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HomeMy WebLinkAboutMiscellaneous - 6 MARTIN AVENUE 4/30/2018 / 6 MARTIN AVENUE 210/045.8-0016-0000.0 / V 1882 Date...... 1,01.! .... "a°� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SS tCNUSf T .................................... This certifies that ...�✓.�J.:.L....�.:...�U.�a.���l � � has permission to perform ..A4d.s.4..(.).A...,f wiring in the building of......r..R.:.(...... ................................ at........!.........►N1 a.2 <t1....,. �' ..................... North Andover,Mass. ,Fee....?..S' Lic.No.-3.74� ....... ., t�.. G /........ ELECTRICALINSPECfOR ;I 4C 170 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer TREIQN LTHOFA (f,.= Office Use only MA DEPARTMEID T 0FPUXJCSAF= Permit No. OFF7REPREYFVI70NREGLE4770NS527CMR 12:00 � Occupancy&Fees Checked PARCEL T ZCw;oQhj PERNIITTO PERFORM ELECRIC4L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 p (PLEASE PRINT IN INK OR TYPE aLLZLQRM -HODate S �'' Town of North Andover FORWARDTo the Inspector of Wires: The undersigned applies for permit to perform the electrical work described ,. PP b below. P P Location (Street&Number) MAtzT110 Av E NANDGVG1Z--j2& MAP LJ Owner or Tenant BRIG t rwA Owner's Address SAME A5 AboNJE Is this permit in conjunction with a building permit: Yes No a (Check Appropriate Box) Purpose of Building 4ppjTj6iy �o?C4A GAMCie- 041-IVIN6:r R4:loj2t Oue;� Utility Authorization No. Existing Service !60 Amps Z2/2q0 Volts Overhead ® Underground ® No.of Meters New Service Amps / Volts Overhead ® Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Nd of Lighting Outlets q No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 171 eround No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumos Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal ® Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis IN H dro Massage Tubs No.of Motors Total HP OTIR Irstaa=Ca�Qra Rasttant.lo the requuana><s dnset>sG=zllaws I ha,&a auent Lmhky hua=Poky urhriing Caripieie opaa=Comm cr ks absn ttial a*valert YES ® NO lhmsbTked,,alidpoofofmriothe0(�YESLJ NU If whaw drked YES,please trdc&theNxcfcu�a bydeckxigthe- wsuRANcE Q BOND D OTIC (>easeSpixily) ETrdbMDM Estx�VahiedExt k2l Wok S Z;.$'/.. 40 WokiDStart -� '—�`i h-spemcnDaseR Rci# Uj L- e41,L Final Wll,& CA6e— se ed uta Pew cifperjtay. FIRM NAME L awNTQ Liensee4a,5-EA14 Li(.XfseNO S766S& BLsinessTd.Na ?7.f-6"7,1-7167 T �0 2 V 14G4 /44 a Z A-LTei Na 0WN-R,SIi�CEWAVERIamawaWttatheI user rrithmethe m medby?i s a�Cjafral12M �S aodtl�rrry rnths sigt�az Pe�t�ga2twaisestltis npmzri (Please chec ) O n , Agent 7387 / Telephone No. 1-178^ 6a-JOPERMIT FEE$ Location 4 AxI g i w A v'e No. r a o 6 Date SAD))?, NORTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ `4L Building/Frame Permit Fee $ Foundation Permit Fee $ s�►CHust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 12O� �0 14e(Z�— Building Inspector 13 t 4 806/o4/99 11:33 130.00 PAID Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD******** ORTH ANDOVER, MA w MAP NO. LOT NO. /� 2. RECORD OF OWNERSHIP DATE BOOK PAGES �:• 'LANE SUB DIV. LOT NO. ~� /m- LOCATION PURPOSE OF BUILDING NO.OF STORIES 2 SIZE OWNER'S NAME L�y' 94 �;f/G K i O44�' v OWNER'S ADDRESS �n �����u BASEMENT OR SLAB 5���� 'r nv „ ao ARCHITECT'S NAME SIZE OF FLOOR TIMBERS I 2 r a! 3 BUILDER'S NAME /CELT SPAN /a DISTANCE TO NEAREST BUILDING �� 1 DIMENSIONS OF SILLS DISTANCE FROM STREET L c30 �$ j� B o �J e�G�s I DIMENSIONS OF POSTS r DISTANCE FROM LOT LINES-SIDES ;Z cI3�REAR ��L oL$D� DIMENSIONS OF GIRDERS �a S>LCL Alt EA OF LOT FRONTAGE / HEIGHT OF FOUNDATION Gf THICKNESS /l 535s� // . /� I$BUILDING NEW }/y s SIZE OF FOOTING / X IS BUILDING ADDITION/ � MATERIAL OF CHIMNEY IS BUILDING ALTERATION w IS BUILDING ON SOLID OR FILLED LAND cO�D WILL BUILDING CONFORM TO REQUIREMENTS OF CODE y�/� IS BUILDING CONNECTED TO TOWN WATER vV BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNECTED TO TOWN SEWER Yes i IS BUILDING CONNECTED TO NATURAL GAS LINE YGs INSTUCTIONS 3. PROPERTY INFORMATION LAND COST EST. BLDG.COST 1'.4GI I FILE OUT SECTIONS I-3 EST.BLDG. COST PER SQ. FT. EST. BLDG.COST PER ROOM 4410 Ov0 ELECTRIC NIETERS MAST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. n ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED G� OWNERS TEL# �97�) 7307 • �� / CONTR.TEL# SIGNATURE OF-O\i'NER OR AUTHORIZED AGENT C!/� CONTR.LIC# II.LC.# FEE $ PERMIT GRANTED Revised 5/5/99 JM NORTH dover Town of � ., oV% No. ,Q /ae - �A COC, C dover, Mass., - /got CRATED P•9 4% IT H � BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT....SIP�i�......... . ...0.V'!.. ....................................................... BUILDING INSPECTOR ........................................ Foundation has permission to erect..a .IX, 0.�........ buildings on ......... .......... � ,... V' ........ . Rough to be occupied as....Ad !T�'!�N 'r 6•�r� �• • Chimney ,.provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough C. *� UNLESS CONSTRUCTION AR PERMIT EXPIRES IN 6 MONTHS Final / 3) ELECTRICAL INSPECTOR onk Rough .......... . . .............................. ............................................... Service BUILDING 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. SEE REVERSE SIDE Smoke Det. FORM-U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT i5Z/r, �>-'y�J/{ Y PHONE -737 LOCATION: Assessor's Map Number 115 13 PARCEL&W /G SUBDIVISION LOT (S) STREET ST. NUMBER__&_ *****************************************OFFICIAL USE ONLY********************************* RECOMMENDATIONS OF TOWN AGENTS: P CONSERVATION ADMINISTRATOR DATE APPROVED0 �( DATE REJECTED COMMENTS �> l� ��'�a S i� A- C rt UV TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT x� FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jim Z The Commonwealth of Massachusetts w Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Al Workers' Compensation Insurance Affidavit Name Please Print Name: Location G Ate%/✓�/ �yc���= City AAlb,✓ mA J L�5 Phone # 641- 7391' N7 I am a homeowner performing all work myself. F7I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address City Phone# Insurance Co. Policy# Comoanv name: Address Citv: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition cf criminal penalties of a fine up to`51,500.00 and/or one years'imorisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy cf this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i do hereby car'dy under the,pains and penalties of pe,rfury that the information provided above is true and correct. Signature � Date 5-/?'9? 0710 Print name 4:-5k1,C- -:7 rvc Phone# 60-173S-Z Official use only do not write in this area to be completed by city or town cffidal' City or Town Permit/Licensinc ❑ Building Dept ❑Check d immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone tt: ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance wit the provision of MGL c 40 S 54, a condition of Building Permit Number oZ©(o cy q is that the debris resulting from this work shall be disposed of in a l6roperly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) sidnatur f P r pplicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Andersen Windows: CTN30-2(Rough=3'-4.25"x 6'-3.875") 2"x12"Ridge Board 28'-2 1/2"de, T W3062-2(Rough=6'-5.25"x 6'-3.8125") (2)TW3062(Rough=6'-5.25 x 3'-2.125") 27-3"ekv. Garage Doors: . Door=78"x 36" 2"xl2"(16'-8"in length)-(Span length=16'-2") 7x12"(16-8"in length)-(Span length=16'-2") anached to inside of block all attache to inside of block wall Frame=Reinforced 8"Bock ' Roof=5 pitch-(2"x12")24"oc ratters 14"gp4wood ..&g fell 25-yr.asphalt shugles _ 8'4" �1'-9"elev. 20'.9 1/2"elev. 11'10" '4 ih 8'4" f4 m 13'4" 12"Steel Bearn °P c 11'x" T-0" 4 m F m 2'-0" 21" 6. 30'-0" Addition Plans Front View Scale'F-- Eric and Gladi Kfoury Milk,Ave,Nonh Andover,MA Frame=8"reinforced block Roof=5-ppitch(2"x12")24"oc rafters 3/4"tg plywood rodfing felt 25-yr.asphalt shingles Andersen Windows:(2)TW3052(Rcogh=5'-51/4"x3'121/8") Window Opening=T-5"x 2'-11" 2"x 12"Ridge Board zs'-z (2)8"Glass Block Windows 2'x 2' Door:78"x 361 2T-3"clev. - Fireplece Opening=3'-4 114 i(3'-4 114" 2"x12"(16'-B"in length)-(Span length=16'-2") 2"x 12"(16'-8"in length)-(Span length=16'-2") attached to inside of block wall attached to inside of block wall 21'9'eke. 2 r-91I2"cln,. 2l'-X;)ay. 6"overhang 6"overhang /18'-1 1/4"Bleu. 3'-4" 14'-0"Bleu. 12'-8"elev. ------ � tqsl 12'-10//4"elm • 10'_6" 12"steel Beam putline of Chase for gas fireplace 3'r 11" b, 2'..7" 4'-3" 3'-10" 2'0" 10'-2" 30-0" Addition Plans Back View Eric and Gladi Kfoury Scale: 6 Muth Ave.,North Andever,MA 2"x 12"rWge bomd wmrw.xm vm..u�.r+pm�wwwww, 2"x8"plate 21'elpv. 18'-1 1/4"alai 4'-B" 4,r 4`7" c T-4" xi4'-4" !n m iV Addition Plans Side View Eric and Gladi Kfowy Scale: 6 Mmffi Ave..Noah Andover,MA (22)2"x6"sftids-T-4"in length 19'-10"elev. t_ 21'•1 1/2"elm 14'-5"elev. 13'-0"elev / 13'-9 1/2"elev. ev J2'-4"el . (9)2"x4"ledge board 12' �(T)2"x 8"ledge board . \. -2l'-V' - -T-23/4"elrv. (5)2"x 8"lo board --6'-0"elev. 14'-0" 5'-6"elev. 5'-0"elm,_ (T)2"x8"ledge board Addition Plans Attached Wall VieNN Eric and Gladi Kfoury Scale:4"M 6 Mmtm Ave.,Noah Andaw,MA Newmofl'veNewmof6r ON—flue Old aofI. Aerial View Back View —NsmKhr Side View Addition Plans Roof Views Bic and Gladi Kfomy 6MarNiAw.,NoMAdm SMA UP 4"comrate slab 6 I I DOWN VT �� Gas Fireplace ® $3 ® O Z 0 0 J_ 7�_AORTGAGE INSPECTION `30l�� A PpletOD- -xg, Land Surveyix SURVEYING * EiNGiNFERING * LANDENiNfl 234 ESSEX SIRM LAAtREMICE, W.SSACHUSMS 01840 (503)636--4924 MORTGAGOR ADDRESS OF PRINCIPAL BUILDING 4f C ------- NOTE: 11-11S MORTGAGE INSPECTION =s prepared spy ificaily - for mortgage purposes and is not to be relied L1,00,1 0,8 0 -SW Ney - A.LS.L accepts no -osponsibility for damages resulting from said reliance by anyone othar than the said mortgagee and its i r' �-� cssions in connection with its proposed mortgage financing to sold mortgagor. The infornnatidn on this rnortgage Inspection is the of ALSA.. Unauthorized use, exclusive properly reprcduct!o-n or modification of this material is strictly -,Ited -,ct to 1091,11 fiction ur,!C---ss prohil, and m-j be subic .0 -2ri rD prior wien consent from kLS,I. is obtained. M C 17_R11FICA111ON TO: 'his mortgage inspection was prepared in accordance WR r -,-h the Technical Standards for Mortgage Loan in— spections as adopted by the Massachusetts Association of Land Surveyors and Civil Engineers, inc. tufa I STATE ljl,'T IN MY PROFESSION L OPINION - the principal structure/s and accessory sttucture/s with the d1mensional setback requirements of the zoning ordinances, and that there are no encroachments of 7 of malor improvements either way across property lines except as shown. rp ❑ Dwelling is not located within a Flood Hazard Zone Dwelling is located within Flood Hazard Zone — Information is insufficient to determine Flood-Hazqrd Flood Hazard determined from F.E.M.A. Flood Insurance rate map. Deed Reference: Dk. _5 Scale:- Pg. Lf, Cert. Date of Inspection: Date'of Plan: Plan Reference: Pl. No. I Location — C2 N6. 6 Date '. ?o. NO;T.,�ao TOWN OF NORTH ANDOVER Certificate of Occupancy $ ` Building/Frame Permit Fee $ •i • Foundation Permit Fee $ SSAtMUSE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ YS TOTAL $ U Building Inspector `J 9809 Div. Public Works s , PERAHT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. �I I LOCATION 7 PURPOSE OF BUILDING RID O OWNER'S NAMESIZE ' - - ' V NO. OF STORIES Sri IIZZE T 1 W -- ..... --. .' -- - ` • .-�;..,;.., OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME I SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAMEY11S '✓ SPAN ` Y -- DISTANCE TO NEAREST BUILDING �L /!- 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 IS BUILDING ADDITION A MATERIAL OF CHIMNEY IS BUILDING ALTERATION �I IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ��S r IS BUILDING CONNECTED TO TOWN WATER BOARD 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 �+ EST. BLDG. COST _ Do - PAGE o -PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER IfQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 1 DATE FILED __��I BOARD OF HEALTH B GNATURE OF OWNER OR AUTHORIZE AGENT F E E PLANNING BOARD PERMIT GRANTED �f BOARD OF SELECTMEN BUILDING INSPECTOR WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer C �Q BUILDING RECORD 1 OCCUPANCY 12, , -- _ SINGLE FAMILY s_Ow ES 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 RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 15 CONCRETE BL'K. ---III PINE BRICK OR STONE HAROW D PIERS PLASTER DRY WALL _— UNFIN_ 3 BASEMENT 11 AREA FULL FIN. B'M'T' AREA _ '/ '/r '/, FIN. ATTIC AREA _ N_O B M-T FIRE PLACES - HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"!D ASBESTOS SIDING COMIIGN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ -"- STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ - - BRICK ON FRAME r CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAMESUPER_ ADECIOTE I� POOR NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD 7011Ei RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD $HINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER - ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I i l HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. _ TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS _ 7 NO. OF ROOMS OI L B'M'T 2nd ELECTRIC 1st 13rd I NO HEATING NORTH Town of 0 dover cn 11 No. 2o? 0 dover, Mass., 19 COCHICHEWIC ORATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT........................................ ......... 4 BUILDING INSPECTOR ............I............................ Foundation has permission to orw&....................................... buildings on ................!;: . ............ &Jke Rough .. ....... tobe occupied as ......I......I............................................ .......................................I............I......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this'office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Fnagh Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. h OFFICES OF: :;Town of, _ z _ _ _ �..,zo5t APPS.'�LS . . _ - --. --,-North- Andover. .;may: NORTH ANDOVERMassdchi efts o 18.3 BUILDING CONSERVATION DMISiON OF HEALTH Plli.�\INc PLANNING & COMMUNITY DEVELOPMENT K1URE_`H.P.NELSON.DIRECTOR wIn acc-ordance with the ric is;c_t o; ae� S : cond:irca or-``Buiidir. P ermi r Number s !"at ;re dc"-is resultine frern this work shall disooseul-ci ih �rerie:i; ., a;; scud w:Is:e : z7cs-.l :acii ..:....c:__ .1_._____._ _.1_.___ c.1,11-S, 11 L... . i ne debris will be dispose:Ll cf of Je .zatt:rc at Fcrnit ;kcoticrt _- Date NOTE: Demolition permit fro= the Tow-a of ;forth Andover must be obtained for ~ this project through the Office of the Building Inspector. - 32 '15 Date. n t pORTM TOWN OF NORTH ANDOVER �3?pa,t.to ,e'�ti00L '. o p PERMIT FOR GAS INSTALLATION CL :�•` g ,SSACMUSEt If7 This certifies that .G,,. L . . . . . . . .. . . . . . . . . has permission for gas installation . . Ilk... . . . . . . . . . . . • • • • m � � in the buildings of . . . . .�. ,;:C,.1 f:. • . . . . . . . . . . . . . . . . . . . .F at . . . . . .f!7?.,fQ. f r-.7. . �"9. ' r�, North Andover, Masa. .o Fee. Lic. No.. . . . . .. /GAS INSPECTOR d WHITE:Applicant CANARY:Building Dept. PINK:Treasurer � r MAP PARCEL_ �� FORWARD 1 > , MASSA -SETISTINTOTM PFrTUTON FOR PERMIT TO DO GAS FITITNG G �tType or print) Date 7-/ y 19 T NORTH ANDOVER, MASSACHUSETTS¢ e� Building Locations to IVIIr 1 I Al / 1/`- Permit 9 Amount S t f 7,Owner's Name /��✓Y, New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ m N m C zOZ i Cn N �, z C r c Cn SUB -BASEM ENT B A S E M E N T I S T. F L O O R 2N D . F L 0 0 R 3 R D . F L O O R JT Ii . FLOOR sTH FLOOR 6T It . F L 0 0 R 7T 11 . FLOOR 13T11 . FLOOR (Print or typel l p N ^ i� ? rI Check one: Certificate Installing Company Name (j ❑ Corp. Address 3 F19Le0 �' 3�� 717 V S lF d Partner. Business Telephone 7!yS 9S—G ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter —JQ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑-- 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 Owners Aaent \ Owner ❑ Asent ❑ 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 wort:and installations performed under 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. By: Signature of Licensed lumber Or Gas Fitter Title Plumber . / ? f 7_S'r7 City/Town ❑ Gas Fitter E u,ense I u m o e r ❑ Master APPROVED(OFFICE USE ONLY) Journeyman