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210/025.0-0016-0013.C
Date-,,'. . .
N2 42- 6 8
„ORTh TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
,SSACHUS�
This certifies that . . . . . . .�_ - ''. � 1. • . . . . . . . . . . . . .
has permission to perform
plumbing in the buildings of . I.let--4 � . . . . . . . . . . . . . . . . .
at . . . . i . . . • . ., North Andover, Mass.
Fee .Lic. No./,�. ,
PLUINBIN INSPECTOR
L/
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) I
N J t[4 A"LL01 , Mass. Date 7 ermit#
Building Location S A U AD--r7 (A)L4 Owner's Name L aur 6� FFI TH S
P"f'j I2, M/A 0 l SUS Type of Occupancy E ti Ti r-1 L_
New ❑ Renovation ❑ Replacement 1r' PI Submitted: Yes ❑ No ❑
FIXTURE
P
Z Y
h N H N O Z f" > y
W Y J fn 6 V F N O C
0 2 N < = ' _Z O
.4 = 2 y a
W H W N hC7 ¢ Y < N W
J H N pf _ W H d - d - 3 x
O = O O Q N W tr S % W Z O < Ul z .Q a 0 W
W S ~ ~ W 3 O ' Br J N G f, < Y G W S
O S d H f. Z O X IL O 41 2 Z W �" O V S
3 Y J m a=i o n -1 3 Y 1-- fn U. 0 a < `s ¢ m o
SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR v
7TH FLOOR
8TH FLOOR
I nstallqg Company Name P5/�
0 r'6Ee? 41, - -'-;4(rm,4 T A e-f) Check one: Certificate
Address C0 a(H(-nt4&) /, ❑ Corporation
/r E!N l,'.--AJ Al Ay r r / ❑ Partnership
Business Telephone_ ,42-W7 I "i
' /Co,
Name of Licensed Plumber •-,f j r=,P T fry A,mmij rrq,,4o
INSURANCE COVERAGE:
I have ayes currentfiability ins rance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
a No If
If you have checked Yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy 1d Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have 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:
Signature of Owner or Owner's Agent Owner ❑ Agent C3
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 pefformed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum • g Oode and qapter of the eral taws.
BJ,-
Y
Title
re o licensed Plum r
y� Type of License: Master � Joumeymah❑
Citown
APPROVED OFFICE USE—ON-LW— License Number -5
BELOW FOR OFFICZUSEbNLY
FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR