HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (47) i'
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MASSACHUSETTS U141FORM APPLICATIOWFOR PERM! pQ pLgMg1
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NORTH ANDOVER ,Ma 1 11-i ,
Buildingn
Location � < Permit I,�
Owners Name
qv�.VVJNew 't] Renovation Replacement (] Plans Sybml ted
FIXTURESinw
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SUB-18SMT. •
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
8TH FLOOR
7TH FLOOR '
8TH FLOOR
Now WNW1!1
(Print or Type) lo
Check one: Certificate
eInstalling Company Nam , A , Corp,
Addresc%ve Partner.
01 Firm/Co.
Business Telephone � /7 3 5 f-Q °-37 I
Name of Licensed Plumber: rPc re-, e �,c, i /d
Insurance Coverage: Indicate the ype of insurance coverage by checking the
i appropriate box:
Liability insurance policy m Other type of indemnity El Bond U
Insurance Waiver: I, the undersigned, have been made aware- that the licensee of I
this application does not have any one of the above three insurance coverages. ..
• Signature of owner/agent of property Owner Agent`s
1 balebr tetlifp drat all of die details and information 1 lu•c submil lcd(or enicrcd)in alwr.e appleslion ire 11W4:810 to dw bed r of
I •••- hwowtadgs sod Ibat all plumbing work and insfallatinns loci(nrmcd undcr permit i4sucd for this appikaliorl wJU be M jaNyrlisllp taitll sll�1
wWou o(AA Mauadtweus State 1'lumbiag Code and Claspfcr 142 of file(:cncral U WL ` w
Title . Signature of Licensed Plumber
1 City/Town: / Type of Plumbing License ,.
Date�'-Pv
tic TOWN OF NORTH ANDOVER
I
PERMIT FOR PLUMBING
,SSAtNUS�
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This certifies t �" . ... . . . . . . . . . . . . . . . . . . . . . .
has permission to perforn>l . . . . . . . . . . . .
plumbing in the buildins o , . . . . . . . . . . . . . . .
at. . . . . . . . .. North Andover, Mass.
Feel:A�'. . . .Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
02/10/98 10:53 25.00 RAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer