HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (29) � �.
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.0RT:1�o TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
49
CHUS
This certifies that . . . . . . . . . . . . . . . . . . :.':-fes''.'°�. . . . . . . . . . . . . . .
has permission to perform . . . :. . . .-f - 1-! ! . . . . . . . . . . . . . .
AP plumbing in the buildings of . . . ... .. . . . . . . . . . . . . . . . . .
at . . . . . . . . . . .. Noah Andover, Mass.
Fee': . . . .Lic. No..? 3. . ..�. .�.' �"Y?�-i. . . . . . . . . . .
� PLUMB�lNZINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)ID - ,`
�l�►�U Q , Mass. Date 3 3 Z00(-)Permit # Zf3O to
Building Location (�R A A S-r aQfd,53( Owner's Name M .TOE G J e-r,AD
AA VA Type of Occupancy-"4-51D E ti T, r-'1 c__
New ❑ Renovation ❑ Replacement P Plans Submitted: Yes ❑ No ❑
FIXTURES
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SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
I
6TH FLOOR
7TH FLOOR
8TH FLOOR/�
Installing Company Name f'1C�t3£1,7 mA7Ae-0 Check one: Certificate
Address ?j rl C(:AC 4m4fd A ' ❑ Corporation
IY1 E TW i 'FA). AAl Ay t�(A/ ❑ Partnership
Business Telephone_ jr,?-'-/9 7 1 915i"ICo -�
Name of Licensed Plumber _2r�r3�,�r fr1 SA(jQmj4 rK)o-0c,,
INSURANCE COVERAGE:
have ayes curre2t.4bility insoura ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
If you have checked ves, please indicate the type coverage
—/ covers e by checking the appropriate box.
A liability insurance policy 1d 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 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner'sAgent Owner ❑ Agent C3
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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
J��Z-zBY v(sL
Title Vw1reof licensed Plum r
City/Town Type of License: Master % Journeymab ❑
APPROVED OFFICE UONL License Number 233 1
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR