HomeMy WebLinkAboutMiscellaneous - 150 LACY STREET 4/30/2018 150 LACY STREET r
J210/105.C-00240000.0
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° 0'<40'R°T:�� TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
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This certifies that . . . . . . . . . . . . . . .
has permission to perform . . . ..IP. f-t--. . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . .
at . ./I .C> . . .-:';!-l.< . . �. . . !. . . . . . . . . . . . . North Andover, Mass.
Fee.2 G. .'. . . .Lie. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
Check # L
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Lo
(Print or Type)
f Mass. Date I ;.2UV( Permit # (456 3
Building Location s Owner's Name/�'!f •C J d ,�j � 11r����^
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Type of Occupancy—/�t S D E N
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New ❑ Renovation ❑ Replacement 2"' Plans Subm' . Yes O No ❑
FIXTURES
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SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
11TH FLOOR
Installing Company Name Dr3EeT mmA47A 7 Check one: Certificate
Address_ ��r C O R(H(y)r4 n) P J ❑ Corporation
IY) E T i41 1 FA) ill Ay 1 SVS ❑ Partnership
Business Telephone 1'fl-i97 ! 9'Kr-r-n/Co.
Name of Licensed Plumber �4 cr3 F,f'7- h' �A,]2m14 tr4,ec"%
INSURANCE COVERAGE:
I have a current I' bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked Yes, please
/indicate the type coverage by checking the appropriate box.
A liability Insurance policy ld 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 C1
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 mdormed under the permit issueofor this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g Oode and apter of the eral Laws.
Title re of Licensed Plumm
Type of License: Master Joumeymah ❑
City/Town
APPROVED OFFIC U ONL License Number � 5
V
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR