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Home My WebLink AboutMiscellaneous - 61 Innis Street 6\ v1 \I Locatiorr NoyDate /7..00 4�4 NORTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ NO x Building/Frame Permit Fee $ Foundation Permit Fee $ sACMUSE 4 Other Permit Fee $ Sewer Connection Fee $ 5 b Water Connection Fee $ TOTAL $ h Building Inspector ' 4 0 5 87 01/06/97 10:17 r1 c'35 O(P tJA iv.Plbblic Works Location I' r �- —/y/Vf S No. _ Date 0 waR*M TOWN OF NORTH ANDOVER A Certificate of Occupancy $ r Building/Frame Permit Fee $ yes+ane Et� Foundation Permit Fee $ s�CHus , Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ,►,`mac- �! 7Z— Building Inspector t L 0 5 a 82/20/% 11:54 150.00 PAID Div. Public Works Location t /I f 1< 12 7 blo. Datero MGRTp TOWN OF NORTH ANDOVER Certificate of Occupancy $ �111111M 'A 1 . WM.L ; Building/Frame Permit Fee $ t<� Foundation Permit Fee $ X12 SACHUs 8 Other Permit Fee $ co # Z Sewer Connection Fee $ ate• C+ Water Connection Fee $ 125 •eo • TOTAL $ fI .t/ �Buildi g Insp or r ► / I' 12/.20/96 1• 1,400.00 PAID 1 Div. P li, Works PERMIT NO. �/� � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, .MASS. � PAGE 1 lw— LOT NO. 2t22 2 RECORD OF OWNERSHIP iDATE (BOOK iPAGE RN TZO E �/ OCATION -rnJNiS S�rC'-�� PURPOSE OF BUILDING OWNER'S NAME/��(_�r� cQ 1'hC/`►!ye. �}h eQ/'a1 NO. OF STORIES -hPlE OWNER'S ADDRESS L� irrSto�he✓' d72 rnethuetll BASEMENT OR SLAB A me f)r ARCHITECT'S NAME ft(, SIZE OF FLOOR TIMBERS ISTx I AND Iq x td 3RD BUILDER'S NAME SPAN Obert-a c4t-A: (�hecr,^� ge� grl'1S l!o G,v C .y1'er__ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS ij =_ .1 v/ T DISTANCE FROM STREET !�Q / qJ�7 _ POSTS ^? r/a/, Co/vm-y.5 DISTANCE FROM LOT LINES-/SSIIID .7DESa`L/ P�5J�' REAR �n / " GIRDERS -3 aC. AREA OF LOT ^ Q/IV J FRONTAGE '�7,•0 HEIGHT OF FOUNDATION i!o THICKNESS IS BUILDING NEW y eJ 7 V SIZE OF FOOTING ,p// X IS BUILDING ADDITION w ,O MATERIAL OF CHIMNEY !J e tC} IS BUILDING ALTERATION•V_ 1� IS BUILDING ON SOLID OR FILLED LAND 5O WILL BUILDING CONFORM /TOO REQUIREMENTS OF CODE ,/ IS BUILDING CONNECTED TO TOWN WATER j e5' y BOARD OF APPEALS ACTION. IF ANY 1 IS BUILDING CONNECTED TO TOWN SEWER �.� IS BUILDING CONNECTED TO NATURAL GAS LINE? INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES Yj'' O EST. BLDG. COST �vJ / PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER f0. FT. PAGE 2 FILL OUT SECTIONS l - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY • ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ,y / _ /994! X♦ _ —� BUILDING INir[CTOR SIGNATURE OF OWNER OR AUTHORIZED AGENTp1� FEE OWNER TEL.# GO_—/-7Q PERMIT GRANTED CONTR.TEL.# I9 _ A> CONTR.LIC.# H.I.C.# BUILDING RECORD'' ' 1 OCCUPANCY 12 SINGLE FAMILY I ,- ISTOWIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICE$ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. y CONSTRUCTION r 2 FOUNDATION 8 INTERIOR FINISH CONCRETE ✓ 3 II3 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW D _= PIERS PLASTER _ _ DRY WALL f/ _ UNFIN. uu// 3 BASEMENT I `3$•-T LO 3 .3 y V7 AREA FULL I/ FIN. B M AREA _ '/, r/r 1/. FIN. ATTIC AREA (f_ NO BMT FIRE PLACES HEAD ROOM _ MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 ` DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH (y ASPHALT SIDING HARD"J'D y ASBESTOS SIDING COMMC:N _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR 4 BRICK ON FRAME CONC. OR CINDER BLK. O STONE ON MASONRY WIRING STONE ON FRAME _ S. SUPERIOR I� POOR , EQUATE NONE AD 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) {� ` �{o�•Da GAMBREL MANSARD TOILET RM. (2 FIX.) 1 FLAT SHED WATER CLOSET _ ASPHALT SHINGLES, t/ LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING 11 MODERN FIXTURES TILE FLOOR TILE DADO / 6 FRAMING I 11 HEATING aoy. WOOD JOIST ✓ PIPELESS FURNACE v FORCED HOT AIR FURN. ✓ TIMBER BMS. &COLS. ✓ STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS oe' AIR CONDITIONING - - Q RADIANT H'T'G UNIT HEATERS - . "m 7 NO. OF ROOMS GOAD �- B' M'T 2ndELECTRIC 1st 13rd I NO HEATING RT Town ofover 6�8 No. - *Ty Z z dover, Mass., Z- 19 9 C7k IANE w 9-COCNICNEWICK yam',• 9 0A,'47 D- SS U BOARD OF HEALTH PERMIT - T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT R - " C f#TY.......... ......................................... Foundation has permission to erect..............-- .............. buildings on/........�a.. .......... N/ .�.5............�.T........... trough //J G X-9' F04G0 / l Chimney to be occupied as.................................................. ........................................................ ... .. . . . .. . . . . . .............. . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of BL4Idings in the Town of North Andover. PLUMBING INSPECTOR Vit,LATION of the Zoning or Building Regulations Voids this Permit. Roux e. Final PERMIT EXPIRES NN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST Rough .............................. ........ Service ... . ........ . ....................................... ........ B ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. 5 ,ke Det FORM U - VERIFICATION 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 IIfills out sn this section***************** APPLICANT: 0be_r 4- GQthQ-riNe IlkeQrA Phone LOCATION: Assessor's Map Number 99C ` _ Parcel Subdivision Lot(s) 7 Street St. Number ************************Official Use Only************************ REC DATIO F TOWN AGENTS: ,,/ Date Approved7/ Co servatio Administrator Date Rejected Comments 15.E fl Date Approved Town Planner Date Rejected Comments QCS Date Approved Food Ins ctor-Health Date Rejected Date Approved 71,;? �Sep ;Zc nspector-Health Date Rejected Comments Public Works - sewer/water connections /j if �ZLl - driveway permit /C ` G Fire Department 'C ,),✓Le. kq� W,at& tl �Ce < d- ��QrpS �`•d2�G ��-r— f1'i' .� � (,�,Cez��. ,�c1 r,�� 7 "�rl � 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) RC)6-2l- r- Ogt�erInle Akecld, �0 Met�. Map and Parcel Vc? P,1/8 Purpose of Application (check below) Phone Number of Applicant: Single Family _Two Family 62 U I the undersigned applicant 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 permits,(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. Signature of Owner or Authorized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. Town of North Andover N°RT4 OFECS OF COMMUNITY DEVELOP-NIEr'T AIrD SERVICES ° lob M, = Sa-wt KENNETH R.uaHONY North Andover,Massachusetts 01845 'SS4cr+u5=` Director (508) 688 Pease print. DAT z JOB LOCATION' to I _T/_)/V I's - 12. /I/- /1 jAl e f2 Number __set.address Section of tow-", ;..:OtiiEO�wER'�go bee � �' f)/0-?, :A_400KA) (SS-q�8 game: / rope crone Wor phone PRES ZN7 MAILING .ADDRz'SS (o �'�{� 6 12b-eC a�2 City/Towr_ State Zip code The current exe:rntion for "homeowners" was exta_ded to include owmer-occupied dwellings of.six units or less:and to allc:v such :omeo:v hers _o engage an indi�:dual for hire :vao does_ not possess a license. provided that the owner ac's as supervisor. (State.Building Code Sac- tion 109.1.1) DEFIvTI'ION OF HO?1vEOW,=- : Person(s) who owns a parcel of la=d on pica aa:sze resides or in tends to reside. on which there is, or is intended to be. a one to six :anvil.: d:raairQ. attacaed or detached s zuctures ac- cessorr to such use and/or farm s�.:c- es. A pe�ca :vco constructs more than one home in a two-year period shall not be coasice:ed a homeowuer . Suca "homeowner" shall submit to 'the Building.Official. on a for= accaptable to the 3uiiding Official. that he/she shall be responsible for all such work per'ormed under the building permit. (.Section 109.1.1) 1 he undersigned "homeowner assumes respors bilitr for compliance :vith the State Building Code and other applicable codes. '-Y-:a7 ^_les a=- :e;uiat ons. The undersigned "homeowner" cer i es that '-e: * a understands the Toco^n of No. :Andover Building Depart--hent minimum in specton prccad•=ss and requirements and that hershe will comply with said procedures and :ecru emeats. HO%fEOwNF_ S SIGNAZURIE LTA z. ./,"v ez, r' ,PD:ZOVr%.L OF BL7LM G OP=-CLA-C1_ t:t-V Note: Three family dwellings 35.000 c ibic :est. or largeL will be required to comply with State Building Code Section Li 0. Cous—auction Control. BOARD OF APPEALS 688-9541 BUILDING 688-9345 CONSER 1A'nON 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie PWTIDO D.Robot.V==x I lk:b-d Howard Sandra Starr Kathleen BradleY C-Iweil CERTIFICATE OF USE & OCCUPANCY I Town of North Andover Building Permit Number_— Date ZZ THIS CERTIFIES THAT THE BUILDING LOCATED ON �/O I S 7 S ��. MAY BE OCCUPIED AS r IN AC RDANCE IV WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. i i CERTIFICATE ISSUED TO ' ADDRESS S ing Insctor NORT r Town of No. 18 over � rn 46 dower, Mass.,- s 19 y� SA,COCMIC MEk!CK r1' LAXE Ah ORaTED~A S' J BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �' '�� r� C� jj E�1.�=.^1......................................... .�.'..?.--... ....... -.... ... ........... Foundation ,� .._g n has permission to erect.................::.:-.............. buildings on ........L-A............. ....................... ........ .I............. Rou to be occupied as Chimney .. ............................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of2Z— Buildings in the Town of North Andover. PLUMB IN PE R ou �O�C 37 VIOLATIV of the Zoning or Building Regulations Voids this Permit. �� 4 1) /`1 ELECOL614LINSP i� ; ' >. �. Rou .............................. ..�.� / :....................... /1 B ING INSPECTOR U in Z Req-,d `r r0 Occ,d r �•;zi' GAS SPEC'POR Rough Display in a Conspicuous Place on the Premises — Do Not Remove: eri-Oa No Lathing or Dry Wall To Be Done RE,DEPARTMENT j Until Inspected and Approved by the Building Inspector. I Burner c! Street No. ��►� j Smoke Det. —O K �f )0,`S 0`S 77 i vo : MASSACHUSETTS UNIFORhi APPLICATION FOR PERI-11T TO 00 GAS FITTING (Print or Type) • h )� ,Mass. Date I1 Permit s- 629 VtBuilding Location• C ff 11 s �'� Ctirner'sName 1 Map: Lot: Zone: Type of Occupancy Ne - RWXenovation ] Replaeersent t0 Plans Submitted: Yes:1w; Fee: I L! a x = Ls L7 L! 2 u H \ O L. � O u 7 � = N < O u ". < = _ j O _ u L! �- u u Q o . O N < V3 0 YJ N U L < o > SUB-BSIAT. I I I I I ( I I I I I I I I I I I I I I I I I I I I I BASEMENT 1ST FLOOR I I I I I I I I I I I I I I ( I I I I I I I I I I 2ND FL0OR 7R0 FLOOR 4TH FLOOR I I I I I I I I I I I I I I I I I I I I I I I I I STM FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Ccrnpzny Na.