HomeMy WebLinkAboutMiscellaneous - 1112 Mass Avenue i - _
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4,° TOWN OF NORTH ANDOVER
'° PERMIT FOR PLUMBING
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This certifies that ., 4Y. .� . . �' �. . . . . . . . . . . . . . . . . . .
has permission to perform . . .)'C'. w . d .ei., , , , , , , , , , , , , ,
plumbing in the buildings of
at Lf/. '' .�!�?. S. . t9v , , . , . , , . ., orth Andover, Mass.
PLUMBING INSP CTOR
WHITE Applicantp
CANARY BuildingDept. PINK Treasurer GOLD. File
?"A„AWIUSli VUS UNIFORM APPLICATION FOR PERMIT TU UU VLUMUMU
•� (Ptint or Type)
fa NORTH ANDOVER, , Maas. Data '7
Building Permit '
Location WS I IANC_ .
Owner's
Name QJA
New (J/ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No.❑
FIXTUIRES .........
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Y W J N t u i N O O Q ui 1M < aNYo .H SO� MsO '• ' N f_.
Na
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Ns
rOor a111 .4N s gNKwra a o 3yz3y ° 0ii01Wioas6i0a a0_
06
sus—asrT.
aAeaYaNT
1sT FLOOR a
2100 FLOOR i l!
$110 FLOOR
4TH FLOOR
IT" FLOOR
ITH FLOOR.
TTN FLOOR
eTHFLOOR -
Check one: CeOPIcmi6
Installing Company NAma VP4jC L � . �--��• 1�%�• �1
Addresaw 2 eon CSN i "' l� ❑Partnership
/ t.�l>`S ►J J V-0 C. ❑Firm/Co.
Buslnes� Lelephona5 �o2 . 62yo—qG�
I/
Name of Licensed Plumber E e f r_-1xj • .. �y�tlS 4Gfy r•,�°
INSURANCE COVERAGE, ec
1 have a current liability Insurance policy or Its substantial equivalent. Yes 0 No ❑
It you have checked y", please Mica-le thwtype coverage by checking the,appropriate box.
A liability Insurance policy t�' , Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WANER: I am aware that the licenses does not havIL 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:
Owner ❑ Agent ❑
Ngnatute o w or Ownw s Agent
I=cwtity that aA of the delalis and inImmailon I have submitted W enlwdl In above application are true and accurate to the best of my
knowledpa and that al plumbing work and Installations performed under the mid Issued for this ap tion will be In compliance with aM
podlnent ptovislons of the Massachusetts State Plumbing Code and Chapter fM"Mai laws.
gnairke of Licensedum et
This
Uanse Mmtfer --/02 3'3
Chy/Town Type of Plumbing Ucense: Master 15�_
AfTnOVED(OFFICE USE ONLY) Journeyman 0
A'�v.'�^'.....,3.,p9'�7toa""�"��'.r... 4� �tz•+z^.r,ti.FTF'•s�'a��.v.:�'t'4�r,r".` y'[.+.,.,.,..{"�...�
P 'moi`
'+y
r � r) Date. 6' .C.
R
Q
NORTH TOWN OF NORTH ANDOVER R
OF
PERMIT FOR GAS INSTALLATION 8
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c -SACFHUt't
rr CAI
This certifies that . !-R .4`. . ./vincr< . . . . . . . . . .
has permission for gas installation . 6�
in the buildings of . FA . . . . . . . . . . . . . . . . . . . . . . . . .?
at . . . . . . . . No ndover, Mass.
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SiNSPECTo �
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 1
(Print or Type) n
NORTH ANDOVER k4ass. Date g C�
-building Location MASS P-VC Permit # A 23
Owners Name
New � Renovation D Replacement p Plans Submitted
FIXTURES
to
y Q N � .O � N = E•-
4t us O! O U Gf F' F x W
x o w Q a .zo M a x W
4 m N t- w w o a rr: W 4
`c w a x ' x " 91 Q > to �.
N C w
w w z a x a n a w tL w x c� s
U < � H M f+ H yW
W . o z O Z w O N X
z 4 w < a -�
4 yj y C tai zz Q rt 4 a O O w a O W 1--
cc x O O u, Q t9 .s U tr y ct a h- o
SUE(-6SMT.
BASEMENT
Z ST FLOOR
2ND FLOOR
3RD FLOOi?
4TH FLOOR
STH FLOOR l
6TH FLOOR
7TK FLOOR
STH FLOOR ELL
(Print or Type) Check Certificate
Installing Company Name Vt-- r l Cc-P. Meek. 1lr— Corp.
Address -�---tJ_ti.i-F- / Partner.
Firm!Co. W. _
Business Telephone- w2- . _
- Name o" Licensed Plumber or Gas Fitter ! QV (.t �J'
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policyOther type of indemnity 0 Bond E]
lnsuraAce Waiver: I , the undersigned, have been made aware that the licensee of
this cipplication does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner U Agent
1 heteby 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 patlnent
provisions of the Massachusetts State Gas Code and Chapter 142 of the Genual Laws.
By TYPE LICENSE:
Plumber
Title Gasfitter Signature of Licensed
City/Town:
Master Plumber or Gasfitter Journeyman 7 a-3 2
APPROVED (OFFICE USE ONLY) License Num