HomeMy WebLinkAboutMiscellaneous - 177 CARLTON LANE 4/30/2018 (2)'MASSACHUSETTS UNIFORM APPLICATION FOR PERMITTO DO PLUMBING
(Print or Type)
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Date ( IOD -2
Permit # Z
` Building Owner's
AT: LocationZ'72C j&I iA ME-, Name Yt&)O , kmtz ;r )
/1), AtinO� rxA Type of Occupancy:
New ❑ Renovation ❑ . Replacement
Signature of Owner/ Agent
I have a current liability insurance policy to include completed operations coverage.
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber
Type of Plumbing License
8678 0 Master ❑ Journeyman
License Number
"Y
PlansSubmitted:
FIXTURES
Yes ❑ No
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2ND FLOOR
3RD'FLOOR
4TH FLOOR
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8TH FLOOR
7TH FLOOR
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ti (Print or Type) Check One: Certificate
Installing Company Name Uptack Plumbing & Heating, Inc [3 Corp 1415
Address 32 Rochambault Street
❑ Partnership
Haverhill, MA 01832
❑ Firm/ Company
z
Business ► elephone 978 372-8503 Name of Licensed Plumber or Gasfitter
Leonard A. Hall
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 Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that 1 do not have liability insurance including completed operations coverage.
Signature of Owner/ Agent
I have a current liability insurance policy to include completed operations coverage.
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber
Type of Plumbing License
8678 0 Master ❑ Journeyman
License Number
"Y
n
Date ...... ...
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ? ............`............... .
has permission to perform ....-'.........
plumbing in,the buildings of :fid-=-�! ....................
at . .......�^ ... ,A-"" . J.......... North Andover, Mass.
�-, .�................
Fee?=�....... Lic. No.h. �7..../-......._.. .
V PLUMBivG R�tECTOR
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Jx Date 20 6
Permit #
Building Owner's
AT: Location C��aA) 44/JE, Namejm,N )E. 466 Z.-O&D
N- Ai0DoV(�( MA.
Type of Occupancy: /z�jG-� •.
New ❑ Renovation ❑ Replacement o
Plans Submitted Yes ❑ No W
(Print or Type) Check One: Certificate
Installing Company Name Uptack Plumbing & Heating, Inc Lal Corp. 1415
Address 32 Rochambault Street ❑ Partnership
Haverhill, MA 01832
❑ Firm/Company
Business Telephone 978 372-8503
Name of Licensed Plumber or Gasfitter
Leonard A. Hall
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 Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
signature of Owner/ Agent
I have a current liability insurance policy to include completed operations coverage. 5 1
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
❑ Plumber
❑ Gasfitter
❑ Master
0 Journeyman
Signature'df Licensed
Plumber or Gasfitter
8678
License Number
Date ..:.;/- . - ! .... .
Check #
5 2'1 ii.
MORTN
TOWN OF NORTI�4ANDOVER
ti D
•
PERMIT FORfINSTALLATION
.
�9SSACMUSES
This certifies that
.....:...1 .................. ............ .
has permission for
gas installation .. ..:.. .. .... ! ....... .
in the buildings of
. t ...... "............................ .
at f C. �':: �.:�'''
`......
`";.:... ,-North Andover, Mass,
Fee . .... Lic.
r.
No. ?G�F? .. ;-. '`..
GGAS`INSPECTOR. J/
Check #
5 2'1 ii.