HomeMy WebLinkAboutMiscellaneous - 100 Oak Ridge RoadNORTq
O 9
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform'b1.... / .. .
plu bin t/4li"e'�u/l"k-ge f�.�
at .. C"?:.'?'.`�?�� ?./, North Androver, Mass.
Fee .//lA'.- . No.. qll-211 . ................. .
l PLUMBING INSPECTOR
�► Check #
6324
MASSACHUSETTS UNIFORM APPLICATION
(Print or Type)
I &
/y- Ah,� ve r- Mass. Datezv'-\
R PERMIT TO DO PLUMBING
2ue3' Permit # �'✓a �v �`�
Building Location _ Owner's Name "k -y
Type of Occupanry L i K, � 1�-� .�,s �
New Renovation ❑ eplacement ❑ Pians Submitted: Yes i� No ❑
FIXTURES
Installing Company Name Youngblood Co., Inc. Check one; Certificate
Address 32 Ashland Street
Corporation
Haverhill, ivi.3. 'GIS30-4143 Q Partnership
Business Telephone ° 7 8- 3 7 3- 5 c 0 7
❑ hffn/Co.
Nana, of Ucensed Plumber 0', v i Y o u n R b 1 o o d
INSURANCE COVERAGE
I have a current liability insurance policy or tts substantial equivalent which meets the requirements of MGL Ch. 142. -
Yes ZI No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy [3 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 perrntt application waives this requirement.
Check one:
Signature of Owner or Owner's Anent Owner ❑ Agent ❑
I hereby oeetify that all of the details and information I have submitted (or entered) in above application are true and accurate to the gest of my
knowledge and that all plumbing worts and installations performed under the permit issued for this
Rertinartt provisms of the Massachusetts State Plumbing Code and Chapter 142 ofZ!
application will be in compliance with all
neral Laws.
Tide gna ure o bet
City/Town Type of License: Mastar ( Journeyman ❑
( Nl License Number �/
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4TH FLOOR
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7TH FLOOR
aTH FLOOR
Installing Company Name Youngblood Co., Inc. Check one; Certificate
Address 32 Ashland Street
Corporation
Haverhill, ivi.3. 'GIS30-4143 Q Partnership
Business Telephone ° 7 8- 3 7 3- 5 c 0 7
❑ hffn/Co.
Nana, of Ucensed Plumber 0', v i Y o u n R b 1 o o d
INSURANCE COVERAGE
I have a current liability insurance policy or tts substantial equivalent which meets the requirements of MGL Ch. 142. -
Yes ZI No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy [3 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 perrntt application waives this requirement.
Check one:
Signature of Owner or Owner's Anent Owner ❑ Agent ❑
I hereby oeetify that all of the details and information I have submitted (or entered) in above application are true and accurate to the gest of my
knowledge and that all plumbing worts and installations performed under the permit issued for this
Rertinartt provisms of the Massachusetts State Plumbing Code and Chapter 142 ofZ!
application will be in compliance with all
neral Laws.
Tide gna ure o bet
City/Town Type of License: Mastar ( Journeyman ❑
( Nl License Number �/
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Location
No.
TOWN OF NORTH ANDOVER
a
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL $ `�
Check #
t 7'98
''Building Inspector/
Oakridge Village Builders, LLC ► '
39548 Town of North Andover
DATE INVOICE NO DESCRIPTION INVOICE.AMOUNT
1-20-05 Trailer Pe 0456 Trailer Permit 220.00
CHECK 1-21-05
CHECK 1006
TOTAL> 220.00
DATE
NUMBER
PLEASE DETACH AND RETAIN FOR YOUR RECORDS
Location AT 06�
No.
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ d: 2l
TOTAL $ ��'
Check # 11)6(, 'e"
17998
ilding Inspect