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R' :'� TOWN OF NORTH ANDOVER
' PERMIT FOR PLUMBING
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This certifies that .. ,:.� �� ....�. .�f�.l�.. ...... .
has permission to perform ......... i� ,, ! /Vorth
plumbing in the buildings of .. .c. !... ........
at. `..... G t ..er, Mass. AFe .. Q.. j�. Lic. No..116d 7.. .... ` PLUMBING INSPECTOR '
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Ci /Town' 11 n C MA. Date: Permit#
Building Location.
Owners Name
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Type of Occupancy: Commercial Educational Industrial _J Institutional Residential+
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New:: Alteration: Renovation:
Replacement: f ! Plans Submitted: Yes:
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FIXTURES
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SUB BSMT.
BASEMENT
1 FLOOR
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4 TH FLOOR
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7 TH FLOOR
8 TH FLOOR
Installing Company Name:; Stark & Cronk Plumbing Inc
Check One Only Certificate #
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✓- Corporation 2486CLl
Address: 308 Main Street _ City/Town� Groveland iState:. MA p
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Business Tel: 978-372-6981 Fax: 978-374-0837
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Name of Licensed Plumber:'
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yesi V
If you have checked Yes. please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy �✓ i Other type of indemnity�T Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner IAgent
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I hereby certify that all of the details and information I have submitted (or entered) regar
Knowledge and that all plumbing work and installations performed under the permit issi
Pertinent provision of the Massachusetts State Plumbing Code and Chapte of the C
By Type of License:
dZicji_ nature of Lice
Title,. ", ✓ Plumber
Master
city/Town, a_ Journeyman License Number:
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Is application are true and accurate to the best of my
this application will be In compliance with all
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