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BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit No. -__1c+5 -
Occupancy &Fee Checked, --
3/90 (leave blank)
APPLICATION FOR PERMIT.TO PERFORM ELECTRIfCALR 12:ooWORK
All work to be performed in accordance with the Massachusetts Electrical Code, 52/ M
Date
(PLEASE PRINT IN INK OR TYPE ALJ, INFORMATION) 10 the Inspector of Wires:
City or Town of -" --
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address -- -
Is this permit in conjure&;tj
n wth a buil ing permit: Yes ❑ No
(Check Appropriate Box)
Purpose of Building - C -A, _- —.•-- Utility Authorization No. _ _-----
Existing Service Amps _J
Volts Overhead ❑ Undgrnd ❑ No. of Meters
P
New Service
Amps _J VGIIS Overhead ❑ Undgrnd U rfo. of Meters —
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work --__.._____— ----------- --"-
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws _
YES N
have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivatent. e
' 1
have submitted valid proof of same to the Office. YES !_+ NO t.' 11 you have checked YES, please indicate the type of coverage by
checking the opriate box._ --
INSURANCE BOND C; OTHER r_ (Please Specify) __.__ ------ -- -' (Expira
Estimated Value of Electrical Work $—
Work to Start Inspection Date Reque, ed:R h _. __-. - -.._-- F I _,------------".
Signed under the Penalties of perlurY:
IC. NO. -->----
FIRM NAME ---
Licensee -
Signnhu„ - LIC. NO. -- -- --- =
..._ .._ -�- --- ..
-- -- - -- --- s. Tel. No _—-----.—.. --- -
All. Tel. No _--------- -
Address _ — -- ----- _ ..._ -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee clues not ha t Insut:rnce coverage r its ubstantial erlulvalenl s re-
quired by Massachusetts General Laws, and that my signat'.rre on 1IM; permit � plication waives this r quirernenl, Owner gent
(Please check one)
lolephone 1.10.
(signature of Owner or A(port) x.rSr 5
---
Total
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers KVA --
Above In-
Swimming Pool grnd. ❑ grnd. ❑
Generators t<VA_—_-_-
No, of Lighting Fixtures
-
No. of Emergency L:chting
No. of Receptacle Outlets
No. of Oil Burners -_- —
Battery Units
No. of Switch Outlets
No. of Gas Burners _- -
FIRE ALARMS rte OI Zones
No. of Detection and
Total
No. of Ranges
No. of Air Cond. Ions
--Total
Initiating Devices _
Ilo. of Sounding Devices ---
No. of Disposals
No.ol Ileal Total
Pumps Jbns KW
No. of Sell Contained
No. of Dishwashers
Space/Area Healing -- KW —
Delection/Sounding Devices -- —
C 1 Municipal r� Other
Local connect:on
Iiealing Devices KW
No. of Dryers
-
No. of Water Heaters KW
No. of -- No of
Signs Balla_ls --
Low Voltage.() I
Wiring —L✓l
—
No. Hydro Massage TLibs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws _
YES N
have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivatent. e
' 1
have submitted valid proof of same to the Office. YES !_+ NO t.' 11 you have checked YES, please indicate the type of coverage by
checking the opriate box._ --
INSURANCE BOND C; OTHER r_ (Please Specify) __.__ ------ -- -' (Expira
Estimated Value of Electrical Work $—
Work to Start Inspection Date Reque, ed:R h _. __-. - -.._-- F I _,------------".
Signed under the Penalties of perlurY:
IC. NO. -->----
FIRM NAME ---
Licensee -
Signnhu„ - LIC. NO. -- -- --- =
..._ .._ -�- --- ..
-- -- - -- --- s. Tel. No _—-----.—.. --- -
All. Tel. No _--------- -
Address _ — -- ----- _ ..._ -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee clues not ha t Insut:rnce coverage r its ubstantial erlulvalenl s re-
quired by Massachusetts General Laws, and that my signat'.rre on 1IM; permit � plication waives this r quirernenl, Owner gent
(Please check one)
lolephone 1.10.
(signature of Owner or A(port) x.rSr 5
1-205
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... ....-........... ...........:a............. ...... ..... r.......................
has permission to perform�rr...� .................-'...............
wiring in the building of
f �� `'�",................ .North Andover, Mass.
at............................................................
Fee—?O , .... Lic. No. 113AB ................................................................
ELECTRICAL INSPECTOR
10/10/97 11:15 35.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Date .. f ............. ` ... .
