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HomeMy WebLinkAboutMiscellaneous - 63 BRIDLE PATH 4/30/2018 6i-BRIDLEPATH 2101063.0-0017-0000.0 MetLife Auto&Home® Homeowner Operations Field Claim Office Attention:Claims P.O.Box 6040 Scranton,PA 18505 (800)854-6011 March 30, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: James and Joan M. Medeiros Claim Number: JD000687 OG Date of Loss: February 15, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313,please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten(10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 63 Bridle Path,North Andover, MA Sincerely, Home Ops CAT Team Sarah Lackey Metropolitan Property and Casualty Insurance Company =_ Claim Adjuster (800) 854-6011 Ext. 7440 Fax: (855)411-6689 Email: MetLifeCatTeam@metlife.com MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI. MPL MA-REGDEPT Printed in U.S.A 0698 Locatiorf � No. Date NaRTh TOWN OF NORTH ANDOVER F a Certificate of Occupancy $ q Building/Frame Permit Fee $ 3 Foundation Permit Fee $ CHU Other Permit Fee $ Sewer Connection Fee $ t Water Connection Fee $ TOTAL $ Building Inspector �I21"' 8,9.00 PAID Div. Public Works ► _ Locatiori I r r No. _ / Date �r NORTH TOWN OF NORTH ANDOVER F A Certificate of Occupancy $ ` ' Building/Frame Permit Fee $ k ��s'•• E<� Foundation Permit Fee $ JACNUS Other Permit Fee $ Sewer Connection Fee $ 3 Water Connection Fee $ TOTAL $ Building Inspector t 5i�8/98 09:44 839.00 FAIL Div. Public Works 63 Bridle Path No. Andover, MA M I�, 43.1 ' _ F 2`� I I t`g 7 i U-=�T 5 i i MORTGAGE INSPECTION PLAN BUYER: `�(� (�Of7 1 J AItiCS 4 �1 GA tJ I LOCATED M To Me UnD ) . I�(3 , tLw]� 'Q Imo. AND ITS TITLE INSURERS. MASSACHUSETr'S ! CEZRTdY THAI f HAY EXAMINED THE PREMISE*- AND THE BUI DRUGS SHOWN DO ( ) CONFORM TO THE ZONING LAWS AND AMENDMENTS, I.s.(FRONT, SIDE, 6 REAR YARD SETBACK ONLY OF N O, A NTS J DTZ NMEN CONSTRUCTED. • . 1, . , I FURTHER CE.R71FY THAT THIS PROP IS OOT LOCATED IN THE ESTABUSHED FLOOD DEED 1-- HAZARD AREA.COMMUNITY PANEL NO.: Q C,,OO1 6- —S50ATE: 6-15- $"3 BOOK EXAMINATION OF THE RECORDS IS MADE ONLY SUBSEQUENT TO THE RECORDED DATE OF THE PAGE 127LATEST DEIN AND DOES NOT INCLUDE VERIFIING THE ACCURACY OF THE DEED DESCRI^TION PREVIOUS TO 113 DATE OF RECORD. CETT. N0. THIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED DATE OF THE LATEST DEED OF RECORDED. 1N-IENE" BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY UNE IT IS ADVISED PLAN BK. PAGE THAT A MORE PRECISE SURVEY BE MADE TO VLMFY THESE MEASUREMENTS. PLAN + -754 DAM NOTF— THIS CERTIFICATION IS BASED ON 7K-, OCA110N,OF SURVEY MARKERS OF OTHM AND DOES Tep" Z I NOT REPRESENT A PROPERTY SU ' r'. , 199 Z THIS CERTIFICATION FOKF! ORTGAGE PURPOSES ONLY. ; 1•- 40' OFT AS &H ',NOT TO BE USED FOR ES,T Lj�$ .MEFF N PROPERTY LINES 57," BRADFORD v 1 �� -I,TP ENGINEERING CO. P.O. BOX 1244 HAVERFRED W. CHASE III R.L.S. #15755 TEL oB( I!j 37~5--223" Collins Center Announces Scholarship for Municipal Employees Full tuition and fees for Master's Program at UMass Boston's € McCormack Graduate School The Collins Center for Public Management is pleased to announce a i two-year scholarship for high achieving, motivated municipal officials and employees. The Edward J. Collins, Jr. Scholarship will provide 4 i the recipient with full tuition and fees to the Master of Science in ! Public Affairs (MSPA)program in the McCormack Graduate School of Policy and Global Studies at UMass Boston. i Scholarship recipients will serve as Collins Center Fellows during the two year program and participate in I Center projects, activities, events and performance management professional development opportunities, as time permits. The MSPA program is a two-year, interdisciplinary, professional course of study with evening classes and i occasional weekend seminars to accommodate working professionals. This academic program prepares ' students for careers in public service and enhances the skills of those already employed in the public o sector. Participants in this program analyze current policy issues and concentrate on subjects relating to metropolitan Boston, Massachusetts and New England. The curriculum is a carefully planned sequence of courses and seminars that provides academic instruction in politics, economics, management, budgeting, statistics and public finance. "This scholarship is true to the core mission of the Collins Center-improving the efficiency and effectiveness of government-by helping dedicated municipal officials gain professional skills, equipping them to further their careers and improve service in their communities,"said David Sparks, Executive a Director of the Center. "We are looking forward to having these Collins Fellows as students in our graduate school,"said Steve Crosby, Dean of the McCormack Graduate School. "Their practical real world experience will enrich our I program and their fellow students.We very much appreciate this commitment from the.Collins Center." { This is a competitive scholarship open to all current municipal officials and employees in the i Commonwealth of Massachusetts who are residents of Massachusetts.An applicant for the scholarship {must meet the following requirements: i I • Possess at least a Bachelor's degree and be admitted to the MSPA program at UMass Boston, ' following the normal application and acceptance process.Application deadline: April 15 For information on the MSPA program,please click here. I • Serve full-time or part-time as a municipal official or employee in Massachusetts ; • Be recommended by their Mayor,Town Manager or other appropriate local official I • Have at least three years of professional experience in municipal government j • Exhibit a strong commitment to public service I • Commit to serve in a municipality for two years following the completion of the program and to maintain municipal employment status while enrolled in the program. I • Be available for enrollment starting in Fall 2012 I For more information on how to apply for the Collins Scholarship, click(application instructions)and (application form)or contact Sandra Blanchette at 617.287.5534 or sand ra.blanchette a)umb.edu. I P E R M I T IN0. APPLICATION FOR PERMIT TO BUILD**J*****NOIZTII ANDOVER, MA huPNO21 _ Lor.No. 2. RecnuuoFownel2slllP DATE BOOK PAGE LONE L�I SL1B DR'. LOT NO. p 2-Z�-9Z. LO(A I ION ,�� ,,/1�� !(PCLI� (�1-'*t�,-�- PURPOSE C)F IJUILDIN(i =�f!.{� 4 I f-C /L.,U /t 3�T/�} lzocD/ -r �t �/ OWNER'S NAME J l(/ � lnEl„�E-le NO.( STC 2IES SIZE CS'/`�.e� / OWNER'S ADDRESS /s QC(` BASEMENT OR SLAB t3A,J /Nti j ND AR('llIIECf'SNAME rchJ1I/'I1 ��nL Us SIZE OFFI.00RI1MBERS L-� 1 ST 2X�Q z Zx�� 3 RD BI III.DER'S NAME #A[ 't SPAN lo DIS IANCE*10 NEARESTBUILDING T'rp� �C(J f)IMENSI(NJS(x SILLS '2 ACK �O DIS 1'ANCELR(N.7STREE f yo DIMENSIONS OFPOS 7S DIS I ANCF FRC*J I CA LINES-Sl DES40 1E KREAR I%O OIMFNSIONS OF GIRDERS AREA OF LOT 2 ACtfE FR(NIIAGE 15(o IIEIGlff o FOUNDATION g TI IICKNESS l✓� �� ISBIIILDINGNEW vE� f '/ SIZEOFF(X)TING lj��f X�O �' X IS BUILDING ADDITION L- ! j MATERIAI.OF CIIIMNEY IS BIIILDINO AL:IERATION Y�S IS BUILDINGO OIJD FII LED LAND N'11 1.BUILDING CONFORM TO REQUIREMEN I S OF CODE 1 IS BUILDING CCNJNECTED IOQ2WN WA fER �ES BOARD OF APPEALS ACTION,IF ANY �(,/l7N� IS WILDING COJNECI ED 1O TOWN SEWER IS BUILDING CONNECT EO TO NA'IURAI.GAS LINE IN''STUCTIONS 3. PROPERTY INFORMATION LAND COST — ES f.BLDG.COSI- Z9 Oo PAGE I FILLCNII-SECIIONS 1-3 EST. BLIX;.COS TPERSQ.IT EST. Bt DG.COST PER R()Ot i ELECTRIC NIETERS MUST BE CNN(Al"ISIDE 01;BUILDING SEPTIC PERMI I NO. ATI-ACI IED GARAGES MUS ICONFORM fOSTATEFIRE RUR GU1.ATl(NdS 4. APPROVED BY: PLANS NIUS"f BE FII.EDAND AI'PROVED BY Bl11LDING INSPECTOR BI{II.DING INSPECTOR •DA-IL 1:11 ED /�; �� OWNERS"f FL# ���� .71"D 117 C(N11'R.IEL# Lry SI(. I1RIOFOWNER O{ AU'I-I IORIZI:D A(1L•Nf sm FI.I. $ PFRMIT GRANTEDc? '` r 19 c3 S _\FORM U - LOT RELEASE FORM �A 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*********************** ,��i� APPLICANT D/i IZ /Z&✓ NA-1Z%/ll/D PHONE C( LOCATION: Assessor's Map Number PARCEL 5 SUBDIVISION LOT (S) � STREET S((OLC f Ate- ST. NUMBER_ OFFICIAL USE ONLY** *** ** *************** * RECOM,NF215kTIONS OF TOWN AGENTS: CONSER A ION ADMINISTRATO DATE APPROVED -5 lob I Iffl n DATE REJECTED COMMENTS' I U�0"L ' OWN PLANNER DATE APPROVED DATE REJECTED COMMENTSU ll��2Q,S ' Q- FOOD INSP TOR-HEALTH DATE APPROVED DATE REJECTED E C I CTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS 77—: PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE i rI :iecci' ik :.,.�._.. .. ..... .. /yea (`` ✓�ee iiia�ni ��ineoreu�eal,( r�./�i�inaa�fiwifa.C(e �—\ HOME IMPROVEMENT CONTRACTOR Registration 124961 Type - INDIVIDUAL Expiration 09/17/99 Darren Marino 17 Williams St G��o�ieoW �e-��1 uen MA 01844 ADMINISTRATOR NORT�y o o _ = ove r 0 No. Z . / * 7-- * 8 19`cr - over, Mass., 62 s LAKE .. S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System p D BUILDING INSPECTOR THIS CERTIFIES THAT.................................... s..............� .. .l .I.! .. .................................................... Foundation buildin son.:....�. ........ �'"`.(. .�. .......... ....�... .......... Rough has permission to erect .... .. 9 Chimney .l. ..... to be occupied as................z4�.d:���.c7-!J........ .......� .................................................................................. .. provided that the person accepting this permit shal in every respect conform. onform 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LJNLESS CONSTRUCTION ST ei� Rough Service ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ^•„'L.F"�^Yv'ti'Y� .S�'r��wY-�..:"tri�a"+'�vy`VIF.. Vw�::Ss�n.+1++.ev�^"-'�a�.w..�G^'. -. -F 'S_-A`�..l' Dat..... .71................ 2 19.62 Ota+qac �a1ti �o� TOWN OF NORTH ANDOVER o p. PERMIT FOR WIRING ,sSACMUS� .. �'.. This certifies that ........S.a ..!..Gt....+...... ....................................................... has permission to perform ........ ........Se. .J. �. .e wiring in the building of.....1Y.l. C. ..! ...:..........:. ' at.. .�...3............OR.c�0.�...... :.t/ELECTRICAL � ,North An ver.r.......s� Fee. U Lic.No. Pr A %.f�.....,.... ..... .. .INSPECTOR - 1-233 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 3 f Oftlee Use Only :( use (f ammo ialth ofriPermit No. 11tvM tntnt Ef Public *afrtq Occupancy A Fie Chocked BOA RD OF FIRE PREVENTION REGULATIONS 521 CMR 12.00 3190 Pam blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, S27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Q or Town of NORTH ANDOVER To the Inspector of Wlns: n; The udersigned applies for a permit to performAhe electrical work described below. r Location (Street & Number) Owner or TenantC Owner's Address ��� rru0 1. •.;I. Is this permit in conjunction with buildi � / .. �g permit: Yes 'Y No ❑ (Check Appropriate Box) Purpose of BuildingA Utility Authorization ,No. . Existing Service ao Amps . moi' a volts Overhead '.1 Undgrnd No. of Meters � .4 ' New Service Amps ._J Volts Overhead Undgrno r No. of Meters Number of Feeders ano Ampacity ( ti Location and Nature of Proposed Electrical Work 0r OGII-5 n V', S7c tC Q C(A t61 No. of Lignting Outlets I No. of Mot acs I No. of Transformers Total 4: VA No. of Lighting Fixtures i Swimming Pcoi Above.— In- grr.a. _ grno. _ Generators KVA No. of Emergency Lighting, ,, No. of Receotacie Outlets No. of Oil turners I Battery Units No. of Switch Outlets I No. of Gas _um.ers FIRE ALARMS No. of Zones R!: No. at Ranges No. of Air C-,r.c. otai No, of Detection and a :Cris Initiating Devices No. of Disdosais I No.ot Heat To:af Toter : Pur,.cs :ons KW No. of Sounoing Devices No. of Sed Contained No. of Dishwashers SoacerArea �+eatir.o K%Y Detection/Souneing Devices No. of Dryers I Heating Cevices KW Locai ; Municipal ^Other Connection • it a No. of VO. of Low Voltage r No. of Water Heaters KW I Signs ?aflasm Wiring f,. I No. !