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Home My WebLink AboutMiscellaneous - 72 COMPASS POINT ROAD 4/30/2018�� . - f \ 7 i ��. .. 'ln\v/` n - ` c� �. �, � . � � �. i 1 - `. ,, 1 ,. _ � ,.. ,. �, �. .' (." _ �. �; s - �' _ . �_ — �s l � _,. �. �� k LY �. �. �, k. ... '- FFr - . .. _ i � - � - .. t� � � � _, � � ., r .. ... ,_ _ -. �* _ _ \. , ,, ,Y - .. '. ,� _ '� a Date ....)/�//6 ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that......./-/'C-�/ C-a�e 0 - .......................................... A. ....................................... . has permission to perform �"'. .....'`� �.- ..................................................................................... wiring in the building of....,.,.,.//..,/...,.,,7e ........................................................................ at ... „.......................Q..H...N hAndover,Mass. ... ...... . Fee !*F...... Lic. No.1.� ................ ELECTRICAL INSPECTOR Check # ��" �� Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. I a� 1 ,� " Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspect r f Wires: By this application the undersigned gives notice of his or her intention t r orm the electric ork descri , ed b V. Location (Street & Number) ll' Owner or Tenant JfAcor-iftr4pTelephone go. Owner's Address I a- Com,% Lj � S' Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate )Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / ao Volts Overhead ❑ Undgrd ro No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed LuminairesNo. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones v1 No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number .......................................................... Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters I Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: - Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3 a a > (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑BOND F1 OTHER El (Specify:) I certify, under the pains and penaltie ofperjury, that the information on this application is true and complete. FIRM NAME:. C CaR LIC. NO.: Licensee: Ali 9chS 0u,411!� Signature LTC. NO.: (If applicable, enter "exempt" in the license number line) Bus. Tel. No. - Address: Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. __ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the e permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed ' on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an \1� 4 electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signat e: Date: ROUGH INSP CTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: 4 ZI 09 Inspectors Signature: Of Date: — ) — /S FINAL INS ECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com -,.The Commonwealth of Massachusetts F Department of IndustrialAccidents M _ r I Congress Street, Suite 100 0. Boston, MA. 02114-2017 • -; • � SV.ywww.mass.gov/dia °ten. . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piwoabers. OBE FILED WITH THE PERMTI f1 NG AUTHOIUTY. • T Blease Print Le 'bl A • • licant Information Name, (Business/Organizatlon/fndividual): prl T { It P Address: City/State/Zip: Vi 1 N -4;Q Are you an employer? Checicthe appropriate box: Phone #: 1.Q I am a employer with employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. (No workers' comp. insurance required.] In I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6. Q We are a corporation and its, officers have exercised their right of exemption per MGL c. 152 61(4) and We'liave no employees. [No workers' comp. insurance required.] Type oftproject (required); 7. ❑ New'construotion 8. Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 1Z[] Plumbing repairs or additions 13%[] Roof repairs 14.[] Other *Any applicant that check's box 41 must also fill out the section below showing their workers' compensation policy information: Homeowners who submit• this affidavit indicating 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 (hose 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 the policy and joh site information. Insurance Company Name:_n Svc G Q L• # �aQl� I da�110� �1- Expiration Date: _ `40\5 Policy if or Self -ms. ic. /� (� r f , Job Site Address: ` 1 L C J e -R � City/State/Zip: �w 1' PrP Attach a copy of the workers' compensation policy declaration page (showing the policy nuniber and expiration date). Failure to secure coverage as requited under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a and/or one-year imprisonment, as w ay be forwarded to the Office of Investigations of the DTA for insurance day against the violator. A copy of this statement m coverage verification. Ido hereby cert under tliepains andpenalties oftlerjury that the information provided above is to and correct. 5 Official use only. Do not write in this area, to he completed by city or town official. City or Town: permit/License Issuing Authority (circle one): i 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is' d'efuied as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enferprise, and including the legal representatives of a deceased employer, or the receiver'dr trustee of an individual, partnership, association or other legal entity, employing employees.. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to opdrate a business or to construct buildings in the commonwealth for any applicant who: has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of ludustrial-Accidents. Should you have any questions regarding the law or if you are required to obtain aworkers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia fav,. COMMONWEALTH OF MASSACHUSETTS A :,3 Date .... .... 7/.....`.? .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... z /I ` ".` ` /, � ' - " I/ %, � r , .................................................................................................... has permission to perform ... �' .........:�.......f...... . ".'.-- wiring in the building of.......... L/ ! w ....................................................... ........................... at .... 7�..... `.......`. "..........4 f` .....:..... .............................iCAL rth Andover, Mass. Fee. �.f..�.. ...." ..... Lic. No. t. �.��`2 .... .t11.�.4-:�............... ELECT INSPECTOR Check # ` 4 • R j.r LL Q 2 0 H I2 �r r I r Y � U .ry �s Ai y� II "1, 6 7 Date ... 5 1-; R 7- / .... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING "r IeA, 4e / " �le-� Thiscertifies that ....................-/ /60– ............................................................................... has permission to perform .....N.:PN..... ..... ...... A."L-a— ................................................. plumbing in the buildings of........ .......................................... at ................................ (Lr ....... ........ . P. - ". .1 .... ....- ................... North Andover, Mass. Fee..'.4-1...'.9. ..... ? ........ Lic. No/3.o/"?/ ........ ................................................................................. Check # 7eqq_ PLUMBING INSPECTOR TCITY POWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK NORTH ANDOVER MA. DATE 5-27-15 PERMIT # � )1� JOBSITE ADDRESS 72 COMPASS POINT OWNER'S NAME TRUST CONSTRUCTION ADDRESS: 51 MT JOY DR TEWKSBURY MA 01876 TEL: 978 851 3456 FAX: OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL Q NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXUTRES Z FLOORS— Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER 1 DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT 1 FLOOR / AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK 1 LAVATORY 1 1 ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES 1 WATER PIPING 1 SPIGOTS 2 r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY N 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted (or entered) regarding this application are a nd accura o t best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application. pplication III i omp' ce h all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME: MIKE BURKE LICENSE # 113127 SIG URE COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP ADDRESS: PO BOX 8 CITY: PLAISTOW STATE: NHJ ZIP: 103865 _ FAX: 6033780040 _ TEL: 116O31780020^ _ _ CELL: 119784909385 1 EMAIL: J.LAURENCIO@POWERHOUSEPLUMBING.COM MASTER ❑■ JOURNEYMAN ❑ CORPORATION X # 2482„ __J PARTNERSHIP ❑ # LLC ❑ # H O z z O F U a � z a � d z w � oEl Z Z O w H ;D W °z CL LLI 3 LU O a a W�W C4 w P4 O w 3 N a O o a a � w a � U J d IL a � w = W 1- LL rA w H O z z O F U W a z a �a. x a I Date ...... .7.... ............ . is TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..............................................� �i.�... .............................................................. has permission for gas installation .......N.....�!- ......f 1.<,h,. ........................... in the buildings of ..........%..! .f.i"..:....��r. �.5<.................................................. at .......... 2 ....... 6-�-�/� ss...........e ............. . North Andover, Mass. Fee./...b b..-...... Lic. No../ I........................................................................... Check # 7b / �( GAS INSPECTOR 0IJ8z I hereby certify that all of the details and information I have submitted (or entered) regarding this application are nd acc to a best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applicatio ill a in nc 'th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASFITTER NAME: I MIKE BURKE _� LICENSE #1 13127.-_ _ IXGNATtRE COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP ADDRESS: _P0 BOX 896____ CITY: PLAISTOW _ _ .�T STATE: NH ZIP: 03865 —� FAX: 16033780040 TEL: 16033T8LOZO CELL: 9784909385 EMAIL: EMAIL: HEATING.COM -71 MASTER❑■ JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION ❑■ # 2482. ____ PARTNERSHIP ❑ # LLC ❑ # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK — TYPE OR PRINT CLEARLY CITY NORTH ANDOVER MA. DATE 5-27 15 PERMIT # I �^ JOBSITE ADDRESS 72 COMPASS POINT OWNER'S NAME JJRUST CONSTRUCTION OWNER ADDRESS: 151MT JOY DRIVE TEWKSBURY MA TEL: 978 851 3456 _ FAX: OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL R NEW: ❑■ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXUTRES Z FLOOR— Bsmt 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 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES R NO ❑ If you have 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 AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted (or entered) regarding this application are nd acc to a best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applicatio ill a in nc 'th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASFITTER NAME: I MIKE BURKE _� LICENSE #1 13127.-_ _ IXGNATtRE COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP ADDRESS: _P0 BOX 896____ CITY: PLAISTOW _ _ .�T STATE: NH ZIP: 03865 —� FAX: 16033780040 TEL: 16033T8LOZO CELL: 9784909385 EMAIL: EMAIL: HEATING.COM -71 MASTER❑■ JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION ❑■ # 2482. ____ PARTNERSHIP ❑ # LLC ❑ # `F O z w w Q z w op Z a �O z } o � w WzIL LU H LU LU Q 3 N a O o a � v J IL a w a � w x w U- W F O z z 0 U W a LeiF z C7 C7 D O a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations W 1 Congress Street, Suite 100 W Boston, MA 02114-2017 ..°v www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): POWERHOUSE PLUMBING CORP Address: PO BOX 896 /State/Zip: PLAISTOW, NH 03865 Phone #:6033780020 Are you an employer? Check the appropriate box: I. F01 I am a employer with 6 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 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.: required.] 5. F-1 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 reauired.l Type of project (required): 6. Q New construction 7. [] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ 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 indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors 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 the policy and job site information. Insurance Company Name: HARTFORD UNDERWRITERS INSURANCE COMP Policy # or Self -ins. Lic. #: 04WECIT2480 Expiration Date: 7-28-15 Job Site Address: 72 compass point City/State/Zip: N Andover Ma 01845 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 of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year ',yriprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the 4 lator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of 0A for i ance coverage verification. I do herebycer ify de e r s and penalties of perjury that the information provided above is true and correct. - - _ 5-27-15 60:S3780W0 Official use City or Town: Do not write in this area, to be completed by city or town official. Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Location No p�,f4� " �S Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ U Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL s LM Check # / �� • tiiiding inspector