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HomeMy WebLinkAboutMiscellaneous - 187 WAVERLY ROAD 4/30/2018Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ap This certifies that .......... ...... has permission to perform in ings 0 ...... ...... f ...... plum�in thp buildi orth Andover, Mass. at . . . . . .. . .... ....... N Fee..�. . ..... Lic. No.. .. .............. ............... I PLUMBING INSPECTOR A Check # 60u4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date Permit # ✓G ` Building New ❑ Renovation ❑ Owner's Name "rte 40-1 Type of Occupancy RESIDENTIAL Replacement n Plans Submitted: Yes ❑ No ❑ EMERGENCY RENTAL WATER.''FIXTURES PPATPP RF.PT.AC'F.MRMT Installing Company Name WELCH BROTHERS CO. INC Address 148A TANNER ST LOWELL MA 01852 Business Telephone 9 7 8 4 5 3— 210 0 Name of Licensed Plumber THOMAS F. CAREY Check one: l Corporation ❑ Partnership ❑ Firm/Co. Certificate 1501—C INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes n No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box. A liability insurance policy [� 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: 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 work and installations performed wxlefAe permit issued this plication will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Cha 142 of the G r a BY 4 Signature of umber Title Type of License: Master [N Journeyman ❑ City/Town 8481 APPROVED (OFFICE USE ONLY) License Number MUMMA 011-11111 ��n�Nmm�nwmm�� an�ap000�o�ono� Installing Company Name WELCH BROTHERS CO. INC Address 148A TANNER ST LOWELL MA 01852 Business Telephone 9 7 8 4 5 3— 210 0 Name of Licensed Plumber THOMAS F. CAREY Check one: l Corporation ❑ Partnership ❑ Firm/Co. Certificate 1501—C INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes n No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box. A liability insurance policy [� 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: 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 work and installations performed wxlefAe permit issued this plication will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Cha 142 of the G r a BY 4 Signature of umber Title Type of License: Master [N Journeyman ❑ City/Town 8481 APPROVED (OFFICE USE ONLY) License Number