-fycr0 Massage Tubs I I No. of Motcrs Total HP 'r , K, OTHER: f INSURANCE COVERAGE: Pursuant to the reoufrements cf ',tassacr.csers ;eneral Laws I have a current Liaoi ity Insurance Policy inctuafng Cmc:elec Ocerations Coverage or its substantial equivalent. YES = NO = I have suomrtted valid proof of same to the Office. YES = .14 01Qfynave checxea YES. please inoicate the type of coverage oyChecking theiDpro late Dox.INSURANCE 2' 80N0 = OTHER = (Please Scer.",i) Estimated Value of E!ectncal work S L _ (Exotration Oriel Work to Start Insoecaon Date Racces:ec: /R ,Fn Final r g.. Signed unser((•h Penalties of pe u _ FIRM NAME -' LIC.NO. Licensee S r.a; re UC.NO. fT•I1 y l s us. T.I. NO. .S-0 rR,6 S—.p qR 5` ! Aodresa ' Alt. Tel.No, FL OWNER'S INSURANCE WAIVER: 1 am are that the License C es not nave the insurance coverage or its autistantlal equivalent as ro-t; ouirea by Massacnusetts General laws, ana that my signature t fs :ermft aoprtcation waives this requirement. Own e Agent (Please check oner 'e eonone No. PERMIT FEE S } (Signature of Owner or Agenn C�(L /f o{7,3- P "C w•b366 i� Date.. ............... No 2Ji2 NorerM °••"'° '•�"� of TOWN OF NORTH ANDOVER 3: •..r -..._• p PERMIT FOR WIRING A • ,(, � s s i ii�_�-� ' • �,SSACHUSE� This certifies that .,---,.................................................... '� , ............. has permission to perform :.:.................................. ................................... ..... wiring in the building of ..............y z ............................................................... r..... � . ..................................� �-- .North Andover,Mass. Fee.`.. ............. Lic.No.l'...'...... ............................................................... ELEcriucALINSPECPOR ()8/25/9813:50 35.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 315-CPO Office Use Only Permit No I ?, �eti71CnL072ZI/�i�.C?; rY��1!✓�SS (�r+nlSF. $ Occupancy&Fee Checked Dt�artiuit�P�!/e Spry I BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts,Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 8/5/98 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 63 Bridle Path Rd. Owner or Tenant James Mederios Owner's Address 63 Bridle Path Rd. Is this permit in conjunction with a building permit Yes (X No ❑ (Check Appropriate Box) Purpose of Building Home Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Eiectncal Work Burglar Alarm System Total No.of Ughtsnq Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency lighting No.of Receptacles Outlets No.of Oil Bumers Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Dioosal No. Pum s Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Soace/Area Heabnq KW OetectioruSounding Devices ❑ Municipal ❑ Other No.of Dryers Heatinq Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Sailases Wiring Burglar Alarm Vo.Hydro Massage Tuds No.of Motors Total HP OTHER INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts 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 the Office YES= NO = Ifhive checked YES pl16a7ylicate the type of coverage by checking the appropriate box INSURANCE = BONO = OTHER = (Please Specify) Insurance 99 (Expiration Date) Estimated Valu q o�F�ei l Works 2-000.00 Work to Start Wit t Inspection Date Resquested Rough Final Will Ca 1 1 Signed under the Penames of penury: FIRM NAME Inte n LIC.NO. 0001 1 5 licensee Glen A. .Smith Signature LIC,NO. 90MR Bus.Tel No. 603 893-8803 Address 40 Lowell Rd. Unit 2 Salem N.H. AItTeI.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivaient 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 5_�- (Signature of Owner or Agent) t % 1 ) 7 $ Date...'E.'.19.....0,.-. Of�IORTM gti0 o: ,� TOWN OF NORTH ANDOVER '° PERMIT FOR WIRING �SSACHusE� This certifies that �.J. ,: :": ...... ......................... has permission to perform .......................... ............... wiring in the building of................ --� :........../.................................................. at...... .3.. /. Z��.... ll........... ,North Andover,Mass. ......� ��,,---- uJ 791 Fee�!t,7..'....... Lic.NoA. ............................................................... iLEC MCAT.I pEcroR 08/46/98 14:13 125.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachuse "Ce `'Se Y Department of Public Safety Prrrit w: tcked— BOARD OF FIRE PREVEN11ON REGULATIONS S27 CMR 12 (leave blank) 3/90 Occupancy b Fee a blank) APPLICATIOvmrk N �obe FOR m�PERMIT TOrdance udih � PERFORM a�ELEC Code. 527 ELECTRICAL WORK R 12:00 (PLEASE PRINT IN INK OR TYPE AILI. INFORMATION) Date �l3'qd' City or Town of n�p r n o Vc r' To the Inspector of Wires: The undersigned applies for a permit too perform the elect ical work described below. Location (Street &Number) l� 3 1 ) I" Q'L �C, Owner or Tenant Owner's Address h1 e— Is this permit in conjunction with a building permit: Yesp No ❑ (Check Appropriate Box) Purpose of Building R?_6iLJicl 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 No. of Lighting Gullets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures - Swimming Pool Abogrnve❑ In-d. grnd ElGenerators �.No. of Receptacle Outlets, n No of OL1 Burners ;n No 'of�Emergency Lighting y.h t .. t .. . Batter UnLt5 ' } No. of„SwLtchxOutletsof Zones t No. of hGas,Burners FIRE AI ARMS No. No. of RangesNo. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Heat Total Total Pum s Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. o f Self ContaineDetecding Devices No. of Dryers Heating Devices KW Local 0 Municipal Connection❑Other No. of No. of Water Heaters KW No,Sigf nsBallasts WirLow ng Voltage No. Hydro Massage Tubs No. of Motors Total HP OTHER: { INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO Q._L_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 box. INSURANCE Value BOND F] OTHER❑ (Please Spec if ) C o PJrGL4,),,j Li Qfj r ri, LCC Estimated Value of Electrical Work $10 O V p Ex iration Date Work to Start Inspection Date Requested: Rough 6 Final \1/ Signed under the penalties of /Iperjury: FIRM NAME I h CL f El c t"i C- 0. 1n C, _LIC. N0. 67 Licensee Signature l/i LIC. NO. Address -11L R vZrL 01203 Bus. Tel. No. Alt. Tel. 014NERIS INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) 00 Telephone No. PERMIT FEE S S Signature of Owner or Agent Date.,7 H' 3770 NORTH ?�.,�-•°.;•��co TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING SACMUs� ! This certifies tha . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform ,. . . . . M s plumbing in the buildings of . .. . . . . . . . . , , . , , at. z�. . . . . , . . . . . . . . . . . ., North Andover, Mass. � Y t FeeLic. NWeF1A*f�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR e 07/29/98 09:21 80.00 PAID WHITE:Applicant CANARY:Building Dept. PINK:Treasurer . � I l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ype or print) a I NORTH ANDOVER,MASSACHUSETTS Date Building Locations /off Permit # Amount go 4;&�/WA—s Owner's Name New Renovation © Replacement 1:1 Plans Submitted n FIXTURES w a a d d d ►dl S A A d F � a oa SLBBQm B'1g1Vlm M 11" JL ZD FLOCK Z M RO(R 4M FI.O(R 51H FID(R 6M IWIR 711-1 RIM SIH F19R (Print or type) r f Check one: Certificate Installing Company Name I0�A Corp. t Address 3 u.AA(V[P S i Y �4 KE Partner. Business Telephone --�� r Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 5��+ Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been mdde aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent F1 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 L compliance with all pertinent provisions of the Massach efts S Plumb' g de and Chapter 142 of the General Laws. By: wgnafure or Licenseuu Type of Plumbing License Title wz7 1 a City/Town License Numuer Master Journeyman APPROVED(OFFICE USE ONLY