HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (38) Y�
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°',"AORT+ TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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This certifies that
has permission to perform . . . .--. '. . . . . . . . .1
plumbing in the buildings of . . :. — c-�. (._, -. . . . . . . .
at . �`!!f?. . . .�?"`f� �—. . ?�. `�`�.`f . . . North Andover, Mass.
Fe� . . . . . .Lic. No�l' � . . . %c�a� . . . . . . . . . . . .
�PLUM,B NG INSPECTOR
Check !I
5861
MASSACHUSETTS UNIF RM PPLICATION FOR PERMIT TO DO PLUMBING
(Type or print) �� (�:q yl
NORTH ANDOVER,MASSACHUSETTS ✓
Building Location i l/0 P,1A-,-N �N Owners Name rv\C V cie 6 Permit#
G
S L4,rorj P, r, Type of Occupancy L� O gj I:,5 Amount
New Renovation Replacement M", Plans Submitted Yes No ❑
FIXTURES
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(Print or type)
PS Check one: CertificateIAStalling Company Name dp O -v n
❑ Corp.
Address __ < < V 0-0 ❑ Partner.
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Business Telephone 7 g S-d j _ aZ $ El Firm/Co.
Name of Licensed Plumber: VI�5� vqo ly
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy � Other type of indemnity El11
❑
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature OwnerEl 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 performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing ode and Chapter 142 of the General Laws.
By. 1QTla ure O Irene
Title Type of Plumbing License
City/Town O 8'7Y
APPROVED(omcE USE ONLY License NumDer Master Journeyman ❑