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Date. -1/t. CA /. .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that . rb.!1API. If. ,�...��.
1.�..
has permission to perform ... �Q.- x.. . r, �..:.................. .
plumbing in the buildings oftrt.............. .
at ..1.6.1 ... ✓ ,-- - . ,! -(I-"..... i .......... North Andover, Mass.
Fee.Lic. No..? .`.. .......
PLUMBING INSPECTOR
Check # /i6 c 6
6938
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
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(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date to
Building Location Permit # 30 clr
Amount ,3"%q • i
Owner / L�1G1 /-��C !'l �� ��.el �,ll f+''e,�-, i
New 0 Renovation ❑ Replacement 1:1 Plans Submitted Yes 1:1 No
FIXTITRF.0
(Print or type)'e // f Check one: Certificate
Installing Company Name � 61AWel Ale=Ll is s A44"IV, , o Corp.
Address ^� �/� � f/(/� rY%i 14611144, Partner.
Business Telephone —_3 G Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Er Other type of indemnity D Bond D
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 1:1 Agent 1-1
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 P mbin de nd Chapter 142 of the General Laws.
BY Signx,u/re 01 Ll4censeuum er
Type of Plumbing License
Title 126-117' yj
City/Town Mcense NumDer Master D Journeyman
APPROVED (OFFICE USE ONLY
Date.. '?-o - ( ........
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
i This certifies that ...A rl. � �?�! �... � ....� �,r..............
has permission for gas installation .... h! C. `.'� .. W `. "�. ':'..... .
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in the buildings of ...!r e!4. � ...� �. �.,t :1 ..................
at .�/ ?.... G :-."... w .......... , North Andover, Mass.
Fee p%. v . ' .. Lic. No.) G S `.! `. . . 1....... .
GASINSPECTOR
Check # 6 6 - / 7
5539
I�(IFORNI APPUCATON FOR PERM TO DO GAS FMING
�IASSACHCSETTS LI
3 .
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
/
Building Locations 16, 611T40 Pen -nit # J
Amount � �/
' Owner's Name. ���-' � �✓�=(/� ��r�
i
• , ■ .Submitted"2ND.
FLOOR17TH.
F OR
(Print or type) f _ C.W one: Certificate Installing Company
Name �I'2 r %t Corp.
Address
/'flLc�i
Partner.
mlq Firm/Co
.BusinessTe ep one �
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one
I have a current liability Insurance policy or it's substantial equivalent. Yes Q Noo
If you have checked yes, please i dicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 1:1 Bond El
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter lag 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 0 i
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 ,Nork and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the NIassachu�ettsState has Com fd,Chapter 142 of the General Laws.
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City,)Town
APPROVED,OFFICE G5E O,NLY),
Signature of Licensed Plumber Or Gas Fitter
Plumber C -Z G V 02
Gas Fitter License Number
er
Master
Journeyman I