HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (67) Date/!?,. .a 2--.
TOWN OF NORTH ANDOVER
00 p PERMIT FOR PLUMBING
49
,SSAC14US�
his certifies that . .'`. . . ! . . . . . ...- . . . . . . . .
has permission to perform . .....:;;� ...�. . -�-u. .
plumbing in the buildings of . . C- .- . . . . . . . . . . .
at North Andover, Mass.
Fee . .Lic. No.l�''�1 . . . . . . nowING
"!h . . . . . . . . . . . . . . . . .
�`o, / INSPECTOR
Check # f C
5394
� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
MN-\ (Print or Type)
Mass. Date . 200'z Permit # 1.S
Building LocationAzz/'eOwner's Nam _ tlae—
` Type of Occupancy "Rt--51 DE= j TI AL—
V �•�`'
New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑
FIXTURES
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N O Z > N
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< F- > N O 00 N F' ZOO N Z _Y W r.. O t„� 2
< < S < Q O < J J < ¢ ¢ a < O < 1--
021 m O
SUS—BSMT.
BASEMENT
IST CLOOR
2N0 FLOOR
SRO FLOOR
4TH FLOOR
r STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
In .Jling.Company Name Or3Ee7 'AWMATAelf Check one: Certificate
Address n. C.-f;Ac N mA&) tj ❑ Corporation
l71 E_!N U - n . Al A 0 t tT a ❑ Partnership
Business Telephone Z-Irl 177 1 9-Mim/co.
Name of Licensed Plumber rS f'r�3 Fje T" ig S/-)eM,6I rq [-4kaf-,
INSURANCE COVERAGE:
I have a currentpbility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes (a No ❑ 10
If you have checked yes, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy Ad Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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:
❑
Signature of Owner or Owner's Agent 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 Derformed under the permit is
sued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of Laws.
AAv
L•Lrc..d
Title
re of Licensed Plum er
City/Town
Type of License: Master Journeyman E3_
A 41 4ED OFFICE USE ONLY) License Number q 3-3 5
BELOW FOR OFFICE 1151:ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE_
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR