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HomeMy WebLinkAboutMiscellaneous - 600 Turnpike Street X LAat!on %�� No. Date V12 41 q2- NORTH TOWN OF NORTH ANDOVER Ot tt� e . 1,�,00 Certificate of Occupancy $ + ! ; Building/Frame Permit Fee $ 5 oundation Permit Feed $ u�' ``• "` Other Permit Fee $ Sewer Connection Fee $ App _� -9z ' ter Connection Fee $ Q•� �`�Q TOTAL $ v" Y� �/ ' nAL O �'Building Inspector 5 1 3 4 Div. Public Works Location A00 %Ult-Y8I J-iE -57— No. TNo. 06 rDate "ORT Al WN OF NORTH'ANDOVER, s j pft ` o 1 05 0,of Occupancy $ SDS Off ` • '` Building/Frame Permit Fee $ ion Permit Fee $ 100. 00 s�CH SE WINSewer Other Permit Fee $ N� � Sewer Connection Fee $ Water Connection Fee $ J TOTAL $ f.SO. 00 Building Inspector � �l!�7fEif J O z �y� Div. Public Works. Location �2,6 6 r : No. � r , V f r _ Date t3 11 16't aORTq �1 ` ' OWN OF NORTH ANDOVER \v`Certificate of Occupancy $ , iilding/Frame Permit Fee $ Founa#ion Permit Fee $ e, QA%r Permit Fee $ Sewer Connection Fee $ l6-053.400Water Connection Fee $ (� - -' OTAL $ 410D, 00 Id',/sz� Builldyi�ri InspQdtor � i Div. Public Works ttsoy V PERJRPS NO. '0 6 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 a � O 4-40. ILOT NO. an 2. U�RECORD OF OWNERSHIP BO (PAGE ZONE SUBDIV. LOTNO. / O~ G �� /eC �/� � 7 a� c LOCATION — Q� �• PURPOSE OF BUILDING OWNER'S NAME �c ' ' y�4 e C 6NO. OF STORIES J SIZE .f� y V OWNER'S ADDRESS`-•�cldtn®%V e, f"777�.s�� 6©O BASEMENT OR SLAB ,rJ�, o,��.e"7T ARCHITECT'S NAME J(`4yr�;1,11.fJ:v"• Gv� V SIZE OF FLOOR TIMBERSrl3l1GSTCAX/ Q'JND ; r/ G 3RD BUILDER'S NAMEff•O C .y- f, • /7 a SPAN / CT/� �( DISTANCE TO NEAREST BUILDING /O O PT- DIMENSIONS OF SILLS CQX o/ --- DISTANCE FROM STREET /® GT •' POSTS /)� , DISTANCE FROM LOT LINES-SIDES �O�, ?9 REAR i� " GIRDERS Com/ `/Y/0 Y AREA OF LOT iy p�O�� j96�rJ-I FRONTAGE /217 l/f HEIGHT OF FOUNDATION �CZ�./` THICKNESS /') •-�.�^_j IS BUILDING NEW ®CJy . SIZE OF FOOTING / X , / V if7GA'! IS BUILDING ADDITION ,-�,O MATERIAL OF CHIMNEY IS BUILDING ALTERATIONC IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE l e f IS BUILDING CONNECTED TO TOWN WATER V/p F BOARD OF APPEALS ACTION, IF ANY '� J IS BUILDING CONNECTED TO TOWN SEWER YVL 4L9 f IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION y LAND COST SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY EST. BLDG. COST 7 ;� PAGE 1 FILL OUT SECTIONS 1 - 3 REGULATED BY PARA: 112.7 S.B.C. EST. BLDG. COST PER SQ. FT. G, PAGE 2 FILL OUT SECTIONS 1 - 12DATE: y FEE PAID:3 13 ft_V, EST. BLDG. COST PER ROOM ld SEPTIC PERMIT NO. ,ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING .. .... 4 APPROVED BY ATTACHED`!SSARAGES MUST CONFORM TO STATE FIRE REGULATIONS 0 PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGNA E OF NER O AUTHORIZED AGENT OWNER TEL.# F E ,�'�S�- (9t'J CONTR.TEL. 663 CONTR.LIC.# 00st?7� PLANNING BOARD PERMIT GR TED OD 'goo t9 J BOARD OF SELECTMEN -PERMIT FOR FRAME/BUILDING gam,PERM � LESS FDA DATE: y FEE PAID- DUE FRAME PERMIT$ `�'' BUILDI G SPE, BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY- STORIES THIS SECTION M.UST,.SHO.W.;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 I 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. --'� PINE BRICK OR STONE HARDW D _ PIERS k;WILA— DRYW — DRY V✓ALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '✓• 1/1 '/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 - WALLS II 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDY✓'D OC _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME - BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR IV,/j POOR _ ADEQUATE 4' \ NONE 5 ROOF 10 PLUMBING GABLE I . HIP BATH (3 FIX.) — GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES VC TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD 401ST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS OV AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T 2nd _ ELECTRIC 1st �j 13rd NO HEATING f . � __ V /V 3� /09 00, �3. kY sqxcr fi N y,_y a � � L0T- 3 \CO h ARTA 25,005 s. f. 161 ' 109- 10 - -- 78. 3/ 23 5. 66 ' --- S 45 47= 27 E • Rte 1 4 ) 3 iYEE 7" �• _ FOiki U T014N OF NORTH ANDOVER LOT RELEASE FOR k1 SUBDIVISION ASSESSORS MAP RD, 1 Z SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY STREET - l 1) f j P APPLICANT — ,. \I ✓� Q Cf Pub �� PHONE -_�9 .— 3.3 i � z DATE OF APPLICATION _MAP, C , H 7 $ TOWN USE BELOW THIS LINE LPLANNI G BOARD r— DA'T'E APPROVED Zj �Iz_ TOW PLANNER 4?4e, -,1 A ►Il DATE REJECTED 24 T-A.:� 10 to 2— CONSERVATION CONSERVATION COM2•IISSION SIC>,►�, DATE APPROVED �f' � 9l" CONSERVATION ADMIN. DATE REJECTED B9ARD OF HEALTH c, "U'On (JAI i� DATE � iE ArrRovED HEAL'i•H SANITARIAN DATE REJECTED DEPARTMENT OF PUBLIC WORKS 4, DRIVEWAY. PER11ITOn - A 0-1-W,0 SEWER/WATER CONNECTIONS FIRE DEPT. t , RECEIVED BY BUILDING INSPECTION DATE - This form shall be signed by the agents of the Planning and health Boards , the Conservation Commission prior to the issuance of any building permits J--or the subject lot . This form shall not releive ' the applicant from the compliance of any applicable Town requirement or Bylaw, Carroll 1c 1 P. • Box 1957 Andover,MA 01810-0033 RESIDENTIAL DESIGNERS 508-475-1486 Fax 508-474-9354 DRAWN unumuuunnnuumiluwuleul aulmuuuunulnmmauuunnuuuonlmnAfan Carro IIIIILIIn�llllllllllllli;il{IwUIII:1n1111I1iII:ItlI;IIIIIWIlI11111111:I11U11Ullllllllllll!hUII1LL111111HIIIhiilitl:.liIIIC111111Wllllllllllld!tltllwl1111111111111111111111111111L111!IiIIIIGIII!I' 11191WIIIIt1_lin"rnlln'111 nn°ul°I Ilnplulllu IIIif11iI1111!UI!IIIIIIIIIII!IIIIIIIIIIIWIIIIIIIIIIIIIIIIIfIIII1111nIII1111111111111111nBtlllll!IUllllllllllllnnl!IIUIUIIIIIIIIIIIII IIIIIIIIIII;IIIIIIIIIt11111tl1n116a1i11111111111111innIIn�U111111!IIIWIB1111WUInUUnI1�Illlllllll�IIIHIInIIIWWIIIIIIIIIIillllllll®UUlln!IIIIIIIIIIIIIIBIIIIWIIIIIIIIIIII IIII !!In lllillnlllnnWllUII11U1111111UWIIIIIIIII11111111111111UIHIIIIIIIIIII1111N111p111�lIIIUIII!111{fU�81�Ullllll111111! tl0�llnllwmimI a pnnn - - _' February 28, 1992 BER DATE"lwmom 92011 r _ Illtl•'IIIIII•"' ( 'UNmWIIIP � �a'•11 1111--1 l tlpl 1 1 1 1 1 1 UI I I I I f 1� fll��'lI1 f i n"— "olliiii I p mr. • • nump IiIIIIM tCUI Nlr •� 1�1� W ulwu:unuuamnunmminmfnlulmlwmuuuuuom®loumunuuupluutuwuuwn �III1111Iunwuuw�ulnuunnaumll/muwulllulumul�Ynuunnluwrmlluoulnnuuuuulpyminuml�wmwluulfulmuuwmli�ll� IIMIIIIIIminnnw���•, uuuaunmltfafBU�nnnulmlUl�Ufl!!IU!®818Nt1{U®11111I1tlll®III®IaIII1nfl1fl1811I11111nMll�lluluuwm X11®IIUIt®Illualu{utl�nlUluunnnutlmBU�flAflnfliI1111RUfl@Unum � �'y�ulunnmr, w„�`(�Itrllmumm nnnl m tl�tmin un m11�1Ylxnrnn m mlmuwnn�u f nnn f ,nr•nnnul nitnn run IrtLtpl• n Itumflnu l aftwu mluww9PRIDm n aumnujl�np� �4it► � •• � RAISED 7RANCHPLANS. I , MON 41+ O( __ • _ • v\v:+»};1j{{j .. \vii}:•.•'Xi*' �" ................ rail it 1 11 Carroll Designs P.O.Box 1957 Andover,MA 01810-0033 RESIDENTIAL MASTER BEDROOM r- - DINING ROOM DESIGNERS 508-475-1486 9AT H I K I T C H E N Fax 508-474-9354 Oi O I i DRAWN Afan CarToff ODATE ! February 28, 1992 JOB NUMBER ! _ 92011 i 0 T 1 00 :zcn _ ---- 0 u _ - - - - ----- Oa) UJ _� _ - -- -- — cn U) V - cn W Z _ -- - - - - -- Q o w - - - -- -- - - -� CO OC BEDROOM BEDROOM LIVING ROOM � J Jim RAISED RANCH PLANS FIRST FLOORIPLAN 1/4"=V-0" SH 2 OF 5 MON 4,4,' ofl 81_ � Z i. Carroll Designs P. O.Box 1957 Andover,MA 01810-0033 RESIDENTIAL GARAGE FU R N AC t LAUNDRY _ FAMILY ROOM DESIGNERS Q 508-475-1486 _ 4Fax � O � �� � 508-474-9354 3 -� AWN ACanRCarroff DATE 2 0 = February 28, 1992 JOB NUMBER ,.._ .-. , a.L L p'o,o pt=, i I 92011 co i � r 9 U _ Q --- V W _ –_ –- --- — C/) C/) V � W Z - OFFICE - Q O w a =� � CcCC . M E N T RY Q J r �! . RAISED RANCH44:7 BASEMENT FLOORPLAN PLANS 1/411=,4-0° SH 3 OF 5 V GENERAL NOTES: F1� � �IEE�JT 1** 1. ALL DIMENSIONS ARE TO BE FIELD VERIFIED BY THE > : >> —5/g�l PL�(��p CONTRACTOR AND ANY ADJUSTMENTS MADE ACCORDINGLY. Carroll Designs 2 x� @ 32'Io.�• P.O.Box 1957 2. ALL WORK SHALL BE COMPLETED IN COMPLIANCE WITH ALL Andover,MA 01810-0033 12 APPLICABLE PLUMBING, ELECTRICAL AND BUILDING CODES. FIaE(z.G-�LliSs 3. ALL WASTE MATERIALS AND DEBRIS SHALL BE REMOVED RESIDENTIAL SU L - {N ,&T I o tJ AND DISPOSED OF PROPERLY. DESIGNERS Z x 8 C' L�o� O,G. 4. ALL NEW STRUCTURAL MATERIALS SHALL BE VOID OF 508-475-1486'--- ANY 08-475-1486ANY DEFECTS THAT MAY DIMINISH THERE CAPACITY TO Fax FUNCTION IN AN ADEQUATE MANNER. STRUCTURAL 508-474-9354 i - - ENGINEERING AND DETAILS SHALL BE PROVIDED BY DRAWN OTHERS AS REQUIRED. . 2 �4.@ i�''o�. - _,��N r-e o [Can Carr'oCl DEA-94P-Jr- hJA.LL �pFF 17- 5. ALL FRAMING LUMBER SHALL BE S-P-F#2 OR BETTER. DATE February 28, 1992 r JOB NUMBER 92011 �2r.10 @ iro "o.c. T co - � 2 G @ :lm ` c, G, Z cn = 0 cn w cn c U � W Z Q o W CO J BUILDING SECTION. RAISED 4 RANCH PLANS SH 4 OF 5 • X'±C ,,•,;�� '•' `;;..kms,'`:' kv r—_ --- -- -- -- -- — kid �w\•..+:.:��$: a all :.:....::.::.:: ` - Carroll Designs P.O.Box 1957 Andover,MA 01810-0033 40 RESIDENTIAL (- - - - - - - - - - - - - - - - - - � �•� � DESIGNERS 508-475-1486 - Fax L � =�a ✓=���S� O� ., `O 508-474-9354 —� DRAWN . fan Carrod •�• DATE February 28, 1992 JOB NUMBER 92011 L 1 J L 1 co cn • N F- o z Ci W _ Oc/) uw CnW V Cn W COCD Lu 5 7 - -. Of RAISED -a, 01 RANCH FOUNDATION PLAN 1/4"=1'-0" PLANS SH 5 OF 5 . , � � ___ R i C OOL T 1 F 1 E D ' Fou N DA-no N PLAN g ik-ov V RONEERS, IN , Awrzovaik, MA ALFRED A. SHABDO, P.E. SGA LB : l " _L10' r7► )9412. P.O. Box 516,160 Pleasant Street, North Andover, MA 01845 • (508)683-3893 1.. CE<Rr iIP Y T+4AT. TtAF—. . COMPLY WITH _Q.v-= MOR-r �N.D0Vt=-2, MA WA SHOWN ARS . Fes.. TiAC (-t,s� OF T41� 'Solt DIrJG �Ns.PI;c.ToS?..-.ON.I,Y.,._. « .TSE ��T�-2ntit.NATIoN. . .Urr .�C1N.lN.v,...GUN�g2nM�-fi-.Y c72 N.O_N GU N.Fzp2 M 1 T-Y'- W.A E=-:W Gc�NsT2ucTE—=Q i i t - N Sia 9. oG, `v ( t 33 f yy' ' � �XIST1AtG � O 41 24 �.it�flATtotJ ` 2' J "94 A7 � i V � N 0 tU � Z o Z L. c T 3 w-J. t o' Y' $ 415 Y K E S-rR r ET `.NY -tJ¢>�4 � Dr � u r" 4 Y Ill t\ ' 71992S1 i MASSACHUSETTS QUITCLAIM DEED I, LOUIS J. KMIEC, JR., as I am Trustee of the I<AIEC REALTY MUST under Declaration of Trust dated February 25, 1981 and recorded at the North Essex District Registry of Deeds at Book 1489, Page 40, of North Andover, Essex County, Massachusetts, being unmarried, for consideration paid, and in full consideration of $40,000.00, grants-to J. J. Associates, Inc., a Delaware Corporation,., whose address is Suite 1, 380 Essex Street, Lawrence, Massachusetts 01840 WITH QUITCLAIM CNENANTS the land in said North Andover, Essex County, Massachusetts and shown as Lot #3 on a Plan of Land located in North Andover, Mass., owned by Louis J. Kmiec JrScale 1" = 20', Hate: October 28,'1985, S. L. Gile, R. L. S., Lawrence, Mass., which plan is recorded with the Essex North District Registry of Deeds as Plan No. 10102, and being more particularly bounded and described as follows: NORTHWESTERLY by Lot 02 as shown on said plan, one hundred - eighty-seven and 98/100 (187.98) feet; NORTHEASTERLY by lard now or formerly of Roy R. and Elaine Houde, one hundred nine and 00/100 (109.00) feet; SOUrrMASTERLY by land now or formerly of Gordon, Harrington & Osborn, one hundred sixty-one and 28/100 (161.28) feet; and S0UnfWES`I!ERLY by Itz npike Street, one hundred eighty-seven and 41/100 (187.41) feet. Containing in all 25,005 square feet, more or less. i The premises are conveyed together with and subject to the benefit of a utility easement as shown on said plan and as more particularly described in instruments recorded with the Essex North District Registry of Deeds at Book Page 349 aryl in Plans Nos: 8732 and 8997. 1.526, Page 171 arra Book 1617, i Together with the right to pass and repass over and use for driveway purposes including the right to pave and maintain the easement area, and to utilize. for the purposes of laying and maintaining a sewer line within for the benefit of said Lot #3, a 15' wide easement over Lot #2, which easement abuts and runs parallel to the existing 20' wide utility'easenent as shown on the j aforementioned plan numbered 10102 and as shown on an easement plan recorded herewith. Subject, however, to and upon the condition that the grantees, at their own expense, take all reasonable and necessary steps to keep the easement areas landscaped and well-maintained. This restriction may be enforced by an action brought in any court of competent jurisdiction. Being a part of the same premises conveyed to me by deed of Mildred May Lager, also known as Mildred M. Lager, dated August 27 1984 and recorded at the North Essex District Registry of'Deeds at Book 1857 , Page 226 WITNESS my hand and seal this 3lstday of March 1992. _ �s IS J. 10LUU, JR., STEE C94 UNWEALIN OF MASSACHUSETTS Lawrence, March 31 Essex, ss. 1992 Then personally appeared the above named Louis J. Kmiec, r. Trustee aforesaid and acknowledg4thefor 4instrument his free act and deed, before me, ILIA, ss• expires 9/24/93. SEWERIV WEN u UAL own o 6 ® Andover 110. otit RIVEWAY ENTRY PERMIT rt �` er Mass 1 CiAt K C HEWIC AoRR Q�\ IV SSA BOARD OF HEALTH PERMIT T .LID 40 t * .....XiM4.4r ,I�c THIS CERTIFIES THAT40.11 . ........ .... • .!...... BUILDING INSPECTOR has permission to er� .. . . �ldings on &.12..... .. . . ..... Rough AVEChimney to be occupied asjjt$j.Lf... � �y....PAW(aCMt&.................. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the'Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY Final VIOLATION of the Zoning or Building Regulations Voids this Permit. cREGULATE BY PARA: 112.7 S.B.C. PERMIT EXPIRES I O N T H-SbATE: 3/ y FEE PAID: `0•lj ELECTRICAL INSPECTOR Rough UNLESS CONST UC T STAR S Service PERMIT FOR FRAME/BUILDING Final DATE: JEE PAIDOEO BUILDING 1 CTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuildiPERMIT EEE :Z; ,00 Rough IS FDA FE DUE FRAME PERMIT$ 1S Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by STREETSmoke p Nu. Building Inspector CERTIFICATE OF USE & OCCUPANCY Building Permit Number 066 Date J U L Y 31 1 9 9 2 THIS CERTIFIES THAT THE BUILDING LOCATED ON 182 HILLSIDE R D . ( AKA : 600 T u r n p i k e St. ) MAY BE OCCUPIED AS SINGLE F A M I L V DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. OF NO oTM q.y F CERTIFICATE ISSUED TO Louis J . Kmiec , J4 . /JJ A S o c . Inc . ADDRESS Turnpike St. , North Andover , MA Az/`9 /1 ' SSC HList �I i Adding Inspector L d A A L 0 R T 1-11 f 0 Andover 17'1,N Oit o n of 71 No.* C. R/C 11VEWAY ENTRY PEIRMITZI�&.---,a. Al er, Mass J719" I gpi. BOARD OF HEALTH PERMIT 0 . THI.S CERTIFIES THAT40a is.....4;.....xooucc........ I BUI has permission to er ildings on SO-10...... .. . .... .. ih i%mn e y to be occupied as. ..... ... FW&LUAt6w•.................. Fina provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in 7-11 - P U 'BWG'l0iSP!CTOR," 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. PERMIT FOR FOUNDATION ONLY Final jr VIOLATION of the Zoning or Building Regulations Voids this Permit. JL 3 REGULATE _BY PARA: 112.7 S.B.C. -7 ELECTRICAIkINSPECTO PERMIT EXPIRES I ONTH'S ATE:—113 4 2 2 FEE PAID: X0.12 Rough IJNI-ESS CONST UCT STA SC14rvice PERMIT FOR FRAME/BUILDING V . ... ... ... .. ... . . BUILDING 1 CTOR GAS INSPECTOR DATE: q�jil a EE PAID:, G..PERMIT FEE Rough Occupancy Pert-nit Required to Occupy Buildii /o-o _rSS FDA FEE I I'V-a),WA DUE FRAME PERMIT $ Fina –t_-r Display in a Conspicuous Place on the Premises 31 FIRE DEPT. Do Not Remove Burner VP- No Lathing to Be Done Until Inspected and Approved by STREET W*s. Smoke Det. Building inspector Date._3.: . .: .� .?. s "oRTM TOWN OF NORTH ANDOVER o ,+ PERMIT FOR PLUMBING SSACMUS� This certifies that . . .r ... .(A. .. . . . . . . . P) J-1 . . . . . . . . . . . . has permission to perform . . . ...? . . . . . . . ... . . . . . . plumbing in the buildings of . . . P.A.�.l. �� . . . . . . . . . . . . . . . . . . at. . . . . . . . . . ., North Andover, Mass. �- PLUMBING INSPECTOR Check # 2 V- 5528 5528 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMIRING (Type or print) j L ` } NORTH ANDOVER,MASSACHUSETTS ,yam Date Building Location to(, w' a e S�wners Name ' ' Permit# Amount Type of Occupancy New Renovation Replacement .� Plans Submitted YesEl No FIXTURES COO r , D�-]7e1Y�1`u ISS-HDCIR 4" M-- MKOM (Print or type) ` Check one: Certificate Installing Company NameCorp. Address 0 Partner. Business Te ep one q 7 y', 3'7`q—/, 6 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy IDL Other type of indemnity � 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 OwnerEl Agent 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 MassachusetPle Plu Code d Chapter 142 of the General Laws.-.- By:—o Licenseum Der 4- of Plumbing License Title 1'1-777--t City/Town License lNumoer Master Journeyman Q APPROVED(OFFICE USE ONLY