HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (10) Date./4/. C. `. .
"oRTM TOWN OF NORTH ANDOVER
o� ,..o ,•�tia
PERMIT FOR PLUMBING
SSACMUSE�
This certifies that . . . . f./-al.' �L-`: ��''` . . . . . . . . . . . . . . . . . . .
M
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has permission to perform . . . . . . `. . . . . . . . . . . . . . . . . . . . . . . . . .
pluipbing in the buildings of . . . .`. . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . North Andover, Mass.
Fee. Lic. No..c5. . .. . . . . . . . . . . . . . . i. . . ... . . . . . . . .
PLUMBING INSPECTOR
Check # `
5424 -
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING �� .
(Print or Type)
_ a f2 . Mass. Date_ 2Lgo 2 Permit # TYX
Building Location
' Owner's Name rc 4� 1e142,?/J_n� '
Type of Occupanci5+ 17E1J-TI AL_
New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑
FIXTURES
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SUB—BSMT.
BASEMENT
1ST FLOOR
2NO FLOOR
3RD FLOOR
a 4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing.Company Name Ot3E2T SAgr M A T Al e 7 Check one: Certificate
Address , CTO/-}C W/Y1�}n) y- ❑ Corporation
l71 E Tf40 j�_A yil A 0 1(1a ❑ Partnership
Business Telephone &f?-W7 l 915irm/Co,
Name of Licensed Plumber 'Zmd ,Z70'T temp,
INSURANCE COVERAGE:
I have ayes current(}ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
a No 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: I am aware that the licensee does not have the insurance coverage required by
Chzpter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signat re of Owner or Owner's Agent
1 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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum 'ng Dde and Cbapter of the eral Laws.
Title
re of Licensed Plum er i
City/Town Type of License: Master % Journeymab E]
APPROVED OFFICE USE ONLY I License Number 3- 5
1
MdL sW FOR OFFICE USE 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