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Date. !X
TOWN OF NORTH ANDOVER
400 %
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation ................
in the buildings of .6 ft�. 4 ..........................
at �. / ... * ' .7 .............. I North Andover, Mass,
Fee.4-.C!--r"5� Lic. No....R)�� ..........................
GASINSPECTOR
Check# I/ c�5
7900
SRS
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town:_ ii . 4I j l Lj t1+-1 -MA. Date: t Permit#
Building Location: Ce ( t't'` ` *- Owners Name: G 4 n' '0
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [�
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [, Plans Submitted: Yes ❑ No ❑
SUB BSMT.
BASEMENT
1 FLOOR
2 FLOOR
3 FLOOR
4 FLOOR
5 FLOOR
6 FLOOR
RO
7 FLO RO
8 FLOOR
Installing Company Name: A t `U ` 5 44-).04 4e. f �•�— �t
Address:_ " �c, �x S 7 City/Town• `moi �% - #� �L*
`''State:
Business Tel: ?L7 9_1/ R, d5_1`6 Fax: % �f
Name of Licensed Plumber/Gas Fitter: 4L/, o f"
Check One Only Certificate #
[4orporation
❑ Partnership
❑ Firm/Company
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes i�rhio ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [jam 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
❑
Signature of Owner or Owner's Agent Owner ❑ Agent
By checking this box ❑, I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the Gejeral Laws.
By
Title
City/Town
ONL
Type of Licens
[Plumber
❑ gas Fitter
2'Master
OJourneyman
❑ LP Installer
Signature
License Number:
Imber/GasFitter
//
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Installing Company Name: A t `U ` 5 44-).04 4e. f �•�— �t
Address:_ " �c, �x S 7 City/Town• `moi �% - #� �L*
`''State:
Business Tel: ?L7 9_1/ R, d5_1`6 Fax: % �f
Name of Licensed Plumber/Gas Fitter: 4L/, o f"
Check One Only Certificate #
[4orporation
❑ Partnership
❑ Firm/Company
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes i�rhio ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [jam 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
❑
Signature of Owner or Owner's Agent Owner ❑ Agent
By checking this box ❑, I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the Gejeral Laws.
By
Title
City/Town
ONL
Type of Licens
[Plumber
❑ gas Fitter
2'Master
OJourneyman
❑ LP Installer
Signature
License Number:
Imber/GasFitter
//
r7) ,S (6
t
Location 1,201
No. Date /41
±fit CA 9,/
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
OAT.. Foundation Permit Fee $
CHUS
Other Permit Fee $
P'Sewer Connection Fee $
Water Connection Fee $
3Y cmIRTAC $
PAID �' �3E
Building Inspector
�D
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j'"PIRATION DATEQ1(j 0 1 CONS'iR� i.SUP_ERy;IS'OR { r. IRED FEE,
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91 1,'+•'' AvMAD PAY LE TO
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LASTING OPR ONLY) FEE:
j✓ HEIGHTS►`"M,ro
NOT vAlm ur+Tll SIGNED BY LICENSEE AND OFFICIALLY r. SIGN NAME IN FULL-ABOVE SI NATURE LINE
,Id� y,.. ^!%AMPEOr10R • SIGNATURE OF THE COMMISSIONER ,
$IGNATIA F L10EN E « SIGN NAME IN FULL-ABOVE SIGNATURE LINE 1
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RIGHT THUMB HOL�K,E}acRS '
i OTHERS - LIMB PRNT -EbE IN TIS F et T; COMMISSIONER • .
A
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OFFICES OF:
APPEALS
BUILDING
CONSERVATION
HEALTH
PLANNING
�IORiM
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,• Town of
D
NORTH ANDOVER
CRU9E440 I)I�'I til( )N ()I
PLANNING & COMMUNITY DEVELOPMENT
KAREN 1 1.1 . NELSON,
120 NMil l Street
North /Midover,
N/Iassilchtlsetts OI84 5
(G 1 7) 685 4775
In accordance with the provisions 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 c 111, S
150A.
The debris will be disposed of in:
/—"eq 40A;::1r,2z
(Location of Facility)
l
Signature of Perini pplicant
67---
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
Location LIIIW(111�1(
No. Date
TOWN OF NORTH ANDOVER
4, 6 6 0
0
, - aivi'mAk Certificate of Occupancy $
Building/Frame Permit Fee $
CHU Foundation Permit Fee $
Other Permit Fee $ 1L) t/,V
Sewer Connection Fee - $
EIVapt-, Connection Fee $
:r'p --
TOTANF.AfT $ 410
�/ TJ-
Alo. Building Inspector
Andoty4el, C
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No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
j, j I- ) / 1;�.- �-
Other ermit Fee
$ j
Sewer Connection Fee $
Connection Fee $
JD BY CHEOVater
TOTAL $
MAR 2 5
Andover Collector Building Inspector
Div. Public Works
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies-ThzrL ............... ....
has permission to perform. k -A ..............
plumbing in the buildings of. . C-4,10-4 . ...................
Ot Rd, North Andover, Mass.
A 33 "zL-
.. 'U ................. ...
Fee..,F-A Lic. Nh .*.0.'.'' * *e'.1—.'' * I
PLUMBING INSPECTOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
Ri' C RC1' /02/0
I
CITY MA DATE %���'� PERMIT #
7• g..-
NORTH ANDOVER r?A
V"
JOBSITE ADDRESS // D,9 OWNER'S NAME
OWNER ADDRESS S,' -j -0 e— TEL FAX
TYPE OR
OCCUPANCY TYPE COMMERCIAL }mY EDUCATIONAL w.,Y RESIDENTIALyC
PRINT
CLEARLY
NEW � RENOVATION: ?, REPLACEMENT:,,,'- PLANS SUBMITTED YES NO!,
FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE 1
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIL(SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR / AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE I MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1
4VATER PIPING
OTHER
r
INSURANCE COVERAGE:
I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. ` YES),, NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY, OTHER TYPE OF INDEMNITYF ' BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER y_ AGENT Gy
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this 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 provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME THOMAS HALLORAN LICENSE # 24833 SIGNATURE
MP_ _ JPx CORPORATION_;# PARTNERSHIP,`:,# LLC ,#
COMPANY NAME HALLORAN PLUMBING ADDRESS 826 DALE ST.
CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978-685-9504
FAX CELL EMAIL o
Ri' C RC1' /02/0
I
1
µ� The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
m -
a 600 Washington Street
` Boston, MA 02111
g
www.massov/dia
,v -
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers
Applicant Information Please Print Legibly
Nairie.(Business/Orgmization/Individual): %1,4ZZ etAA-1 Pz-coli g; /a 6-
Address: , C. 014 L- if S7—
City/State/Zip: / e-'Vj i 1Y AV&Ii4 K_ Phone.#:
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with '
4. I am a general contractor and I
employees (full and/or part fame):
have hired the sub -contractors
2. I am a sole proprietor or partner-
listed on the -attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.t
required.]
5. We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no -
employees. [No workers'
comp. insurance required.]
Type of project (required):.
6. 0 New construction
7. 0 Remodeling
8. ❑ Demolition
9. [] BuiIding addition
10.0 -Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
13.0 Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicati g 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 state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site
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 ofMGL 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 5250.00 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 coveraee verification.
I do hereby certify under thhegepains-aaannd penalties ofperjury that the information provided above is true and correct.
Signature:- `�r. Date
Phone #:
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. EIectrical Inspector 5. Plumbing Inspector
6.. Other
Contact. Person: Phone #:
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that //0 /f A-Ij f ItA C41%
....................
has permission for gas installation. . .......
in the buildings f ...
at
...... /,". ......... North Andover, Mass.
Fee:��O Lic.No-:?qPl�. ./tV ................... ...
GASINSPECTOR
Check
GOWNER
TYPE OR
PRINT
' CLEARLY
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY NORTH ANDOVER ' 00 MA DATE l/%G;�� PERMIT #
JOBSITE ADDRESS 11/4 1/t�6j W OWNER'S NAME CO&/91?0 �i jiPQ�r/r2
ADDRESS s,JIVe / TEL FAX
OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
NEW D, RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES El NO,��C`'�
APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM 1 SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER 1
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER L—jAGENTEl
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this 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 provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME THOMAS HALLORAN LICENSE # ✓ , SIGNATURE
MP[_ MGF [D JP a JGF LPGI CORPORATION # PARTNERSHIP # LLC # 'n
COMPANY NAME:HALLORAN PLUMBING ADDRESS 826 DALE ST
CITY NORTH ANDOVER STATE MA ZIP 01845 TEL
FAX 978-208-0840 CELL EMAIL
Qbo
Date. .
TOWN OF NO
PERMIT FOR GAS
R
TION
/? I , -< Iliq 4-A- -10- - 'O'o- / -/-
This certifies that ................ I/ ....................
has permission for gas installation ..... 7- ej V --e
....................
in the buildings of. ..........................
at cl. . �� R.� :� �-. �.) ............. North Andover, Mass.
.... Lic. No4!� 1 A . . . ......
Fee.�:
GA INSPEC �;�
Check #
6178
Fa
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations
4(
Permit #
A
(Print or type)
Name —7\ a
Address Sy i U Sl
Business a ep one
Name of Licensed Plumber or Gas Fitter
A4 -
INSURANCE
-
Check one: Certificate Installing Company
D Corp.
ElPartner.
