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CHUS
Date..6.. .6. '-
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that 1.( ................
has permission to perform .... �f? k? ................
plumbing in the buildings of . . . J. . . . . . . . . . . . . . . . .
at ... / ...... 7.� .......... North Andover, Mass.
Fee�'.- . . . . . . .
Lic. No. �4. �. ... ........
'� 7 ? 1, PLUMBING INSPECTOR
Check # t/ Y 2 9
5261
A
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) ;'
ass. Date Permit #
_a Building Location Owner's Name
% Type of Occupancy esidential
New I..I Renovation LI Replacement l Plans Submitted: Yes ❑ No ❑
g u��
Yea.
FIXTURES
Installing Company Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate
Address -3 Pleasant Sti:eet [X Corporation 714
Stoneham, Ma 02180 [] Partnership
Business Telephone_ _781 ��_-_7 7 7 6__ C l Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes �-K] No l..]
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy L Other type of 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:
Signature of Owner or Owner's Agent 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 v:ork and installations performed under the pormit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter 14 f the General Laws.
Signatu of L1 nsed 'I r i or
Title
City/Town Type of Liconse: Master IX Journeyman E]
8 3 2 2
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4TH FLOOR
5THFLOon
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7TH FLOOR'
8TH FLoon
Installing Company Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate
Address -3 Pleasant Sti:eet [X Corporation 714
Stoneham, Ma 02180 [] Partnership
Business Telephone_ _781 ��_-_7 7 7 6__ C l Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes �-K] No l..]
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy L Other type of 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:
Signature of Owner or Owner's Agent 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 v:ork and installations performed under the pormit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter 14 f the General Laws.
Signatu of L1 nsed 'I r i or
Title
City/Town Type of Liconse: Master IX Journeyman E]
8 3 2 2
APAPPROVED(OFFICE l3SE ONLY] License tJurnbor
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FORM D '
DESIGNER'S CERTIFICATE
�/ u�✓� 19 q3
TO THE PLANNING BOARD OF THE TOWN OF NORTH ANDOVER:
In preparing the plan entitlediPc
I hereby certify that the above named plan and accompanying data is true
and correct to the accuracy required by the current Rules and Regulations
Governing the Subdivision of. Land in North Andover, Massachusetts, and
my source of information about the location of boundaries shown on said
plan were one or more of the following:
1. Deed from to
dated and recorded in the
Registry in Book Page
2. Other plans, as follows
3. Oral information furnished by
4. Actual measurement on
the ground from
a starting point established
I by
5. Other Sources
(Seal of Engineer or
Surveyor)
Signed/
(Registered Professional Engineer or
Registered Land Surveyor)
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Address