HomeMy WebLinkAboutBuilding Permit #1476 - 274 CHESTNUT STREET 9/15/2005 Date. - . . .�. . . .. .
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TOWN OF NORTH ANDOVER
° MOM PERMIT FOR PLUMBING
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This certifies that . .I.�. . . . . . . . ..... .,. .i . . . . . . . . . . . . . : . . . .. /. .
has permission to perform . . ._ . . .> . . . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . '. !: . . . . . . . . . . . . . . . . . . . . .
at r�. . . . . . .�. : . .: '�.!--1 �. . C. , North Andover, Mass.
Lic. Nol..y,.J-'': .'. 01_. : . . . . . . . . . .
l PLUMB{NNSPECTOR
Check #
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
t)�h Av1bc t-. Mass. Date q-[S'20 CS Permit
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1
Building Location Owner's Name_
Type of Occupancy L'KL2
New Renovation ❑ Replacement O Plans Submitted: Yes O No�
FIXTURES
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Sue—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STM FLOOR
GTH FLOOR
7TH FLOOR
STH'FLOOR 44�
i Installing Company Name k: Fb l uw "� ti-c Check one: Certificate
Address � 3 M 4 n S Corporation 2�Z
a _ w-0 G tea- , N,n Vj keto ❑ Partnership
Business Telephone Fs l--2-'53 1513 ❑ Firm/Co.
Name of Lkensed Plumber
INSURANCE COVERAGE:
I have a current liability insurance policy or.Its substantias equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
,If you have Led Ves, please indicate the type coverage by checking the appropriate box.
A liability insurance policy r Other type of Indemnity O 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 pem,it application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent
I hereby certify that all of the derails 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 the permit issued for this application will be in compliance with all
pertirmt provisions of the Massachusetts State Plumbing Code andCh ter of
Title
Laws.
BY
,e gnature of U
City/Town
Type of license: faster Journeyman ❑ ev,
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I License Number