HomeMy WebLinkAboutMiscellaneous - 165 AMBERVILLE ROAD 4/30/2018 (2) mum"
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Date. Q
9
f HpR7N, TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSAC NUS 1-21
This certifies that . . . . . . . . . . . . . .
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has permission to perform l_.-�f!la% .. t:!�1 .Y. : .1 .. . . . . . . . . .
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plumbing i/m/the buildings/of .�. . . . . . . . . . . . . . . . . . . .
at �fJ t .I.ll�t�� .1 rC = - /< . . ., North Andover, Mass.
s Fee ' . . . .Lic. No. �d 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
t PLUMBING INSPECTOR
Check 4 Jb i_
670
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
1 Date j
Building Location 4� /' Owners'Name Afy
Permi #
Amount 70
Type of Occupancy
New Renovation 0 Replacement 0 Plans Submitted Yes n No ❑
FIXTURESIii
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(Print or type) Check one: Certificate
Installing n Name Corp.
V El
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Address Partner.
BusinesN Tplephone. Firm/Co.
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Name of Licensed Plumber:
Insurance Coverage: Indicate We type W insurance coverage by checking the appropriate box:
Liability insurance policy Other tYPa 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
ignature Owner ❑ Agent
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 wo4kai s performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the tts Stat umbin Code and Chapter 142 of the General Laws.
By: re o cense um er
Type of Plumbing License
Title nt
City/Town c nse i um ei Master Journeyman
APPROVED(OFFICE USE ONLY ❑
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