HomeMy WebLinkAboutMiscellaneous - 178 BRENTWOOD CIRCLE 4/30/2018ej e7
Date .... .4. .
of -1
TOWN OF NOtT7H ANDJOVER
0 -PLUMBING PERMIT FO LUMBING
S3 CHUS
This certifies that ....... .............
has permission to perform ...................
plumbing in thebuildings of'
at. %....... North -Andover, Mass.
Fe4*1Q! .... Lic. No.M MqZ�6) .... ..........
PLUMBING INSPECTOR
Check #
7837
Uj
1
W=
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
I "6 ' "QOye,r Mass. Date / / 4f} ermit#
Building Location `7 Owner's Name _ 110e rso,7
PSI, d DN 7 "L-1' Type of Occupancy
New ❑ Renovation ❑ Replacement Pians Submitted Yes ❑ No ❑
FEATURES
Installing Company Name I'f�tn �{� P�Cr� SQL �- —rfliC . Check one: Certificate
Address 195 P!'+nq�y 43 S-1r�/r
�.poration �7? i ��
❑ Partnership
Business Telephone �-�Iv �— i u o ❑ Firm/Co.
r �
Name of Licensed Plumbe UUel&.
INSURANCE CO ERAGE:
I have ac
liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
YesurNo ❑
If you have checked yes, please in icate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNERS 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:
SlOnatufA of Awnnr nr [lurrwde Annnf
Owner ❑ Agent ❑
i its, twy Germy mai an of ute agitans ana Inform - I have submitted (or entered 'n above application are true and accurate to
the best of my knowledge and that atl pit
and installations performed r the permit issued for this application will
be in compliance with all pertinent provtsi of It Massachusetts State Plumbi ode and Chapter 142 of the General taws.
By
igna re o can Ffum
Title Type of License: Master Journeyman ❑,„
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Installing Company Name I'f�tn �{� P�Cr� SQL �- —rfliC . Check one: Certificate
Address 195 P!'+nq�y 43 S-1r�/r
�.poration �7? i ��
❑ Partnership
Business Telephone �-�Iv �— i u o ❑ Firm/Co.
r �
Name of Licensed Plumbe UUel&.
INSURANCE CO ERAGE:
I have ac
liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
YesurNo ❑
If you have checked yes, please in icate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNERS 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:
SlOnatufA of Awnnr nr [lurrwde Annnf
Owner ❑ Agent ❑
i its, twy Germy mai an of ute agitans ana Inform - I have submitted (or entered 'n above application are true and accurate to
the best of my knowledge and that atl pit
and installations performed r the permit issued for this application will
be in compliance with all pertinent provtsi of It Massachusetts State Plumbi ode and Chapter 142 of the General taws.
By
igna re o can Ffum
Title Type of License: Master Journeyman ❑,„
r
3
4
Date./.
. ........
Of NOR TM
o? �` TOWN OF NORTH
PERMIT FOR GAS R
M j
. 9
�9SSCeHUSEtS
This certifies that ......... 1. :................. .
has permission for gas installation ....114W." Y....`' .............
in the buildings of .... �� «r ......................... .
at North Andover, Mass.
Fee. 3 Z ` Lic. No. ... �'. . �t--...�M-i:...... .
GASINSPECTOR
Check # Z S d
MASSACHUSETTS UNIFORM APPLICATON FORPERM TO DO GAS FITTING
(Type or print) Date���'Q�
NORTH ANDOVER, MASSACHUSETTS �y /
Building Locations 6 6 /i/%� Q-� 7d`dr7 C /��(r2 Permit # �� 6
ount $ L 7
Owner's Name Alkl';it Al
New Renovation D Replacement 11 Plans Submitted
(Print or type) r I)S
Name L
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter 10A4 / ) 6 �'7t AA-,--�
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 0-- Noo
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy [a 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 ❑
I hereby certity that all of the details and intormation 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 StateS,as)Code and Chapter V12 of tl}AGeneral Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber l O% [jl�
Gas Fitter License Number
9aster
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❑ Journeyman
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SUB-BASE_M ENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6 T H. F L O OR
7TH. FLOOR
8TH. FLOOR
FF
(Print or type) r I)S
Name L
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter 10A4 / ) 6 �'7t AA-,--�
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 0-- Noo
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy [a 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 ❑
I hereby certity that all of the details and intormation 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 StateS,as)Code and Chapter V12 of tl}AGeneral Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber l O% [jl�
Gas Fitter License Number
9aster
0-
❑ Journeyman
Date.... ... .
OORTH
?? °` TOWN OF NORTH,'A DOVER
. PERMIT FOR GAS INSTALLATION
M � •
�9SSACNUSES
This certifies that .�.- ...-:Q /..... .
has permission for
in the buildings of.................
...�! ................. .
at .%/� �? ... ... . ........ . North Andover, Mass.
Feed Lic. No%/.i?? ......
GAS ISP - TOR
Check # /'V�/
6528
coo -d-0
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
�_
' � (Print or Type)
..�
:,+ a
- 1V16 Ar -d 6 vein, , Mass. Date / 20 d Permit#
, �:fr4,
I
Building Location % `%b � Pn ��� e �� Owner's Name " A
New ❑ Renovation ❑ Replacement
Type of Occupancy
Plans Submitted Yes ❑ No ❑
Installing Company Name nlGttrP+��-- P- C1.f>tJi""L.CoaCertificate
rjiCNUAddress q6 Ption
C t` ��5� �� ❑ Partnership
L
Business Telephone d Jf J 000 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter F, -CA f _ %a u V e i «.,
INSURANCE CO RAGE:
have a curre iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes V No ❑
It you have checked yes, please rinte the type of coverage by checking the appropriate box.
A liability insurance policy 12 Other type of indemnity ❑ Bond ❑
OWNERS 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:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or en ed) in above application are true and accurate to
the best -of my knowledge and that all plumbing work and installations pe r ed under the permit issued r t is application will
be in compliance with all pertinent provisions of the Massachusetts Std PI tubing Code and Chapter 1 of he General Laws.
By T lum Lic se
Title ❑ G er Sig ature of Licensed PlumbV or Gas fitter J�
19WPffV_ED_0F_F_1M_U_§_E
❑ JourELM neyman License Number ONLY1
+
•
VA 11"I a role]
Installing Company Name nlGttrP+��-- P- C1.f>tJi""L.CoaCertificate
rjiCNUAddress q6 Ption
C t` ��5� �� ❑ Partnership
L
Business Telephone d Jf J 000 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter F, -CA f _ %a u V e i «.,
INSURANCE CO RAGE:
have a curre iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes V No ❑
It you have checked yes, please rinte the type of coverage by checking the appropriate box.
A liability insurance policy 12 Other type of indemnity ❑ Bond ❑
OWNERS 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:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or en ed) in above application are true and accurate to
the best -of my knowledge and that all plumbing work and installations pe r ed under the permit issued r t is application will
be in compliance with all pertinent provisions of the Massachusetts Std PI tubing Code and Chapter 1 of he General Laws.
By T lum Lic se
Title ❑ G er Sig ature of Licensed PlumbV or Gas fitter J�
19WPffV_ED_0F_F_1M_U_§_E
❑ JourELM neyman License Number ONLY1