TOWN OF NORTH ANDOVER
' PERMIT FOR GAS INSTALLATION
This certifies that. ::.:.........:`......................... .
i'
has permission for gas installation ........................... .
in the buildings of ..........................................
at ................................... . North Andover, Mass.
Fee......... Lic. No........... ..........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
1
MASSACHUSETTS UYVORM APPUCATON FOR PERMIT TO DO.
Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
3uildine Locations
Owner's Name
"yew 7 Renovation ❑ Replacement 1"
P« s# 3 3 T6
AS
C►.1d �0. r�r
Plans S mitted C] 4'
Print or type) Check one: CertiCtc,aie Installing Company
`:ame Andover Plb4. & Ht4. Co., Inc. Corp. p1?9
-;dor--Ss 20 Agean Dr. , Unit -10 ❑ Partner.
usiness Telephone
,:me or Licensed Plumber or Gas Fitter
❑ Firm/Co.
SUfL-\ivCE COVERAGE Check one:
have a current liability Insurance policy or it's substantial equivalent. Yes ❑ NoQ
t .,ou have checked ves, please indicate the type coverage by checking the appropriate box.
lin insurancepolicy 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:
Sienarure of Owner or Owner's Agent Owner ❑ Agent »
nerehv certify that all of the details and information I have submitted (or entered) in above applicationa„t.and accurate to the.
t oi' my knowledge and that all plumbing work and installations pertbrmed under Permit Issued for this, ag 4cadon will be in
:ompiiance with all pertinent provisions ofthe Massachusetts State Gus C and Chapter 1 1 o Ganerw.l'aws.
Town
.-,PP 0VEDiUFnch:USEONLY)
Signature of Licen4d Plumber Or Gas Fitter
[Plumber 9983
�as Fitter LicenSe Number
lasfer
❑ Journeyman
140
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Print or type) Check one: CertiCtc,aie Installing Company
`:ame Andover Plb4. & Ht4. Co., Inc. Corp. p1?9
-;dor--Ss 20 Agean Dr. , Unit -10 ❑ Partner.
usiness Telephone
,:me or Licensed Plumber or Gas Fitter
❑ Firm/Co.
SUfL-\ivCE COVERAGE Check one:
have a current liability Insurance policy or it's substantial equivalent. Yes ❑ NoQ
t .,ou have checked ves, please indicate the type coverage by checking the appropriate box.
lin insurancepolicy 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:
Sienarure of Owner or Owner's Agent Owner ❑ Agent »
nerehv certify that all of the details and information I have submitted (or entered) in above applicationa„t.and accurate to the.
t oi' my knowledge and that all plumbing work and installations pertbrmed under Permit Issued for this, ag 4cadon will be in
:ompiiance with all pertinent provisions ofthe Massachusetts State Gus C and Chapter 1 1 o Ganerw.l'aws.
Town
.-,PP 0VEDiUFnch:USEONLY)
Signature of Licen4d Plumber Or Gas Fitter
[Plumber 9983
�as Fitter LicenSe Number
lasfer
❑ Journeyman
+Location /
r
No. . Date ( 2
TOWN OF NORTH ANDOVER
OL
p Certificate of Occupancy $
+ ; , Building/Frame Permit Fee $
Foundation Permit Fee $ �-
cMusE�
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL ($ 3
/ Building Inspector
�117p-698 15:11 31.00 PAID
Div. Public Works
tLocation
No.
0
Date
NORT"
TOWN OF NORTH ANDOVER
o
3?',t`•O •,4,
n
Certificate of Occupancy
$
'
Building/Frame Permit Fee $
b•••° '�
u+ustt
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
t
Building Inspector
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Div. Public Works
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TOWN OF NORTH ANDOVER
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization,
n
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at lean one butresidence or build ng" be done by regt more than four eistered ng (contractors,
structures which are adjacent to such resp
with certain exception, along with other requirements.
1(9f�U1� Est. Cost
Type of Work: Ju [S
Address of Work,
Owner Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s): For office Use Only
Work excluded by law Pemit NoDate f.
4*y
_Job under $1,000
Building not owner -occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
CONTRACTORS
OWNERS PULLING THEIR OWN
IMPROVEMENT WORK4LING DO NOT HAVE ACCESS TOTH DTHEE ARBITRATION
FOR APPLICABLE HOME IMPROPRO
PROGRAM OR GUARANTY FIND LINER MGL C. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date
Contractor Name
Registration No.
OR: fora permit as the owner of the above
Notwithstanding the above notice, I hereby apply
property:
t I I Z S Owner Name
Date
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COL oN
RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES
1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town
of North Andover without a valid permit from the Division of Public Works.
2. All water services shall be installed a minimum of five feet below the finish grade.
3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964.
4. Service connections shall be 1" type k copper tubing.
5. All fittings shall be brass flange type Mueller or equal
H 15202 Corporations
H 15212 Curb stops
H 15402 Three part unions
H 8185 stop and waste valves
Curb boxes shall be installed at the property line and shall be of the Erie Type with 4'/x foot rod and brass plug
type cover.
N® 1228
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.' (Gi1� 195,7
Application by the undersigned is hereby made to connect with the town sewer main in rSt e
subject to the rules and regulations of the Division of Public Works.
The premises are known as No.
or subdivision lot no.
P, � � 4) 4 1(' - /�- �er e c--, —ZZ, Z
Owner
Contractor
ve-
Street
A4 e" EgS 57
Address
A14ress
/Wpplicant's Signature
PERMIT TO CONNECT WITH SEWER MAIN
�--
The Division of Public Works hereby grants permission to L 4� r
to make a connection with the sewer main at / Fl -
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
v'p
Street
D -vision pf Public Works
By
See back for rules and regulations
RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES
1. No unauthorized person shall uncover, make any conects with
or ening intosion of Public alter,
Works disturb any public sewer
or appurtenance thereof without first obtaining a writtenpermit
om
be borne
he
wner The
2. All costs and expense incident to the installation and connections f directly
th e building sewer
eectly beloccasioned bbytthe � stallat on
owner shall indemnify the (town) from any loss or damage that Y
of the building sewer.
he
A separate and independent building sewer shall be provided
lablefor vorycanibencgon constructed torthe rear buildinge one tthrroughands at tan
3. p
rear of another on an interior lot and no private sewer is a the front building may be extended to the rear building
adjoining alley, court, yard, or driveway, the building sewer from
and the whole considered as one building sewer.
4. old building sewers may be used in connection with new buildings only when they are found, on examination and test by
the (Superintendent), to meet all requirements of this ordinance.
e methods to be used in excavating,
5. The size, slope, alignment, materials of construction ofren hull hialgl all conform tsewer, and o the fo lows g requ rements. The sewer
placing of the pipe, jointing, testing, and backfilling the t
shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall absta/8 tprencher obott mmoflhard dupablefc crushed stonesewer shall etoua
feet below finish grade. Sewer pipe shall After
installed o
After the pipe has been installed, crushed stone shall be brought up to the crown
minimum (6) inch depth below the pipe.
of the pipe. Care shall be taken to carefully grade and compact tamping nafter each Ipftpe displacement. The remainder o
the trench shall then be backfilled in one foot lifts with mechanical
possible, the building sewer shall be brought to the bflowlng to theapublic sewer, e
basement floor. in all
6. Whenever P sanitary sewage carried by such
buildings in which any building drain is too low to permit gravity
building drain shall be lifted by an approved means and discharged to the building sewer.
No erson shall make connection of roof downspouts, exterior foundation i dr Ins, or to a publiother sources
urcese f surface runoff or
7. p
ground water to a building drain which in turn is connected I y
he a licant for the building sewer permit shall notify the ( e invade ntendunder the super) when the
o supervision ing sewer is ready for
8. Tn of the (Superintendent)
inspection and connection to the public sewer. The connection sall
or his representative.
II excavations for building sewer in shall be then public
guarded d disturbed idnethencourrselights
of the work protect
shallthe
be
9• A and other pub property
public from hazard. Streets, sidewalks, parkways,
restored in a manner satisfactory to the (town).
n
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Name of Applicants BuildinA Permit (below) Address of Property for Per
Map and Parcel : Purpose of A cation (check below)
PZ-- bpr a� pplicant: Single Family _ Two Family
I Ke undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
Bylaw.
This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section "senior" shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the
environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland. The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and
commissions have been received and the project is in compliance with those permits), and the Development Schedule
does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the su ittal of misleading and or
inaccurate information, or the checking off of an above item which do n c hether done to my
knowledg? or not, is grounds fc of sal by tie B0,/ding Departme o is a it n Permit.
ature of Owner or Authonzel Agent who-si b the AttXCMed Ing-�-ermlt
form must be attached to the Building Rhrmit upon applic6tion for such
LAW OFFICES OF RALPH R. JOYCE
l • ELLIS BUILDING
95 MAIN STREET
'C/ l NORTH ANDOVER, MA 01845
RALPH R. JOYCE
July 21, 1997
Town of North Andover
ROBERT NICETTA, BUILDING INSPECTOR
120 Main Street
North Andover, MA 01845
RE: LOTS 3, 4, 5 & 6 ROSEMONT & WILDROSE DRIVES
Dear Mr. Nicetta:
(508) 685 4555
FAX 685 - 3148
I enclosed herewith as built plans for lots 4, 5 and 6.
