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HomeMy WebLinkAboutMiscellaneous - 73 LINDEN AVENUE 4/30/2018O Date.?����'.� . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....4 ...� has permission to perform ..... ....... plumbing in the buil/dings of .......................... at, �/A ......... North Andover, Mass. Fee c9 : t0 . Lic. No .......... ..... � . :.l?� ......... . /� PLUMBING INSPECTOR Check #� 7316 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS j -4P—Date �GA-) - Building Location -131- /'4' a -P'�- - Owners Name D U i Permit # A `/ Amount New M Renovation 1:1 Replacement 011� Plans Submitted Yes ❑ No (Print'or type) ///� ^(�, /f / Check one: Certificate Tnetallina('mm�anvName � 7 !/� C AUt J- 1 1 COPD. Address ra i�d y- A 'f /1 - c( 5 r 11 Partner. . Li U A-, c4 t7Lie Li.r Business Telephone 1 -2 6- & (o - 0 O irm/Co. Name of Licensed Plumber. I Jy b 5 --., -,-- Insurance Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity ❑ Bond ❑ 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 Owner 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 Massa s State Plumbi g Code anc Chaptqj,442 of the General Laws. By: Signature of Licenseaer Type of Plumbing License Title City/Town License NumDer Master 0-- Journeyman El APPROVED (OFFICE USE ONLY .j •Y (Print'or type) ///� ^(�, /f / Check one: Certificate Tnetallina('mm�anvName � 7 !/� C AUt J- 1 1 COPD. Address ra i�d y- A 'f /1 - c( 5 r 11 Partner. . Li U A-, c4 t7Lie Li.r Business Telephone 1 -2 6- & (o - 0 O irm/Co. Name of Licensed Plumber. I Jy b 5 --., -,-- Insurance Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity ❑ Bond ❑ 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 Owner 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 Massa s State Plumbi g Code anc Chaptqj,442 of the General Laws. By: Signature of Licenseaer Type of Plumbing License Title City/Town License NumDer Master 0-- Journeyman El APPROVED (OFFICE USE ONLY 4280 Date ..... l. h. -A2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......7 Al�y......�FA.............................................. ` � l�tiP Gia o � ha; permission to perform ..f! NCp..... �...... �............................................ wiring in the building of ....."a.`''. S ©v S a ............,................................................ 6-f!'4D "' ` J "''......... , North Andover, Mass. ..... Lic. No..J�.���.$ £ J...�'i.....�. t Fee.............. ........ ......... .................... ELECTRICA INSPECTOR Check # �5 7'HECOMMONWEAL7HOFAL4SSACHUSETIS Office Use only DEPAR7[AIDVT0FPUX1CS4FE7Y permit No. BOARDOFFIREPREVEMONREGUI HONS527CMRI2M Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ✓rl (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date U� Town of North Andover To the Inspector of fres: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes UQ No M (Check Appropriate Box) Purpose of Building restO'^ [_es Utility Authorization No. _ Existing Service G d AmpsG%*/ Ift Volts Overhead ® Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work «levo • Z IN. A301blefle No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ound round No. of Receptacle Outlets O No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- lbawaamatLmb&ykwxmmPbkynxixkgCaTVW2LaawmCoverdWcrgssbswbaleqzvabt YES �' NO Ihawsubrr&dvi dptoofofsametoft0ffi e YES j-? IfycubawdrdodYES, pleMirr5c*thetypeofcoverageby drekirlgdie appta ' box 11��11 INSURANCE :l --- BOND ('�'j O�II-IQt (PleaseSpecify) E*afimDate Est Tmbd Valle of l Woik $ �1 a Irl 1 .w:�l e�s�:- •:� :al:� Signattue Rough Final G //40-SM4 SC ige" A OWNER'S P,k RA CE WAIVER, I am aware tha dr-1-icense does nothave the instuar= 13wrag and thatmysigrlattueon dmpem>itapphcation waives this mgmemmt i;Please check one) Owner Agent Telephone No. Signature ot Uwner or Agent 0 11 IT, IWIEW Alt Tel. oritsstttantialegtrivalerttasretltmedbyMaxtasetts(3erral PERMIT FEE $ &-r The Commonwealth of Massachusetts }� Department of Industrial Accidents Office of Investigations Boston, Mass. 02119 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name.