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This certifies that
Date ...C�-
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
has permission to perform
plu��m11b��ing in the buildings of
at ............................. , North Andover, Mass.
Fee14. �% . ' . Lic. No. A—PR A .......
�..gg,LL�.. ....... .
--PLUMBING IN5P£GTOR
Check # 2—;�,I R
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location ��� AN4LOUPlz.J /
n Date
)wners Name LONb
Amount
of Occu anc ^ 1i ftp. Ck
New Renovation Replacement Plans Submitted Yes No
►NY t W
(Print or type) Check o : C rtificate
Installing Company Name
Address / E] Panner.
G e - L_I
Business Telephone Firm/Co.
Name of Licensed Plumber:
isurance Coverage: Indicate e type urance coverage by checking the appropriate box:
ability insurance policyLjOther type of indemnity ❑ Bond ❑
Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 13 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 FF�—
igninure
llations perform der ermit Issued for this application will be in
compliance with all pertinent provisions of the Matts Sta 1 b' d hapser 142 of the General Laws.
By: o icense um er
Type of Plumb' g License
Title /q Y
City/Town icense1"U11157 Master �i J� ourneyman
APPROVED (OFFICE USE ONLY LSI
Location /-�/
No./ �73
Date 11,n
40RTol TOWN OF NORTH ANDOVER
f �
9
Certificate of Occupancy $ l
�as�cHuSE<
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # ,5
22"► 91 J
Building Inspe f r
n
Y
CERTIFICATE OF USE & OCCUPANCY
TOIMI OF RIORTHANDOVER
Building Permit Number
/9�
Date % 5�-, t�- 51?
THIS CERTIFIES THAT
THE BUILDING LOCATED ON -�-' -�-� 19.5
MAY BE OCCUPIED AS
IN ACCORDANCE WITH THE PROVISIONS OF HE MASSACHUSETTS/STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO�1J �►�1�
Building Inspector
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4-7, OL
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
NcNus�� BUILDING PERMIT #
ADDRESS/LOCATION OF PROPERTY: 451 hy671A hTLVA
`—M.4
Map Parcel Lot Number
SUBDIVISION:
DATE REQUESTED FILED/READY FOR INSPECTION:
CLOSING DATE ON PROPERTY:
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A
REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES.
APPLICANT SIGNATURE
Permit Issuedle�WJ /YI��C' J�t� � L ✓��%��/lG�-�
Address:
ROUTING
CONSERVATION ❑
PLANNING ❑
DPW -WATER METER ❑
SEWER CONNECTION ❑
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
DPW
SIGNATURE
File: Application for OC form revised Jan 2007