HomeMy WebLinkAboutMiscellaneous - 20 NORTH CROSS ROAD 4/30/2018 (2)�iOR7M
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, This certifies that
Date /-. �2 7 .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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has permission to perform :. y. .: . -. .............. - �-
• plumbing in the buildings of ...��'. P .............. .
at . .............. ^. ?.......f . ? , , North Andover, Mass.
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Fee 4�".r..... Lic. No..931 n...
�f PLUMBING INSPECTOR
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(� (Print or Type)
Mass. Date Z_ . Permit # 20.
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Building Location Owner's Name(' P
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Type of Occupancy `, /
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New Renovation C Replacement &�--
FIXTURES
Submitted: Yes E-7 No Q
Installing Company Name r+l 111AhTC nCCI!_`AI
Address 7 Stewart Street
Haverhill, MA 01830
Business Telephone
Name of Licensed Plumber
Lic. Plumber:
Check one: Certificate
iiCorporation
Cl Partnership
INSURANCE COVERAGE:
I have a curren liability insurance policy or its substantial equivalent which meets the requirements of .MGL Ch. 142.
Yes No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity L:: Bond C
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.
Signature of Owner or Owner's Agent
I hereby certify that allot the details and information I have submitted (or entervo'Jl� the above applica' a e true/a
and installations performed under the permitissued for this application will be n mplian rth all ertine pr / on'
General Laws.
By Signatur Licensed Plumber
Title Type icense. Masten!�/ loumevman G
CityRbwn License Number �? ` v /,
APPROVED (OFFICE USE ONLY)
Check one:
Owner Agent G
accurate to the best of my knowledge and that all plumbing work
of the Massachusetts State Plumbing Code and Chapter 142 of the
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Installing Company Name r+l 111AhTC nCCI!_`AI
Address 7 Stewart Street
Haverhill, MA 01830
Business Telephone
Name of Licensed Plumber
Lic. Plumber:
Check one: Certificate
iiCorporation
Cl Partnership
INSURANCE COVERAGE:
I have a curren liability insurance policy or its substantial equivalent which meets the requirements of .MGL Ch. 142.
Yes No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity L:: Bond C
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.
Signature of Owner or Owner's Agent
I hereby certify that allot the details and information I have submitted (or entervo'Jl� the above applica' a e true/a
and installations performed under the permitissued for this application will be n mplian rth all ertine pr / on'
General Laws.
By Signatur Licensed Plumber
Title Type icense. Masten!�/ loumevman G
CityRbwn License Number �? ` v /,
APPROVED (OFFICE USE ONLY)
Check one:
Owner Agent G
accurate to the best of my knowledge and that all plumbing work
of the Massachusetts State Plumbing Code and Chapter 142 of the
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Date./ .17?. /'.d3.....
i� TOWN OF NORTH ANDOVER
-+ PERMIT FOR GAS INSTALLATION
This certifies that ..:.� ..:,.�. l ... -. .. .
has permission for gas installation � . �� �....
kki the buildings of ... .�... ...................... .
at ..� .y.�'.....?�' . � `f.. , North Andover, Mass.
Fee '-.,/ . Lic. No......... �
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Check # (' Y()
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4280
MASSACHUSETTS UNIFORM APPLICATION FOR Pj:QAAIT TO DO GASFiTTIIv'G
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(Print or Type)
Klass. Date�� // S Gi et mit
Building Location _20 /Vo DSC Owner's Name A17 19 fir ,(���/� .
T v p e of Occupancy 424-, 1 Psi ha -C
New Renovation '_ Replacement Plans- Submitted: Yes 7I No ❑
FIXTURES
Installing Companv Name
v�uwinI L UL-I.JIUII
Address ' 3ewa�?ree
Haverhill, MA 01830
Business Telephone Lic.'Plumber: T,kri ?r I+AA;t�g(jI
Name of Licensed Plumber or Cas Fitter
Check one: Certificate
Corporation 2Y2'76
%6
= Partnership
— I Irm Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of 'ACL Ch. 142.
Yes _::�- -No L_
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type or indemnity G Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 or the Mass.
General Laws, and that my signature on this permit application ,.valve=_ ;his reoulrement.
Signature or Owner or Owner's Agent
Check one:
Owner Agent
I hereby cenuv that all .v the details and information I have submitied for entered) .n the aoove auulicauon are true and accurate to the best of my knowledge and that all plumbing .vork
and installations oenormed under the permit issued for this application will be in comoliance with all penfnent provisions of thervsa chusetts Swte Gas Code and Chaoter 142 of the General Laws.
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Gasfilter _
Tide ",ld eter / t atur of 1JCensea wn' „r ,as Fin,,
journeyman license
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APPROVED !OFFICE USE 0r11.y1
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2nd FLOOR
3rd FLOOR
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Installing Companv Name
v�uwinI L UL-I.JIUII
Address ' 3ewa�?ree
Haverhill, MA 01830
Business Telephone Lic.'Plumber: T,kri ?r I+AA;t�g(jI
Name of Licensed Plumber or Cas Fitter
Check one: Certificate
Corporation 2Y2'76
%6
= Partnership
— I Irm Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of 'ACL Ch. 142.
Yes _::�- -No L_
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type or indemnity G Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 or the Mass.
General Laws, and that my signature on this permit application ,.valve=_ ;his reoulrement.
Signature or Owner or Owner's Agent
Check one:
Owner Agent
I hereby cenuv that all .v the details and information I have submitied for entered) .n the aoove auulicauon are true and accurate to the best of my knowledge and that all plumbing .vork
and installations oenormed under the permit issued for this application will be in comoliance with all penfnent provisions of thervsa chusetts Swte Gas Code and Chaoter 142 of the General Laws.
r
tl Fvne w Ltccnse:
y _ Plumner
Gasfilter _
Tide ",ld eter / t atur of 1JCensea wn' „r ,as Fin,,
journeyman license
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t_itvrTown license Number GJ V
APPROVED !OFFICE USE 0r11.y1
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