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i
Date.
".0 RT:�� TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
CHUS
This certifies that . . 10("A'1.4.k. s>.y. . . . .I. �. . . . . . . . . . . . . . . . . . . .
has permission to perform . . . . r. f.e . . . . . . . . .
plumbing in the buildings of . . . )-)tt . . . . . . . . . . . . . . . . . . .
at. . �U. f �o� f !. . . . . . . . . . . . .. North Andover, Mass.
f .
Fee. . Lic. No.. ?. . . . . . . . . . . . . tet. . . . . . . . . .
(PLUMBING INSPECTOR
Check # `� V
4961
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
1�R S�4(/l wy Date �iF
Building Location t) W14-(-Qv, f Owners Name Permit
�/ # Y
Amount 2.00"
Type of Occupancy
New Renovation Replacement Plans Submitted Yes No
FIXTURES
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H w d 0.00" E~
p
x � d � � J
A A a F d d
ST$BgVIC
R4SeWiT
lS1C IIOM
mFLOQ2
FIOQ2
4M FIOCR
SIH HOM
6M H-OM
7M FLOQt
SIH FLOOR
(Print or type) Check one- Certificate
Installing Company Name--_- R j Qv G Corp.
Address C Partner.
&to W-1011
Business Telephone /9 f?– 3 3 2–�i« Firm/Co.
Name of.Licensed Plumber. Ini c4 21-t Al 00 fel—/?iv
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
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 submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations perfeffiked under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massach etts S reP b' g C ap 42 of the General Laws.
By ignatufe of Licenseaum er
Type of Plumbing License
Title 7 3
City/Town 17cense i um er MasterJourneyman
APPROVED(OFFICE USE ONLY