HomeMy WebLinkAboutMiscellaneous - 146 OLYMPIC LANE 4/30/2018 146 OLYMPIC LANE
210/106.6-01240000.0 '� ��
Date �'l'rL./ f `�'O
N° 4 .7, 87
,"��'"�+ TOWN OF NORTH ANDOVER
oo�
SO
p PERMIT FOR PLUMBING
SS US
This certifies that . . .'fp! . . . . . . • • • • • • • • • • •
has permission to perform . . . . . ... . . ..... !. . .. .�!�?✓. . . . .
plumbing in the buildings of . . '�L. . J�. � ��• . . • • .
atell. 1.19T"J.'. . . . . ., North Andover, Mass
F ``' �.0. .Lic. No.. Z z O . . . !/,rte tG�s .f_J.! k
PLUMBING INSPECC 0
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS U?iIAWM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
f� Date
BuildingLocation �G �� p r`C Owners Name ictal by be5r-� Permit# ��'
¢ �f / Amoun0/�5�"O /��
Type of Occupancy /l 0(� r.,a
New Renovation Replacement 1:1 Plans Submitted Yes El N
FIXTURES
cnCnt
w w
�. d
At> Q a
w w arA w
F c
cc
s�sBgvlc
We>FM'
ISS ELaR
M HDQt
3M Irk
4M RaR
5IHH M
6IHHDQ�
7IH ROM
Mi BffR
(Print or type) Check one: Certificate
Installing Company Name or of Corp.
Address c:;20 0 r C Partner.
Business Telephone Firm/Co.
Name ofLicensed Plumber.
Insurance Coverage: Indicate the tvve of insurance coverage by checking the appropriate boa.
Liability insurance policy Other type of indemnity Bond
Insurance Waiver L the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
ignamn Owner Agent
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 performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Mqx5oAetts StataP b' C and Chapter 142 of the General Laws.
By: signature or Licenseu-rumoer
Type ofPlumbing License
Title
City/Town License NumDer Master 'tom' Journeyman
APPROVED(OFFICE USE ONLY u