HomeMy WebLinkAboutMiscellaneous - 2002 DOGWOOD CIRCLE 4/30/2018Date. Lol�.
8926
TOWN OF NORTH ANDOVER,
PERMIT FOR PLUMBING
This certifies that ... . !i, din.�.�!!
has permission to perform ... L)sq .. ............ .
plumbing in the buildings of . .� ... . ill.-. .` . .
at �l s v ` � "` :"I North Andover, Mass.
Feel. -2 Lic. No. 5.. .....! .' .. ... .
PLUMBING INSPECTOR
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
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Cit Town. o MA. Date•� /�� Permit#
Building Location: o W Owners Name: mt>
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Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New:iQ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑
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Check One Only Certificate #
Installing Company Name: P v � �
❑Corporation
Address: 3,q C1 City/Town: P % State:
J ❑ Partnership
Business Tel: �p'Z� X76 0ax:
❑ Firm/Company
Name of Licensed Plumber: C � t"-Cll ( �
INSURANCE COVERAGE:
I have a current lia_ bility insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes 21 No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 19011" 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 hus tts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By
Type of License:ZK:
Title ElPlumber Signature of Licensed Plumber
City/Town El Piasterf� '� '1�tJ O
APPROVED (OFFICE USE ONLY) License Number: ourneyman f ✓OC
766
f014 Date... !. A -. /....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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This certifies that ... ...... L cIM . 4 t n
has permission for gas installation ...' �c�!... �. J/.� 4 ..........
in the buildings of ...... V. D ...........................
at ' . 4C5 U.wr! ... ....(.M E � 2M � , North Andover, ass.
Fee93(o., 0P . Lic. No..3.43 4.. )-' UP-. ,. .
GAS INSPECTOR
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FIYTI IRC
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
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City/Town: MA. Date: Id C Permit#
ee,
Building Location: 0a0 !Def�) G�3d�c�( ��,� Owners Name:4.1
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New: [t?"' Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑
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SUB BSMT.
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13rFLOOR
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2 FLOOR
3 FLOOR
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4 FLOOR
5 FLOOR
6 FLOOR
7 FLOOR
8 FLOOR
Check One Only Certificate #
Installing Company Name: L rut,
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Address:�� -1 -f'&'p aiR City/Town: k*iriQ52State: dY
❑ Corporation
El Partnership
Business Tel: (00Fax:
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❑ Firm/Company
Name of Licensed Plumber/Gas Fitter: l/ %-
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes-ZVo ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
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 useVs General Laws, and that my signature on this permit application waives this requirement.
Chec One Only
Owner Agent ❑
Sin u of Owner or Owner's Agent
By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
4U%;urdir w cne oesi or my nnowieoge ana mat all piumomg worK ana installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Type of License: �
By El Plumber �—
Title ❑ Gas Fitter SIgnalrur of Licensed Plumber/Gas Fitter
❑ Master
City/Town [9joumeyman License Number: P 0 131 T
APPROVED OFFICE USE ONLY ❑ LP Installer