HomeMy WebLinkAboutMiscellaneous - 22 Pleasant Street -- - - e
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.'',, ,MASSACHUSETTS UNIFORM APPLICATIOPI FOR PERMIT TO DO GASFITT1110 �
(Print or Type)
NORTH ANDOVER Mass. Date v
�UiAng Location Permit IOU
/ Owners Name
New ' M Renovation Re lacement f, - Plans Submitted
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BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TN FLOOR
;S
STH FLOOR
6TH FLOOR
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7111 FLOOR
8TH FLOOR
(Print or Type) _ Check one: Certificate
Installing Company Name� —1 Corp.
Address Partner.
C.� rill/Co.
Business Telephone: 6„ j( 6 D & Ly
Name of Licensed Plumber or Gas Fitter L) (rj ✓�-% K,
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy 1[71 Other type of indemnity [_] Bond (�
Insurance Waiver: I , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
', -Signature of owner/agent of property Owner U Agent u
I hereby certify that all or the de(AUs and information I ha re tubmitted (or entered)in above application are true and accurate to the best of my
knowledge and that aU plumbing work and InitnUadons petforntcd under'fermit itseed for this application wU1 be in compliance wllh alt pertinent
pwrisions or tho Massachusetts Slate Gas Code and Qraplet 141 of tho Cenetal Laws,
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By' TYPE LICENSE: 4zi� Ci --
Plutriber
,Title Gasfitter Signature of Licensed
.City/Town:
Master Plumber or Gasfitter
I : I' Journeyman
'APPROVED (OFFICE USE ONLY) License Number
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10/03/00 Action King Enterprises, Inc.
Disposal Report
September 2000
Date Source Name Qty
Service
DISPOSAL RPT
DISANDOVER
DISAND/COR
09/29/2000 RAMADA INN 1,000.00
Total DISAND/COR
DISAND/FIT
09/14/2000 50 FRONTAGE RD,CAMBRIDGE ISOTOPE SEP 2,500.00
Total DISAND/FIT
DISAND/LOW
09/29/2000 Q-2-PLEASANT STREET;,PSOINES 2,000.00
Total DISAND/LOW
Total DISANDOVER
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