HomeMy WebLinkAboutMiscellaneous - 1895 SALEM STREET 4/30/2018 1895 SALEM STREET
210/106.6-0060-0000.0
Date.r.'. ..
s 3937
HORTIy
�'. �° •'tic TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
•'SSACMUsE�
This certifies that . ,v.t. . .! . . . .74
. . . . . . . . . . . . . .
has permission to perforn � �.�' -'!�. . . . . . . . . . . . .
plumbing in the bui in s of . . . . . . . . . . . . . . . . . . . . . . . . . .
x
at. , North Andover, Mass.
Fey^.! . . . . .Lic. N019
/1 PLUMBING INSPECTOR
9 � V
15.00 PAID
WHITE: Applicanl,99 1201NARY: Building Dept. PINK:Treasurer
r�?11
MASSACHUSETTS UNIFORM APPLICATION FO ERMIT TO DO PLUMBING
(Print or Type)
LT
` - Mass. Date 2— Permit#_
. A
L
Building Location l c l�
Owner's �I
�n� nek, Type of Occupancy
New K_ Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑
FEATURES
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
r 4TH FLOOR
5TH FLOOR
6TH FLOOR
TTH FLOOR I YT-1
8TH FLOOR
Installing Compan N me l- r
� Check one: Certificate
Address C'U
(/ /` D Corporation
❑ Partnership
Business Telephone
D Firm/Co.
Name of Licensed Plumber Cli
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes 0 No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity G Bond D
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:
innatilre oLOwner or Owner's A em Owner ❑ Agent ❑
1 hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to
the beat of my knowledge and that all plumbing work an i stall 'ons rfo a er the permit issued for this appllcation will
be in compliance with all pertinent provisions of the M h tts ing C de and Chapter 142 of the General Laws.
By
gna ure
Title leans um er City/TownType of License: Master
�Z j��u2(Jmgyman El
t
APPROVED OFFICE USE ONLY) License Number__
7 ��
J L ✓ 1 Date..:"....;2 ......
a
r10RTM TOWN OF NORTH ANDOVER
3 py �.ao ,e,hOL
O i m
PERMIT FOR GAS INSTALLATIONS
f 9
i c i
SSACHUSEt m
O
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ko
has permission for gas installation . . . . . . . . . . . . . . . . . .
in the buildings of . . ... . .v` . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
J�
at .`. . :� J�� . . .` *'. r.: . . .. . . . . . . . North Andover, Mass.
. . .
Fee.'. . .' . . . Lic. No.. . . .. . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
_ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TOASFITTING
(Print or Type))
Mass. Date 19 Permit#
Building Location 1 � J r Owner's Name V S l
r2 e of Occupancy
New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑
U)
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
1 8TH FLOOR
Y
7TH FLOOR
8TH FLOOR
Installing Comp ny N me vim_ til Check one: Certificate
r
Address ❑ Corporation
AA S= ❑ Partnership
Business Telephone 17 Firm/Co.
Name of Licensed Plumber or Gas Filter01 Fl__ItLA�
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes';b- No ❑
If you have checked yes, please indicate 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:
L-SOwner ❑ Agent ❑
i r r r' A nt
1 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 pe for ed under the permit iseued for this application will
be in compliance with.all pertinent provisions of the Massachusetts State P ing a pt of the GGeneral Laws.
By Type icense
❑-Plumber
Two ❑Gasfitter Sign tore o Likens umbe as Fitter
❑ Master
City ❑Joumeyman License Numbery /Z
APP�ED OFFICE uLY)
6