HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (65) /�`���d�e� S�a�
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�'.".O R':1ti, TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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"`This certifies that . . . . . �7 s!. 6?". L. . . . . . . . . . . . . . . . . . . . . .
has permission to perform . .�. . . . . . /? .0..
. . . . . . . . . . . . . . . . . . . . . . . . . . .
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plumbingQ in the buildings of . ./ f?. . . . . .
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at . . . . . ... . . . . . . . . . . . . . . . . . . . . North Andover, Mass.
Fee. . . . . . . . .Lic. No..4V?. . . . . . . . . V�-r? .. . . . . . . . .
i PLUMBING INSPECTOR
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Check # ?` l
5507
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING x,30
(Print or Type)
Mass. Date v 2C�.3 G
�L�il/' `� _ Permit #
Building Location f'���wlL?L �''Yc� O er's Nam
NI Type of Occupancy DEN Tt Al—
New
L_New ❑ Renovation ❑ Replacement � Plans Submitted: Yes ❑ No ❑
FIXTURES
2 N
N = Y Q
h N N N O Z > N
W Y J N >. Q Q N W W
U) Z V) Q ¢ Q ~ Z O 2 N a x
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x ¢ uw m a. 3 x
V = O O ¢ca N W ¢ W Z p Q tlf Z .¢ a CQc O LL
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W = < S O Y x Y d h Q Y W LL Y W
i h > F- O N H O H h Z O p of z z W f O v S
1 B Q z i �. i Q 4 Q -j J G Q i G-
�L LL t9 O p Q S C m O
SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR t
STH FLOOR
6TH FLOOR
7TH FLOOR y
8TH FLOOR
Installing.Company Name f iOtlEe7Q �ramr»�47,q�°t� Check one: Certificate
Address 3(-) CO4 C N(-n4&) �j ❑ Corporation
Ir E TN40 C--AJ f?l A 0 ❑ Partnership
Business Telephone -�7� -5<7 7 1 p-�'irm xo.
Name of Licensed Plumber T ri 5„qMMpq r_tq eC)
INSURANCE COVERAGE:
I have a current!lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 13' No ❑
If you have checked Yes, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy >,d' 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 El 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 nerformed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ng a and apter of the 7o�oral Laws.
-7 77/L Lrc-E
Title
re of Licensed Plum er
City/Town
Type of License: Master % Journeyman❑
_
APPROVED OFFICE USE ONLY) License Number--Yl 3 5
i
VIM 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