HomeMy WebLinkAboutMiscellaneous - 112 Middlesex Street .�
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TOWN OF NORTH ANDOVER
° a PERMIT FOR PLUMBING
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This certifies that !����` .c 1,44 ./-.
has permission to perform . . <"`�. �.� .`� ?l.'.`.`. . . . . . . . . . . . . .
plumbing in the buildings of . . ✓L: r c l . . . . . . . . . . . . . . . . . . .
.. . . . . . . . .. North Andover, Mass.
Fee!_. . Lic. No..l 1.6 . . ) '. . . . . . . . . . :.. . .
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS wag� 1 Q ` gyp
Date
Building Location 4Mcn+ l est- Owners Name� ��� Permit# � tf y
/ Q, Amount
F t Type of Occupancy .
New Renovation Replacement Plans Submitted Yes No E]
FIXTURES
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SIS FLOOR
(Print or type) Check one: Certificate
Installing Company Name*A C)W Corp.
Address . R 00y, Partner.
Business Telephone --(C>Z (P Firm/Co.
Name of Licensed Plumber.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat
Liability insurance policy ® Other type of indemnity 0 Bond
Insurance Waiver L 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 performed under Permit Issued for this application will be in
compliance with all pertinent provisions of th efts to Plumbing C e d 42 of the General Laws.
By: Sigriature of 17censea Plumoer
Type of Plumbing License
Title 7-0-1.;k—
City/Town
.;=City/Town icense i um er Master Journeyman El
APPROVED(OFFICE USE ONLY