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HomeMy WebLinkAboutMiscellaneous - 75 GREENE STREET 4/30/2018O O - N G7 Q m O m O z M ti C3 X m O m o � Location 6 z 4,-4� No. .o Date± .. A TOWN OF NORTH ANDOVEFF Certificate of Occupancy $ M Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $� TOTAL $ Building Inspector ector 10007 Div. 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SCOTT ►CHU Director CHIMNEY APPLICATION AND PERMIT DATE 10 { � � G) PERMIT # LOCATION S6,e eGO �F- --� OWNER'S NAME_-- Ve�� rz- L - -oz BUILDER'S NAME !�z`TE1—'C-EdJ 7p- MASON'S PMASON'S NAMED C,� �'j'i �j,� &T MASON'S ADDRESS ST. 96- W1 MASON'S TELEPHONE�� MATERIAL OF CHIMNEY_�1�.� INTERIOR CHIMNEY 1 G2> EXTERIOR CHIMNEY FGK NUMBER AND SIZE OF FLUES , (SZ jZ THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received:_ �c DATE 101,2 2 / ; 7 SIGNATURE OF MASO�_b�/ CONTR. LIC. EST. CONSTRUCTION COST/CONTRACT PRICE $/6) IWO, od PERMIT GRANTED ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS BOARD OF APPEALS 688-9541 FEE SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 DATE @9N0DAYIM a 90121/Dr ncrwr.WCY.N<taP�H!uaavee.n Hi: ...Afril .......... . PRODUGPA THIS CERTIFICATE 19 ISSUED AS A MATTtR OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE C d MOWN lns Amoy IAO. HOLDER. THIS CERTIFICATE DOES NOT AMEND, MUD ON d1N>ds MENTON S "LEN 102 AOOr ALTER THE COVERAGE AR0110 By THE POLICIN 11M, of MAIN ST., PC Box f001 COMPANIES AFFORDING COVERAGE WALTHAM NA 022"1001 COWANY A SAFXT1l 1NlOIIANCE CONPANY INSURED COMPANY ShpMn Nowell diMs N will OON!)uu S ■uNd B NARrPON110 INSURANC% GROUP COMPANY 16 M Ynnsn Read d0»rferd NA 010210000 C COMPANY D tltl 1, ::. .. . •f M1 s i '. ..�+a�p ¢ . ��pp ��yy�,�{ ��k�v ��}}� gg##Elm Isl:y `s. . 26 . atom I i $33':tK 333.„ I� � ... �. 1 a $� :" 4� 'a THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTINITHSTANDiNO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, D N REDUCED 0 TVR! OF INSURANCE POLICY NUMIV1 PDUCY LIN DAMN IFF11C i POLICY URRATiON LIMITS (MMMWM DATE MOD" S OMMAI LIABILITY OBSBAON605 06/01/97 06/01/98 009PAL AGGREGATE 1 2,000 000 S COMMERCIAL GE EIIAL LIASp.RY PRODUCTS • 0CMPV AGO 4 2,000,000 MANN MADE F_XI OGOUR PW$ONAL B ADY Nd7RY I 1,000,000 OWN013 S CONTRACTORS PROT EACH OCOLWOCE 1 1,000,000 FPME DAMAGE one MYi a 300,000 MED Er ome p8mro 1 10,000 N AVOMOBLE UABLIIY ISOD162 04/17/97 04/17/98 mmawo DINGLE LIMrT A ANY AUTO ALL CMD AUTOS BODS 1 250,000 X SCHEDULED A= ODDLY MITY ; 500,000 tt HIRED AM X NON- MEV AUTOS For PWERTY DAMADE i 250,000 DAAAOR LIABILITY AUTO ONLY • EA AWDENT 1 OTHER 1NAN AUTO ONLY; ANY AUTO D(GESS LIABILITY EACH IDOOLI eE: OF AGOMMATE e UMOREI-LA IRON = OTHER THiMN UMII$LA FORM A' 4" '• `''v' WOTIMM COMPENSATION AND BAPLDYM, WARL" O�EC1�0247 06101/97 06/01/98 EL EACH ACCIOPTNT rl 100,000 N3 THEA EL GMeE n • POLICY LIMIT 1 —5-0 0 000 OFFICERS ARI Imm EL DIS • EA ; 100 000 OFFICERS OTTIRT OF node NT Y alwaxii' , oYfi:'4. a�'Stiw3i;. .: 33�#S,'�.a ,s $1`s:e'ris''<3i',yr.. 6•,..� � � ... a /�•,' s'r3 � �,r .::�i3Ei8�i ..•': i Svc �.. a �.si '�{' SHOULD ANY OF THE ABOVE DMOMBED POLIOIETa BE CANCELLED 1100E T1$ EW IATION DATE TMER10F, TNB MUING OOMPANY WILL ENDEAVOR TO M UL ftm of memo AnAfewP O was bepwas"d A0 DAYS VMMM NM TO THE CIMMCATE HOLM NAMED TO THE LEFT, 120 NIM sb"t SLIT FAWPiE TO MAUL SUCH NOTICE 8"L W= NO 000GATTCN OR LUSILrTY N60h AfidGVM NA Of M2 OF ANY KIND UPON THE OOI(iPANY, rT9 AMM OR 09*98FNTATNM AUTmmmm mAESENTAT1Vf 2d sm ANT NsoO+A K wcU& two Location 715- 61-1ce 4 I S�- 0 No. 030 Date j o7S ad NOR,h TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ cNuE<� Building/Frame Permit Fee s�s Foundation Permit Fee $ r, Other Permit Fee $ l TOTAL $ Check # 13599 `� Building Inspector Ln c X r G • a ,AL ? s 2 IZ R V• � T w f r ui .� N vi T LA I i I y - T Ln c X r G ,AL ? s 2 IZ R V• � T w r fP, N rr T LA z .? Ln c X r G tq �� N ,AL ? 2 fP, - LA N Z 1 �o a N N y. r I I ( I i r c N �€ i C T i I I I i i I tq �� N BOARDING R ' EGULATIONS ' II License: CONSTRUCTION SUPERVISOR .`' NUmber:'CS 053099 Blrthditb` 0_6/29/1967 7E-Pares 06/29/2001 Tr. no: 10126 ResUicted To: 00 KEVIN W MURPHY a 169 BOXFORD ST it.j. N ANDOVER, MA Administrator. ' I r I i i — E s —t i a t f�. i 1 Name ame: City t\.) ev, A,, \ Phone O —533 I am a homeowner perrcrming all work myself. F7 F7I am a sole proprietor and have no one working in any capacity F -1 I am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address A Leo— Insurance /, City' �`-��� �, ._ i,-.._.�. ��"��- Phone Y L o— 3 . /o p Insurance Co G:,✓� ,t, lo Policv m Comoanv name: Address City Phone rt-. Insurance Co. Policv Failure to secure =verage as requirec under Sec -,ion 25A or MGL 152 can lead to the imposition cr criminal penalties of a rine up to $1,500.00 and/or one years' imprsenment as ,veil as civil penalties in the form of a STOP WORK ORDER and a Fine cf (5100.00) a day against me. I understand that a copy of this state.ywrC�rsty be forwarded to the Office of lnvesreaticns of the DIA fcr coverage verification. f do herebvWrtdy unde�fe pains".-nd genattks or perjury that thp--nfcrmatien provided above is true and correct. Sionature Print name l� Date Phone,", Official use only do not write in this area to be completed by city cr ,cwn crriciai' City or Tcwn Permit/Ucensino Building Dept ❑C,"eck if immediate response is required ❑ Licensing Board F -I Selectman's Office Contact person: Phone m: Health Department Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with.the provisions of MGL -c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this 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 in: t) 'Dys Com®., Location obFaci1WF, V Signatureof PermiE-aTt Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector A m M) m C/) 0 m FA � d CO2 CO) z CO) CL n� � O CL �' y D� O O v CD CD , O cr d CD CD O CD mw C CD y CD O: O_ CO) Lfl CD a v y O 1 Z CD o CD 3 C CD O 'Cf e -f OZ 0 O e 5 F Cn O7� O C/) omq 0 9 cn o14 cn w -n w g G� y w cn o Ci7 n r � O °0'- o C 0'y r � O. O ol 4c Tas J1 0 O C CDK &10 37 Date....,� ............................ In TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... .......... ...................... has permission to perform ..... ... r ........ ....... wiring in the building of ....le.6.& 14. et ..................... at ..... ... 5 .......... . ............ ;.....,,North Ando And �er, M se Fee....6.. Lic. N041,ae Check # Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Tr 3 7 Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NIEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6-(0-11 City or Town of: P�.1p,$ To the Inspector of Wires: By this application the undersi ed gives icnotice 1 of his or her intention to perform the electrical work described below. Location (Street & Number) 7 .s' l -7 (� 9W e sST Owner or Tenantgo-+ P r'=o N (.) Telephone No. Owner's Address s A /A F- Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building S I N & i_07- ELNyi r- c.,Y Utility Authorization No. Existing Service [ &0 Amps I L©/ 2,4 ()Vohs New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ® Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Comnletion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Cell: Sus Paddle Fans p (Paddle) No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures g g Swimming Pool Above ❑ In- ❑ g rnd. rnd. o. o Units Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Dis osers p Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ElOther Connection No. of Dryers I'Y Heating Appliances KW Security Systems: No. of Devices or E uivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications.ofDvicesr Wiring: No. of Devices or Equivalent OTHER: Attach addifzonai detail zJ desired, or as required by me inspector oi w zres. INSURANCE COVERAGE: 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 ❑ OTHER ❑ (Specify:) I - O3 — CZ, �c (Expiration Date) �r Estimated Value of Electrical Work: :�;V o oo (When required by municipal policy.) Work to Start: 6 10 - 1 1 Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under th dins and penalties of, pef jury, that the information on this application is true and complete. FIRM NAME: (_� 0 L:`_ Licensee: (If applicab e � i Address: OWNER'S IN; required by law Owner/Agent Signature _ ex t" r the license n b r lie 1 si b - &D JRANCE WAIVER: I am aware that the Licensee does By my signature below, I hereby waive this requirement. Telephone No. LIC. NO.: VC. NO.. 9 1 Bus. Tel. No.:. / z i 1v/`t'_ z G( Alt. Tel. No.: not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE. $ All e A 5 u a r': COMMONWEALTH OF MASSACHUSETTS Locations No. //0 Date VIJ3,19Z I f TOWN OF NORTH ANDOVER Certificate of Occupancy $ 5 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee f� Sewer Connection Fee RECEIVED connection Fee AMR $ z 5 ' chD $ TOT NT er-<) APR 13 1992 No. AndoverCaJ� 5090 ctQr -04bulldlri. -. Div. Public Works EA�II1: No. !I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP 4d0. LOT NO. PAGE 1 FILL OUT SECTIONS 1 - 3 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONi I SUB DIV. LOT NO. �— I LOCATIONPURPOSE kV 6,r �h � Y� 0 � � � OF BUILDING Ila CUj 9-00P -T0yA r \T OWNER'S NAME I�_ 1 �(+ '�C• \ ;� „\ NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME NO SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME Ty\&,V-\C. ` SPAN --_— DISTANCE TO NEAREST BUILDING 6 e14,4M4.0 -17-&F- 1% DIMENSIONS OF SILLS -- --- DISTANCE FROM STREET O POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW - SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER It I IS BUILDING CONNECTED TO NATURAL GAS LINE i INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 OWNER TEL PAGE 2 FILL OUT SECTIONS 1 - 12 CONTR. TEL. .. / CONTR. LIC. fj ; 0t 6 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR / z' DATE FILED J SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE Ik_7 , PERMIT GRANTED 19 «. — 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST f SQ v EBT. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN �Y�W� irGY�V1{ 1 OCCUPANCY SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE _ iBRICK OR STONE HARDWLA--TE PIERS PLASTER DRY WALL_ UNFIN. 3 BASEMENT BMT 4 WALLS CLAPBOARDS DROP SIDING WOOD SHINGLES ASPHALT SIDING STUCCO ON FRAME BRICK ON MASONRY ` BRICK ON FRAME CONC. OR CINDER 8LK. 5 ROOF GABLE HIP GAMBREL MANSARD FLAT A SHED ASPHALT SHINGLES WOOD SHINGES 6 FRAMING WOOD JOIST TIMBER BMS. & COLS. STEEL BMS. & COLS. _ WOOD RAFTERS FIN. B'M'TAREA _ FIN. ATTIC AREA _ FIRE PLACES _ MODERN KITCHEN 9 FLOORS B 1 2_ J 3 CONCRETE I_ EARTH _ HARMU'D _ COMMCN ASPH. TILE _ ATTIC STRS. & FLOOR I WIRING 10 PLUMBING BATH (3 FIX.( TOILET RM. (2 FIX.) WATER CLOSET LAVATORY KITCHEN SINK NO PLUMBING STALL SHOWER MODERN FIXTURES TILE FLOOR TILE DADO 11 HEATING PIPELESS FURNACE FORCED HOT AIR FURN. STEAM HOT W'T'R OR VAPOR AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING` i BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6F w W a 7�) 71N� Q) 1\ o � 0 ir D C*D m r n j O A ^. m . ► "` CDD > > (D -n - CD CD 1 m m 0 c a O 3 CD m a m n CD 3 m m A 69 fA EA dg 69 d9 U� S0 Z 0 In Z 2 v 0 m m v m I 1 E� m rl sj WA - LU CL cc LU LLI > am O � z, w lq% a ae � .Q V a O in .~.1 O a a 4) 0 i c. -p C OD to .0 G. WLH LLI d F d 0 u I CL u d.c H' H Z e v � Z ow c Z z 5 W CL W a) a O L7 Ix C V � V a z ? W �+ y o z u z � u o � •� -= o a m m m L E J 96 L � J W L V j> L 7 Y 3 O �o W � c. 0 o L o o m o E a: U a: {I ar iL a` U. m LLI > am O � z, w lq% a .Q V a in E a a 4) i c. -p C OD to .0 G. C W F u u ' O CL u d.c H' 4) e v � O ow c to z 5 C •— CL w a) a Ix C V � W y U u � u o � •� -= o a H O W, R V) w J ZD .Q a in E a a 4) i c. -p C to .0 C u ' O CL d.c H' 4) O ow c to z 5 C •— CL O a) — V � 0FFIQUS' OF•. APPEALS BUILDING DING 0.)NSERVA'1'ION HEALTH PLANNING pORTk m Town of NORTH ANDOVER `ss+c�cn�`4 DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECI'OR 120 Main Street North Andover, tvlassnchusctts c11847, (61 7) 685-4775 In accordance with the provisions 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 111, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant az i Z Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Date ..L - . r. . C) ... . ION N TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... i!�-? :.'.... ..�A .................. has permission for gas installation ... A . ................... in the buildings of .. %" �:'. at.... , North Andover, Mass, rx Fee....5�r Lic. No...? ?.`.... .... L �,� ..... GAS INSPECTOR Check # 4550 t I 40ro� i. h: •, E S o .. N ASSACHUSETTS UNTFORN[ �PPLiCATON FOR PERNUTTO DOS GAS-FI`ITIIYG �t.Type or print).. Date D4�21 L'3 NO i. (q INppv, , MASSACH US ETTS 'biding Locations % (z,&*IU'- �— Permit 9 Amount S Owner's game 1-14Folu O w ❑ Renovation 11Replacement Plans Submitted ❑ *int or type) Check one: Certiii�ate Installing Company :me WHITE ROCK PLUMBINGa Corp. 1 q ' X 728 `Jdress. NORTH ANDOVER, MA. 01845 ❑ Partner. 9siness Telephone 1-75 179 q-1121 ❑ Firm/Co. ime:of Licensed Plumber or G: s Fitter .SGRANCE COVERAGE Check orte: :ave a,current liability Insurance policy or it's substantial equivalent. Yes Loo No ❑ you have checked yes; please indicate the type covera�sc by checking the appropriate box: ,'ability insurance policy Other type of indemnity ❑ Bund ❑ 4ivner'.s Insurance Waiver: I am aware that the licensee does not have the lnsutance coverage required by Chapter 142 of the tass.'General Laws, and that my signature on this permit application waives this requirement. a' Check one: inature of.Owner or Owner's Agent Owner ❑ Agent ❑ terebv certifv that all of the details and information I have submitted (or entered) in above application are true and accurate to the "6t ofmv knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in mpliance with all pertinent provisions of the :'Vlassac!t setts State Gas Cede and Chaoter 142 of the General Laws. V:. uv�T,iwn a:PPROV-D (OFFiCii USF. �)1`41.vi Signature of Licensed Plumber Or Gas Fitter ® Plumber 6s'711 ❑GasFitter L,c::nse ;vumoer i ❑ journeynmil .rAkioLIKE *int or type) Check one: Certiii�ate Installing Company :me WHITE ROCK PLUMBINGa Corp. 1 q ' X 728 `Jdress. NORTH ANDOVER, MA. 01845 ❑ Partner. 9siness Telephone 1-75 179 q-1121 ❑ Firm/Co. ime:of Licensed Plumber or G: s Fitter .SGRANCE COVERAGE Check orte: :ave a,current liability Insurance policy or it's substantial equivalent. Yes Loo No ❑ you have checked yes; please indicate the type covera�sc by checking the appropriate box: ,'ability insurance policy Other type of indemnity ❑ Bund ❑ 4ivner'.s Insurance Waiver: I am aware that the licensee does not have the lnsutance coverage required by Chapter 142 of the tass.'General Laws, and that my signature on this permit application waives this requirement. a' Check one: inature of.Owner or Owner's Agent Owner ❑ Agent ❑ terebv certifv that all of the details and information I have submitted (or entered) in above application are true and accurate to the "6t ofmv knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in mpliance with all pertinent provisions of the :'Vlassac!t setts State Gas Cede and Chaoter 142 of the General Laws. V:. uv�T,iwn a:PPROV-D (OFFiCii USF. �)1`41.vi Signature of Licensed Plumber Or Gas Fitter ® Plumber 6s'711 ❑GasFitter L,c::nse ;vumoer i ❑ journeynmil Date.L� C-.3. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Y. �,SSACMUS��ry This certifies that %a.. .<.... P :'.c...` ......PY . ��.... . has permission to perform ....' .�:. J. ..... ............... . plumbing in the buildings of . I./?../ .!:. ................. at .... ... e. 6.e If `.'... ........ North Andover, Mass. Fee.Lie. No..1.1. `? ?.. ........ ,,..0 - �c ,� ..... PPM81NG INSPECTOR Check # �`�'�% 5583 r• --►-qtr UNIFORM APPLICATION FOR PERML,T T D PLUMBING `` r s #•`d"-' ,tom' n - � ... `ti..n'•' � �, • t � ' Mass #iatte '�_� .:Peffn t # Owner's Name .Type of Occu nc pa y wvatian O Replacement Plans Submitted Yes O` No t � tT Y FIXTURES SEWER# SEPTIC# ?'•_' ' `` a. -eijz `5 z X N� I fn ETelephone ie ;ot Licensed Plumber: J ,f�ANCE COVERAGE• ' ;Gel Stgnatur8 of Owner or Owners Went thereby j rtify that all of the details and if knowledge and that all plumbing work anc 'per�inentk, rovlsions of the Massachusetts, CC 7 i. aP `fit , fi.. f rtG4711111� Certlcate Check one # 4 { "V:! �3- • r �t � Sa x Corporation '= b. O Partnership { dy .. O Firm/Co. _..- �icy or. Its substantial equivalent which meets the requirements of MGL Ch. 142 cats the type coverage by checking the appropriate 1box. ( - j` Other type of indemnity ❑ Bond O am aware that the licensee does not have the insurance coverage required by ws, and that my signature on this.permit application waives this requirement , , Check one: Owner ❑ Agent O oration i have submitted (or entered) In above application are true and accurate to the best of my stallations performed under the permit issued for this application.will be in compliance with all to Plumbing Code and Chapter 142 of the General Laws. nature of UcensedHumber Type of Ucense: Master Journeyman ❑ License Number_? r -eijz X "6 < z 7 tl Ic ,W oyC • S y O= z y �' W yyj F V y Y Z i y a W a d < 3 o E •r 1 r r e�KtSt d- W'. : D • '� J y x A cc p a C v J.1 z � 1L 4 O 0 14 O z O p. VS _z W p p V `. �... cc 3 �. a i m a o MT. ' sun-gSiNT SASEMI i `1ST'PLOoR t 7 , t2ND'FLOOR 3RD FLOOR `4TH=FLOOR 'STH FLOOR :aTH FLOOR '7TH FLOOR': N� I fn ETelephone ie ;ot Licensed Plumber: J ,f�ANCE COVERAGE• ' ;Gel Stgnatur8 of Owner or Owners Went thereby j rtify that all of the details and if knowledge and that all plumbing work anc 'per�inentk, rovlsions of the Massachusetts, CC 7 i. aP `fit , fi.. f rtG4711111� Certlcate Check one # 4 { "V:! �3- • r �t � Sa x Corporation '= b. O Partnership { dy .. O Firm/Co. _..- �icy or. Its substantial equivalent which meets the requirements of MGL Ch. 142 cats the type coverage by checking the appropriate 1box. ( - j` Other type of indemnity ❑ Bond O am aware that the licensee does not have the insurance coverage required by ws, and that my signature on this.permit application waives this requirement , , Check one: Owner ❑ Agent O oration i have submitted (or entered) In above application are true and accurate to the best of my stallations performed under the permit issued for this application.will be in compliance with all to Plumbing Code and Chapter 142 of the General Laws. nature of UcensedHumber Type of Ucense: Master Journeyman ❑ License Number_? r