Please note that all lots comply with the 30' set back
requirements surrounding the sides and front of the buildings.
Thd enclosures are actually a portion of a Form A plan
presently filed with the Community Development Department to
redraw the lot lines. I request as previously that we be
allowed to proceed with the framing on Lot 5 and presume that
the Form A plan will be processed by the end of the week. As
before, I assume all responsibility regarding compliance with
the zoning ordinances.
Thank you for Your cooperation.
RRJ:mjj
enc.
Very t ru 1 your's
J o"I'C e
-z,
RALPH R. JOYCE
LAW OFFICES OF RALPH R. JOYCE
ELLIS BUILDING
95 MAIN STREET
NORTH ANDOVER, MA 01845
May 1, 1997
Town of North Andover
ROBERT NICETTA, BUILDING INSPECTOR
120 Main Street
North Andover, MA 01845
RE: LOTS 3, 4, 5 & 6 ROSEMONT & WILDROSE DRIVES
Dear Mr. Nicetta:
(506) 685 - 4555
FAX 685 - 3148
Please accept this letter to evidence our discussion of
April 30, 1997 .wherein I explained my need to move the lot line
between Lots 3 and 4 to expand the building window on Lot 3,
which is presently only 50' wide. I plan on placing foundations
beginning on Lot 6 and keeping them 60 to 65 feet apart. When
the Lot 4 foundation is in place, I will swing the lot line
between Lots 3 and 4 to expand Lot 3's building window as much
as possible.
I additionally disclosed the westerly side set on Lot 6
from the as -built foundation plan shows only a 29' setback thus
requiring a lot line change between Lots 5 and 6. Rather than
bring in a multitude of plans for lot line changes, I will
proceed as above-described keeping 60 to 65 feet between
foundations at which time I will bring in a single ANR plan
showing all four lots with new lot lines in full compliance
with zoning setback requirements.
I acknowledge that you allowed me to continue with framing
Lot 6, the side line notwithstanding. I assume all risk in
proceeding and will hold the Building Inspector's office
harmless from any responsibility therefore.
Thank you for your cooperation in this effort.
RRJ:mjj
MAY I -1997
CERTIFICATE OF USE &OCCUPANCY
Town of North Andover
Building Permit Number 22/
Datei���?
THIS CER ES THAT
THE BUILDING LOCATED ON 2�-'
MAY BE OCCUPIED AS ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE WING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
MORTq
CERTIFICATE ISSUED TO-,
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(Print of Type) ru" PERMITJO DO QASFITTINQ
NORTH ANDOVER , Maas, Date
Bundlng
Location Permit #i_ �
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Name
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Installing Company NameCheck one: CertNicate
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Addr ss�Q�JJ Corp•
u Partnership _
Business Telephone )2r-Firm/Co.
Name of Ucensed Plumber or Gas Fitter
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent. Yescp one
It you have checked yea, please Indicate the No p
type coverage by checking the appropriate box.
A liability Insurance policy Other type of Indemnity p r Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does nd have the Insurance coverage required b
Chapter 142 of the Mass. General Lawn, and that my signature on this y
permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agant Owner p Agent p
I hereby certify that an of the details and Informatlon I have submitted (or e
knowledge and that all plumbing work and Installations perlormed under th
pertinent provisions of the Massachusetts Stele (,as Gbde and Chapter 112
Tof License:
THIS Plumber
GasIllter
�yffown ster
Pima
Journeyman
AITI)OWD (OFFICE USE ONLY)
.SP III' lion are true and accurate to the best of my
aPPI{catlon will be In compliance with all
- u-mizeu rnumoer or uas Filler —
Number ��% •� ! 01
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NORTH ANDOVER 4MMIA Otte . —17
Building S Parma # 3 ��
Location .
Owner's—, �—
Name le`e'Aj c 'Z- I oy �.
New genovatlon O Replacement O Plans Submitted: Yea p No. ❑
FIXTUAE9
Installing
Business Telephone..So
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. Name of Ucensed Plumber
4 '
check one: Certificate
O Corp.
O Partnership
/Co.
1 have a current liabilityinsurance `.necx one
policy or Its substantW equivalent. • Yes O No 0
H you have checked y", please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy , Other typed Indemnity ❑ Bond O
6WNER'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:
Ni7naturs ol Owner or Ownst a rae-nl Owner O Agent p
I Mr�by atlih that all of the details and infix ( have submitted W enl
�+�dpe and that aU p umbing work and installations performed under the
pertlnen provislons of a IAAasaachusetls State PlumbRp Code and Chapter
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Wynown
`'1'WAD (Off10E, USE ONLY)
are true and axwate to the best of my
feaflon will be In compliance with an
ilesnsa Number
Type of Plumbing Ucenae: Master
Journeyman 13
3375
0
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Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ..... P.6
has permission to perform .... tf 0 ..............
plumbing in the buildings of . .7-C &A Ce. . Tor. R-"' .........
at... -7.0 .. ko sib. °» A.,? 7 ............ North Andover, Mass.
Fee .8,37 .. Lic. No.. // J-779
. ..............................
PLUMBING INSPECTOR
36i) 237, 0 pAID
WHITE: Applicant C A N A IRV 'Building'' ' ' ' D: e p I. PINK: Treasurer
yJ ; Date. ... ..........!. ' .
.w_.. ,r•
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATIONA
(QOJ1
[LJ
This certifies that ... ' 7 ` : �............. , ..... .
has permission for gas installation ' ...............:
in the buildings of ... '!.: s �..... ' "� :. ' ........... iS
at %` ............f .. ......TASINsPECTOR
/ Andover, Mak.
Feer— . No.... f ��. �... .......... �.
ry��rj
WHITE:: App c n CANARY: Building DNK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION :FOR.PERMIT; TO:DO'PLUMBiNG
(Type or Print)
NORTH ANDOVER ,Mass., . Dater Q"'M
Building Location 20- Permit Va.. '
�e
? _ Owners Name
v " New Renovation Replacement Plans Submi4dJ;#
FI TURES
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Installing Company Name QWlllj 6 Corp.
Address �, Partner.
a-evt�eiyG� �� Ql�y�
J��CFirm/Co.
Business Telephone
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the
a ro t b
I've prla a ox.
Liability insurance policy �Other
Insurance Waiver: I, the undersigned
this application does not have any one
Signature of owner/agent of property
type of indemnity El Bond
have been made aware that the licensee of
of the above three insurance coverages.
OwnerAgent',
i:.
entered) in ahrrvc application are true an late to fire best of my
1, d for this application will be in compliance with all perlinept pto•.'d
. I hereby certify that all of dre details and information 1 Dave Submiticd
—• - knowledge and that all plumbing work and installations Irer(ormed under rev
visions of the Massadtusetts State Plumbing Code and Clupter 142 of Alre pcn
By
Title.
City/Town:
APPROVED ZOFFICE USE ONLY)
ignature of Licensed Plumber
0,T pe of Plumbing License
License Number ❑ Master ❑
Journeyman
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7TH FLOOR
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(Print or Type) Check one: Certificate .i.,
Installing Company Name QWlllj 6 Corp.
Address �, Partner.
a-evt�eiyG� �� Ql�y�
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Business Telephone
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the
a ro t b
I've prla a ox.
Liability insurance policy �Other
Insurance Waiver: I, the undersigned
this application does not have any one
Signature of owner/agent of property
type of indemnity El Bond
have been made aware that the licensee of
of the above three insurance coverages.
OwnerAgent',
i:.
entered) in ahrrvc application are true an late to fire best of my
1, d for this application will be in compliance with all perlinept pto•.'d
. I hereby certify that all of dre details and information 1 Dave Submiticd
—• - knowledge and that all plumbing work and installations Irer(ormed under rev
visions of the Massadtusetts State Plumbing Code and Clupter 142 of Alre pcn
By
Title.
City/Town:
APPROVED ZOFFICE USE ONLY)
ignature of Licensed Plumber
0,T pe of Plumbing License
License Number ❑ Master ❑
Journeyman
Date9. /'7� -.�
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING a
�8j
This certifies that .... ... .. .
}
has permission to perform ... r .... ........
plumbing -in the bui dings of .5?G........... - . .............
/ ,North Andover, Mass. co
Fee. /V ... Lic. No...... 7.4.0 ............................. .
d PLUMBING INSPECTOR
f ir'L.•
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer