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HomeMy WebLinkAboutMiscellaneous - 14 DOUGLAS ROAD 4/30/2018 Date.. �1PYE"X"/V 10793 Of tt0R7*#j TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 44 o HU C/ This certifies that has permission to perform.... /-/—a/04-7--Z ......................... plumbing in the buildings of l +....... ................../. ................................ at.,..... ......................................................., North Andover, Mass. Fee .. ......Lic. No. k....-�90 ..... .......... ................................................................................ PLUMBING INSPECTOR Check, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ CITY _ _ _ _ MA DATE PERMIT# R' JOBSITE ADDRESSJ_j - OWNER'S NAME P OWNERADDRESS TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:© REPLACEMENT:Ej PLANS SUBMITTED: YES 0 NOE] FIXTURES Z FLOOR-► BSM 1 1 2 3 4 6 6 7 8 9 i0 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM - DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM __ ► _ _ __� DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM i DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK _-- LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING - --- OTHER INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY QL OTHER TYPE OF INDEMNITY [] BOND 0 OWNER'S INSURANCE WAIVER:I am aware.that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application 01M this requirement. CHECK ONE ONLY: OWNER ® AGENT [� SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information 1 have submitted or entered regarding this ap Iicatlon are true and a to to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this appil II be In mpliance all Pertinent provlsi f the Massachusetts State Plumbing Code and Chapter 142 of the General laws. PLUMBER'S NAME lis. LICENSE# 1 d SIGNATURE MP[ JP CORPORATION# PARTNERSHIP # LLCE Y COMPANY NAME ADDRESS Q' CITY ^—�--�� — --SSTATE ZIP b -.0 ..6.. f TEL -- 2 3 I-AV 1 N/arti 1 ItCAAAII Q� tis--fc I l .h• ' � J I •r t • I, i J i 4 ' _ t , . 1 I � s f..; ' OOMMONWHOF MaSSgCHUSET flip Q'F PLUMBER$.. AND GASF;ITTERS ISSUES THE FOLLOWING LICENSE W: L I C;EtJS€Cl_: 'AS A JOURNEYMAN PLNMB,E ,rA RARL'tS B GREENWbOD k" 199 MARS14. RD P: LHANI' t ,w 03076-336 ' 185 o5/01-:1.3;6 21 to 01 -s i Date ....... ......... 10793 NopTH , TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �r� y �J [1LJLsv "i ,83ACNU5� �vV V e �? �s ............................oi . fies that ""' `cc ce This cerci .................. . has permission to perform ............. ......................... .. A��e� .......... ......... . . . .plumbing i the buildings of.... ...... North Andover,Mass. at....f .. `� �y� !�,�IJ... .. ...... Fee=.::.V..•• ••••••I'1C'NO' S •••• •••••" PLUMBING INSPECTOR —7 Check# f r' I i P, 1 Communication Result Report ( Oct. 8. 2014 9:06AM ) 1) Town of North Andover 2) Community Development Date/Time : Oct. 8. 2014 9: 05AM File Page No. Mode Destination Pg (S) Result Not Sent ------------------------------------------------------- 3285 Memory TX 816036359189 P. 1 OK ------------------------------------------------------------------ Reasonfor error E. 2) Busy E. 1) Hang up or 1 i n e fall E. 3) No answer E. 4) No facsimile connection E. 5) Exceeded max. E—mail size E. 6) Destination does not support IP—Fax �J 10793 TOW:::il dM ba PE P ..- NoAhABdov Lit.No.�J`.�..—__.�! CjwCkR r