HomeMy WebLinkAboutMiscellaneous - 10 KINGSTON STREET 4/30/20184.MM.
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D a t e
TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
SACHUS
This certifies that .....
has permission to perform
�L ............
plumbing in the buildings of< .... ///.
.......... North Andover, Mass.
Fee --'D, Li�c. No. ..............................
Check # ;77
23
5847
PLUMBING INSPECTOR
n.1
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) p
Mass. Date GCC Permit * 0 /
Building Location / t?G} 51� Owner's NamdAes S,& z4AG f �KIG/kL4�
Type of Occupancy"�r S + 17 E �1 T I r1(_,.,_
New ❑ Renovation ❑ Replacement 2"' Plans Submitted: Yes ❑ No ❑
INSURANCE COVERAGE:
I have a current li2bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑ '
If you have checked ve, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy 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:
Owner ❑ Agent ❑
1 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 Derformed under the permit issue,4 for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum Vng tode and qapter of the eral Laws.
BY,
re of Licensed Plumber
` Title
Type of License: Master % Journeyman ❑
City/Town C T ,
APPROVED (OFFICE USE ONLY) license Number 3 j 5
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INSURANCE COVERAGE:
I have a current li2bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑ '
If you have checked ve, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy 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:
Owner ❑ Agent ❑
1 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 Derformed under the permit issue,4 for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum Vng tode and qapter of the eral Laws.
BY,
re of Licensed Plumber
` Title
Type of License: Master % Journeyman ❑
City/Town C T ,
APPROVED (OFFICE USE ONLY) license Number 3 j 5
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Date. �()A//o - -
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING -
This certifies that . Ke),j4j ..... i�.H ...... ;k�tl.L ...........
has permission to perform ....... 4—k � � L�A.< k� ..............
plumbing in the buildings of ... &J �Qh i CW.V-. t .............
at ..... ft .... 4- �k ...... North Andove Mass.
� No. ..........
R Lic. ZUT
PLUMBING INSPECTOR
Check #
MASSACHUSETTSUNIFORM APPLICATION FOR PERMIT TO 00 PLUMBING
(Print or Type)
mass, Date I—A20 0Permits !1
Building Location) Owner's Name
Now 0 Renovation, 0
ST FLOOR
NO FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
M FLOOR
Replacement llr�
FEATURES
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Type of.0ccupancy
Plans Submitted Yes C1 No El
Installing Company Name—'Lf '0 Al xhe2ce- Check one: Certificate
Address J zc) 0 V"Corporation tf
.- 0 1 ,9"7!2 0 Partnership
Business Telephone - *"x 5 7 Z -2 0 Firm/Co,
Name of Licensed Plumber n'e-'am
INSURANCE COVERAGE:
I have a culability insurance policy or its subslanft equivalent which meets the requirements of MGL Ch 142,
Yes V4 No 0
It you have checked yes, please indicate thetype of coverage by checking the appropriate box.
A liability insurance policy P""' Other typo- of indemmy C, Bond 0
OWNERS. INSURANCE WAIVER: I am. aware that the hmsee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws and that mysignature an this permit application waives this requirement.
Check one.,
Owner 0 Agent 0
i nereby certify that all of the details and information I have W
the best of ray knowledge and that at plumb! work and insta
be in cornpliance with all pertinent pravisfonsnthe ut
jBy :4
SWn-STU-M or-M-81mad F
Title Type of license. master
Cityfrown License Number ----j
APPROVED OFFICE USE ONLY)
ed (or entered) In above application are true and accurate to
its performed under the permit issued for thisapplication will
State Pluimbin Code anct Chapter 142 of the GineralLaws.
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