HomeMy WebLinkAboutMiscellaneous - 90 HERRICK ROAD 4/30/2018N pI 1-104 i l oxl OF - 5 F- S vc A/ ew- i a pI 1-104 i l oxl OF - 5 F- S vc A/ ew- S'a'J.�lr' �� � fi� v O 11.(i TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 346 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North-West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals, William J. Sullivan, Chairman Published in the Eagle Tribune on 6/30/98 & 7/7/98 /legalnov/2 LEGAL NOTICE LEGAL NOTICE TOWN OF NORTH ANDOVER ✓ MASSACHUSETTS BOARD OF APPEALS Notice is hereby.given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to 211 parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements. - of.Section 7, paragraph 7.1,. 7.2, & 7.3, of Table. 2, for + relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a pro- posed bedroom and bath over garage and rear entry, . and to roof over and screen in an existing deck, on a .non -conforming lot. Said premises is property with frontage on the North- -» West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are availab,e for review at the Office of the Build- ing "Dept., Town Ha11, 120 Main' Street, Monday through Thursday, from the hours of 9:AM to 1:PM. : By Order of the Board of Appeals William J. Sullivan, Chairman E -T — June 30; July 7, 1998 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in, an existing deck, on a non -conforming lot. Said premises is property with frontage on the North-West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals, William J. Sullivan, Chairman Published in the Eagle Tribune on 6/30/98 & 7/7/98 pegaUwv/2 LEGAL NOTICE I LEGAL NOTICE TOWN OF NORTH ANDOVER fte MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for j relief of lot dimension, street frontage, side setback, and I for a Special Permit to allow the construction of a pro- posed bedroom and bath over garage and rear entry, l and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North- West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Build- ing Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals William J. Sullivan, Chairman E -T — June 30; July 7, 1998 Any appeal shall be filed within (20) days after the date of filing of this Notice in the Office of the Town Clerk. o a y R E'er E JOYCE TOWN CLci;l; SA- tit�`' NORTH ANDOVER TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Property: 90 Herrick Rd. NAME: Susan Hattmaier I DATE: 7/15/98 ADDRESS: 90 Herrick Rd.PETITION: 025-98 North Andover, MA 01845 HEARING: 7/14/98 hl Zl Irl 2:; o ' y 8 The Board of Appeals held a regular meeting on Tuesday evening, July 14, 1998 upon the application of Susan Haltmaier, 90 Herrick Rd. North Andover, MA, in the R-4 Zoning District, requesting a Variance from the requirements of Section 7, Paragraph 7.1, 7.2 & 7.3 for relief of lot dimension, street frontage, side setback, and for a Special Permit from Section 9, paragraph 9.2 to allow the construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. The following members were present: William J. Sullivan, Walter F. Soule, Robert Ford, Ellen McIntyre, George Earley. The hearing was advertised in the Lawrence Tribune on 6/30/98 & 7/7/98 and all abutters were notified by regular mail. Upon a motion made by Waiter F. Soule and seconded by George Earley, the Board of Appeals voted to GRANT a Variance requested from the requirements of Section 7, Paragraph 7.1, 7.2 & 7.3 for relief of lot area of 6775', street frontage of 40', right side setback of 4', left side setback of 12 1/2', and to GRANT a Special Permit for relief of section 9.2 to allow construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. Voting in favor. William J. Sullivan, Walter F. Soule, Robert Ford, Ellen McIntyre, George Earley. The petitioner has satisfied the provision of Seddon 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Note: The granting of the Variance and/or Special Permit as requested by the appikard does not necessarily ensure the granting of a Building permitas the applicant must abide by all applicable local, state and federal and building codes and regulations, prior to the Issuance of a building permit as requested by the Building Commission. �BO�ARRD OF APPEALS William J. Sullivan, Chairman / r) ml/decoct/4 1 i1 REC�I�'' JOYCE BRADSHAW TOWN CL' -:["K NORTH 1,Nr, 0VER JuN 22 9 29 APS '99 = e_✓? by Town Clerk,. 77OW 0- NORTH _NDO4_ER, M.�SSACHuSHTTS BOA= OF APPALS APPLICATION FOR RE? =DS' FROM TzD 70N -!'NG CRD;NrNCB Amp:_cant 5 L� � fa �' ���G='% /���/C lZ Address ��L% /7/ Tel. No. 6?- y _ . APe � _ a On _ -e_ e�v made : f -A/ //6 �- a'u i / y J a? a- va_ -'ce 'from z:he _ - emen-- se / 2 -' - ='d -'==t-- - _ . a Spec_al Pe" Tl' -. under Sec:_c^_ParG cG " V ^ �._ ...~� .�.,vP _.?c 2 I GWS p a_s_cr_ made -'-v =nsz)eczor or cc_:'ner au;:cr_-v. ='re.m,_ se_ a= «C z ec are land and ~'`--=a- C i 5 w; Prem_ses af_ec:.ec are proper -.v w_-_::- o c- Nor-_- (I Scute__ ( ) Easy ( �wes� ( s � c-= ,-C=rH w,Cs7t.t'L y 5 /nom Gr `'✓/ CLQ/ Stree,-. ae ', ac Known as No . �U C� �� (C Lr _ SZ:ree�_-. ` -- m-seS G C_^%�L-* .!'.. Gr ._ .� _ �fJ/�'' J` 7.�'� SCI:r c. a ---a =ro ace G_ _ - - 0� a 3 . Owne_ snl;, : G) =game GAC address of Owner ( i _ Jo:nt. owne-'sil_. .~.lve a_ - name s) S -r SO 11 pal GLC C_ _C-..aseh/1l II a:D t 1 _CaCL owi:e= , Cr�eCK .._sj ..1 :-;e o'rem_ses . - r Lessee CGL:._-'?C__.Gcr _.cr DEC_G_ e T-..-__ a ✓. . Zeez a) =_=rcx_':daze Cate cf e="""_cn: o) Occucancv c= use of each. :=oc: c) --v-,)e of: cons t_uczion: was _ne_e been a previous apoea , 11nce_ 7Cr__nc on ..Nese c,_ em_ses? A/0 - If so, wne_^.� n - - - _ _ n_S cet_: S�= 13� JFsc: _:��..cn O "?l - e' sOLCiiC. On _c% ` Deer; = eCC_ Oe0 .n C' e ;zec4 szr',, of Deecs _'n ~ock C) Pace �. Land CourCe=ccar No. ,�� 3cok ?ace �7. .i. r `.-Gy p- ma::�Cn G_ �c_rs ..�cr_ w ---c = - �se - - --.._..- as - ...c__ - c pay e ___I 1"1 C, news 6 0= 8 DESCR7-)TION OF VP�IANCE REQL7ES'�'ED ZON=NG D S—RDCT — f Reez::_ec Setback Exist -mg Setback or Area or Area Lot Dimension ReI_et RecLestec Area �� � I�� 5 Street Frontace ?_ ent Setback,? � C Side Setback (s) i Rea= Setback Spec_ i ?e mJ aer-,gest. J � � c: 8 TOWN OF NORTH ANDOVER DATE: UST OF PARTIES OF INTEREST: PAGE OF SUBJECT PROPERTY MAP PAR # NAME ADDRESS ABUTTERS: 2 - De .2 0 71 /P )EI21-2 -5 51 6 7 2- 9 2- 10 12 13 Z 14 15{ n% tic 94 17 /v 171 18 191 20 DATE: TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North-West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1: PM. By Order of the Board of Appeals, William J. Sullivan, Chairman Published in the Eagle Tribune on 6/30/98 & 7/7/98 /legainov/2 LEGAL NOTICE I LEGAL NOTICE TOWN OF NORTH ANDOVER ✓ MASSACHUSETTS BOARD OF APPEALS Notice is hereby,given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to 311 parties interested in the appeal of Susan Haltmaier, 90, Herrick Rd.; North Andover, requesting a Variance from the requirements.... of Section 7, paragraph 7.1,.7.2, & 7.3, of Table. 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a pro- posed bedroom and bath over garage and rear entry, . and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North- •. West side of 90 Herrick Rd. which is in the R-4 Zoning " District. Plans are available for review at the Office of the Build- ing Dept., Town Hall, 120 Main' Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals William J. Sullivan, Chairman E -T — June 30; July 7, 1998 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 346 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North-West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals, William J. Sullivan, Chairman Published in the Eagle Tribune on 6/30/98 & 717198 /legalnov/2 LEGAL NOTICE LEGAL NOTICE TOWN OF NORTH ANDOVER ✓ MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the. Board of Appeals will hold a public hearing at the Steven's Memorial Library, .345 Main St., North Andover; MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal. of Susan Haltmaier, 90. Herrick Rd., North' . Andover, requesting a Variance from the requirements... of Section 7, paragraph 7.1, .7.2, & 7.3, of Table.2; for + relief of lot dimension, street frontage, side setback, and ; for a Special .Permit to allow the construction of a pro-,'.',. posed bedroom and bath over garage and. rear entry, . and to roof over and screen in an existing deck, on a non -conforming lot. • - Said premises is property with frontage on the North- -* West side of 90 Herrick Rd. which is in the R-4 Zoriing A. District. Plans are availab,e for review at the Office of the Build- ing Dept., Town Hail, 120 Main' Street, Monday through Thursday, from the hours of 9:AM to 1:PM. -> By Order of the Board of Appeals William J. Sullivan, Chairman E -T — June 30; July 7, 1998 OO 9 �9SSAC HUS�t�y TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North-West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1: PM. By Order of the Board of Appeals, William J. Sullivan, Chairman Published in the Eagle Tribune on 6/30/98 & 7/7/98 /legalrwv/2 IMIIIM LEGAL NOTICE I.LEGAL,NOTICE TOWN OF NORTH ANDOVER ✓ MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, .7.2, & 7.3, of Table. 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a pro- posed bedroom and bath over garage and tear entry, . and to roof over and screen in an existing deck, on a .non -conforming lot. Said premises is property with frontage on the North- West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Build- ing Dept., Town Ha 11, 120 Mair, Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals William J. Sullivan, Chairman E -T — June 30; July 7, 1998 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a proposed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North-West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals, William J. Sullivan, Chairman Published'in the Eagle Tribune on 6/30/98 & 7/7/98 Aegalnov/2 LEGAL NOTICE I LEGAL NOTICE TOWN OF NORTH ANDOVER ✓ MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA on Tuesday the 14th day of July 1998, at 7:30 PM to all parties interested in the appeal of Susan Haltmaier, 90 Herrick Rd., North Andover, requesting a Variance from the requirements of Section 7, paragraph 7.1, 7.2, & 7.3, of Table 2, for relief of lot dimension, street frontage, side setback, and for a Special Permit to allow the construction of a pro- posed bedroom and bath over garage and rear entry, and to roof over and screen in an existing deck, on a non -conforming lot. Said premises is property with frontage on the North- West side of 90 Herrick Rd. which is in the R-4 Zoning District. Plans are available for review at the Office of the Build- ing Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals William J. Sullivan, Chairman E -T — June 30; July 7, 1998 N2 Date ..... ? ... 1el - ;/' ...................... ,IORTH TOWN AG&W ANDOVER P PERMIT FOR -SEP 14 V 'V CHUS 08 t� 998 ER, c' Thiscertifies that .......................... ........ has permission to perform ..... wiring in the building of ..... L ....... .................. at .............. I...... ..... ............ ....... North Andover, Mass. Fee—........ Lic. No4. e 2// . ................ *i�i;�,�ZINSPECTOR* ******"*—" O -Go' I WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7W'E o^ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No_ 2 Occupancy & Fee Checked 1:70 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Sec:ncai Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street'& Numbererr f C Owner or Tenant 1441 i � rbta[ f 2. Oate m A Wt To the Inspector of Wires: Owners Address SOt /btu Is this permit in conjunction with abuilding permit Yes � No C3(Check Appropriate Box) i Purpose of Building eC IAy _ems Utility Authorization No. Exsting Service IAmps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity I ocmcn and Nature of Proposed E?ectriical Work &6G-,0 ?J M / 6#9TY 4: �r 116,J IN OTHER: 9 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Com,pleted Operations Coverage or its substantial equivalent YES,— -'/NO = have submitted valid proof of same to the Office YES to NO = If you have checked YES please indicate the type of coverage by checking the appropriate lox INSURANCE %"BOND = OTHER = (Please Soeafy) Estimated Value of Electrical Work$ �` Q'O .0-0 (Expiration Date) Work to Start Inspecion Date Resquested i -1 «- L C P,LL Rough Final Signed under the Penalties of perjury: FIRM NAME (,Ak&0E -- IEL—e c • C0 J, I . -XrJ L • LIC. NO. i.-' _ \R Licensee Signature LIC. NO. Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Llcanses does not have the insurance coverage or its substantial equivalent as required by MaesacnusetM 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) Total No. of Ughtenq Outlets �� No. of Hot fuse No. of Transformers KVA ! Above ❑ I In ❑ l No. of Lighting Fixtures Swimminc Pool gmd C qmd C Generators KVA No. of Emergency Lighting No. of Receotaces Outlets L2 No. of Oil Sumers Battery Units No. of Switch Outlets No of Gas Bunters FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranoes No of Air Cana Tons Initiating Devices Heat Total Total No. of Ciao" No. Pumas Tons KW No. of Sounding Devices No.] of Self Contained No. of Disnwashers Soace/Area Heatinc KW OetecdonrSounding Devices C Municipal C Other No. of Dryers HeatingDevices KW Local Connection Na. of No. of Low Voltage No, of W r Heaters KW Signs 8adases Winne No. Hydro Massace Tuds No. of Motors Total HP IN OTHER: 9 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Com,pleted Operations Coverage or its substantial equivalent YES,— -'/NO = have submitted valid proof of same to the Office YES to NO = If you have checked YES please indicate the type of coverage by checking the appropriate lox INSURANCE %"BOND = OTHER = (Please Soeafy) Estimated Value of Electrical Work$ �` Q'O .0-0 (Expiration Date) Work to Start Inspecion Date Resquested i -1 «- L C P,LL Rough Final Signed under the Penalties of perjury: FIRM NAME (,Ak&0E -- IEL—e c • C0 J, I . -XrJ L • LIC. NO. i.-' _ \R Licensee Signature LIC. NO. Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Llcanses does not have the insurance coverage or its substantial equivalent as required by MaesacnusetM 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) t y� 381 Date.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING `%6� This certifies that ..'1 ... has permission to perform�-/„'�!� . ?. `plumbing in he buildings of....'44 .Z.4r?.. ...r ..!.. . at. ©..%�.. 4.44 ........ , North Andover, Mass. {FeeA1,6 Lie. 9... PLUMBING INSPECTOR 09/10/98 49:47 40.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Q x + MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Y (Type or print) ' �- `p' - CI • NORTH ANDOVER, MASSACHUSETTS %� Date Building Locations C GG �C Permit # &gfd r f Amount Owner's Name `.J, �� l 7m 4,(-e New � Renovation 1:1 Replacement ❑ Plans Submitted FTXTTIRES r� Check one: Certificate Installing gnCompany Name .� �r� � �/I ! C� l 5 ❑ Corp. Address ❑ Partner. ` Business Telephone,/T'2 �7P' /> Firm/Co. Name of Licensed Plumber: ��I �`C � i9/1 d C,/%l� 6 th Insurance Coverage: Indicate e a of insurance coverage by checking the appropriate box: ❑ Liability insurance policy Other type of indemnity ❑ Bond A Insurance Waiver: I, the undersigned, have been made aware tlfat the licensee of this application does not have any one of the above teeinsurance Signature Owner ❑ Agent ❑ bof my lmawle* wd lba aD phmmtimg wait Pates p ®arr Pates i iu itis �o^�is est w� compliance with all pertinent provisions of the Massa tt and5h42 of the General Laws. rc� By: + re o I n um er Type (r Licease Title City/Town License lNumDur Master ❑ Journeyman APPROVED (OFFICE USE ONLY ti- ......_........ 11 com: N p P A CD k 07 m � o 70 3 07 D t— m- - - - - - -- - x-------- H H ci m 0 70 0 0 m o m 70 D � O 3 = co m 0 70 0 0 3 y ru iy °p b b Co •e t�Fl, .... .. ....-....... t ' ..... ;r ��+ �;i: .. .