HomeMy WebLinkAboutMiscellaneous - 17 Harold Street �s
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SACMUS� i
This certifies that . . . . . . . . . . . . ... . . . . ... . . . . . . . . .
has permission to perform ,� ' .% ... . . . .��A. !: �. . . . . . . . . . . .
�- / � /
plumbing in the buildings of . .:/l . . . . . . . . . . . . . . . . . . . . . . . .
at ..� /j! V. . .. . . . . , North Andover, Mass.
Fee-...,-e� `. .Lic. No.....1.*/( /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
Check ri
5804
MASSACHUSETTS UNIFORM APPI, ATION FOR PERMIT TO DO PLUMBING
p (Type or print)
NORTH ANDOVER,MAS CRUS Date
Building Locations - PermitS
�Am-^ount
Owner's Name
Ne Renovation E] Replacement 0 Plans Submitted ri
FIXTURES
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SUMM
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5M FU at
6111)Einar
7M F10C R
(Print or type) r Check one: Certificate
Installing Company Namq,," 6`��1 Corp.
Addres �� Partner.
Business Telephone Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: In 'cate th type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond ❑
Insurance Waiver: I,the ndersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent 13
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 performed un r Permit Issued for this application will be in
compliance with all pertinent provisions of the Mas ac to Plumbi Chapter 14 of the General Laws.
By a e icens
Type of lu bing License
Title
City/Town License Numoer Master El Journeyman
APPROVED(OFFICE USE ONLY
Date. . . . .. . . . . .. .. . .. .
� HORTH
°f
�` '6 TOWN OF NORTH ANDOVER
° 9
• . PERMIT FOR GAS INSTALLATION
SAC
MUSES
This certifies that , .; . .l��. . . . . . / . .,. . . . . . .�. . .
has permission for gaass,installation . .<1 . . . .
in the buildings of (, . �j .� 1� . . . . . . . . . . . . . . . . . . . . . . . . .
/ J / � v
at . . ./... .lM .�. . . . . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee/ !l�). Lic. No..,!
. . . . . . .
GAS INSPECTOR
Check#
46 '17
r
MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT TO DO GAS G
(Type or print) Date
NORTH ANDOVER,MA ACHUSETTS
Building Locations - Permit# fry17
A_ mou $
Owner's Name
New Renovation ❑ Replacement ❑ Plans Submitted ❑
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x O A C7 a 0
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SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or �T --L��' Check one: Certificate Installing Company
Nam Corp.
Address Partner.
Busmess Tereptione El Firm/Co.
Name of Licensed Plu r Gas Fitter ���T�. �1�
INSURANCE COVERAGE Check one:
I have a current liability Insurance p licy or it's substantial equivalent. Yes 0 No
�If you have checked yes, lease i icate the type coverage by checking the appropriate box.
'lability insurance policy Other type of indemnity Bond 13
s
Owner's Insurance Waiv r: 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 0 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 work and installations performed under PennipVXued for this application will be in
compliance with all pertinent provisions of the Massachus s Sta hanto General LaWs.
a
By: Signature of License lumber Or Gas Fitter
Yl
Title Plumber
City/Town Gas Fitter License Number
EUNlaster
APPROVED(OFMCE USE ONLY) Journeyman
ti
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