HomeMy WebLinkAboutMiscellaneous - 024 Boxford Street00
Date. ..........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
at
This certifies th ............ ........
has permission to perform ........
plumbing in the buildings of ...... ...........................
at. .................. d -g k- ..... North Andover, Mass.
Fe& -90. Lic. No. . ..........
Check ff CTOR
7000
IN
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Mass. DateCP �� Permit #
��Building L-ocation /(j �Q }( �� ��' Owner's Name rS h
/" ^6 e,5 _ —7-s T Type of Occupancy Residential
New ❑ Renovation ❑ Replacement Plans Submitted: Yes 13 No ❑
FIXTURES
Installing Company. Name Heritage
Address _ 5 Pleasant Street
>1' Stoneham, Ma 02180
Htg.&Plg. Co. Inc.
Check one:
ER Corporation
❑ Partnership
Business Telephone -781 —43 8-7776 F1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
Certificate
7.14
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 have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IS Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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:
Signature of Owner or Owner's Aaent Owner ❑ 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 and installations performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State bin Code and Chapter 142 of the General Laws.
By
ignature o cense lumber
Title
City/Town Type of License: Master CX Journeyman ❑
APPROVED (O FICE USE ONLY) License Number 8 3 2 2
%" Watts 9D bfp on water line to water boiler— 7Z)
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Installing Company. Name Heritage
Address _ 5 Pleasant Street
>1' Stoneham, Ma 02180
Htg.&Plg. Co. Inc.
Check one:
ER Corporation
❑ Partnership
Business Telephone -781 —43 8-7776 F1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
Certificate
7.14
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 have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IS Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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:
Signature of Owner or Owner's Aaent Owner ❑ 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 and installations performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State bin Code and Chapter 142 of the General Laws.
By
ignature o cense lumber
Title
City/Town Type of License: Master CX Journeyman ❑
APPROVED (O FICE USE ONLY) License Number 8 3 2 2
%" Watts 9D bfp on water line to water boiler— 7Z)
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