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Home My WebLink AboutMiscellaneous - 83 LIBERTY STREET 4/30/2018 (2)I r Date. I% .e.r. Z ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... A�_e . ............................................... has permission to perform ....... . ............... I .................................................... wiring in the building ............................................ ....... �g .... at ... 9�� .... ..... ............... ,North Andover, Mass. — 0�9- -2 -' 2��=X.-/ .................... Fee'- ........ Lic. No&l� . ............. 71"i ELECTRICAL NSPkMR Check # 7379 I -1e Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked" °✓ r` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ;� J// iy� City or Town of: NORTH ANDOVER To theInspT of Wire By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ?3 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location,and Nature of Proposed Electrical Work: Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters 6Wtnpletion of the following table may be waived by the Inspector of Wires No. of Recessed Luminaires No. 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- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of Detection and No. Initiating Devices No. of Ranges No. of Air Cond. To Tons No, of Alerting Devices g 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. o 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 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: (When required by municipal policy.) Work to Start: J 1121AInspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE OV RAGE: 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:) certify, under the pains and penaUi s of perjury, that the informtdi on this application is true and complete. FIRM NAME:— (,C_G�, r LIC. NO.: f Licensee: d /f/ Signature ,l„IC. NO.:/ (If applicable, enter "evempt" in the license number l' e) Bus. Tel. No.: Address: /��i�:f=i�—/` /� `C�Alt. Tel. No.:�>%1-�a�� *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. cg:ze— The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: City/State/Zip:V�jl//l/%j� �`�hone #: �� /� Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 am a,general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. K' II 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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: 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 imprisonment, 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 violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u�)Vr the pain Conalties of perjury that the information provided above is true and correct. Official use only Do not write in this area, to be completed by city or town official. City or Town: 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 #: Date...../..'.:. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... .... ........... ... ............................ 7 ............... .. has permission to perform .......... ................................................................... t %, a Q- 4*1 C wiring in the bililding of..............................1..'............................. at . ... ........ I .. A .............. . . N9rth Andover, Mass Fee .......Lic .. . ......... N ..... PECTO 52(101 NSI Check # ;P 5306 \ TW C0W011WE4L2710F 4&"CHU,SL= Off -ice use only DEPARMWOFPUBLIC& FElY Permit No. tJ BOARD OFFIREPREVENf7ONREGULATIONSS27CMR 12.00 Occupancy & Fees Checked APPLICATION FOR P TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date l/ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the el al work described below. Location (Street & Number) Owner or Tenant Owner's Address A 1.,nv,P Is this permit in conjunction with a building permit: Yes No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps�Volts Overhead Q Underground M No. of Meters New Service Amps / Volts Overhead r --J Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators _ KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. ofSwitch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of AirCond. 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 V No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP . OTHER Ir��arneCo Ptast>�>iotktetegtri[arta>�d>�Gataallaws Iba%eaametLrabtldyftm= PPditym6.&gCar a CovuaWcrds ie*ualat YES ® N IliaveabnifedrabdpicofofmrtetotfrOffioc YES Kf mhmdwdodYES,pl mnfio*ttroFofw=a2pbyd=kmgthe INSURANCE o 1N o oIIER o 0%la:spe* Expir�anDe�e EAmFkd VakedfF mhml Walk $ WctktoSm IrupacficnD eRa pc*d Ra* Final L msee -STru&P? ; SignAlm . Lit�eNo A t—�i� > N t� S' t \�,4 Q.� v� AltTdNa OWNER'SINSURANCEWANER,Iazltawatettrtt cLicamdomnothmtheinsutd=ammWortal leW,ktasmgmWbyN4mmdasettsCtenaallmNs� and�mysagl�ahaern-thispatt� tivm�esthisteglo;enalt Plee eck oneO ® Agent Telephone No.�t� p �;; •�'�j s�' PERMIT FEE $ Date... 6 6 TOWN OF NORTRINDOVER 0 PERMIT FOR GAS INSTALLATION SACHU This certifies .. .......... ... has permission for gas installation . ........ in the buildings of at North Andover, Mass. Fee .... Lic. NOZPIX—<J. GAS �It=�0'01( Check# a w MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FrrnNG (Type or print) ..� Date /Q NORTH ANDOVER, MASSACHUSETTS � — � Building Locations -_ 1L.. I Y�i`PPermit # GGt%o —Y3i9n Owner's Name Amount $ New Renovation Replacement D Plans Submitted D U B-BASEM ENT A S E M ENT ST. FLOOR ND. RD. TH. FLOOR FLOOR FLOOR TH. FLOOR TH. FLOOR TH. TH. FLOOR FLOOR (Print or type) Name W Z 1X U W x y odd OV of� a g w fFe� W a W W [,��'; S Name of Licensed Plumber or Gas Fitter '�^�N V) -12 in Lia , I AA . C k one: Certificate Installing Company Cff Corp. Partner. �. Firm/Co. INSURANCE COVERAGE Check one 1 have a current liability Insurance policy or it's substantial equivalent. Yes NoO If you have checked ves. please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mals. CieneralMand that my signature on this permit application waives this requirement. Check one: n ure of Owner or Owner's Agent Owner 13 Agent I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work apd installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stateode and Chapter 142 of the General Laws. own VIED (OFFICE USE ONLY) .Signature of Licensed Plumber Or Gas Fitter Xm ber /— ,so /f 30 Gas Fitter (cense m uer f Master Journeyman Location No. Date NQRTh TOWN OF NORTH ANDOVER t Certificate Occupancy of $ s�CMwUs Building/Frame Permit Fee $ 14Q!' ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # %O R/ 11 1!190 l� Building Inspector/% TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1.2 Assessors Map and Parcel _1 4 .l'� Map Number BUILDING PERMIT NUMBER: DATE ISSUED: l f3 ao 0 C/ SIGNATURE Building Commissioner/Inspector of Buildings Date crf--r7nhT 1 QTTA TNVnVMATTnNl — 1.1 Property Address: 1.2 Assessors Map and Parcel _1 4 .l'� Map Number Number: ✓oma Parcel Number l` �✓� �� 1.3 Zoning Information: 1113 ZoningDistrict Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage (ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Strppty M.G.L.C.40. 54) s.�.._ n _ o..:.,_.. n I.S. Flood Zone Information: 1.8 lAue . Outside Flood Zone 0 Municipal Sewerage Disposal System: ❑ On Site Disposal System SECTION 2 - PROPERTY OWINERNHIF/AU 1HVKLZLU Akyr, \ 2.1 Owner of Record Ke" (Print) Address for Service: Signature Telephone I 2.2 Owner of Record: Name Print Signature S,Rf'TION 3 - CONSTRUCTION 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: T Address Signature Telephone 3.2 Registered Home Improvement Contractor :ompany Name %ddress �ianature T, Address for Service: Not Applicable License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date .ry nT —T^XT A -"xArDi NcA r7nR rni G r. r 1S2 s 25r(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 buildingpermit. Si ned affidavit Attached Yes .....-0 No ....... 