comp.policy number. 1m an&'Wkyer that is providing workers'compensation insurance for nay employees. Below is the policy andjob s& h orntadon. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job site Address: City/Stnte/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date Failure to secure coveragg as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 a WOW one-year imprisonuu�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.X hoj of this statement may be forwarded to the Office of Investigations of the DIA for insurance covMV verificattoa I dohereby c p and 71 ofperJury at the i formanton provided above is due and cow Date: j /,S.I//, Qj'lcial use only. Do not write in this are4 to be completed by city or town o,,�i'ciai City or Town: Permit(License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector rPlumbing Inspector 6.other % Contact Person: Phone#: COMMONWEALTH OF MASSACHt�`SETTS BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMEN PLUMBER. RbBERT A SAMMATARO 8 DUNRAVEN RD WINDHAM,NH 03087.1263 18214 05/01/20184039 ,COMMON WEALT _OF M SMCHU3SETTS • • •• • BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A MASTER PLUMBER ROBERT RTA SAMMATARO 8 DUNRAVEN RD WINDHAM,NH 03087-1263 9333 05/01/2018 403 r g2MMOMEALTH O MSS COTTS s • lKellms • • BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE REGISTERED AS A PLUMBING CORP ROBERT A SAMMATARO TA O ROBERT A SAMMATARO PSH,INC 8.DUNRAVEN Rff WINDHAM,NH 03087 3373 05/01/2018 34142 ��. _..._.:...�4y...'+i'ihbV}""yG .� .nw'R:<3' F.�vY V✓"i vi':'.-.r..r - Location �"! „ .144,E No. Date NORTH TOWN OF NORTH ANDOVER Of O? Cyt •••o0eA Certificate of Occupancy $ Building/Frame Permit Fee $ 1SSAC14USEt oundation Permit Fee $ W.. Permit Fee $ �� Sewer Connection Fee $ c" Water Connection Fee $ TOTAL $ tg f &36 Build Ing4nspector {' N 1,0413 Di Public Works r PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 t�,IMAP K40.0 1 ,✓ LOT NO. C)003 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE — ZONE I SUB DIV. LOT NO. Ff LOCATION -Free - PURPOSE "' r oo s e �WNER'S NAME IQfY� v s NO. OF STOR E1 SIZE �WNER'S ADDRESS 57� -c ? � o eE7 f- & d BASEMENT OR SLAB ARCHITECT'S NAME C� Gl SIZE OF FLOOR TIMBERS IST 2ND 3RD "IdUILDER'S NAME 7 ti m® J SPAN DISTANCE TO NEAREST BUILDING? V 4L(. DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT _ FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X Z;S BUILDING ADDITION MATERIAL OF CHIMNEY S BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER OARD 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 ST. BLDG. COST 3 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 t SEPTIC PERMIT NO. " ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS y PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 1//DATE FILEDCpl/L 14 NUILDING INSPRCTOR SIGNATURE OF WNER O UTH ZED Ar. :� F E E OWNER TEL # 4? "6 410e PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.# H.I.C.k 7 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY - _rF ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY FICES _ 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 BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/, 1/2 1/1 FIN. ATTIC AREA NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVV'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR POOR _ ADEQUATE I-1 NONE 1 5 ROOF 10 PLUMBING GABLE I I HIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) + FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 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. 8 COLS. STEAM _ STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING M ..max a over , No 4 74 V d� I. L41Z r S., ov dower, Mas 19 xcocwirtiEwrc"K 5 h `T .. _ - � �9TE D PP �� BOARD OF HEALTH t r Food/Kitchen Septic. System IN Y. BUILD THIS CERTIFIES THAT LM :.. :... ... .. ..... Fou dation G INSPECTOR r has permission to.w�et buil Ings on .; ;. Rough to.be occupied as . ... '�.�• : . Chimney, . ; rovided that the pe son k e tin . 'is ermit.s all in every respe nfor the terms of the applica on file in Final P . P . . P g , P nal 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 ,., : t PLUMBING INSPECTOR VIOIJtfiION of the_ZonIn or Buildin :fie Mations Voids this'pe�mlt r - y ry Rough g g y:: S ,rEi3' •4- .^S n. ikk e Final ��TT • ....:. w Mo PERW llv r EXP ELECTRICAL INSPECTOR t.�LES N TRUCT O STARTS Rough rs ° { - fTG is 5t } r s s. fir .¢ 4 . { •� ..- - - - Service g BUILDING INSPECTOR r Final Occupancyy. Permit Required to Oceupj► Building GAS INsnECTOR r TM Rough x, x ns icuons Place on the} Premises Do Not Remove bis la _in �; Co z P_ r.r • F►nal v 4 , w t kf i E Y.IS y1..j ,Cathie or D Wa 'i To De Done FIRE DEPARTMENT = ctor. Until insp ected and A roved br Ythe Buddin P PP a _ Burner - Street No. Smoke Det.` .... ,.i ) .^ ',«y, R _ A .-,f -. A * 4 ,iyY N'.p:h •%S . .. Y kz X awe• �- .-::e, h... ._.' J`v.::..:I..-�-.+1. ,;-} `Cn...•... -. .. .:.:'+.^. .�:..:5%*.+- :�iSx..K.„ 3 -).x "aN.. r5 :t. ...%,. :.:4..w� ::.n:Yi, .4...,vM.:Kv l.w... S.F a ry MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ?1 _- /0 Mass. Date & (3�' 19 ?6- Permit # w Building Location Sr Owner' Name s ,Type of Occupancy New ❑ Renovation ❑ Replacements Plans Submitted: Yes ❑ No f� FIXTURES rgH YW 09 Z Vf to to u oe F- W.tn 09 � O mZ .6 ('e Z O WA o� � OzOZF a' W W = Z 4Q tA ..O >09 W W W y (A Z Q x a• W Z Q W '� d oC ~ ~ Y to O Z O 66 1— W O N x > oe W Z d lY Q 00 O O W tr O H H ode = SUB•BSMT. BASEMENT list FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR #1 8th FLOOR t' Installing Company Name -LLA-44 Check one: Certificate Address Z� C;orporation Ls.12 ff t L L `1 h 3 a ) -3v ❑ Partnership Business Telephone 3 ❑ Firm/Co. 1 Name of Licensed Plumber or Gas Fitter 1 Cl G i, AZA-U 6 Lr- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 4� No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy LK 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: ❑ Signature of Owner or Owner's Agent Owner Agent Ci I hereby certify that all of the details and information I have submitted(or entered)in the 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 Gas Code and Chapter 142 of the General Laws. B T of License: By I r ❑ slitter Title aster ignat re of Licensed Plu r G Fi er City/Town ❑Journeyman / Z Licen a Number / / APPROVED(OFFICE USE ONLY) FINAL INSPECTIONS SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS I FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASHTTER LIC. NO. PERMIT GRANTED Date 19 Gas Merc. f Final Insp. Gas Inspector J I" f : J Date.234 i NORTH TOWN OF NORTH ANDOVER . or , p� PERMIT FOR GAS INSTALLATION # s Un This certifies that" has permission fo s installation . G in the buildin ofp -c . ... . . . at .. � . . . ., North Andover, Mass. Fee. -.� Lic. No...7/ i � GAS INSPECTOR WHITE:Applica i J ANARY: Buil ing Dept. PINK:Treasurer GOID..File i- fi Date ... . .. . t I NORTH 'k r0�``t�tD 3 TOWN OF NORTH ANDOVER O 9 PERMIT FOR GAS INSTALLATION s oq + �9SSACHUSS This certifies that . .tl(. . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . in the buildings of . . .IT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . ...North Andover, Mass. Lic. No. Fee. . .}c .r� !�: 1!. . `. L>�� C .� . . . . .: GAS INSPECTOR Check# )-5 4207 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO D O GASFITTING (Print or Type) Date Building �T ' / Permit # Location__ ,//f Gy t/ Owner's 1 - -- Name- New ❑ _ `- _Renovation ❑ Replacement 0/ Plans Submitted: Yes ❑ No ❑ Building Permit No. N W N I I I I I In I I LL' i I I N I N O W W Q I O U m S of z l p �W < Q � z 5 O Z w < I m al a W w FO V, LL CO' w W H W Z Q = C W W 0 - = Uj Z J Z 1- IL Q LL H W -j Z W Q } H m Z 0 Z 0 N = d 2 0 l 7 = LL : 3 a OU of > a F O I I I SUB-BSMT. I I l l l l l l l i_IIII I I_I I I I I I I_ I I J BASEMENT I I I I I I I I I I III I I I I I I I ST FLOOR I I I I I I I I I I I I I I III _IIIIIIII _ 2ND FLOOR 3RD FLOOR 4TH FLOOR I I I I I I I I I I I I I I I I I I 5TH FLOOR I I I I I I I _IIIIIII ( I I I I I I I I_ IIII. 6TH FLOOR I I I I I I I ► 1 1 1 1 1 1. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 'j7TH FLOOR I I I I I I I I I I I I I I I I I I I I I I I I I I I 8TH FLOOR III . I IIII I I I I I I I l I I I I I I I I - I I ` Check one: Certificate Installing Company Nome WATER HEATER INSULLERa= MCorp. '93,09 Address 94 DARTMOUTH STREET ❑ Partnership VAMENr MA 02148 ❑ Firm/Co. Business Telephone 39-7—,r-,9? /Z3 Name of Licensed Plumber or Gas Fitter ��fl� 64� INSURANCE COVERAGE: Check on I have a current liability insurance policy or its substantial equivalent. Yes � No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Ef 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 the 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 Gas Code and Chapter 142 of the General Laws. Type of License: Fee ❑ Plumber 1Z 416E� Check # ❑ Gasfitter Signature of Licensed Plumber oror Gas Date p'Master APPROVED (Office Use Only) 0 ,Journeyman License Number J7 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO.. APPLICATION FOR PERMIT TO DO GASFITTING i NAME AND TYPE.OF BUILDING LOCATION OF BUILDING PLUMBER/and or GASFITTER PERMIT GRANTED DATE 19 PLUMBING AND GAS INSPECTOR