HomeMy WebLinkAboutMiscellaneous - 15 COLBY COURT 4/30/2018 J /5 Co ! by co"vt
U1 LDIN,
Date.`�r/a .a !
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
;,SSACMUS� r'
This certifies that / ... .�.. . . J . . . . . . . . . . . . .
has permission to perform . . . . . . . . '. . . . . . .
plumbing in the buildings of . . . . . .'. . . . . -.
at .'. . .16 —. . . C? . . . . -North Andover, Mass.
Fee�o. . . . . .Lic.
PLUMBING INSPECTOR
Check # � 2
6959
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
S� ��10 Date
Building Location) C �/ �� ��7�U 0 �/ +� Permit# �
Amount Zd,
Owner
New Renovation Replacement Plans Submitted Yes 13 No D
FIXTURES
CL
IP
SUBBWW
WEVENT
1ST.RAOOR
2M FLOOR /
�u F><noR
4M FLa R /
5M FLOOR
M FLOOR
7M HOOK
9111 IM
(Print or type) 1 Check one: Certificate
Installing Company Name ►l tN 01, D Corp.
Address Partner.
o �
Business Telephone 777 77- =3 �'Firm/Co.
Name of Licensed Plumber: h
Insurance Coverage: Indicate the type of insurance overage by checking the appropriate box:
Liability insurance policy Other type of indemnity D BondPr
D
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent
I hereby certify that all of the details and information I have submitte (or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations pe ormed under Permit Issu�forhis application will be in
compliance with all pertinent provisions of the Massac usettsS g o nd Chaptethe General Laws.
BY ign e o icense um e
pe of Plumbing License
Title
City/Town License umqer Master Journeyman D
APPROVED(OFFICE USE ONLY