0 SECTION 5 Descri tion of Proposed Work (check a licable New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: SD SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beO Completed by permit applicant j , 1. Building (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 OWNSSECTION NER A TIO OBE COMPLETED WHEN JRS AGENT O NTRACTO PLIES 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 pennit application. Signature of owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1 as Owner/Authorized Agent of subject property ( Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date EM NO OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TrNMERS 1 2 ND SPAN DIMENSIONS OF SILLS DD,4ENSIONS OF POSTS DIDvENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 3 FORM - U - LOT RELEASE FORM INSTRUCTIONS:. This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. �................■ ■..■ ........... ............ ..SOME....................■ APPLICANT �if�G HONE ! �O ASSESSORS "NUMBER 1"'aR6 LOT NUMBEI Q�p SUBDIVISION LOT NUMBER STREET 7 TREET NUMBER ........................... .............. ...........M.EM....... .....0 CTAL USE ONLY RECOVIVffiNDATIONS OF TOWN AGENTS Inman DATE APPROVED C SERVATION AD TRAT / DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS ' DATE APPROVED FOOD INSP TO IiE?;I,TH DATE REJECTED DATE APPROVED S E OR -HE DATE REJECTED COMMENTS !� rz / i� i-�� i L/..� - �,n►� ; r , .-� ' PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR ,MORTGAGE JNSP,ECTION PLAN Location: 83 Liberty Street, North Andover, MA i Date: 08-11-03 Scale: V=80' Borrower: Danca, Frank & Dianne Deed Ref: 2935-150 Plan No: 10170 Drawn per CitylTown of N/A Tax Assessors Map LOT /O rs'eThAc%� A=54,403 sf. IAT 4 ,ei PRCH Q ? p j LOT 2 2 STORY) W.F.D. STET To: Reading Cooperative Bank I hereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is not intended or represented to be a property line or land survey. It can not be used for establishing fence, hedge, walls or building lines. No responsibility is intended herein to the land owner or occupant. The location of the original building(s) as shown herein was in compliance with the local applicable zoning bylaws in effect when constructed, with respect to horizontal dimensional requirements, to lot lines or is exempt from violation enforcement under Mass G. L. Title VII, Chap. 40A, Sec. 7, unless otherwise shown herein. I further certify that the property is not located in the flood hazard area as shown on FIRM map Community No. 250098 Dated 06-15-83 Job No. 03-7570 EASTERN ASSOC IATFS, P.O. Bax 4459, Peabody, MA 01961 (978)535-8934 _C Wcr CS ca -C -*,o co) =r -f = a lw m CL o. 0 a ' ==r r.L CL a =r mr .* CD go CA O CD --jo a eN IE 0 CD =r!gt a CA O .0 0 ZC CO) Cl) C., 0 plo =r z C,* CD 0CL an 0 Fig. CL c C/) dc CD C/) co co 0 CD CL CD ego c=, rar O 0 CO q 0 CD J= c- I Dc iii c CD: =r :E CL cl) cr CA � lCA o. CD T cl CD 0 CD CS) ccl ca N IF m CD fit c CD co) Er lb CD 0;3 CD CO) 4 CD CD C., CD C=, y 0 cn 0 cn z wIV z :j n T zx cr- 0 9- M � Or- n R 4 T A T pa 12 0 w 5 cp Ill U I Ej I loq FORM - U -LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. 10- �........... �.........■■.■...■...."■....�...................■ 00fo APPLICANT �� A-) Cl' HON r �' f r" ASSESSORS "NUMBER I/ LOT NUMBED 6)— SUBDIVISION LOT NUMBER STREET S:� TREET NUMBER ........................... .............. ...................... ■ ..... FICIAL USE ONLY RECO6WNDATIONS OF TOWN AGENTS DATE APPROVED `I I CO-NSERVATIONADMMSTRAT DATE REJECTED CON ENTS DATE APPROVED 'TOWN PLANNER DATE REJECTED CONRV ENTS DATE APPROVED FOOD INSP T�BEALTH DATE REJECTED DATE APPROVED S EOR - IIEA7 DATE REJECTED COUNIENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED CONIIV=S RECEIVED BY BUILDING INSPECTOR DA' a FORM — U —LOT RELEASE FORM INSTRUCTIONS:. This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the .applicant and or landowner from compliance with any applicable requirements. APPLICANT �� AJnoun HONE _mmonnoom"f t1 ti ASSESSORS MAP NUMBER 'S%z. LOT NUMBED 61G'�_ 7 SUBDIVISION r ILOT NUMBER STREET TREET NUMBER ............................ .............. .. I ......... 1 0 0 ■ .. ■ 0 ■ ■ ■ ■ . 0 0 ■ CIAL USE ONLY ............................................■... a............. 0. a....... 0.■ RECO NDATIONS OF TOWN AGENTS �............................................................ ........... DATE APPROVED 7 C SERVATION ADI&ffSTRAT DATE REJECTED CO1XVIENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS FOOD INSP TO 7BEALTB S EJrnOR — DATE APPROVED DATE REJECTED DATE APPROVED 4> DATE REJECTED COMMENTS IDca / ; f• c > .i L. _; ': C PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED SAGE INSPECTION PLAN ,cion: 83 Liberty Street, North Andover, MA ate: 08-11-03 Scale: 1 "-80' Borrower: Danca, Frank & Dianne Deed Ref: 2935-150 Plan No: 10170 Drawn per CitylTown of N/A Tax Assessors Map IAT 3 -p A=54,403 sf.TDT 4 / .� h D� 4,60 to /o rPORCH Q LOT 2/S V �3.�` 5'11AI-1 P'.-/ 2 STORY W.F.D. 33 Z9 LI�EP STREET I To: Reading Cooperative Bank I hereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is not intended or represented to be a property line or land survey. It can not be used for establishing fence, hedge, walls or building lines. No responsibility is intended herein to the land owner or occupant. The location of the original building(s) as shown herein was in compliance with the local applicable zoning bylaws in effect when constructed, with respect to horizontal dimensional requirements, to lot lines or is exempt from violation enforcement under Mass G. L. Title VII, Chap. 40A, Sec. 7, unless otherwise shown herein. I further certify that the property is not located in the flood hazard area as shown on FIRM map Community No. 250098 Dated 06-15-83 Job No. 03-7570 EASTERN ASSOCIATES, P 0. Box 4459, Peabody; MA 01961 (978)535-8934 I � HORTM O F 4 i r a1 ♦ ; '' r ,c ,SgACMUSE� Date j ! . Z y :` ?... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .`•`............................ . has permission to perform ...D. F. �. .......................... . plumbing in the buildings of .�1?....................... at .. �. 3..,�.�, rC. �S... ................ North Andover, Mass. G ` Fee3.2...:... Lic. No..5.371...9 ............ PLUMBING INSPECTOR Check # ) � Z 5812 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) f n% /`4'1 zgndo Mass. Date ! Permit # Building Location R 3 / !`7f�, 4�aOwner's Name o tic 4 i Type of Occupancy Residential New ❑ Renovation ❑ Replacement Pians Submitted: Yes ❑ No ❑ Installing Company Name Heritage Htg. &Plg. Co. Inc Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone 781'-4.3B-7776— Name 81`-438-7776_Name of Licensed Plumber Gordon Switzer Check one: EX Corporation Partnership ❑ Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes N No ❑ It you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy IN 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: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. By i o Q -A-) Signature of I con -sed P1um er Title Type of License: Master [2 Journeyman ❑ City/Town $ 3 2 2 APPRUVE (OFFICE License Number. W :n Y 2 N In a: 4 fL a u h z o ul a N OJ _ fi 2 )e - W .. _2 U W s V) f0 V) 3: tr ~ > W y h W ID (L - fl Z W 0 ¢ V) Q W N � Q - V) t] Q fr N Z J - M O O M w= r- a f > F' s h W 3 3 o s N 0 a N O z= v1 J x H z a C � p ) 0 fn a x = z W � LL w t� Y 1- o 0 SU -t► 4 3 a Y J Q t0 S VI O t] a J a � C¢ = h J V) J 4 LL f7 Cr rt 7 '.� tG Z a C Q 3 LT N ++ rt1 Id iii rl1 } 1 33 33uQi' S(30—BSMT. BASEMENT IST FLOOR 2NDFLoon 3110 FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8THFLOon Installing Company Name Heritage Htg. &Plg. Co. Inc Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone 781'-4.3B-7776— Name 81`-438-7776_Name of Licensed Plumber Gordon Switzer Check one: EX Corporation Partnership ❑ Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes N No ❑ It you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy IN 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: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. By i o Q -A-) Signature of I con -sed P1um er Title Type of License: Master [2 Journeyman ❑ City/Town $ 3 2 2 APPRUVE (OFFICE License Number. I r O U W 'a N Z_ N N W cc O O 0. ' I T J Z O W N m W U_ LL LL O m O LL 3 0 J W A I r