HomeMy WebLinkAboutMiscellaneous - 160 Amberville Road i�� .
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Date./,.).-.
"OR'M TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
,SSACNUSE�
This certifies that . . . . .`' 5./�e.h. . • . . . . . . . . . . . . . . . . .
has permission to perform . . . .n. f. . .:'. . . . . . . . . . . . . . . .
plumbing in the buildings of . . . P:,,,.t. .4. . . . . . . . . . . . . . . . . . . . . . .
at . . . ... . . . . . . . ., North Andover, Mass.
Fee. . Lic. No. G!. . . . . . . . . �/ ���_ - - . . . . . . . . . .
'PLUMBING INSPECTOR
Check # t 31
582 '
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS 1
D Date
Building Location/Ko Quit Owners Name Permit#
/
Amount--'-
mount� �Zt'
Type of Oce u Cy Pel&e
New M/ ,-' Renovation Replacement Plans Submitted Yes No
FIXTURES
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(Print or type) t Check one:
3 /Certificate
Installing Company Name Corp
Address ` Partner.
Business Telephone - /6/ 1571 El Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type.of insurance coverage by checking the appropriate box:
Liability insurance policy J'/ Other type of indemnity ❑ Bond ❑
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 submitted(or entered)in a�e application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed un ermit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat eFPlumbi a and chapter 142 of the General Laws.
By: Signature oo icYZ ensecTP um er
T e,of P umbnse
Title ,
City/Town icense INumDer — Mastermeyman ❑
APPROVED(OFFICE USE ONLY
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