HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (61) i
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Date. . . . . . .�.y. .
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"pa'" 4, TOWN OF NORTH ANDOVER
° PERMIT FOR PLUMBING
41
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This certifies that . . �- '" � . . . �. . .C!�-':. .. . .. . . . .
a has permission to perform . --* ? ? s-L . . /!A-: �?. . . . . • • • . • • .
plumbing in the buildings of . . t,.)J�Z. . . . . . . . . . . .
at . �'.�'. . .?-lam, .-- ila!`�-c Sr?z' . . ., North Andover, Mass.
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PLUMBIN/ NSPECTOR
Check ,N
5660
MASSACHUSETTS UNIFO PLICATION FOR PERMIT TO DO PLUMBING
08
(Type or print) �;' e
NORTH ANDOVER,MASSACHUSETTS — ci
Date 7AVV 8""- 0 y
Building Location Owners Name L�N. C M"L- Permit# V
Amount �i
Type of Occupancy FANWD:. I e
New Renovation Replacement Q71110' Plans Submitted Yes No ❑
FIXTURES
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(Print or type) II Check one: Certificate
Installing Company Name Ro -o wP L�,ti.� ,� ElCorp.
Address UP TAGY-
y F1 Partner.
Busmess Te ep one q a.t- a(0 4-19' E] Firm/Co.
Name of Licensed Plumber: Sj 6y h N l✓' 0 O'�(,
Insurance Coverage: Indicate the type of insurance coverage by checking theappropriate box:
Liability insurance policy L - Other type of indemnity ❑ Bond ❑
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
threeinsurance
Signature Owner 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 MassachusetA State Plumbing C e and Chapter 142 of the General Laws.
By:
7T=77 oi 1-Menseci riumDer `
Title Type of Plumbing License
o " 14
City/Town icense um er Masterjourneyman ❑
APPROVED(OFFICE USE ONLY LJ