HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (48) 2 .
„OR'” TOWN OF NORTH ANDOVER
01" ..,h0
PERMIT FOR PLUMBING
CHUSEt
This certifies that . . . . . . . . . . . . . . . . . .
has permission to perform . . . . . �� r!'. : �. . . . . �f . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . .
at. . . J. ! . .�az/:?!� . .�. . . `° . . .%1. , North Andover, Mass.
Fee. .: . .Lic. No.. . . . . I._... .i`.
PLUMBING INSPECTOR
Check # 2( '
5481
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING tp�
(Print or Type)
_ A)U , Mass. Date 24-Z Permit# r
Building Location /� U Owner's Name /, A)i Lx�_ e,
—Ltd + � Type of Occupancy '2t51 17 E�1 ll r_IL_
y 1r
New ❑ Renovation ❑ Replacement a?' Plans Submitted: Yes❑ No ❑
FIXTURES
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SUB—BSMT.
d BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR/�i'1
Installing.Company Name 0 MeT Check one: Certificate
Address 3/-) CO-4c H m ❑ Corporation
1716 T14 0 C--A) [3 Partnership
Business Telephone 1?- 17 7 1 9-virm/Co.
Name of Licensed Plumber t�,f;r�3 Fe T X; 5A.-v AiA req ec';
INSURANCE COVERAGE:
I have acurrent Lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes
p'
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
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's Agent Owner ❑ Agent C3
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 nerformed under the permit issueofor this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
-U <!���
Title
re of Licensed Plum er
City/Town Type of License: Master % Journeymali E]
APPROVED OFFICE USE ONL License Number q
a
\Y ,
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME do TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR