HomeMy WebLinkAboutMiscellaneous - 107 SANDRA LANE 4/30/2018 (2) 107 SANDRA LANE
210/097.0-0010-0000.0
MASSACHUSETTS UNIFORM i APPLICATION FOR PERMIT TO DO PLUMBING
tFrtnt or Type)
(moi • Mss=. Date_ c� to� Permit *2-2-23
9u11ding W.-W.-Z® Owners Name
Type d Occupancy e s f IJ•e.mac
New D Renovation ❑ Pians Sudred: Yes C] No G
B•P•# SEWER# FD=RES SEPTIC#
A A N d
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Z O = N 0 a+ wa+
N N w I- u W A �e t A n. � ' 41 !t . .
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4 e s W s o w = a ac O k•
ria Z
M a o {i ; x kv oaw ; s i p O
h4TMFLOOR
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OR
OR
OR
OR
4TH FLOOR
7TH FLOOR
4TH FLOOR
IntwlnO Company Name_G�/fti /�' ,f o,�,� pll�(/ pleck One: Certitlate I
Address /y���/� f 5 �a u) o /f
p patbw ship
Bualnesa Telephone •vim - 3 7y yu, -
Name or Lkensed Plumber
INSURANCE COVERAGE:
1 have a currant IMfltY hwance Pdky or b avbstanu equML*t yyft Mee&the
Yea u NO Cl repuMartyents of Mal Ch 142.
tf Y*J have checked jU, please indicate the Arps covmape by the t Wgxiate boot.
A lkdAlty Insurancm polky M" 00W type of Indemnity ❑ Bona ❑
MAY ` 51397
OWNER'S INSURANCE wAIVEA: I am swum that the tree QM no have General Laws. Me huurance coverage rsqulred by
upter 112 d the A�ttsa, and that mY alpnatun on thb WM spplk
Ctalfon waNes this requtrement
Cheek one:
Or Owrw t Owrw Q AQP O
horsey cirUty that ala Of the d*U"and lntamndm I have uAxr9bd(or atbra0)IA abov"Okadw sm trw and secants to the tMtt at my
70Isdgs and that as pturnbinq wont Ind hutat;atbna pwtnred under the
4 WSW MIS 80POCadm
»*W"prv"Mns Of N Mas:adwartta Stab Phrmbinq Coda and 142 a w L wt�Da in oDmPMsnce*10 ul
�a ��`lrNtLItUN SKETCHES BELOW FOR OffiCE USE ONLY
i
FEE
- NO.
A"UCJ►TION EOR PERMIT 10 00 PLUMBING
NAME i TTrE OE BUILDING
LOCATION OF BUILDING
• PLUMBER '
PERMIT 6R/1 ILD
Date
U.G. leap.
Rooms Insp.
Final leap.
S .
Date:31.
. .
33?3
p
NORTH a
�;<•��� •1ti0 TOWN OF NORTH ANDOVER
3r • .. O40 L g
PERMIT FOR PLUMBING
w40
.
SSAcHUS�
This certifies that V C/?. . .1... .q j. . .
.g
has permission to perform . .fl.c-4-_ ?`. . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of P .. . . . . . . . . . . . . . . . .
�
at. . . S,/9 h c!�?!`r. .�!�! . , North Andover, Mass.
Fee. -. . .Lic. No. .� .Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer