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HomeMy WebLinkAboutMiscellaneous - 88 ROCKY BROOK ROAD 4/30/2018 (2)t> ,s' • S I No CERTIFICATE OF USE & OCCUPANCYjt Town of North Andover Building Permit Numbercl-y THIS CE S THAT ; A; THE BUILDING LOCATED ON a, MAY BE OCCUPIED AS IN ACCORDANCE , k WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY'APPLY.' n CERTIFICATE ISSUED TO 49 ADDRESSt kir r s'"`""'`uilding Inspe for, 4 1 9 T *0 p =r --4 0 cr 4c0• CO) So a: 10 4=0 9. CD 0 a 0 -1 0 CL C.) m col CD a70 Z =r -C co) 0 9L 11. Lo'. = CL. =r CL. -* m Er 0 =r 0 0 CO2 3E =r a = 0 ;; i c -00 CCD m0 O 0 LO)0 . C2 Cc 0 S. CA CL. CL. ..* cl) dc C41 O : CD n C-)-=:: 0 CD: CL -I CD ca =r: 00) cIL N CIO O_ I C40) 17 C.CD IE CA CA So 0) C401 O Wi O Cb 0 CD c (A 10 0 Lit mC -4i M ED CL. -S S ci GA - 0 ry A 0 '12L. C� n 0 r -L 0 cn CDtp M tmTj %kJ Certificate of Occupancy # $ 0% _ : Building/Frame Permit Fee $ ' 'A"° "<� Foundatlo Permit Fee SAC14USE $ w a - Othd/ Permit Fee $ 4 Se4er Connection Fee $ o ater Connection Fee $ TOTAL $ Building Inspector A*3 .... 1 0.9463 n Div. Public Works �o` t, - �� �1�0 Date o�Ncor TOWN OF NORTH ANDOVER �r. 3?.,',�• �s SOL - j A . ' Certificate of Occupancy $ Building/Frame Permit Fee $ j CN„s c�' Foundation- Permit Fee $ Other Permit Fee $ { SewerConnectionFee $ Water Connection Fee $ A� TOTAL Building Inspector a 0,94 2 Div. Public Works (oZ�tiLocation Lt''cD ` No 2 DatIJ7 e 0_` °R,.. 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C n C a0 d -• y \ / d_ OCr7 = d y :D a y _CPOEL: C C CCD M (n a 'c = c o ►n j H CDCn H m o CLca CF. C ^` m m , d C=Dr c. o CD CD CD o CD �• � gyp' m o CD d 0 CA -• Q !m7 •-► (n ? ir CO CD m . S p CD vi d t` Oq If" CD r m : d: d d O CDc� G7 o m. Q' �+ y p CD , c o _ r v cn eb cn 2 z ° T � z w 9d ^T C) z w R m x 8 � m "X E. X w z °� n 7 T � T rL G� cn ^' �'�� T °n. OTJM v6 a 0 c a e FORM U - LOT RELEASE FORM ;. INSTRUCTIONS: This form is used to verify that all necessary, ' approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: v ems Phone LOCATION: Assessor's Map Number Parcel Subdivision dA17 -o Lot(s) o� Street St. Number ************************Official Use Only************************ RE DATIONS OF TOWN AGENTS: ` J Date Approved �� 2 Conservation Administrator Date Rejected Comments own Planner Date Approved Date Rejected Comments i Food Inspector -Health Date Approved Date Rejected Septic Inspector -Health a� 9� Date ApprovedDate Rejected Comments Public Works - sewer/water connections - driveway permit Fire De artment ,erri.1,VJ j - I Received by Building Inspector Date Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) Ma and P rcel : Purpose of Application (check below) Pho pe Number of Applicant: k Single Family _ Two Family 1 the undersign -ed appTicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building pennits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not is grounds for refusal by the Building Department to issue a Building Permit. �Q7 Sign ur f Owner gr A nz gen o sign the Attached Building Permit D to This fonn must be attached to the Building Permit upon application for such permit. a IMr MMMM a 7MM=. � MM 4D uunnnn■ - �� . � — uu•I �ro�w�IPo�p1116�N�ll�l�°"°�IIIIRIIII�����;���nleII�W '14 n.....__..•....... - . 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"4494 � � � � "018 Date. tel: •��• 4 No 4864 �+ TOWN OF NORTH ANDOVER 9 PERMIT FOR PLUMBING This certifies that .,,...�.... . • . • •;lf ` y U has permission to perform.......... plumbing in the buildings of ............... !r .... • • • • • • • • • • % ........ _ ... - L ,North Andover, Mass. Fee 4 ....... Lic. No.. `,! � ��..... /,�.......... . ���`•PIUMBIN LIJSPECTOR Check # WHITE: Applicant CANARY: Building Dept- PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBI1VG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building New �/ Renovation F1 I Date 4 Ar J�e/1 Owners Name Permit Amount Type of Occupancy Replacement FIXTURES r r Plans Submitted Yes No El (Print or type) Check one: Certificate ;nstalling Company Name 60L ► rL m a n r r ► a 4 -ri e L, Corp; .Address g 461 r e %..,. & m J 7T z P- I— M L � Partner. Business Telephone S ? �, 3 *7-!t w 7 Firm/Co. Name of Licensed Plumber. r Insurance Coverage: 'Indicate the type of insurance coverage by checking the appropriate box: " Liability insurance policy Other type of indemnity Bond E Insurance Waiver. I, the undersigned, have been made aware that the licensee ofthis a three ice pplication does not have any one of the above n 6►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 Massachusetts .State Plumbinode and Chapter 1 2 of th�n6aws• sy canA 'u.�.* C;t Nigna ur of Ei. msec riumSer Title Type of Plumbing License Z City/Town icense um er Master APPROVED (OFFICE USE ONLY11 Ioumeyman G--- 2285 114� 0 Date ........ ....... V177 .." .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ............... ................................................................ 1q0') 5YjA17-1 has permission to perform ...... � 1?...................... ... ..... jj wiring in the building of ........ e it L4 . ......................... North AndovpTMass. -eat ..... .................. �.Fee ....... 3.�.. ....... Lic. No../. ... 4/ ... �.(..Y(.. ......... ELECTRICAL INSPECTOR 03Y09/99 12: i 1 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer r11v L1C INUMDer:v/ tuljgU "I_iLop Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Boz) Purpose of Building __ - Utility Authorization.No:- A Existing Service, _Amps— Volts _.. _ _-O.verhead ❑ _ -- Und rnd g ❑ No. of Meters - New Service " _ Amps / Volts Overhead ❑ Undgrn' ❑ No. of Meters Number of .Feeders and Ampacjty ` Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets ijll No. of Ranges r• No. of Disposals';.' . r No, of Dishwashers No. of Dryers No. of Water Heaters KW No. Hydro Massage Tubs OTHER: No, of Hot Tubs Swimming Pool Above In- grnd. ❑ grnd. ❑ No. of Oil Burners No. of Transformers Total KVA Generators KVA No. of Emergency Lighting Battery Units No. of Gas Burners FIRE ALARMS No. of Zones No. of Air Cond. -.. Total _-.- No. of Detection and tons Initiating Devices No.of, Heat Total Total Pumps Tons KW No. of Sounding Devices Space/Area•Heating KW.." .__.' No. of Self Contained Detection/Sounding Devices Heating Devices KW Lo nic' al Co Other No. of No, of Signs ction--E] ow Voltage Burg Fire Ballasts WtrinO i \n_- . _ _ No. Of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ 1 have submitted valid proof of same to the Office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE C' BONDEl OTHER ❑ (Pleaass�e� Specify) Travelers Property CaSllalt CO. 9/10/99 Estimated Value of Electrical Work $ -r �• " (Expiration Date) Work to Start ' Signed under the Penalties of perjury: Inspection Date Requested: RoughFinal 2)?,c�j) -L-F-- FIRM NAME Alaritluard -I' . Licensee Michael A. nor—ta ` LIC, NO.. 1488C I Signature LIC. NO. 00051 Public -Safet Address - 110 Florence St; P.O. Box 667 Malden, Ma 02148 sus. Tot. No. 781 388-9700 Y) t. OWNER'S INSURANCE WAIVER: I am aware. thatnsee does .not have the' insurance (coverage or hits substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner (Please chock one) Agent Telephone N (Signature of Owner or Agent) — p. _ _ PERMIT FEE S N POSTED . Alp FEB 171999 GIL. #-12�- 10 �- lug"014t cfommonweaO of :Ittsoot4adta lepartmettt of Public 2TWU BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. Occupancy & Fee Checked 3190 (leave blank)i(, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code; 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �_._1 -7 _ (%* or Town of -NORTH MOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) -i(��T Owner or Tenant d G-Unla STT�l TJ�✓� ' - Owner's Address Is this permit in bonjunction with a building permit: Yes CJ No ❑ (Check Appropriate Boxes) �%F�s� //D% Utility Authorization. No. 7A2 Purpose of Building Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Service 900 Amps j�Volts Overhead ❑ Undgrnd 'ice No.. of Meters i _ New Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Above In - I Swimming Pool grnd ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No.of Heat Total Pumps Tons Total KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ILocal No. of Dryers Heating Devices KW Municipal ❑ Other ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws —/ I have a current Liability Insurance Policy including Complet�e .`Operations Coverage or its substantial equivalent. YES .Z NO have submitted valid proof of same to the Office. YES .1N0 = If you have checked YES, please indicate the type of coverage by checking the ap_py�ate box. INSURANCE :z BOND = OTHER :: (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Work .to Start Inspection Date Requested: Rough 7 �7 Final 1�1d Signed under the Penalties of perjury: FIRM NAME S )� O cj LIC. NO. -1 O Signature LIC. NO. Ji4. m Licensee _ 6 Bus. Tel. No. All. Tel. Na. Address pp OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not helh in u nce coverage or its substantial equivalent as re- av qutred by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) . `J 1-049 Date ... � .... .�.. ,: �i NORTH C7 46 TOWN OF NORTH ANDOVER EE PERMIT FOR WIRING - $ _ SSACMUS� - vh'�5 ..eG` C...... � This certifies that ..... .. ......:.............. �.i.... ... �- has permission to.perform ..... ... LCN^24,.....s.,N..t (z.(A ;t .. 'ter. wiring in the building of ......:. alt . .... cJrteR ...... '' i� �vd 6-'Of. 2-.i.?.... ....... :......... . ............. .North Andover, Mass.. at .. <Fe€f.. +C�a? Lic. No. . i?. ;.. ......:.. ......... ......i.. ................ ELECTRICAL INSPECT_ OR' WHITE: Applicant CANARY Building Dept PINK Treasurer 114partultill of vublic P�aftlu Occupancy S Fee Checked ��7790 . (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 UIR 12:00 APPLICATION FOR RERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with•Ihe Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dale May 19, 1998 Q5){ or Town! of— North Andover To the Inspector of Wires: The udersigned applies for a permit, to perform the electrical work described below. Location (Street & Number) 88 Rocky Brook Road Fooden No. of Lighting Outlets Owner or Tenant No, of Transformers I KVA No. of Lighting Fixtures Owner's Address Same I Generators KVA Is this permit in conjunction with a building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building ResidenceUtllil y 803579 Authorization No. Existing Service Amps — I Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacily NO. of Ran es I No. of Air Cond. Ions Initiating Devices Location and Nature of Proposed Electrical Work at underground service .Weal _ •:..Total Total Pumps... No.:of. Disposal$ -. -_ No 01 Tons,,,,KW NO. Nyoro massage ruva r ---• -- -� - OTHER: Remove and replace service entrance cable from meter socket to panel due to Bell Altantic drilling hole in wire INSURANCE COVERAGE: Pursuant to Ine reoutrements of I.lassachusens general Laws I _ ivalent. YES NO _ I have a current Liability Insurance Policy including Completed Ooerations Covemoe or Its substantial equ have submitted valid proof of same to the Office. YES _ NO _ It you have checked YES. please inoicale the type of coverage by checking the appropriate box. _- INSURANCE 21 BOND = OTHER = (Please Soecrty) (Expii.mon Dalel. Estimated Value of Electrical Work 5 320 . 