—,e• EASTERN PRO?ANF, GAS 1 NK C C,Seck one: Ceri:ica:e Address 131 WATER STREET DANVERS MA 01923 3 Ccrperadcn Es'-.^3!e Value of Work: ] Partrers`ip Business Telephone ( 5 08) 774-1930 ] Firm/Co. Name of Licensed Plumber or Gas Fi-er INSURANCE COVF-PAG E: I have a curant liabl y irsc:rance pc: y c its ss:ar.::al e e which rnee:s :ha require M, en,s of MGL Cy. 1 yem No ] If you have checked yes, please indica:e t`e type COve:a;e by checking the appropriate box. A fiability insurance policy J Other type of inder..ai y Bend •- _. OWNER'S INSURANCE WAIVER: i ani aware t.`.at t`,e licensee does rat h2i'3%ha•irst;r nce coverage required Chaplet 142 of the Mass.General Laws, and that ry sigra:;:ra on this perrtit a;�piicauori waives this requirener,: Check one: Owner O Agent O signature of Owner at ownoes Ment I hereby certify that an of Vie detains and inlorr:atian I have subrviced(or er.:ere-)in above application are true and ar...rra!e to Vie bev My knowledge and that all plumbing work and i s ezlons performed under Vie permit issued for Viis application wiD be in ampUr ice x` all pertinent provisions of the Nassar users Sa-e Gas Code and Chap:er 142 of Vie General Laws. a P tuber 'Signa^,:re of Licensed Plumber or Gas Scer Master Ucense Yur..ber n , %?-S C;y I Town Jowr•Iy::an APPROVED (OFFICE USE ONLY) �/ 1 CJ S" J" Date. ..� .�l• �. 0 f NpRTti TOWN OF NORTH ANDOVER g ,6.ti0 � _ '� � `p PERMIT FOR GAS INSTALLATIONQ _ SSACHUSEt This certifies thatC =' has permission for gas installation in the buildings of . . . .� 4..;� . . .. . . .! . . . . . . . . . . . . . . . . .o. at . . .G.t . . ..�:"to 3.�. . . . � !. . . . . . ., North Andover, Mass. Fee. ./�.09. Lic. No.`-e-M..? . . . . . . . . . . . . . . . . . . . . . . . . . . cif N 739 61 GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPI_.ICATION FOR PERMIT TO DO GASFITTINI>v (Print or Type) t NORTH ANDOVER Mass. Date 312- u 9 7 Building Location 61 Permit /V. �?1v,00u•P/7 Oipy S Owners Name New Renovation II Replacement Q Plans Submitted Q � vi of GIt WA - to W W Q T a C W W W .47 _ ._d _ C: a W Y W t7 Y J t` F w w O ? U_ Y U 1 F- to - - _ Q y C w O 6 C < O O W O W t- - . C O V � L ��f �+ G I C Iff ... U I G� �• D a Y O _ Sua—as. { I. I I I I r 1 I i . ! ++ f t tf --TT- — _ .._ ._ 1 I IST FLOOR 2`tII FLOOR 11%a FLOOR I ( I I I ( I` I I I I I I I I ` I I I .{ .J I --I- - - 4TH FLOOR .I_. I 5TH FLOOR TrK FLOOR I I ( I I I I I I I ! I ( I 1 t STH FLOOR (Print or Type) Check one: Certificate Installing Company Name Alwe L�zuiS !Pu�?,QiNG Q Corp. Address �g `Z�/,'!� i c A(j , Q Partner. Glpgy Firm/Co. Business Telephone: J'6,3'_ 6d 27 06 �l Name of Licensed Plumber or Cas Fitter , k?k e,':J Insurance Coverace: lndica;e .ne :•ape o` i:-surance coverage by checkin_g._the appropriate box: LiabiIityinsurance .policy, � Other type o; indemnity .Q ,Bond Q. Insurance Waiver: 1, the ur.dersianed, have been made aware that -the licensee-ot this appiication ,does not have any one o; the above three insurance -coverages, Signature ofowner/agent or property Owner Q Agent Q 1 he:ehy ccr;iry taut all at the details and information I hsve atttruitted (or entered)in at:ove avpiication are true and accurate to the best of my $aoWted;e and that ata ptuatbin; work and ltutaL'.ttioa= ;riorme;, vnd:r':"crr..it iz=zd ro: this sppiiat:aa wiil be in compdartoa with aU paSlaat provisiotu or the.X&&%aa4usetts Slate Cai Cede and CIapte I<-'r:.f ald Cc-%=1 Lars 3v TVP= LICENSE PI=Lber Title l Gas iitter Signature of License, CItyyTown- Master Plumber or GasfItter Journeyman �19� APPROVED (OFFTCE USE ONLY) License Number ir. .✓' n ..�.. � v--�....�. +..`�.-... _• � .a.1 .tip.... Cyt.. .. 4 .. ,. .. TODate. .. .�i�� .''.. ... . 2499 ,� NORTIy TOWN OF NORTH ANDOVER pF +�ao ,^,tip PERMIT FOR GAS INSTALLATION F � F t o • • s � • �'Iss CHUSEt O This certifies that . . ! /+� . . .c�. .44.�. ,� . . . . . . . . . . . . . . has permission for gas installation . . A . f . . . . . . . in the buildings of . . .!��i!. . . . . . . . . . . . . . . . . . . . . . . . . . _ •.a at S.�. . . . . . . . . . . No Andover, Magg. Fee. t12:fir. . . . Lic. No./X?. AS�INSPECTOR ro WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:I?e 0"AQQA%,"UQc i i J UNIFORM APPLICATION FOR PERMIT TO OU FLUNItl1r lu (Prini at Typal NORTH ANDOVER, . Masa. Date /%Aaz. l0 9 .707 BtrndingPemntt *- 3 02 70 Locatlon :Tn n;S ST) . Owner's /V• Ati,oau P/? . IY)loallof 1pel�- Name 60'e Ck("p, P,94A) New,e Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No.❑ FIXTURE$ 21 w w s W a » W A a } °u s w s t+ 2 a s M a s s s s w u s i ll : 31s �r • ssr i • a �t J s — as r` s a ac o !- u 3+ M O u M F� IL O s ! tc 3 1 i w o rr o w >: 0 a o < > s s i o ■Aeaala14T iaT FLOOR / 3140 FLOOR / P 71110 FLOOR 4TH FLOOR iTH FLOOR •TH FLOOR TTHFLOOR STH FLOOR - n Check one: Certtflcale Installing Company Name Corp. Address /q dui3O /vice /9e/. ❑Partnership I�Tlrm/Co. Business Telephone ��6�f'� 6e-)- 067 .Name d Licensed Plumber_.1;9oPk INSURANCE COVERAGE: CAiacx one I have a current liability Insurance policy or As substantial equlvalenL Yes Is No ❑ It you have checked yM, plesse Indicate the type coverage by checking the appropriate box A Itabilly insurance policy f: . Other type d 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: SignOwner ❑ Agent ❑ stars o et a Owner s ant I hereby cartity that all of the details and Inimmation t have submitted for entexedl In above application are true and accurate to the bait of my knowledge and that all plumbing work and installations performed under the permit Issued tot'this application wr7 be In compliance with aA pertinent provisions of the Massachusetts Sista Plumbing Cade and Chapter 142_=d rive(iet�at�liwsivz Trite Signature of Licensed Plumba License Numbee Ir City/Town Type of Plumbing License: Mastet ,1. APFIUVED(OFFICE USE ONLY) Journeyman 0 4 • Date. ORT:'�o TOWN OF NORTH ANDOVER ° n PERMIT FOR PLUMBING SSACMUSEt L ►.. This certifies that . ��>�/i� 1I . . . . �? .4� .l .S . . . .�� .M. . . . . . S has permission to perform t'. . . . . . . . . . . . . . . plumbing in the buildings of . .'Iq .. . . . . . . . . . . . . . . . . . . . . at—t/5.4 . A. s!L. . . . . . . . . .:: . . . . North Andover, Mass. �o Feee3Q "�. .Lic. No..//!-?'.-:5. . . . . . . . . . o PLUMBING INSPECTOR w" v+ M WHITE: Applicant CANARY: Building Dept. PINK:Treasurer