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14
,,So I TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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This certifies that . . . . . /. . . . . . . . . .
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has permission to perform . . . . .t?. . . . . . . .. . . . . . .: . . . . . . . . . . . . . .
plumbing in the buildings of . . . . s'. t".-/. ?�. . . . . . . . . . . . . . . . .
at. . ./.y.?. . . . . . . North Andover, Mass.
Fee. . Lic. No.. .0.7.1-X . . . . . . . . ... . . . . . .
LUMBING INSPECTOR
Check # U G
5182
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS /2
Date f�
Building Location '� 5/�''� we)O S Permit'#
Owner /�1 191l ,� AIA�s.GM mount
NewEr 1:1
Renovation Replacement Plans Submitted Yes No
FIXTURES
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(Print or type) Check one: Certificate
Installing Company Name Ad- S �Lv � ❑ Corp.
Address Z M C tv ❑ Partner.
Business Telephone 47 77-2 S6- 46 7 0—Firm/Co.
Name of Licensed Plumber: 1114 s(/duT r
Insurance Coverage: Indicate the fype of insurance coverage by checking the appropriate box:
Liability insurance policy 0— 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 above application are true and accurate to the
best of my knowledge and that all plumbing work and installations perfo nder Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts ate Plum ' g Code--and—Chapter 142 of the General Laws.
By ignature of iicenseamer
Type of Plumbing License
Title /72. -1
City/Town License iNumoer Master Journeyman
APPROVED(OFFICE USE ONLY