HomeMy WebLinkAboutMiscellaneous - 1401 GREAT POND ROAD 4/30/2018 (14) Date.s9. . .
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oc TOWN OF NORTH ANDOVER
0 _ PERMIT FOR PLUMBING
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This certifies that . . r D. . .W. c.IZ.f. . . .P�.4 . . . . . . . . . . . . . . . .
has permission to perform . . d.1,tiT. . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of W.p.>.. . . . . . . . . . . . . . . . .
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at. r�/.?�<4. /.�o'? . . l�. . . ., North Andover, Mass.
Fee. o?J,. Lic. No.//.? G4.J . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
1
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05/12/9710:23 25.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
2,3
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Mass. Date 19 1? Permit#
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E._ ..`J Building Location � n. �o�� Owner's Name
0 AX-
Type of Occupancy
New ❑ Renovation 1-1 Replacement P�-' Plans Submitted Yes O No 14--
FEATURES
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR ^� `
Installing Company Name_ %1D. f4
- � -� - Check one: Certificate
Address Kki c, 1 1
FJ Corporation
17 Partnership _
Business Telephone__ 6C _ $ I^ 3�j�D LI-Firm/Co. _
Name of Licensed Plumber. ���CaLD W�LL3
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes iK No O
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy IV Other type of indemnity I-1 Bond
OWNERS 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:
Si nature of Owner or Owner's A ent — Owner Ll
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to
the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will
be in compliance with all pertinent provisions of the Massac a Plumbin Cod Chapter 142 of the General Laws.
By
igna urs o icon -
Title Type of License: Master 1.-4— ourneyman ❑
CltyrTown License Number__
APPROVF.r)OFFICE USE OWY)
BELOW FOR OFFICE USE ONLY
FEE
NO:
APPLICATION FOR PERMIT TO DO PLUMBING
OWNER:
NA:NE & TYPE OF BUILDING
LOCATION OF BUILDING:
PLUMBER OR GASFITTER:
LICENSE NO:
PEP-MIT GRANTED
DATE: 19
I
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PLUMBING INSPECTOR