HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (6) /�f� ��=��� -aid
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O',N� TOWN OF NORTH ANdOVER
PERMIT FOR PLUMBING
•'SSACMUS�
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This certifies that .
has permission to perform .& . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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plumbing in thebuildingsof . .
at .1. . . /� Fy. r� �/h . . . . . . North Andover, Mass.
Fee. .y/�Aic. No.. . . . . . . . .
PLU IN NSPECTOR
Check 4
� 2
7999
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town:-&A:b MCQ d ; MA. Date:, 2� U Permit#
Building Location: U�1U� 1'u�U C�`{l(,t U Owners Name: �,(�Y ��V 1« Cale
Type of Occupancy: Commercial❑ Educational ❑ Industrial❑ Institutional ❑ Residentia)
New: ❑ Alteration: ❑ Renovation:.❑ ReplacementPlans Submitted: Yes E]. Ni
FIXTURES
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SUB BSMT.
BASEMENT
1 FLOOR
-2NOFLOOR
3 KFLOOR
4 FLOOR
5FLOOR
61" FLOOR
VH FLOOR
-8"' FLOOR
c.4i n // Certificate#
Installing Company Name: � l9 i����r Check One Only Certi
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d ❑.Corporation
Address: L T4��pCi City/Town: Rvjk V t-y State`
Partnership
Business Tel: Fax:
❑ Firm/Company
Name of Licensed Plumber:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑
ti
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Si nature of Owner or Owner's Agent
I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best
Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License: .
Title ❑Plumber Signature of Licensed Number
Cityrrown ❑Master 15"U
APPROVED OFFICE USE ONLY []journeyman License Number: