HomeMy WebLinkAboutMiscellaneous - 151 BERKELEY ROAD 4/30/2018 151 BERKELEY ROAD
210/047.0-0057-0000.0
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4076
"pRT" TOWN OF NORTH ANDOVER
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° p PERMIT FOR PLUMBING
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This certifies that ./`. —. . . .-.-.'.*. ... ..'. . . . . . . . . . . . . . .
has permission to perform . . . .•. . . . . . . . `. '
plumbing in the buildings of . . . . . . . . . . . . . . .
at. . e . . .��— -. �: . �` .*` North Andover, Mass.
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7 ` 5 �- PLU IS INSPECTOR
Check # '�� ((��//
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or T
a. Mass. Date o2 OLr Permit #
Building Location Owner's Name
V, A A Type of Occupancy 2t S i D c
New ❑ Renovation ❑ Replacement ED- Pians Submitted: es1:1No ElFIXTURES
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SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name SQMM4 TAeQ Check one: Certificate
Address (� co R t:H M,10 <-Pi
❑ Corporation
I� E l N l! ✓Yl a U I,T( () ❑Partnership
Business Telephone �k1f, z-i97 1 2" irm/Co.
Name of Licensed Plumber Y4 f 3 r=,�'T h� SA,�►�ryl a4 �r4�c"
INSURANCE COVERAGE:
I have a currentfiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
A Yes No ❑ 1
If you have checkedrtes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy 1d" 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❑
1 hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations nwformed under the permit issueof0
r this application will be in compliance with all
pertinent provisions of the Massachusetts state Plum ' g e and ter of the oral Laws.
8y vLL
Title @Wlre of Licensed Plumber
Type of License: Master % Joumeymah❑
City/Town U
APPROVED 0 I ONL License Number J
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME A TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR