HomeMy WebLinkAboutMiscellaneous - 15 Acorn Drive 15 Acom Dfive BUILMMG HLE
Date.7/ 7/i..".
f NORTI�,
3?�<< •�,;.,�ooL TOWN OF NORTH ANDOVER
00
PERMIT FOR PLUMBING
This certifies that 11 c— L.c c. . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perform . . ).( . . R . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . t-J.4. �. (r 'r. . . .P,�,.( .�7. . . . . . . .
at. ./ n.'^. . . . . . . . . . . , North Andover, Mass.
Fee O/,e�.." .Lic. No. )4.�. . . `I-�.-r� . . . . .
PLUMBING INSPECTOR
Check # /07) 3
6625
�� � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
iz, (Print or Type)
1 Mass Oate d 3 r;`J 1,44 Permit # ^ L
62�—
Bui<dinQ Location , - Owner's Name
hcvrn
Type of Occupancy
New Retwva ❑ Replacement ❑ Ptans Submitted: Yes ❑ No .C3
FIXTURES
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BASEMENT
IST FLOOR
2N0 FLOOR I S I
El
3RD FLOOR 1
ATH FLOOR
STH FLOOR
�► 6TH FLOOR
7TH FLOOR 1 I
STH FLOOR f
lnsalling Company Name Youngblood C o . , I n c
CtKck one: Certificate
Address 32 Ashland Street
XM Corporation
Haverhill , MA 01830-4143 -
0 Partnership
eusinesz Telephone 978-373-5607 p F,�co_
Name of Uceued Plumber David Youngblood
INSURANCE COVERAGE:
I have a ccirrent liability insurance policY r-1y or as subs'.antiai equivalent which mees the requirements of MGI_ G'ti. 142:
Yum-`s- '' P1
If -cu have checked yes, ,ease indicate the type coverage by -iecking.the appropriate box
A liability insurance pclic
Cti'tef type at Inde-wtty ❑ SCRQ ❑
I
t OWNER'S !NSURANCE WAIVER: ! am aware tiat the 'icensee dors not have dze insurance coverage required by 1
C:tacter 142 of the Mass_ General Laws, an that my signature tin this xrmtt acRlic=tton waives this iecuirement
deck one:
Cwner r' Agent ❑ i
Signatene of C—er or(3wner'z,:gent
hereby certify jhat ad at the details and intormation i have 3uc hated'or anta(ea):n above aoolic=bon are uue zna:acatrate"c:.'te;est Of my
cwmage and that�W olumbmq x*=and installations oenonned unam the Da"n issued for?his aobiicztion Mil cm in with h ail
garti
anent provisions of ttm iKassacwseftS-late,plumt)inq Cade aha t'Sacter 'd2 of the G4rprad Utas.
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rue i
;Te<:( license: ;taster y ;ourneyr,. ;
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