HomeMy WebLinkAboutMiscellaneous - 14 ALCOTT WAY 4/30/2018 (3) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING '
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/•/��`� ' rJ , Mass. ..oats �� /�� Pefmit # 4-(6C
Building LocatlanAl /�/�Zy ' wnet's Name,
_Type of OccupancyTB�/ �l��
New ❑ Renovation ❑ Replacemert LTJf Plans Submitted: Yes O No ❑
FIXTURES
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SUR-BSMT.
µ BASEMENT.
r , - IST FLOOR
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;2110 FLOOR
3RD FLOOR_ - _ -
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4TH FLOOR`
5TH FLOOR
15TH FLOOR
TTti FLOOR
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9. Pa Y Nam � X�/>./1Y >ri • /rJ,/, /Check.one: Certificate
Address (hS' flan r S J ►U' Corporatlon
0 Partnership l i
Business Telephone L,P/� �',�D�� 4 i ., O Pl(rWCo.
Name of licensed-Plumberu s��J`/i��r�'�%i•.
INSURANCE'COVERAGE: p
I have a curre9jkbility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes T NorIf you have checked yg„ please Indicate the type coverage by checking the appropriate box.
A liabHy insurance policy G Other type of Indemnity 0 Band ❑
OWNER'S INSURANCE WAIVER: .l 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'thls permit application waives this requirement.
- Check one:
Owner ❑ Agent❑
Signature of Owner or Owner's Nent
I hereby certify that all of the details and inlormation I have submitted for ente(ed)H above application are true and accurate to the best of my
knowvlod9e and that all plumbing work and installations performed u the psrrr4,lssued for this application will be in compliance Kith all
Pertinent provisions of the Massachusetts State Plum ' 9 Code Chapter t the General Laws.
lure o ber
Tae
City/Town
Type of License:Master Journeyman[] .
_
1 ONL License Number
Date.!
N2 4815
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSACNUS� /
This certifies that . ./�,19!!�.y.x . . ./.�!�.� . . . . . . . . . . . . . . . . . . . . .
has permission to perform . . . . .��r"v/ �. .�.7/. .�. . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . .
at. . .�. �. �`� �. / �`
. . . . . . . . . . . .�. . . . . . . . , North Andover, Mass.
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Fee. Lic. No..IG.'. .?. �. . . . . . . . ,. . 1,.� -s. .. .. . . . . . .
/PLUMBING INSPECTOR
Check 4 y"�?
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer