HomeMy WebLinkAboutMiscellaneous - 197 MASSACHUSETTS AVENUE 4/30/2018 (2) .�
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Date/.�
O� ORT".�,�,p TOWN OF NORTH ANDOVER
R p PERMIT FOR PLUMBING
SA US
This certifies that . . . . ?/? ... . . . • • . . . . . . . . . . . . . • • • •
has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . (. . . . . . . . . . . . . . . . . . . . . . .
at . . . `. . . . . . ^: . . , North Andover, Mass.
Fee. Lic. No.. .5. . .2. `. . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
Check # S
576
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)) _
, Mass. Date Permit #`
Building Location 9 Owner's Namer�ll
Type of Occupancy Residential
y New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑
FIXTURES
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BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLoon
6TH FLOOR
7TH FLOG
STH FLOOn
Installing Company Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 ❑ Partnership
Business Telephone 781 -438-7776 171 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked,res, please indicate the type coverage by checking the appropriate box.
{ A liability Insurance policy IS 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❑
Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter 1 2 of the General laws.
Signature o !censed-Pluml5er
- title
Type of License:Master[X Journeyman El
! City/Town $3 2 2
APP O S License Number
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�l BELOW FOR OFFICE USE ONLY
. FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE "
i APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OF BUILDING
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i LOCATION OF BUILDING
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PLUMBER
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PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR
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