HomeMy WebLinkAboutMiscellaneous - 1193 GREAT POND ROAD 4/30/2018 1193 GREAT POND ROAD
210/103.o-0010-0000.0
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Date. . `l.c9°.Z"
TOWN OF NORTH ANDOVER
10 minim. PERMIT FOR PLUMBING
,SSACMUSE� � �.�/ �'
This certifies that . . . . . . . . . . . . . . . .
has permission to perform
plumbing in the buildings o ' -`."` . . . . . . . . . . . . . . . . . . . . . .
at f�. . . . . . . . . , North Andover, Mass.
�.�
Fee%c�/. .i. . .Lic. No.. . . . . . . . � �. . . . . . . . . . . . . . . .
UPL� IBIN'F INSPECTOR
Check # �/ U
5285
� 5ts sG
MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVISCHUSETTS
Date
Building Location Cq Permit#
ta
Owner V U 01 J'U'1 O v S�%c u c--dO u s C Amount
New Renovation El Replacement plans Submitted Yes No ❑
FIXTURES
cr
Cr
w
xCZ
SMEME
&ASEUM
M HIDCP. a
4II3 H-OCR
5M HDM
6M HIDCR
7M)H-CM
SIH HDM
f
(Print or type) Check on • Certificate
Installing Company Name ` % o
` rp.
VID
Address ❑ Partner.
Business Te ep one / Firm/Co.
Name of Licensed Plumber: C4
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Elm._ Other type of indemnity 11 Bond ❑
a 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 performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .
By: Signature oi Licenseaum er
Typ�f Plumbing License
Title k:J
City/ icense777171577- Master Journeyman
APPROVED(OFFICE uss ONLY