HomeMy WebLinkAboutMiscellaneous - 1 Court Streetn
,40RT)l
0
0
CHUS
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... I .......
has permission to perform ... :,.I. ...............
plumbing in the buildings of ......
. . .1./ .......................
at ... ................ North Andover, Mass.
Fee. .... Lic. No .......... ......... .......
PLUMBING INSPE&OR
Check # (-/ " / —
� ec
i�Mi� o
MASSACHUSETTS UNIFORM APPLICATION F R PERMIJ' *UMBING
(Type or print) ` L�
NORTH ANDOVER, MASSACHUSETTS
?v 6e rT A / jc 5 /zTTb Date
Building Location / f!r T .S' / Owners Name 7► c A"�K_ Permit #
Amount
Type of Occupancy , Si �/G /e L y
New Renovation Replacement Plans Submitted Yes F1 No
FIXTURES
(Print or type) Check one:
Installing Company Name n '�'rq I u S 1C l Corp.
Address �0 Partner
A L e r1i AJ !d o 30 7 9
Business Telephone �e O3 ��/_ 6 6 /Lz LJ Firm/Co.
Name of Licensed Plumber.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Certificate
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 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State
r 142 of the General Laws.
City/Town
APPROVED (OFFICE USE ONLY
Type offPKrnbing License
1946.6
e i Q umoer
License Master
Journeyman ❑
j 110
rc
PCP /a
:,
,•
a
: :� .-------..-------..--O---
:. - Bmmmimmmmmmiiiiiiiiiiiiii
-., ..• WWMMMaMMMMMMMMM
MMMMM��
,•..•��������������������
MMM
NNN
(Print or type) Check one:
Installing Company Name n '�'rq I u S 1C l Corp.
Address �0 Partner
A L e r1i AJ !d o 30 7 9
Business Telephone �e O3 ��/_ 6 6 /Lz LJ Firm/Co.
Name of Licensed Plumber.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Certificate
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 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State
r 142 of the General Laws.
City/Town
APPROVED (OFFICE USE ONLY
Type offPKrnbing License
1946.6
e i Q umoer
License Master
Journeyman ❑
j 110
rc
PCP /a