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HomeMy WebLinkAboutMiscellaneous - Exception (759)Date .... ........ I 1 %51 %-Ij �-,7 TOWN OF NORTH ANDOVER I. -:v .4 10\0 PERMIT FOR PLUMBING CHU4f �'his certifies that .... . ......................... ............................................. ........ .. t;as permission to perform ..... LA.ec . . ................................................................. plumbing in the buildings off).., ...... &.1 .. C� ................................................... at ........ 4-�) ..... O..bW North Andover, Mass. ........................................................k . ..... Fee.:� . . ...... Lic. No. ..... ................................................................................. Check#'l N1 PLUMBING INSPECTOR Ix MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITYMA DATE ��.� PERMIT # I JOBSITE ADDRESS OWNER'S NAME ) P OWNER ADDRESS TEL AX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL RESIDENTIAL) PRINT CLEARLY NEW: [ RENOVATION: ® REPLACEMENTS PLANS SUBMITTED: YES ® NOV FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM f DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM "��"�� > w �" _ .` DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ,. FLOOR /AREA DRAIN s INTERCEPTOR (INTERIOR) (,tel KITCHEN SINK : LAVATORY ROOF DRAIN SHOWER STALL _ . , 9RVICE / MOP SINK _ ]LET , 6 RINAL]Rr ASHING MACHINE CONNECTION ,WATER HEATER ALL TYPES .. f=. ...... s WATER PIPING_ -y': E OTHER Jg� -:. .. ... ,.. _.amu. ....... i i1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. I CHECK ONE ONLY: OWNER [j AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 co iance wit all Partin e provision of he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE # SIGNATURE MPIQ ;JP"[J. '-,*—',' _ ., ;;_' CORPORATION]#PARTNERSHIP®# LLC [j# COMPANY NAME ADDRESS CITY STATE ZIPTEL fir' FAXI CELL EMAIL Ix The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/individual): Address: City/State/ZipZ)2QVivrS 9A Phone Are you an employer? Check the appropriate' box: l.❑ I am a employer with employees (full and/or part-time)." 2I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.[D I am.a homeowner doing all work myself. [No workers' comp, insurance required.] t 4.O 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp, insurance., 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152, ✓i1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. Plumbing repairs or additions 13.E] Roof repairs 14. ❑ Other _,a appucum Ula[ enCCKS oox u t must also till out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check ;this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. lam 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. #; Expiration Date:__ Job Site Address: 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 MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do certvy unaer!�e paps and penalties 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 6. Other Contact Person: 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #: i.. fi r ti, r Date I 1 I Town of North Andover U6 l Your permit has been sent back to you for the following reasons: �n 1) Check amount incorrect _ 2) No copy of current license / V 3) Insurance Binder not on file or expired / 4) No Workers' Compensation Insurance Affadavit Form ✓ e,&,,� , Please call with any questions 978-688-9545. Fax 978-688-9542 Workers' Compensation Form and Schedule of Fees can be found on the Town of North Andover Website under Building Department. I Mailing Address: 1600 Osgood Street, Building 20, Suite 2035, North Andover, MA 01845 a� I - F -4b pl-f�j -, j �" In;6 (10 , I c�A-s 60,cc..k �-�-V TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SACMUS� filud C This certifies that .. ... .-... has permission to perform /) / �j. �-�-• plumbing ' t e u' din sof at j/.. (..`C ..aj �.�-- • • • • • • • • • • , North Andover, Mass. Fee./J. .Lic. No. � .............................. PLUMBING INSPECTOR Check !1 f- 5,7'1 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ftM or Type) `` l�_ Lib Mas& Datef J Fennel Building Location E5 III ' . 1�.� �" s flame 14/CCA -Z'0'J9.� a G Type of Occupancy/ %'� . New D Renovation 0 /Replacement Plans Submitted: Yes 0 No G FIXTURES Check am Certificate Installing Ccffq=W Name G <<� s I �, r�,� 1,a1,aQ 0 Corporation Addres y u - . �2e , 4p no 0 Partnership - 0'!�, &k" I A-1 ^= �iI .. FrreMCo. Business Telephone 1- 2 . Name of Licensed Plumber ' INSIRRANCE COVERAGE: 1 have a currant liability policy or its substantial equivalent which tweets the requite of MGL Ch• 142 Yes A. No 0 If you have checked yes, please indicate the type coverage by checking the appropriate bo:. A liability insurance policy �j Other type of indemnity O Bond G 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 appli , 2"m waives this requirement. Check one: Signarge of Owner or Owner's Agent Owner Agent 0 the best Of - - _• �• •••` �•cwua.rn, mswir��pn I rune suarnmW (or � in apme D CitiOn and aCGUri[e to my IQnoMrledge and that all phrtnpirg work Ind insmllaborns ur� appiiptipn will be in OOrrlalianee vritln all Pertinent Provisions Of the � 42 tune General Laws -%Wmd ue of Licensed ft nsber Type of Lim Masts Lira = Nomber - /.�2/Dj _ y • ■ENNEN MEEMMEMEN■ y Check am Certificate Installing Ccffq=W Name G <<� s I �, r�,� 1,a1,aQ 0 Corporation Addres y u - . �2e , 4p no 0 Partnership - 0'!�, &k" I A-1 ^= �iI .. FrreMCo. Business Telephone 1- 2 . Name of Licensed Plumber ' INSIRRANCE COVERAGE: 1 have a currant liability policy or its substantial equivalent which tweets the requite of MGL Ch• 142 Yes A. No 0 If you have checked yes, please indicate the type coverage by checking the appropriate bo:. A liability insurance policy �j Other type of indemnity O Bond G 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 appli , 2"m waives this requirement. Check one: Signarge of Owner or Owner's Agent Owner Agent 0 the best Of - - _• �• •••` �•cwua.rn, mswir��pn I rune suarnmW (or � in apme D CitiOn and aCGUri[e to my IQnoMrledge and that all phrtnpirg work Ind insmllaborns ur� appiiptipn will be in OOrrlalianee vritln all Pertinent Provisions Of the � 42 tune General Laws -%Wmd ue of Licensed ft nsber Type of Lim Masts Lira = Nomber - /.�2/Dj r m _2 z z a A O z a O vt m 4 A s • a A 8 V" Vj _14W MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY MA DATE PERMIT # JOBSITEADDRESS_ .....__ CI�Q-y OWNER'S NAME ,kG xMn�� OWNERADDRESSTEL I .. � __.._,� FAX . TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Ej RESIDENTIAL CLEARLY NEW: Ll RENOVATION: REPLACEMENT: �. PLANS SUBMITTED: YES _ Nov APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERI �. BOOSTER CONVERSION BURNER! COOK STOVE DIRECT VENT HEATER.# DRYERI FIREPLACE If ::... ......,. FRYOLATOR .....,._,_. FURNACE.' _... GENERATOR „ _ ......w ._ ._.... ......':. W... _ _. _.._._� GRILLE _ ,. _.... . INFRARED HEATS LABORATORY CO MAKEUP Date 1 t)�1 � AIR UNII ..... OVEN L yl POOL HEATER pF N�A,TN,r i ROOM I SPACE For °°� TOWN OF NORTH ANDOVER I ROOF TOP UNIT * o s TEST W._ �`"� PERMIT FOR HEATER ;' ;� : -�+ ,. a GAS INSTALLATION f+UNIT UNVENTED RO�� ss�cnus�t s „WATER HEATER OTHER This 4 certifies that7 has permission for gas Inst Nation . in the uildin s oe. ..... ............................................ ►SES NO .. . have a Curren at ........... �.......... �P �.► ................ ....... ..1.�..�............North Andover, Mass. I IF YOU CHECK F z-{�_. ee ....................... Lic. No....... +.. ............ OWNER'S INS{` Check # �1(,pq GAS INSPECTOR 142 of the Massachusetts . I j AGENT 1 hereby certify that all of the details and informal o7 n i 6Vd-Swma best of my knowledge and that all plumbing work and installations performed under the it issued for this application wil elm in-wmptr mr .znt rovisie perm Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME _ LICENSE # SI NA URE �, MP;MGF JP [D JGF ,, LPGI [j CORPORATION # PARTNERSHIP !#� LLC#�� COMPANY NAME: ADDRESS i✓y�����q�� CITY rj STATE ZI µ3.m -._..__..�......_._ _ TEL .... _., m...._ _.._ ._ _._ FAX CELLEMAIL� �,ia.�.� V" Vj _14W Date..... ........... o� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Oq s AcHU This certifies that . ........... .. ter. - has permission for gas i talk ion in the buildin of .... ................ at.J���. .. .. , North Andover, Mass. Fee. -� Lic. No. X&460. ......................... . GAS INSPECTOR Check # 4 4705 MASSACHUSETTS' -UNIFORM APPUCA rumor I ypw. M , A If I? OV L__ — Mass. Dat 1-3 de),615L.t. Now 0 Renovation. 0 I FMPEFfWT TO 00 GASFITTING I to Permit Owners Name- ---Type of Occupancy !L/ _AILF-� Plans Submitted: Yeso No Cj Business Name of Ucensed Plumber or Gas F111w. LF =_ v 0 F7 Pq 707 "t A Firm/Co. INSURANCE COVERAGE.* I have acwTentliability Irwirancepollecy or Its substantial equivalent -which -meets the requirements d.MGLCh, 142., YesNo 0 ff you have =verage -by dmcklng to _appropdste. box A liability insurance -policy )( OtIter-typeol-indemnity. (2. Bond 0 OWNER'S INSURANCE WAIVER: I am - aware that the Jlcensm floes -not have- the Insurance -coverage required by Chapter. 142 of the -Mass. Genenif Laws. and 1hat. my signature on -#ft -permit -application waives this requirement. Check one: Signature of_0WWW_.0WrW:s Agent,,, OwnerO Agent 0 'hthat all of the details and information I have submitted (or entered) in above application me true and accurate to. the bad of my knowledge that all plumbing work and installations Performed under the permit issued for is app6catien be in compf with all pertinent Provisions of the Massachusetts gate Gas Code and Chapter 142 of the General BY Tof License:Plumber gnature o um or atter Title fter Master License Number 31 CX0, fJoumeyman T Business Name of Ucensed Plumber or Gas F111w. LF =_ v 0 F7 Pq 707 "t A Firm/Co. INSURANCE COVERAGE.* I have acwTentliability Irwirancepollecy or Its substantial equivalent -which -meets the requirements d.MGLCh, 142., YesNo 0 ff you have =verage -by dmcklng to _appropdste. box A liability insurance -policy )( OtIter-typeol-indemnity. (2. Bond 0 OWNER'S INSURANCE WAIVER: I am - aware that the Jlcensm floes -not have- the Insurance -coverage required by Chapter. 142 of the -Mass. Genenif Laws. and 1hat. my signature on -#ft -permit -application waives this requirement. Check one: Signature of_0WWW_.0WrW:s Agent,,, OwnerO Agent 0 'hthat all of the details and information I have submitted (or entered) in above application me true and accurate to. the bad of my knowledge that all plumbing work and installations Performed under the permit issued for is app6catien be in compf with all pertinent Provisions of the Massachusetts gate Gas Code and Chapter 142 of the General BY Tof License:Plumber gnature o um or atter Title fter Master License Number 31 CX0, fJoumeyman 1 <1 I° v Z' a H H r N O A = O O W O H ~ V O a O = s a c 66 ti 3 = O O J W O < Li J IL d Yf W 1 <1 I° UDcation No. Date y ,40RT1y TOWN OF NORTH ANDOVER O'tt�ae ,a'�•y0 Certificate of Occupancy o Building/Frame Permit Fee $ yds '�s'••a'"���' Foundation Permit Fee $ j s�cMugE Other Permit Fee $ Sewer C"*tion Fee $143 k ,Water' Connection Fee $ TOTAL & �d 7095 $ 'DSO Building Inspector Div. Public Works Ufc4tion,� .A Na. Date +4 NORTh TOWN OF NORTH ANDOVER �'A Certificate of Occupancy $ , t2 * ; Building/Frame Permit Fee $ s'CHust Foundation Permit Fee $ /1"0" 4 y d Other Permit Fee $ —�—' Sewer Connection Fee $ __---- Water Connection Fee $ TOTAL $ • do I Z117 f?13 nn Building Inspector � 7 (�CC667 0 /�ypp ire. 00 PAID Div. Public Works `Location No. �%� 5�� Date U A TOWN OF NORTH ANDOVER Certificate of Occupancy'. $ BuildinglFfame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ -5- f5 Sewer Con f 1j6', w§ Water Con TOTAL y4eh 01/ItL'94 09:41 Conn Ftp A QQ .� ti'on ee 21000.,,,, �nTOulldin�,pector DY Public Works ^PER:IiIT�NO. /� S� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /,) �/l� �/f� !� PAGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP JDATE BOOK 'PAGE ZONE, SUB DIV. LOT NO. LOCATIO S Q PURPOSE OF BUILDING OWNER'S NAME a !�NO. OF STORIES 7 SIZE�� („ OWNER'S ADDRESS , BASEMENT OR SLAB r��r y GYwO ARCHITECT'S NAME & SIZE OF FLOOR TIMBERS IST i� fO 2ND Jy RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING i�i DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS u�I� DISTANCE FROM LOT LINES —SIDES e./ /ice REAR '7 GIRDERS & , AREA OF LOT /Z5 -,ft FRONTAGE/�rJdU -o.4 HEIGHT OF FOUNDATION 10THICKNESS IS BUILDING NEW ,/ SIZE OF FOOTING �O « x .P IS BUILDING ADDI ION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LANrj WILL BUILDING CONFORM TO REQUIREMENTS OF CODEIS BUILDING CONNECTED TO TOWN WATER / J BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS INE INSTRUCTIONS JJ SEE BOTH SIDES Q, pm MMIT /y .t �s{P�gw�+rx PAGE 1 FILL OUT SECTIONS 1 - 3 LM FDA �...� �.�■.■r■�Ifwi�wr�rr�r�r�r PAGE 2 FILL OUT SECTIONS 1 - 12 DUE FRAME PERMIT $ Z 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 I DAT SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE /I>YU� 0 U PERMIT GRATE" • D O u 19 . { i MAR 1 tIlk OWNER TEL. CONTR. TEL.-// L � CONTR. LIC. # '/Z 949 _ 3 PROPERTY INFORMATION LAND COST / ® Awm ,tr o EST. BLDG. COST a 3 53S' Q EST. BLDG. COST PER liQ. FT. EST. BLDG. COST PER ROOM /a// SEPTIC PERMIT NO. `��C�3 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN W%ps YlAV inir ulum BUILDING RECORD - 1 OCCUPANCY 12 SINGLE FAMILY / SiOkIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —{ 8 INTERIOR FINISH 3 I 2 13 PINE CONCRETE CONCRETE BL K. BRICK OR STONE HARDW D _ _ PIERS PLASTER DRY WALL — _ _ _ _ UNFIN. 3 BASEMENT AREA FULL s FIN. B'M'T AREA _ '/4 '/I % FIN. ATTIC AREA N_O 8 M'T FIRE PLACES HEAD ROOM MODERN KITCHEN _T 4 WAILS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING B 1 2 �_ 3 _ CONCRETE EARTH HARDIN D COMMGN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME _ ATTIC STRS. I FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE �' NONE 10 PLUMBING 5 ROOF GABLE HIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES I' LAVATORY WOOD SHINGES KITCHEN SINK 7— SLATE SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST ✓ PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS / AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T2nd _ 3rd ELECTRIC NO HEATING 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. 4 ri t✓ FORM U IAT RELEASE FORK 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: J4&L- a C,�=A-4 &A, u S JPhone -G R 7-// Z g LOCATION: Assessor's Map Number Parcel Subdivision re6blts1 .." Lot(s) StreetCo �ru-,L. r,V-& St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: -V�> Date Approved Z Conservation Administrator Date Rejected Comments Date Approved d q wn Planner Date Rejected Comments Health Agent Comments Date Approved 2 Zea Date Rejected Public Works - sewer/water connections - driveway permit zGIA1112 Fire Department.