HomeMy WebLinkAboutMiscellaneous - 126 COLGATE DRIVE 4/30/2018 126 COLGATE DRIVE
2101074.0-0019"0000.0
Date. /or--
30,03
e NORT1y TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
cHusE�
This certifies that , . . . . . . . . .
has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . L<V4.l.y e. .�. . . . . .
at. . � .�. . .�G.�.��9.f . . /?.. . . . . ., North Andover, Mass.
Fee/15 i . . . .Lic. No..77-?'�.`. . . . . . . ` . . . . . . .
PLUMBING INSPEC oR
is
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO O PLUMBING
(Print or Type)
' _ 11/ �,t/dOdG�/+✓ , Mass. Date 19 Q8 Permit # , _
Building Location /.16 -mzi ---De• Owners NameAQ_SA-1yc: N 6/G el
Type of Occupancy '
New ❑ Renovation ❑ Replacement 99 Plans Submitted: Yes ❑ No ❑
FIXTURES 4.07- 75-"F y.
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SUB—BSMT.
BASEMENT
IST FLOOR
211D FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
MOM
InstallinnCompany Check one:
AddressName/IjAIC •Ip�vin6ins ,rs/�i��Jltf/A4 Z,VC
. Certificate
S/
9 Corporation ./a 3 q
' - CDo��c.y n�� • O a.�4 9
Business Telephone �/a..'� .. ❑ Partnership
' °� 9�� ❑ Ftrn/Co.
Name of Licensed Plumber
INSURANCE COVERAGE:
I have a current liability insurance polity or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 19 No ❑
If you Have checked ves, please indicate the type coverage by checking the appropriate box
A liability Insurance policy ❑ Other type of Indemnity ❑ gond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required
Chapter 142 of the Mass. General Laws, and that my signature on this q by
permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent❑
I hereby certify that all of the details and information I have su mitted(or entered)in above
knowledge and that all plumbing work and installations orm under the application are true and accurate to the best of my
pertinent provisions of the Massachusetts Stale Plumbi Code Permit imued for this application will be in compliance with all
9 Chapter)42 of the General taws.
LBy
Signature'it
censed Plumber
Type of License: Master Ig Journeyman❑ cry
(OFFICE U:SE License Number 5 '
B=LOW FOR OFFICE USE ONLY
TiOt:S 51:=C''cS PROGRESS 'NSPECTIONS
H0.
APPLICA T ION FOR PEPW.IT TO DO PLUMBING
RAM' & TYPF OF BUILDING
LOCATION OF BUILDING
PLUW.SE R
PERMIT GRAINTED \
DATE Z9
PLVW.B:_._ :hSP0R