- Address ame: Address City: Phone # Insurance. Co. Policy # Company name: Address City: Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,5w.00 and/or one years' imprisonment_as_weH-as_civil.penWhesinlhelmmnf-aBTOP WORK_ORD.ER,and_a.fine_af.($1jl)o.DD)-aAWagainsi_me, t understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the pains and penalties of perjury that the ird rmation provided above is true and cormd. Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town officiary J City or Town Permit/Licensing Building Dept FICheck if immediate response is reguired .0 Licensing Board p Selectman's Office Contact person: Phone A E] Health Department E] Other Location '73 1 N d1AJ /Y No. L30 Date U Q- N�RTN TOWN OF NORTH ANDOVER i? Ot 0 9 " Certificate of Occupancy $ CNUS c�' Building/Frame Permit Fee $ �a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �a U Check # 16048 Zw rGc--- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMjrpOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:DATE ISSUED: �o �a-aa� SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Liivn�n� it vr- a---2— ?� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: lt7� 0y 1 0 0 ZoningDistrict Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record a �l StioS A Name (P n Address for Service -7cl'ff —00 S Signat&eV Telephone 2.2 Owner of Record: O w ,,J L eT V �- ��.s S� � '� L r cu f� Oyu �J �' _ ✓Ks:L c'r-! � r� °la oy�� Name Print Address for Service: Dom, W, � � 9 --7 �,�f o Si nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ N611l S T+cKs uN Licensed Construction Supervisor: OS -0 License Number Z i! A k ANF ��€WI? CAle i=; /'�i9sS Address" 2 % — % Fl—(o 3 — L`o �o % Expiration Date Signature ' Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 103 S- `i l' Company Name V or Registration Number o2oaS� rA � A iy/= .� A W45lvc, = �%4SS Address �J tta+� �% �� •?" 6�7 Expiration bate Signature Telephone QA fir O z M 90 O ic r M rM _r ^^Z Y/ i SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 $ 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No....... SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 7ddltlon ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify FINIS .2 Y/ f=��vl'• Brief Description of Proposed Work: 0,c D R U a M S T Til„Ivo r-/- o f i 0 13 t l=/niin JN9 vL A /:-, TO 0001 QQA95 AIV/-) f!i4c Flt Irl S7—/kI-L T RII++ ANn /300P -c . GLoc--rs IN 130!->, %(0a"*11 S. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICJAIL USE” 0NLY .: - 1. Building 1/" S o 0 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name r l Si ature of Owner/A ent Date RUM NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2 14D3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH VINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ti North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: L.L,JSS P 0C; -ss, (Loi 3R- — F`7L0wr_LL %l04 p SAA? A/. 14, of Facility) -4z L1,41fz J V�—ge I �/ Sign ture of Kermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers, Compensation Insurance Affidavit Name Please Print Name: �� I S �� C- /<s -OA/ Location: '� LAI D E N /I k�e city ND NDOvE A /V/ ss Phone # 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Comgany name: Address City Phone #: I nsurance. Co. Policy # ComppLiy name: Address Ci : Phone #: Insurance Co Policf # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as_weg-as_ciAl penaltiesjn.ihef=.d-aZTOPIN_ORKORDER.mid.a.fine d-($1AO.OA)-ajlay.-gainst-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y 1 do hereby certify �n;yand pens ies of perjury that the information provided above is true and correct. Signature Date Official use only do not write in this area to be completed by city or town official' Print name Phone.# City or Town Permit/Ucensina � Buildin De t 9 p []Check if immediate response is required Q Licensing Board E] Selectman's Office Contact person: phone #. E] Health Department 0 Other m m m m 0 m CO) 10 CD .n Z CD O 06 fm Co CL �cm O CL Q !D O c CCD �O �O . CD CA 10 CD O CD CD y■ CD y O CD CCD 0 CD ® C• Vl crc EL SO .0 CH CL ®n ® C°9 o N .m . c � = Z 0, -0 a o' CD? �O ® d C y N N o s m : c� _ �� o �� O �o .. 0 ii o Z y n O A �0 CD L4 O >w 9i: , <<' r^ = a r.. VJ m y Com. m UR C3 m o w (p `i- � o a m . n CA f e•r , O 0 low N '- =r ►Q h� N WC -CD Cj N fG ^ m Pf = m A O �� �otl: cn O 3 r bd o m 0 cn - ' CD N A r � � R �. r: C a -a r� CD d o W d z y o O 'n3 � � o n GOD b y �, o Z OOTJ b y :p n z o a� r z y C/) o 7CC) O 9 d O M M r 8 0=3 0 9 0 c '�'.:�•:�� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that..../1....�u'......................... . has permission to perform F plumbing in the buildings of -;-?-rte. - .................. at . �%,'.. ..... ...... North Andover, Mass. Fee .lt-.6.... Lic. No. �.. . -PLU J, INSPECTOR Check 5011 Location 9 No. 29 Date MORTIy TOWN OF NORTH ANDOVER Oft�•c '•��O i • OL .. 9 Certificate of Occupancy $ •� s�1C►1t15Et� Building/Frame Permit Fee $- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 15473 Building Inspecto . TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Name( t)_ Address for Service: %XI�.Sa� by Y F � �` g"�3 &Fd *� $ R3:.� ., .,x ♦ � .: F � fi ''7LSi .•.:S°` .. , _- 2. . �"'"��a BUILDING PERMIT NUMBER: 531 DATE ISSUED: I C-a4�� SIGNATURE: AA Ilk Name Print Address for Service: Building Commissioner/IEE&for of Buildings Date Parcel Number SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: TA -M Se- J S A 77) .z' L- I lo 0 a..rj . Name( t)_ Address for Service: (� Signatur ' Telephone 2 �;D&)NkSA % �i �^t.voaw *� Name Print Address for Service: Map Number Parcel Number Signature Tele hone 1.3 Zoning Information: SECTION 3 - CONSTRUCTION`SERVICES 1.4 Property Dimensions: 3.1 Licensed Construction Supervisor: Not Applicable ❑ 00 C>0 t 0o Zoning District Proposed Use License Number Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard Required Provide RegWred Provided Re 'red Provided 3 1.7 Water Supply Z.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone �k Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record TA -M Se- J S A 77) .z' L- I lo 0 a..rj . Name( t)_ Address for Service: Signatur ' Telephone 2.2 Owner of Record: �;D&)NkSA % �i �^t.voaw *� Name Print Address for Service: q -t _ 7°14Po0�� Signature Tele hone SECTION 3 - CONSTRUCTION`SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address *� C rsnrrw.tir/ Expiration Date Signature Telephone ,a / — 'l 1 3.2 RegisteAd Hom6linprovement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Si nature Telephone SECTION 4 -WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) " Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Descriution of Proposed Work (check all aonlicable ) New Construction '� I Existing Building ❑ I Repair(s) ❑ I Alt.erations(s) ❑ I Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: Ua�K 'To die 6UlLr liFF Q"K O1' go%J' Ur 6 Tt'jffury liA-4-A-C`v� A-tg4> JLbC E3Y�n�-C- LX11.2 . lcf�N ©Cum ize-A R. SECTION 6 - F.STIMATFD C0NSTR TCT10N COSTS Item 1. Building Doll Estimated Cost(Dollar) to be ( Completed by permit applicant O l7 �3FI�C�t)+IL (a) Building Permit Fee Multiplier u ,.. 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) a 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) 0 0 Check Number SEC TIU1N 7a OWNER AUTHURIZATIUN TU BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ppp�L�i as JO/Authorized Agent of subject property ' Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief a'-, k . Name D. Robert. Nicetta, Building con-Imissloner TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Sen ices '27 Charles Street lvioilh Andover, Massachusetts 01845 DEBRIS DISPOSAL FORM Telephone (978 ) 688-9545 FAX (978) 688-9542 In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of at 1 in: ?I 5,V-0 Qb U-4- L, L, A (Site location) igna�Vffre of permit applicant Date Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diozzi, Gas/Plumbing Inspector D. Robert Nicetta Building Commissioner (978) 088-9545 -.-'i'978) 688-9542 Fax Town of North Andover Building Department 27 Charles -Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Please prink DATE JOB LOCATION Number Street Address "HOMEOWNER Name Home Phone PRESENT MAILING ADDRESS_ . A City Town L Map / lot `1 S - M4- 6 10a LZ_&jq-4144 aw, Work Phone aTro Q I.A- QZ' e; e Zip Code • The current exemption for "homeowners" was extended to include awner�ccupied: dwellings of two units or.less and to allow such homegvmers to .engage an individual1br hire who does . not possess a license,. provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) .DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is irrtended to be, a one or two family dwelling. attached or detached structures ac- cessory to such use and/or faun structures. A person who constructs more than one home in a two-year period shall not be 'considered a homeowner The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-{aws, rules and regulations, The undersigned "homeawnW certifies that helshe understands the Town cf No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. . . HOMEOWNER'S SIGNATURE • APPROVAL OF BUILDING OFFICIAL A.w. FORM U .-LOT RELEASE FORM '3> INSTRUCTIONS: This form is used to verify that all necessarya _�� Boards and Departments having jurisdiction have been obtained. 'This does no Ire from lie the applicant and/or landowner from compliance with any applicable or requirements.Ve ----- ^-Arr'LICANT FILLS OUT THISSECTION*********************** APPLICANT a 5 M !�� �� A LOCATION: Assessor's Map Number SUBDIVISION_ 9 at o kt t.L_ STREET o,.>pev,) `-o Z7\) CC CO PHONE Cti_ 7g4f -o u PARCEL &,t�w _; to LOT (S) _-� L ST. NUMBER **** *** ** ****"** ****""OFFICIAL USE ENDATIONS OF TOWN AGENTS: ATION TOWN PLANNER FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ Lt) h I on DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED s DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm ATE___ 09:41 FAX 978 470 8807 ATTY. ROBERT WYMAN Q 002 MORTGAGE INSPECTION PLAN NORTHERN ASSOCIATES, INC. BROADWAY, LAWRENCE MA. 01843-3522 TEL -.(978) 837-3335 FAX -.(978) 837-3336 -OR: JAME5 M 4 BONNIE K 50U5A DEED REE: .5988 / 230 ON: 73 LINDEN AVENUE PLAN REF: 507 Ails: NORTH ANDOVER, MA 5CALE: I'= 30' aTE: 07 r 1 1 / 2001 JOB #: 201 / 05774 LOT 42 LOTS 90 4 9 1 LINEN AVENUE 11UNNEMAN MORT CORP one has been determined by scate es/sate.UntiL defn­i!�ve plans PIVD d$Tad��OT a 418Tt'L4^iat CQTYt':'Ol S2A.Ta1Q� ^eci6e elevations cannot be determined. r 45 P C. 10X Cl) m C m Cl) 0 C 10 C •� d CA C n z CO) CL n� r MW C _ � C CO) � O � c cD CD O _ C7 d CD CCD O CD C CDCD N!� d O CO) =CDI � v y O 'O Z O O .V.* 71 O CD O C CD C C =� 11, o d _ O �• fI! Q N Sno5o � CIS �m� m C7 o 44p. Z =r-0 y m & — Fn a O m CO) C y N IE o-=*rm: m S Oto �(n o z mom p CL C -+•m ,., •• to *Nb CD CDH :V o ® v 71 m ny� O o a, y ' z,JC, W � clJ� d C vC o o. a > > r �• V / EQ y y C* cl A O O o 0 V' o .Q z � Wog � O �•oo;�:� 0 CD CD aCD mi\ G CL*s I C-) „.. o b: n: a_• r►b : 0 . LEr � O row o 7 '; °� y� `+. R x Cil r 'In p? 'JO a- 'ti r mcn w � o a C� (DO �^ n a x po o a 0=3 0 0 c e 0 O ap o e � 1VIASSACHUSETTS UNTFORM APPLICATON FOR PERMITTO DO G.4,,S FITTING Y f �kType or print) Date %3 ZO) 6/ NORTH ANDOVER, MASSACHUSETTS/�nn__ j Building Locations 73 /'y�E''� �T ✓ Permit 9 ��� l Amount S 14Owner's Name t ` SU L) S New ❑ Renovation ❑ Replacement Plans Submitted ❑ (Print or type)'j` Check one: Certificate Installing Company Name 4V I loleon.-i4le /"'� �T ❑ Corp. Address (-D o X Fg) j c S ❑ Parmer. Business Telephone I Firm/co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑� No r7 It you have checked ves. please indicate the type covet -age by checking the appropriate box. Liability insurance policy❑'yam Other lupe of indemnity F7Bond ❑ Owner's [nsurance Waiver: [ am aware that the licensee does not have the Insurance coverage required by Chapter 1=42 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sianature of Owner or Owner's Agent Owner ❑ A2ent ❑ I herebv certifv 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 pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe.lassach tts tats Code a I I Chapter 142 29he Gzn��r 'Laws. By: Title C i tyi Tow n -PPRO' ED Il)FI'ICi= USE' )NLYI Signature of Q'Plumber ❑ Gas Fitter ❑' J )oumeyman seT Plumber Or Gas Fit/ter /' Z, (7 Icense Nu oer :r (Print or type)'j` Check one: Certificate Installing Company Name 4V I loleon.-i4le /"'� �T ❑ Corp. Address (-D o X Fg) j c S ❑ Parmer. Business Telephone I Firm/co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑� No r7 It you have checked ves. please indicate the type covet -age by checking the appropriate box. Liability insurance policy❑'yam Other lupe of indemnity F7Bond ❑ Owner's [nsurance Waiver: [ am aware that the licensee does not have the Insurance coverage required by Chapter 1=42 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sianature of Owner or Owner's Agent Owner ❑ A2ent ❑ I herebv certifv 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 pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe.lassach tts tats Code a I I Chapter 142 29he Gzn��r 'Laws. By: Title C i tyi Tow n -PPRO' ED Il)FI'ICi= USE' )NLYI Signature of Q'Plumber ❑ Gas Fitter ❑' J )oumeyman seT Plumber Or Gas Fit/ter /' Z, (7 Icense Nu oer I Date. .✓... 0/...... TOWN OF NORTH ANDOVER 9 • PERMIT FOR GAS INSTALLATION This certifies that ...1 l`._ ,.� ..:e -,.t..., . ............... has permission for gas installation -3 ..'-�-f..�: ........ . in the buildings of ..:.-i �..................... . at jam' . ...... ....` .............. , North Andover, Mass. Fee..Lic. No. r .... ......... GAS INSPECTOR Check # 30'.;6 MASSACHUSETTS UNIFORM APPL CATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS ` t' i^ � Date / v/ 3 �( Building Location 7 3 -�r gyral l�✓✓ 'L Owners Name J -f-( S6y f'4 Permit # n Amount / 1, Type of Occupancy New ❑ Renovation 1:1 Replacement ol Plans Submitted Yes 1:1 No (Print or type)�j Check one: Certificate Installing Company Name �, -�( I �� �� ❑ Corp. Address Q J� r-4)YL Partner. Business Te ep one / �Firm/Co. Name of Licensed Plumber: J Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 1:1 Agent El 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 install'ons performed under rmit Issued for this application will be in compliance with all pertinent provisions of the Massa s State Plu ng Cod nd Cha 42 of the General Laws. By na ure Of icense um er T Type of Plumbing License Title TO � b City/Town icense um er Master Journeyman ❑ APPROVED (OFFICE USE ONLY • ---------------------�-.- (Print or type)�j Check one: Certificate Installing Company Name �, -�( I �� �� ❑ Corp. Address Q J� r-4)YL Partner. Business Te ep one / �Firm/Co. Name of Licensed Plumber: J Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 1:1 Agent El 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 install'ons performed under rmit Issued for this application will be in compliance with all pertinent provisions of the Massa s State Plu ng Cod nd Cha 42 of the General Laws. By na ure Of icense um er T Type of Plumbing License Title TO � b City/Town icense um er Master Journeyman ❑ APPROVED (OFFICE USE ONLY r Date 7 J y. as . . ,40 RT" �tio TOWN OF NORTH ANDOVER a PERMIT FOR PLUMBING s � _ .•' x This certifies that '.............. .........F....`.............. . ' has permission to perform ...................... - e plumbing in t e buildings of ................... at:.' .y.. ' .. Y •-�.........0........ .. , North Andover, Mass. Fee" .. Lic. No. '�.!7�.. :.. �:".................. . / PLT BM ING INSPECTOR Check # 5530 MASSACHUSETTS UNIFORM APPLICATION DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS o Date 3. Building Location „ c (� ► UC Owners Name , AMf S 1 O. J OO Sft Permit Amount Type of Occupancy New E] Renovation 1300" Replacement FIXTURES Plans Submitted Yes 1:1 No ❑ �. (print 'or type) y� ,6 /� i 1 Check one: Certificate Jnstalling Company Name 11A 1 I� /(DS I� l U M `�1 YW Corp. I ` El Address oat Clore It. � Partner. Q IM A 0 W Business Telephone - --WoY Finn/Co. NamPe of Licensed.Plumber: -mA y T6 I" A-$ VU C kj,j Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 10 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 gnature Owner 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 Ma�ss�a�husetts Stet jPlumbing Code and Chapter 142 of the General Laws. By: -- VED (OFFICE USE ONLY Type of Plumbing License �S ho icense um er Master11 Journeyman KA