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"°RTM TOWN OF NOR ANDOVER
PERMIT FOR PLUMBING
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This certifies that. . . . . . -ffr. . .. . . . ,✓ . . . . . . . . . . . . . . . .
1. .
has permission to perform . . . "� --- `
plumbing in-the buildings of . f
at.f . . . L4�. . . , North Andover, Mass.
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Feey -r. .Lic. Nod � .1. . . . . . . . . . . .G1INSPECTOR
Check #-/61;1Z
7201 r,
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS -2— G
// / Date lJ/v
Building Location 7 ,^,r� G�►/2 Owners Name Permit#
Amount
Type of Occupancy /
New B/ Renovation 0 Replacement 11 Plans Submitted Yes No
FIXTURES
0
SLBIRa
WS04M
M FIM /
2110 FLOCK
3MFIOCR
4M FIDQZ
5M FLOCK
6M RDCR
7M FLOM
I a- I .—_++
Sm FLOOR
(Print or type) Check one: Certificate
Installing Company Name /�/ Il-✓ //rte G l' ® Corp.
,,� j/� i
Address —2 �` , � 1'!_l/ - ® P er.
F Business Telephone —�-- Firm/Co.
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* Name of Licensed Plumber. J Zzx
Insurance Coverage: Indicate the tmxrof insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond ❑
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 El
I hereby certify that all of the details and information I have submitted(or entered)in ave application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under it Issued for this application will be in
compliance with all pertinent provisions of the 2tus Plumbing Code Chapter 142 of the General Laws.
By: r o rcens um er
7e of Plumbing License
Title
City/Town LJCenSC NurnDer Master Journ an
APPROVED(OFFICE FI E USE ONLY