HomeMy WebLinkAboutMiscellaneous - 24 MILLPOND 4/30/2018`..
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This certifies that
Date. �... !//U .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
has permission to perform ..... 1--k.. S ......................... .
plumbing in the buildings of .... V.e.� t6A ...................
at ...%::`/..1".1f � f (�° `: t ............... . North Andover, Mass.
Fee. Lic. No..2 3!. (.-). ......CU .........
PLUMBING INSPECTOR
Check # 4530
8575
Massachusetts Uniform Application For Permit to do Plumbing
F. (print or type)
Of
In
Ipswich, Massachusetts
VNl
At: Location: Z `1 1An i
Owner: Jurjri 1I.2 / -4 i-2
New ❑
Plans Submitted
Date: `_/_ 5� .20 j o
Permit # (?)--? r
Type of Occupancy:
Renovation ❑
Yes ❑
Replacement E
(rnni or i ype)
Installing Company Name:
Address:
"d
GhecK one
❑ Corporation
❑ Partnership
cert. a
City /State /Zip: '0 15-" ❑ Firm / Company
Business Tel. #: 00V - SJ, L( PRINT Name of Licensed Plumber:
WA—v/on-r.6-1.r?=c
Insurance Coverage:
I have current liability insurance policy or its substantial equivalent, which meets the requirements of M.G.L. Ch. 142.
Ye No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy ❑ 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
Check One
Owner's Agent❑
I her ebv certify that all of the details and information I have submitted (or entered) in above application are true and a to to the best of my
knowledge and that all plumbing work and installations performed under Permit issued for this application vill be ' com liance th all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type License
Title 2rPlumber Signature of licensed plumber / gasfiner
City / Town ❑ Gasfittef
Approved ❑ Master f 3 2 1
Journevman License Number
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