00 Final Work to Start Inspection Date Requested: ovgh Signed bnoer the Ponallfes of perjury: 14302A_ „ FIRM NAME Andover LIC. No. Robert J Branca Signature �laC. NO. Llconiee iS5 47 -4995 Bus. ret. No. 206 Address All. `Tel. No. OWNER'S _INSURANCE WAIVER: 1 am aware that the Licens d s not h the insurance coverage or.Its.substantial eouwva!ent as re- - - - rt.a,op6cation warvos this reovuemenl. Owner Agent 9 qurrod by Massachusetts General Laws, and that my' -signature on Ce __. (Please check onoj 15.00 _......, _PERMIT FEE 3 --. -.... _ .._ -•. .Teleonone No,. (Signature of Owner cr AgeMn I Total No. of Lighting Outlets No. of Hol Tubs No, of Transformers I KVA No. of Lighting Fixtures Above In' I Swimming Pool grnd. ❑ grnd. ❑ I Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I I Battery Units No. of Switch Outlets - - I No..of Gas Burners FInE ALAnMS No. of Zones No. of Defection and __.. Total NO. of Ran es I No. of Air Cond. Ions Initiating Devices ;. Noi•of Sounding Devices , .Weal _ •:..Total Total Pumps... No.:of. Disposal$ -. -_ No 01 Tons,,,,KW No. or Spit Conialned Space/Area Heating KVV Detection/Sounding Devices 7— No. of Dishwashers Mvnlcrpnl r^ Other Local ❑ Connectloh Heating Devices KW No. of Dryers No. of No. of Low Voltage No, of Water Heaters KW I Signs Ballasts Wiring rr' _ '111-1.1 NP NO. Nyoro massage ruva r ---• -- -� - OTHER: Remove and replace service entrance cable from meter socket to panel due to Bell Altantic drilling hole in wire INSURANCE COVERAGE: Pursuant to Ine reoutrements of I.lassachusens general Laws I _ ivalent. YES NO _ I have a current Liability Insurance Policy including Completed Ooerations Covemoe or Its substantial equ have submitted valid proof of same to the Office. YES _ NO _ It you have checked YES. please inoicale the type of coverage by checking the appropriate box. _- INSURANCE 21 BOND = OTHER = (Please Soecrty) (Expii.mon Dalel. Estimated Value of Electrical Work 5 320 . 00 Final Work to Start Inspection Date Requested: ovgh Signed bnoer the Ponallfes of perjury: 14302A_ „ FIRM NAME Andover LIC. No. Robert J Branca Signature �laC. NO. Llconiee iS5 47 -4995 Bus. ret. No. 206 Address All. `Tel. No. OWNER'S _INSURANCE WAIVER: 1 am aware that the Licens d s not h the insurance coverage or.Its.substantial eouwva!ent as re- - - - rt.a,op6cation warvos this reovuemenl. Owner Agent 9 qurrod by Massachusetts General Laws, and that my' -signature on Ce __. (Please check onoj 15.00 _......, _PERMIT FEE 3 --. -.... _ .._ -•. .Teleonone No,. (Signature of Owner cr AgeMn I N2 1861 Date ........... NORTH TOWN OF NORTH ANDOVER 0 .'&MjSjjff& PERMIT FOR WIRING This certifies that ..-ektA ........................................................i 1?j r has permission to perform ........ ............ �.f Z . ....... wiring in the building of ..... ................................................ at .......�qll.. ..... ....................... . North Andover, Mass. ............ ..... Fee.... Lic. No. �.YVJ ............................................................ ELECTRICAL INSPECTOR C � � 0L6f/41A 6:21 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer hnA�onVf•tust t i 5 UNIFORM APPLICATION FOR PERMIT TO DO PLUMBINU (Print or Typal NORTH ANDOVER, Maas, Oat• 8undint7 Permit * Locattan Owner's % Name _0644110 y L f New 10--' Renovallon O Replacement ❑ Plans Submilted: Yea ❑ No. ❑ FIXTURE$ ......... Installing Company Nome_ye c/%7715_ Check one: CertWIcate ❑C Address— y l31;14 C /yyl/") ❑ Partnership ] " of I� 4 Y� c�>"i �/ /✓tom ❑ Firm/Co. - Business Telephone Name d Ucensed Plumber 15 INSURANCE COVERAGE: _... _.._... __ I have a current liability Insurance ec one kY policy or Its substantial equtvalerd. Yea �• No ❑ If you have checked yam, please Indicate the - type coverage by checking the appropriate box: A liability Insurance potter Other�.4 y - - type d Indemnity 0 Bond OWNER'S INSURANCE WAIVERi tem aw' sre `that the. Ilceneee sloes not have the Irisuriince coverage required by Chapter 142 or the Masa. General Laws,.and. that my signature on this permit appllcagon wolves _tht re qukemeat Check Ninatufs Ovmer ❑ 0Wnet. a. Owner_a en , ... hereby certify that AN of the datalls and Information I have submitted (or misted) h above Inowted a and that all Plumbing work and Inilalratibna appfleatlm ate,bucand.aoauata-b lhatseslat; ` p pts performed under the pem-A laved for IN* appk&Uon wit be, ti perllnenl provi$lom of the Massachusetts Slats Plumbing Code and Chapter 142 of the Ganem (cwt. Compliance with all try TRIO &Vnslurs Cfty/To*n Uomsa Number. W'P "f0 (OFFICE USE ONLY) Type of Plumbing Lkense: Master ❑ ! Journeyman w r w w s O rc Is < = w s M J 4 w i s- < u < M a 3 0 O it It rr s a »31 y el = ~ i V qty » tt < w 06= L s a It 1 .. 30 of X _ .. ... � .. � 11 st ` J • M 0.. 4. OeMT. •Ile-ILIF— ! SAtttM�NT 1ST FLOOR 1tN0 FLOOR $111D FLOOR _ 4TH FLOOR. OTH FLOOR OTH FLOOR. TTM'tOOR doollor - -_ OTHPLOOR - -- Installing Company Nome_ye c/%7715_ Check one: CertWIcate ❑C Address— y l31;14 C /yyl/") ❑ Partnership ] " of I� 4 Y� c�>"i �/ /✓tom ❑ Firm/Co. - Business Telephone Name d Ucensed Plumber 15 INSURANCE COVERAGE: _... _.._... __ I have a current liability Insurance ec one kY policy or Its substantial equtvalerd. Yea �• No ❑ If you have checked yam, please Indicate the - type coverage by checking the appropriate box: A liability Insurance potter Other�.4 y - - type d Indemnity 0 Bond OWNER'S INSURANCE WAIVERi tem aw' sre `that the. Ilceneee sloes not have the Irisuriince coverage required by Chapter 142 or the Masa. General Laws,.and. that my signature on this permit appllcagon wolves _tht re qukemeat Check Ninatufs Ovmer ❑ 0Wnet. a. Owner_a en , ... hereby certify that AN of the datalls and Information I have submitted (or misted) h above Inowted a and that all Plumbing work and Inilalratibna appfleatlm ate,bucand.aoauata-b lhatseslat; ` p pts performed under the pem-A laved for IN* appk&Uon wit be, ti perllnenl provi$lom of the Massachusetts Slats Plumbing Code and Chapter 142 of the Ganem (cwt. Compliance with all try TRIO &Vnslurs Cfty/To*n Uomsa Number. W'P "f0 (OFFICE USE ONLY) Type of Plumbing Lkense: Master ❑ ! Journeyman ,. Date.! OH- 0 \�oRT ��"oL TOWN OF NORTH ANDOVER . O F PERMIT FOR PLUMBING . ,SSACNUS� This:c rttfies that ./? .v.� E` ..... °�.1.. has permission to perform ... NaVA., ..�:Ean-f........... .. . t plumbing: n the .buildings of .. %. w /. N. .0 f : ..: c� >. t.- s. .... , North. Andover, Mass. Lic. . .............................. PLUMBING INSPECTOR 3�7A5/97 14:15 285. 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �a.Y.'f�'E�:'�r•,. .x r�..;iC._j ti+t;w��,S �r�"''r'��`4.:1-:.-�=:.•/"S'._j_',yT,�--4.'�`?'i�.7-"�'�" 0