► ---- Received by Building Inspector Date A/O WX1 MAR 3 1 M 011N, G DEPART I%A ENT � r rfle R1. or Rz.4,.,v AV EO av r11,rzOr,f.f 40AIllcaellff AV ,*'Irll V,"*A0 Awjonp-lAe zolllwa -%eref orx "a"COW X,-,eeers, If 'Oval— 'W'F'O'e0 A.PEA,, FFR V-4 . t4 ep)e A4 ,447'10AW 64 .00 O m cn m D 0 z v CO) d G � 10 O CD 0 Z CO) C O 0MM. r c = c CL y �C D CD 14 CD ,c o CL Q CD CD O CD C CD rA Qv y •O CO CD � v CO) O � Z O O o CD 0 c CD M rm "*7 G 0 0 Z 0 CD 0 C2 C c c C2 CD 0 0 a y O C 51i O Fl- Z S. . O Crp• G. om .o N2 CD n S! C,. N m, d C S'fl C,* cF m H T ®c=d 2 m -loos p CO) O O = �� o` C 0 Z�•o Sy7 :� a � CL � cl) CD W y CL CD CO) .Z d H CL a CLdW G A W H IA O O � O w c, •O O O CC oo- � CD C 4N 1 CO2o` CDC mouE �o N CD 'v CO 4 o 00 O r3 CD m cn �- d cn ^ o nCD °� Y ?' cp iT1 (� y a� , r tz z w- n �' ora o. r cn b �• y (D al . 0 x ::r O Y t7l Ilk 0 c m z m C� C-) O z cn m x T z CO) 10 CD C F CD O CL r— CM M CL >Co. O CD %ocv CL Q CCD O wommu a: a) ccCD CO) 10 CD 0 W IM 0) C) CD O r� CD CD a CH. CD Cn C 0 0 z o_ CD 0 O ao C a Co CD to O y C=. CA CA M CD S. o = a0�CD y 0m n CA CL 3 O cow y r o r► cn ,,, TI CD -ioo�o y y O ? CD CD = �� o`CD 0 0 oCA n o o � PA a � CL o CD co CD y O CD CL CD cD d y _ ca C2. Ca G �<c CD y CD N A _ col CDCD �CD to 0 o O O CCD o ' CA — : �o R 4 bb . 00. cc; CD y —�. Is �r 0 omh Cn 0 7G"• CD CT CD n O �i �+ ^ oz 7� �tf y ",C7 C OC G1 cn M oIz '17 y (n " rD •JJ G OQ M y z O 7J � O QQ t..i z co p �y w . ? O4 G "J' rL w ° Ccnx r' O n '�• f1 0 CL �- tz o x Location�� No. 0.5 2 - C Date 3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ '— Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 2 S c) r� '1 2 b Buildinb Inspector i 7 CSL cy34 13c39 25.00 MTP Div. Public Works t it rll .l)IN(; (:( )N 1 a I VAT1 )N I If A :!'I !I.ANNINI ;i ;t ATE )CATION LINER'S NAME: Nta��'1'kI.c1►NI�U�'L'1t rltttrlt.,,ttIt1% ''.••'a:�,,' t.l: t�:�:ii ru ra •rr•; a Itr.� '`�n"'"� 1�1�'I:iillNl,l° llil illilr!i•1 i i!i . l'l,jkNN1NG. L4 (;t)(11[►1L.rN1"1'1' Ul'sti'1sl,Ul'Al1:N"!' 11.1'. Ni: LSO)N, I )II II :t :'I ()I I 1ILDER'S NAME:— : AME: ' ' ' SON'S NAME.,, kSON'S ADDRESS: ISDN' S TELEPHONE: J' . CHIMNEY APDL IC'Af ICN ANO I'C131I I' JERIAL OF CfUNEY: 11'ERIOR CHIMNEY: _ L'X1 ERIOR CHIMNEY: 11�IBER AND SIZE OF FLUES: n 1I CKNESS OF HEARTH: � /� j -- -,U eh,ullrley on, 6iuptaee eon(anm to Ae kequb(cuierl.t.6 u( the eude and have auce.3 and :guta ti.ojo beers ucebed: 4dZ G'NA :KNIT GRANTED: / —c;� 3 5� FEE d 0 'BERT NICETTA ILDING INSPECTOR SPECTEU: :AIARKS : _ SOLID BLOCK RLQUIRLD THIS PERMIT MUSF GL: UISPLAYLU 014 WE ITL1,11 SCS i i . t 4 i i CL0 /, Ai m m O r C i mn cr 0 Oil Z mn 0-0 re LO d C b>Cj) d[ z. f m i-1 z y r v N n ^r M z m o w� H �c ("D t rt rt 'K� o j H• C- ", 77(D t7 % moi•' (p n rtoEn d z ' ri)' z y �A z �{r`ti i t • 1r. %_ t Ft, c+\f�R a Sfi tLl r�\t ti til .'�ti�'ti 14 1 `c 1t.?jiS.0 '+v r: Yt �+,-'t t � 5,; 4 i;ttj i:.., ' l �. �.'.4: � �. .its _t ; F4,:. \ ` '.l S t •t t ; ti t ti i ., t j.�' 't, .� ♦ � .. ♦ a � ';�\ i� \ \ k ae• i r`s�•-., c 4-;� j,/a`i +f,.:, J:1\ t. `V y:. .t t. a a fel.'• + ,i f_t i. tY � f.`C '.`i� \ "�r.1�,.�Fy i.t t. ii•1,�, � 113i 4i �•<t,1 � `♦ �� .1 - t .` � .. .� ..�.:� ♦-'+��t..:.`-T s v`�7 icy \ 1 � 1 •~ ci1����. �'4. +F. !Ti'ti-Z �::, tS:, L` � S `fit. ,� ♦ t 1i ? •. _.. ♦� ♦ +. ` a , y. , `.-f C, .���\ \1,j��r v �'`a w'.! +��'".�k", �d'�.t"-'� a w �- '•`_i � ♦. 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