HomeMy WebLinkAboutMiscellaneous - 11 FIELDSTONE COURT 4/30/2018 „!4ate/. . . . . .. . . .
4, TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
1 CMUSEt
This certifies that . . .`': l�. . .r.'�``. '(. . . . . . . . . . . . . . .
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has permission to perform .�.. . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . : .;.'�?�'"'. . . . .
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at .!. . . . -� !`' . . ” . . . . . . . . , North Andover, Mass.
Fee =�,� ,3 .Lic. No.. . . . .. . . . . . . . . . . . .
PLUMBI G INSPECTOR
Check # l � a 7
6750
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS jj n
4�C 1� , Date
Building Location/Q I�S� Q C Owners Name p S Permit#
- ) �� �� ✓�� Type of Occupancy
Amounts 5"7�
New Renovation Replacement � Plans Submitted Yes No ❑
El
FIXTURES
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5M FLOOR
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(Print or type) Check one: Certificate
Installing Company Name 11 Corp.
Address / 1 v� �—
Partner.
D -ye 7
Business a ep one c Firm/Co.
Name of Licensed Plumber: QJA
Insurance Coverage: Indicate th type of insuranVe coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
t
Insurance Waiver: I,the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑ Agent ❑
I hereby certify that all of the details and information I have sub fitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installatio pe fo ed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachuset S ing Co nd Chapter 142 of the General Laws.
By: igi re ot-LieWsea Flunmer
Title ype of Plumbing License
City/Town is ns umer Master
APPROVED(OFFICE USE ONLY Journeyman ❑
Date. L/. . �GJ. ^. ..
,aORTry
pf „ao ,tip
o� TOWN OF NORTH ANDOVER
' PERMIT FOR GAS INSTALLATION
�,SSACMUSEt
This certifies that . . S?! ? �''?� . . . .��. . . . . . . . . . . . . . . .
has permission for gas installation . . . �a�!I 5 't
in the buildings of . . . . t
at ... . . . . , North Andover, Mass.
Fee. Lic. No..�3`!. ?. . �.--^.. . . . . . .
;GAS INSPECTOR
Check# Z
5 �
MASSACHUSETTS UNwoRMAPPT.TCAw&FORPERMITTo DO GAS mTiNG
(Type or print) Date y— —p y'
NORTH ANDOVER,MASSACHUSETTS
Building Locations E LAS a t:71 Permit# S%0 8
GRT L \ IV t t_L Amount$ 3
wn 's Name
New 0 Renovation El Replaceme t Plans Submitted ❑
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U a
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SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
STH . FLOOR
or type) g Company
1 t Check one: Certificate Installing
Name S,��A(:r1: ?k%A*%)D!t h 3 44gA,&!@ Corp.
Address �r sox 391 SA Le—,A �j Partner.
Business Telephone C?—113 — 209 - 1160 Firm/Co.
Name of Licensed Plumber or Gas Fitter go"P, Id 9 A J AG
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes W No 0
If you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy r Other type of indemnity13
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:
Signature of Owner or Owner's Agent Owner [3 Agent ❑
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 in tions performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massac set tate as ode a hapter 142 of the General Laws.
Signature of Licensed Plumber Or Gas htter
Title Plumber 13 L4
Tit
City/Town ® Gas Fitter License.Numoer
Master
APPROVED(OFMCE USE ONLY) Journeyman