HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (19) ���
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NORTIy
�'< �•° •�4, TOWN OF NORTH ANDOVER
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PERMIT FOR PLUMBING
,SSACNUSE� /
This certifies that . . . fir f � y�!!.... . . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perform . . . . ..�. . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . l.. - ... . . . . . . . . . . . . . . . . . . . . .
at . . .l�/. .YY. . . . .17117. . . . . > . . . , North Andover, Mass.
Fee. Lie. No.G1:3. . . . . . . . . ---... . . . . . .
L PLUMBING INSPECTOR
Check # qJ 1 ?
7573
MASSACHUSETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING
(Print or Type)
k-t 14W
Mass. Date 20 Per it #
Building Location
_ A .Owner's am
Ma Type of Occupancy ,
New 0 Renovation 0 Replacement Q-1, Plans Submitted: Yes 0 No 0
FIXTURES
PzS.P. # SEWER # SEPTIC# .
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Q U > ¢ p H (A � ¢ ~O Q O0 O0 Ln z� ct Q LU o Y Q w
m Ln 0 z to U- c7 Q ,r m O
- SUB-BSNR
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
i 4TH FLOOR
STH FLOOR
6TH FLOOR
}- 7TH FLOOR
8TH-k-00—R —
++—F-144—
nstalling Company NamefA& Check ong: Certificate
lddress 0 Corporation
h idly a m N 4 . v3y�7
lusiness Telephone 0 Partnership
/10d� � / 3y f
lame of Licensed Plumber or Gas Fitter_ V-<,m/Co.
)
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes C/ No .0
if you have checked Yes, please indicate the type of coverage by checking the appropriate box. T
A liability insurance policy P11*-, Other t i
ype ofindemnity ❑ Bond ❑
OWNER'S INSURNACE WAIVER: I 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.
Signature of Owner or Owner's Agent Check one:
Owner p
Agent 0
hereby certify that all of the details and information I have submitted entered}in above application are true and accurate to the best of
.y knowledge and that all plumbing work and installations perform
e nd r the permit iss for this application will be in compliance with
.I pertinent provisions of the Massachusetts State Plumbing CodejSin
Wur
a142ofhe eral Laws.
Ti f Licen ed lumber
Title 3
City/Town ( I.
APPROVED(OFFICE USE ONLY) I Type of License: Waster DJourneyman
License Number_