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Miscellaneous - 59 SANDRA LANE 4/30/2018
59 SANDRA LANE 210/098.A-0076_0000.0 f i 1. 9907 Date. ... .....'..../... pORTp TOWN OF NORTH ANDOVER PERMIT FOR WIRING -Z, CH This certifies that ........ ........... has permission to perform ......... . ....................................... .......... wiring in the building of..... v..... ../�..... at...&�. 4� ...................... .North�Gdovei,Mass. A Fee..o2 Lic.No.�,-&/O�Fs�25 ...... ........ 111b" ELECMCALdtNSPECTOR Check # I ) / Commonwealth of Massachusetts Official Use Only Department of Fire Services 9Permit No. 1 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(Iv1EC),527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFOR4 TION) Date: ;7 q - 1 f City or Town of- To the Inspector of Wires: By this application the undersi ed givesWnofefhis or her intention to perform the electrical work described below. Location(Street&Number)— � 9 5►a N 914 L-/4N E. Owner or Tenant A RrtAPAN© Telephone No.� �g Irl/5 Owner's Address 5 _A M Is this permit in conjunction with a building permit? Yes ❑ No ❑ BLDG PERMIT# Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ 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: �1} �t1 All 1 Wi l'n e l to Completion of the followin table may be waived by the Inspectoraof 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.o mergency ig ting rnd. rnd. Batte 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 Initiatin Devices No. of Ranges No.of Air Cond. TotaTon No.No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons... KW No.of Self-Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* ' o No. of Water No. f No.of Devices or Equivalent Y No.of Heaters Signs Ballasts Data Wiring:No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 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: Z y --I i 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 ❑ BOND ❑ OTHER ❑ (Specify:) I cert, render thepains andpenalties ofperjury,that the information on this application is true and complete FIRM NAME: LIC.NO.: Licensee: - (A Y^)AJF Signature� � ���� LIC.NO.• 5�- (Ifapplicable, enter "exem�pt'in the license number line.) Bus.Tel.No.,5! Address: 1 t o(, AIR h1 ! A-0 ��tpf y .�� lM 0/,832 Alt.Tel.No.: *Per M.G.L c.147,s.57-61,security work requires Department of Public Safety"S"Licen 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 El owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 20.00 Y o ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL r 1.ROUGH INSPECTION: , Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 2-FINAL INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Sign ure- o initials) Date s ' L 3.UNDER GR UND i Passed— [ ] Failed—[ ] Re inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mas..gov1dia Workers' Compensation Insuranee Affidavit: Builders/ContractorsNIectricians/Plumbers Applicant Information ]Please Print Legibly NaMe,(Business/Organization/Individual): Y M N F_ Address: Loft Y City/State/Zip: f}Jep W�\ MA 01 ?32. Phone#: 975 Are you an employer?Check the appropriate box: Type of project(required): 'L❑ 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 paitaer- listed on the attached sheet.s �• E]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 10.❑Electrical repairs or additions required.] officers have exercised their 3.El.I 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.] employees.[No workers' comp.insurance required.] 1311 other *Any applicant that checks box#I 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name: Policy 0 or Self-ins.Lic.#: Expiration Date: I 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certify under the pains andpenaldes ofperjury that the information provided above is true and correct. Signature: Date: Phone#: E only. Do not write in this area,to be completed by city or town official n: PermtitlLkense# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector son: hone 4: Date....��..... ......0' f NORTN 1 3?;•t:�`` "�,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SS�cMus� This certifies that . � 17 has permission to perform ...../ y .�:!�.�.�n............................................ wiringin the building of................................................................................... S S/r�- I ......... ,North Andover,Mass. Fee... ........ Lic.No . Z-ly3 f ...../ .... . ./}:a.. .: ELECTRICAL INSPECTOR Check # 9-1 44 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No, q `� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Occupancy (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Co*(MEC527 C12OWORK (PLEASEPRINTWINKORTYPEALLINFORAUTION) Date: pCity or Town of: NORTH ANDOVER To the Inf fres: 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 Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes NZI EN NO ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / _Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps —.L_Volts Overhead ❑ Undgrd❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: 00,1 Completion of the following table may be waived by the Inspector of Wires. No,of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total . No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA j No.of Luminaires Swimming pool Above ❑ In- o,o mergency zg g d• � Butte No.of Receptacle Outlets No.of Oil Burners d. Units FIRE ALARMS Pdo.of hones No.of Switches No.of Gas Burners No.of Detection and s No.of Ranges No.of Air Cond. Tota! Initia ' Device Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW p Totals• -•-••- o.of Self-Contained y Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW cal❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or E uivalent Heaters KW Si s Ballasts. Data Wiring: No.of Devices or E uivalent i No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: OTHER: No.of Devices or E uiv dent 14ttachaddition Estimated Value of Electrical Work: at detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Stark 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 4 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury, that the informa ' on his FIRM NAME, t �O ap acatio is true and complete Licensee: LIC.NO.-._a &y Signa a LIC.NO.:I !� (If applicable, enter "exempt,,in the lic nse number line.) /G Address: opo, jq® °�S/�j e���� ®��y y Bus.Tel.No.: - $_6/V *Per M.G.L c. 147,s. 57-61',security work requires D „ „ Alt.Tel.No.: ;26 epartment 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. Iz 1 7 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4-02111 www.massgov/din Workers'rs Compensation at ion Insuranc e Affidavit: Builders/Contractors/Electricians/Plumbers cr. anslPlumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: ;�T Phone#: Are you an employer? Check the appropriate bog: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction . 2. I am a sole 7 ❑ proprietor or partner- listed on the attached sheet.t [�Remodelmg ship and have no employees These sub-contractors have 8. ❑Demolition working for 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.❑Electrical repairs or additions 3.❑ I 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.E] Roof repairs insurance required.] t employees. [No workers' comp• insurance required]. 13.0 Other *Any applicant that checks•box T]-- alsa�A]out the section below showing their workers'compensation policy information- Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information I ant an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. l Insurance Company Name: V Policy#or Self-ins. Lic.#: �j V Q�� ,�Q�9' Expiration Date: /0 f a Job Site Address:_ q• ✓ 2 -City/State/Zip:l A 2 R A- l ,Pn/ !v Z� 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 Investigations of the DIA for insurance a verification. I do hereby certify u e e a' and aloes of perju that the information provided above is true and correct Signafore: < A14Date: n Phone#: 01, _,Y/ — 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 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: s Information and Instructions Massachusetts General Laws chapter 152 requires all employers toprovide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,.or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a,deceased employer,or the . receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs.persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability.Partnerships(LLP)with no employees other than the ` members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being reauested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog Iicense or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us!a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of fnvesteggations 640 W.,ashington.Street Boston,MA 02111 Tel. # 617-7274"900 ext 406 or 1-877-M-AS.SABE Fax # 617-72.7-7749 Revised 5-26-Q5 m,v,,A7,mas.s.zov/dia Date. 01, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUS This certifies . 1 . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . plumbing in the buildings of at .. . . . . . . . . ... North Andover, Mass. Fee.�7. .7. . Lic. No.. . 7. .f. . . . . . . PLUM844G INSPECTOR' Check # /'Ra 8304 y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING gype or lit) NORTH ANDOVER,MASSACHUSETTS .. / Date Building Location 5,-V 4)1)1 4N Permit# 3d Owner /y11�('i= /if.�i2AT.9�o Amount 1-12 °D New Renovation Replacement Plans Submitted Yes No JY FIXTURES 06 SWUM WMINr WFUM ra"M 1 3MEL00R a1H HDM sjH>D sMELOCR 7M ROM 9MROR (Print or type) �� Check one: Certificate Installing Company Name �(1 i.�i� '�i� !� Corp. Address r���wdd �� 0 Partner. ct)I'do 4f 01 AIH o 34' �> Business Telephone ,603 3- /44 ® Firm/Co. Name of Licensed Plumber: !G Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policyEl Other type of indemnity 1-3Bond ❑ 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 Signature Owner Agent I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and install ;brm under Pertiiit for this application will be in compliance with all pertinent provisions of the Massach etts State Plb' g pter 1 of the General Laws. By: igna e or LicenseariumSer Type of Plumbing License Title 71ve City/Town License Num Master ® Journeyman 0 APPROVED(OFFICE USE ONLY 11,17 e i The Commonwealth of Massachusetts Department of Industrial Accidents LX Office of Investigations 600 Washington Street Boston, MA-02111 www.massgov/dia Workers' Compensation Insurance Affidavit:t. Builders/Contra ctors/Electricians /Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 15 r2o City/State/Zip: A)Y 03,4?7 Phone#: (!CG 3-- '5993 a"4? Are you an employer? Check the appropriate bog: Type of project(required): 1.[R I am a employer with r;k _ 4. ❑ I am a general contractor and I 6. E] 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. 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.El Electrical repairs or additions 3.❑ I 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.❑ Other comp.insurance required.] y applicant that checks box,.. .f.=-_'Sc 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. tcontractors 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 thepolicy and job site information. Insurance Company Name: /✓./r'%"/v�//� ��2i9t)G.s {f?� ✓ L� Policy#or Self--ins. Lic.#: Expiration Date: Job Site Address: 5 c1 5,4"V,0i?,4 L.y City/State/Zip: 4/a R r64;.2 *eW 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 Investigations of the DIA for insurance coverage verification. Ido hereby, derthe , i pe es of perjury that the information provided above is true and correct. Si afore: 1 Date: 11',92 Phone#: Gd3 — . �r13-t�r•.� in 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 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions 2-✓ Massachusetts General Laws chapter 152 requires all employers toprovide workers' compensation for their employees. Pursuant to this statute,an einployee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of.a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and.who resides therein,or the occupant of the dwelling house of another who employs persons"to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employmeot,be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or,Iocal.licensing agency shallwithhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability.Partnerships(LLP)with no employees other than the members or partners,are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. .The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used-as a referemmnumber. In addition, an applicant that must subitiif tnultip�le•permitllicense applications in any given year,need only'submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the ; applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Mamchusetis Department of Industrial Accidents Office of Invest tions 600 Washington Street Boston,ASA 0.211.1. Tel. # 617-7274,900 ext 406 or 1-877-MASSABE Revised 5-26-05 Fax 4 617-727-7749 vArvwv.mass.govfdia Date.................................. 40RT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING -SA U This certifies that . .......... ...................... has permission to perform ............................................................................... wiring in the building of........6.r..PWA4.n+�P................................. -5 4A1........................North Andover,Mass. at.....4........................................... P ` 7 77 Lic.No.IV41 Fee ................... .......... ............... . ...... EL9cmcAL INSPEcrOR 7 Check # 0?41/ 664) 9 014t Tommonmtolth of Massac4ttsetts Office Use Only�J Department of Public Safety Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 - Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Flectrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPf AL INFORMATION Date City or Town of u Y � �'"' Nm_ To the Inspector of Wires: The undersigned applies for a permit to performtheelectrical work described below. Location (Street & Number) U. IAC{electrical ✓1 Owner or Tenant /r)1 Ke i W07Aps 0 C! ��! J //J Owner's Address ,I Is this permit in conjunction with a buildi permit: ]] Yes No 11 (CheckAppropriate Box) Purpose of Building �ei X a 4-N 0, 9 Utility Authorization No. r Existing Service Amps_ /__ Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps J Volts Overhead ❑ Undgrd ❑ No. of Meters r t Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work l)� � TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above in- No. of Lighting Fixtures Swimming Pool grnd. ❑ gmd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No.of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Conditioners Tons Heat Tota Tota Initiating Devices No. of Sounding Devices_ No. of Disposals No. of Pumps Tons KW No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal No. of Dryers Heating Devices KW Local❑• Connection ❑Other No. of No. of Low Voltage i No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP t OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES❑NO❑ !have submitted valid proof of same to this office. YES❑ NO ❑ if you have checked YES, please indicate the type of coverage by checking the appropriate � �f,�►�Y box. INSURANCE 0 BOND 11OTHER❑ (Please Specify *,k11 AA D l (Expiration Date) Estimated Value of Electrical Work $ _X_() Work to Start yf 3b/U 6 Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME /I LIC. NO. fW 2?14 Licensee q n l- j Signature ,l /e LIC. NO. ..�(��� 4 C Address 4� fit' P/�5�'v�. 1 /` f�T�l 1C�+n V� L Y Bus. Tel. No. r 517836157S-6 Alt. Tel. No. !22r DO7r ma F97 / .OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my signature on this permit application waives this requirement,Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) aA� r Date. ay . �.�. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ;,SSACHUS� - This certifies that . . Cr. . /1 k. r. has permission to perform . . . .t�.�'/r. 9.� �. �!� .--. . . . . . . . . . . . . . plumbing in the buildings of . . 16. . . . . . . . . . . at. . . IA. A:. . . . .Z.lc-� . . . . . .. North Andover, Mass. Fee.-� . . . . .Lic. No`/.7C5.`.: . . . . . . . . g,. . PLUMBING INSPECTOR Check # 5 �� 1 a 6934 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,,MASSACHUSETTS NJ�1-� G Date Building Location I S4 N �/�/ Permit# CZ` 'y4 Amount Owner rfi l b G1 A (z2,g�,4d,-)o New El Renovation D Replacement 0 Plans Submitted Yes No FIXTURES w SUSB9VII: U17 1SC FLOOR 2Nn HAOOR a 3AD FLOOR 4M RIM SIH FLOOR 6M FLOOR 7III RIM SIH FLOOR (Print or type) ^ / Check one: Certificate Installing Company Name �/`t'6 G/�j��-Q t/yy� ,6,h/� Corp. Address Partner. Business I a ep one . 3 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy El Other type of indemnity D Bond D 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 Signature Owner D Agent D 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts t lumbi g Codeyd Chapter 142 of the General Laws. By: Mignawe 01 Licenseuum er Type of Plumbing License Title J 6 / y City/Town 71cense um er Master Journeyman D APPROVED(OFFICE USE ONLY TAORTIy c TO" of �G® - �` io dover, Mass., ��•/� 'ds > O COC MIC HE WICK V 7�S RATED G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT....... ........0..........404-a.... . ............................................. ........................................,... Foundation has permission to erect...... ................................. buildings on . ....�... !, A........ to be occupied as .. ........... �/.... ........... ............................................................ Chimney . . .................................... provided that the person acc Ing this permit shall in ery respect conform to the terms of the application on file in Final this office, and to the provis s of the Codes and By- ws 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 EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION T ELECTRICAL INSPECTOR -15MW4.rx1 Rough ............................................................. ...................... ... Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy- Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 7 9. SEE REVERSE SIDE Smoke Det. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT DATE ISSUED. X SIGNATURE: Bui ding Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Emsed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqllircd Provided. R red Provided 1.7 Water Supply M.G.L.C.46. 54)•R4` ^ 1.5. flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT rilstoric District: Yes No m 1P '2.1 Owner of Record ALCAkO-e� (S % c►rcaAgvx* �9 �� ��. LcEne— �\Je"t( An'4dvPr Name(Pri t Address for Service: 972 6 ?3 71 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ i Licensed Construction Supervisor: Li s N Address Expiration Date Signature_ Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Duval Roofing, CJ .�2� 1°fli PO BOX 637 Registration Number Address No. Reading, MAO!864 7 /51 k Expfra46n Date ^� i`lnaatture Telephone V Y �� f A. SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin rmit. .Signed affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Work check aII applicable) New Construction ❑ E�xistiq Building ❑ Repair(s) ❑ Alterations(s) 1'0. Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 14! SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beQi+ CIA ,USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(s)X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Num SECTION 7a OWNER AUTHORI7ATION TO BE COMPLETED WHEN OWNERS AGENT T OR CONTRACTOR APPLIES FOR BUILDING PERT cAkae\ G Q f ria.Tei wcs ;as Owner/Authorized Agent of subject property C\ Hereby authorize 1 &I c to act on My be atter rel tive to work authariz by this building permit application. C)4c,61�7_ SignaCurFoYer Date T-SECTION71i OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the f,5egoi �ppI' ion'a�e tree and accurate,to the best of my knowledge and belief UUVV 11--8 11TIng LLt� PO Box 637 Print_.Na e No. Reading, MAO!864 Signature of Owner/A ent Date V—S7 S NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvMERS iST 2 3 KD SPAN DMIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t i North Andover Building Department Ter: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Fa ity) Afffff//17!/ 'l C Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts > Deparhnent of lndusftl Accidents Offics of►nvestigsdons Boston% Mass. 02111 - Wvrkers'uTpensaUm Insurame Atlr bW =Nam Please Print . Phone 71 1 tint a honumner pedoming ail viork myself. 0 I am a We proPrieW and have no one vmMng in any caparaty I am an employer provicling workers'compensation for rry employees working on this job. Comhitt nmw, n. W Reef s. LLC PO Box 637 No. R-e-Wrig, CIS. Pfiarte# 7 r� Insurance Co. ��QiL-c�.L; ._._. Policy# cphnne Insurance Co. �,r FdMrre to eeaae cowrage as►mired under secdm 26A or MIX 152 cat lead to"teQ UMM d OtMnd pwMfflw d.e fln•up to si'GWAD wWor one yuW imPrbrt ayma.ae chmj maRleeia.Wei=dAZMPWDRr(DROULa dAffi a dtSIW Al i'sGalmdM& r and wMmd that a copy of this statement may be forwarded to the Office d Utvesrt s im of the l)lA for coverase vw ticallon. f da hereby asOy under rhe pskw and perreNes of perjury Nut ft bdomwtbn provided ebow is etre end carrac� signature -...� Date Printf name C P mo# S"4 OMdal use only do not write M NO eros to be completed by dty or town ofticfai' CRY or Tovm Pa�ff iCeretnn 0 adIc" Dept []CAedr Y hrrmedrab response Is regrried ❑ Lkonft Board Q %h?CIMan's Office Co»bd person: Phone# Cl IHeaM Department 13 OMOr l0//1 k/- G Waw Page No. of Pages Builders License # 58443 ,llJ" Home Construction Reg. # 109288 r � 0 ��000 . D O ij959jf 944-9994 (998) 664-8559 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 PR AL SUBMI ED TO ^` �11 DATE V-){� STREET r JOB NAME / CITY,STATE ALyD IP CODE JOB LOCATION f� i /_ We hereby submit specifications and estimates for: Recommended Optional (Included in price) (Not included in price) –Rip& Remove all shingle debris from roof&job site: 0/1 layer ❑2 layers ❑3 layers or more i P/ Repair/or Replace any roof decking; not to exceed 50sq.ft. P,"' Install'8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mil whit r brown e1 Install ICE&WATER underlayment along horizontal eaves,valleys,sidewalls and sky-lights&chimneys Install premium base sheet underlayment between roof deck and roofing shingles Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shingles ❑40 year ❑50 year ❑Lifetime See manufacturer warranty policy for more details f Install new aluminum vent-pipe flange(s) t/ Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing Ridge-vent/exhaust vent with low profile design, hidden by shingle caps I ❑Soffit-ventilation ❑ Roof louver-vents • Seamless style aluminum gutters-custom fabricated at job site GU – – O downspouts - - ---- - _ — r f - G,4 Zr' Other ti *Please Note:All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: 3 7 i./ Total price not including options. dollars($ / Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 I Late charges of$50 per week for all outstanding bills due upon day of Authorized / completion. Signature 1 ' -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within � L� days Location v No. ` Date NORTH TOWN OF NORTH ANDOVER OH 0.1."'G +,41 n Certificate of Occupancy $ ` Building/Frame Permit Fee $ ,SSACMUSEt Foundation Permit Fee $ Other Permit Fee $ a� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ V 4 Building Inspector 206k!9@08:43 � t � 206/2 .9@08:43 25.00 PAID Div. Public Works 4 Location -� No. Date 1 I NORTH TOWN OF NORTH ANDOVER �� a Certificate of Occupancy $ ♦ i i Building/Frame Permit Fee $ Foundation Permit Fee $ s�cNusE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ f Building Inspector :7 06/26/013 06:43 25.03 • Div. Public Works PERMIT NO. 'Ac!�?v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K-4O. I LOT NO. 00762 RECORD OF OWNERSHIP IDATE BOOK "PAGE — ZONE SUB DIV. LOT NO. f y1 LOCATION 17 PURPOSE OF BUILDING Ne&j OWNER'S NAME ,17/`�j r �-. NO. OF STORIES Yl SIZE OWNER'S ADDRESS /`- S.LI� �„ / 7 BASEMENT OR SLAB "i//o4 ARCHITECT'S NAME I/ SIZE OF FLOOR TIMBERS IST ZX JO 2ND Zx�Q 3RD BUILDER'S NAME i1 �QW.e�s SPAN /14 DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET N POSTS �/d DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT .1/t FRONTAGE HEIGHT OF FOUNDATION w 7 J/l THICKNESS IS BUILDING NEW N D SIZE OF FOOTING X IS BUILDING ADDITION / b MATERIAL OF CHIMNEY - IS BUILDING ALTERATION -S IS BUILDING ON SOLID OR FILLED LAND N t/, WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ..1/7 BOARD OF APPEALS ACTION. IF ANY ,/ O / 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 Q of PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. ' ' V PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 1 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 VED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED C LDINa INSPECTOR r SIGNATURE OF OWNER OR AUTHORIZED AGENT /�" FEE Q OWNER TEL.# / / v PERMIT GRANTED r CONTR.TEL. 19 17 CONTR.LIC.# d H.I.C.# L Z ? a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I 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 I I GES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH \� CONCRETEAl _ 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE � HARDW _D PIERS PLASTER _ DRY WALL UNFIN. �-y 3 BASEMENT I / AREA FULL FIN. B'M'T' AREA = ✓�L` �! �-7/ J C{ ��o '/. V2 °/, FIN. ATTIC AREA J B M'T FIRE PLACES HE HEAD ROOM MODERN KITCHEN ' I 4 WALLS 9 FLOORS /AJ 1- CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _I _ f�\ 'dell, Ts ASPHALT SIDING HARDW'0 _ ( ASBESTOS SIDING COMMON _ VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR I_ J�1A BRICK ON FRAME / (/�_ J u �� C /Aj CONC. OR CINDER BLK. c r STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ -ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR d GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 1 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. d COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOM GAS hA OIL B'M'T 2nd ELECTRIC • 1�t 13rd I NO HEATING W.— C/C' -�o�r+mzancuea� a�.I,�llaaaaGu,�et�' DEPARTMENT OF PUBLIC SRFET�' %fie. i CONSTRUCTlI6h,SUPERVISOR.LICENSE HuNke Expires: Birthdate: "0 /03/1999 08/63/1963 'Res`tilR di o x 00 C�i,,.,.,,Xfiva BRgOIE E POWERS JR Ib f!3 f; PLAISTOW, NH 03865 -071. HOME IMPROVEMENT CONTRACTOR a� Registration 122776 Type - INDIVIDUAL Expiration 10/16/98 BRAD POWERS CONST B ADLEY E. POWERS JR ADMINISTRATOR FORREST ST PLAISTOW NH 03865 I F �1ORT Town of _ Andover L r O * 19 * Zo _ _i dover, Mass., FAKE A COCH ICHEWICK OtY'1` IfF A • r �S '9A AArED C2 v �G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System OW)f t 04 BUILDING INSPECTOR THIS CERTIFIES THAT / '..I.r`�C....... O rp� � ...... .... ................................................ .. ............ .................... Foundation has permission to erect........... buildings on . �' Rough ............... ................! .............N.......... ........� to be occupied as............ ... ...! ............ ....... ..�'1�.. ......... a►. ......2....!� ....... 1............. t Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on f**A' hr 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 PES EXPIRES THS Final ELECTRICAL INSPECTOR UNLESS CONSTR ST Rough ............. ........ ....... Service BUILDING Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough nal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector.; FIRE DEPARTMENT Burner Street No. a Smoke Det. Date.1 �� . . 3863 HORTM TOWN OF NORTH ANDOVER F " A PERMIT FOR PLUMBING ,SSACMus f l This certifies that . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v plumbing in the buildings of . .G t"/. . . . . . . . . . . . . . . . . . . . . . . . at. . .> .S. . :r/1e-�.�t.�? . .1 .�.t— . . . . . . . . . .. North Andover, Mass. Feel" . . . . . . . � . . . . � PLUMBING INSPECTOR r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer '"`-t'r„',rrt�r-�'.,��c 1:'--�'=r^•�--'�..._^s.r.t:Yr-�.>.-S .. ..-s. _ ,. ,. �+. Date. . . . :/. . . oORTH jo� °^;•.��oo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACHUS� This certifies that . . . . . . . . . . 5 f.. . . . . . . . . . . . . . . . . . . . . . I , r has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .'. . . .z: .. . . .. . . . . . . . . . . . . . . . . . . . . . . at. . . ... . . . . . . . .`.`. . . . . . . . . . . ., North Andover, Mass. c- Fee. �'.�. t- . .Lic. No.. . . . .- . . . . . . a/. . . . . �+ PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer + .... .(Type or Print) _. r, I,. .�/:...�.r.t,,,uullolryG : NORTH ANDOVER ,Mass. Date: Building Location Penult Owners Name V-J4 New j] Renovation n ' Replacement Q Plans Sytbmitted ❑ :'` F TU F ' ' z to •. . Z N 03 O = > w Y -j P U h 41 a O_ ¢ Z z rn a 43 ac = = at z to z z 46 o W = , h W X ! tW1Va vl < pa Y7 a= lto1C oas► eG o3; ,K ac p W >- a h Nz O a . G J ac w ►- r. W z < _ Br 2 a O ~ z Z < W �. X W • F- V > f. O to U3 7 N t-. 2 o Q al ._ W �' p V Z ac .� m o a .� ; z �- to v o s tl; o o SUB—,BSMT. BASEMENT I . 1ST FLOOR 2ND FLOOR 3RD FLOOR ATH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Named ❑ Corp. Address Partner._ �^7) X E-j /t S % —7-1 I�4 Firm/Co. Business Telephone (y ( • b f Z d Name of Licensed Plumber: ; Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [2-- Other type .of indemnity 0 Bond ❑ Insurance Waiver: I, the undersigned, have been made aware- that the licensee of i this application does not have any one of the above three insurance coverages. I • Signature of owner/agent of property Owner Agent ,, (� I bembr cutifr that all o(thc dcuili and Waimalion I ha•c awbmil Icd lot catmcd)in ahu.c applialian tiwc Itoc Z814 to lbs belt ty of bwwkdgs aad that all plumbing walk and in:Ialtaliana pet(nrnicd unit, rcemit IiwcJ rot Ih(t appikuioo wia be in aNitNiegp Iy"&a"of lbs Mauacbwolta Stale rlumbiai Codc and Cluplct 142 a(IlAc Cknual Laws. I � By i • Title . Signature of Licensed Plumber City/Town- Type of Plumbing License t� A 000r)VFZn 7OFFICF USE ONLY1 License Number Master ❑ Journeym&q