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HomeMy WebLinkAboutMiscellaneous - 238 MIDDLESEX STREET 4/30/2018N O O Oo °D A � Qv v O m m w m x O C/) g m m o m Date../../.d� N° 4264 TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING This certifies that `��.x.c...,��L.�.�.�—t..................... has permission to perform .. ? . . `.. ... .�h. ........ r plumbing in the buildings of . 1 ?!.. ....................... at .: ... 1i.`. C'...:......... , Ncco--rtth�h Andover, Mass. Fee.)- Lic. No...2 .......... >>.,, ...�.? .,.�.� ..-�..... . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PE IT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS �/ po G Date P/ Building Location �G/j %� ���� Se, Owners Name /D O ti% e Permit # .Z 5' (�? Amount Type of Occupancy /k-- New �J / f �' �� �` �, k -- New Renovation ❑ ReplacementEl_---P—lans Submitted Yes No - ©�— FIXTURES (Print or type) _ Check one: Certificate Installing Company Name r G / y _ G a�7 Partner. Finn/Co. Name of Licensed Plumber. LL C lam- T �C-j l �) / Insurance Coverage: Indicate the typqofinsurance coverage by checking the appropriate box: Liability insurance policy o Other type of indemnity 11 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent El I hereby certify that all of the details and information I have su fitted (or entered) in a ve application are true and accurate to the best of my knowledge and that all plumbing work and ins ari s performed and It Issued for this application will be in compliance with all pertinent provisions of the Massachu State Plumbing C d Chant of the General Laws. z By: alure o Ice er Type ofPlu ing License Title City/Town Icense um er Master Journeyman APPROVED (OFFICE USE ONLY i it .�..� .................�.. i • - �.-....--M®S®M-.-.-..-.-M (Print or type) _ Check one: Certificate Installing Company Name r G / y _ G a�7 Partner. Finn/Co. Name of Licensed Plumber. LL C lam- T �C-j l �) / Insurance Coverage: Indicate the typqofinsurance coverage by checking the appropriate box: Liability insurance policy o Other type of indemnity 11 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent El I hereby certify that all of the details and information I have su fitted (or entered) in a ve application are true and accurate to the best of my knowledge and that all plumbing work and ins ari s performed and It Issued for this application will be in compliance with all pertinent provisions of the Massachu State Plumbing C d Chant of the General Laws. z By: alure o Ice er Type ofPlu ing License Title City/Town Icense um er Master Journeyman APPROVED (OFFICE USE ONLY