11�irm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance, policy or it's substantial equivalent. Yes 1311' No
�
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity D Bond 13
--e
Owner's Insurance Waiver: l,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 rl
I hereby certify that all of the details and information —1have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installa ' ns performed under Permit Issue for this application will be in
compliance with all pertinent provisions of the Massachus s tate Code and apter 142 f the Gen Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed umber lumber Or Gas Fitter
Pl
A 43
Gas Fitter License77u—morr
Master
Journeyman
Owner's Name
/ $
/d. Jt It&k mount j,,,,jr
New
Renovation
Replacement
[a—
Plans Submitted
11
(Print or type)
Name —7\ a
Address Sy i U Sl
Business a ep one
Name of Licensed Plumber or Gas Fitter
A4 -
INSURANCE
-
Check one: Certificate Installing Company
D Corp.
ElPartner.
11�irm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance, policy or it's substantial equivalent. Yes 1311' No
�
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity D Bond 13
--e
Owner's Insurance Waiver: l,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 rl
I hereby certify that all of the details and information —1have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installa ' ns performed under Permit Issue for this application will be in
compliance with all pertinent provisions of the Massachus s tate Code and apter 142 f the Gen Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed umber lumber Or Gas Fitter
Pl
A 43
Gas Fitter License77u—morr
Master
Journeyman
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11�irm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance, policy or it's substantial equivalent. Yes 1311' No
�
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity D Bond 13
--e
Owner's Insurance Waiver: l,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 rl
I hereby certify that all of the details and information —1have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installa ' ns performed under Permit Issue for this application will be in
compliance with all pertinent provisions of the Massachus s tate Code and apter 142 f the Gen Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed umber lumber Or Gas Fitter
Pl
A 43
Gas Fitter License77u—morr
Master
Journeyman
Okocation 4,1 -
No. 11,2 Date
v4ORTh TOWN OF NORTH ANDOVER
Certificate of 6ccupancy $
Building/Frame Permit Fee $
WF un ation Uer it ee
.ez j!
e r P
rmit $
r Permit Free
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
05/12/94 09:14 26. 00 PAID
7236 Div. Public Works
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HOME IMPROVEMENT CONTRACTOR
�I Registration 108659
Type - INDIVIDUAL
y Expiration 08/0/94
Steven Sadezwicz
'School Street
ADMINISTRATOR Metiuen MA 01844
I
.mow , - - --; .a.k
� K".-S`x<o.r.+..r.,.r 1�d Pr.r
. aa"'.` rt � a •1k ^, �' � AUM w seri `>* y �,�,��'x 1fZ"'Y� v •Py ���-.
0 .-. xr ,� h �I f 'x •� t {^ tY !(•F�u.
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SSR
�PARAMaU�t11T_',-
VINYL SIDING &CARPENTRY :• 7SchoolStreet
MA LIC #056858�'Methuen, MA 01844
Y
Reg 4108659 ..r: 508 794-9950
( )
PROPOSAL SUBMITTED TO
/ Al ' u,,in/ it rev
PHONE
6 11rK �' � g v 61
DATE
1
STREET
JOB NAME pC•1v� f
U �} f L "(/t' �l� S :5 j`
�IiE' �✓ ;j E &'✓0 0
CITY, STATE AND ZIP CODE
JOB LOCATION
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
C- v
7';i��j ���0L;�_:</ i< <�/% r`a ��r%E" f7r %!Ol/<C_ �i� <i
r
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411
V/ IVO
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It
It shall be the obligation of the contractor to obtain all permits as the owner's agent; owners who secure their own construction -related permits or
deal with unregistered contractors will be excluded from access to the guaranty fund.
"' `.i
_rC � �. r. �:< ,'� ;" r V _>.v J,�_ •- • �' � ;/ �' �;,� >`� •,�°='s�:�.-, dollars ($ %T /�'...)," ,. ;.� u � •
Payment to be made as follows f' '
/7
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifica- Authorized
tions involving extra costs will be executed only upon written orders, and will become an Signature
extra charge over and above the estimate. All agreements contingent upon strikes, accidents %
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be
Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days.
ArrrptWIt It j1r11;1n,0a1 —The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized
to do the work as specified. Payment `will be made as outlined above.
Date of Acceptance: � ",' 1 L� Signature.
p0 NOT SIGN THIS CONTRACT IF
!THERE ARE ANY BLANK SPACES
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OFFtChLb 01=:
APPEALS
BUILDING
CONSERVATION
HEALTH
PL-ANNING
U0
:�w: NORTH ANDOVER
„�`r DIVISIONOF'
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
North Andover.
Massachusetts O 1845
(617)685-4775
In acczrdance with trovisions of MGL c 40, S 54, a condition of Building Permit
he
Number is that the dcbris resulting from this work shall be
rep
disnosed of in a periv liccnscd solid waste disposal facility as dcfincd by MGL c 111, S
150A.
The debris will be disposed of in:
/�2A-T1-1vr1/ ZIWI-2 L L
(Location of Facility)
Signature ofP it Applicant
Date
NOTE-: Demolition permit from the Town of North Andover must be obtained for
this Droject through the Office of the Building Inspector.
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