HomeMy WebLinkAboutMiscellaneous - 245 OLD CART WAY 4/30/2018 (2)MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Ste\ (Print or Type)
NORTH ANDOVER, . Mass. Data - Io S / 4, w
Building 7S ls�L \ ` l `V Permtt * - o2b 8D Glc. jy'D
Locallon />
ker 1-Z Nme a� '
New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No. 93-`
OIXTURE3
Installing Company Name
Address rte. �S
Business Tel
Name of licensed Plumber
IWA
Check one: Cartlacata
❑ Partnership__..
❑ Firm/Co. 4
INSURANCE COVERAGE: Qbacx one
1 have a current habil y Insurance policy or Its substantial equtvaler;t. Yes No -Cl
It you have checked y", please
/indicate the type coverage by checking the appropriate box
A liability Insurance pcilcy Itd Other type of indemnity ❑ Bond O r�
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. -General L.sws. and that my signature on this permit application waives thls_reGuirement.
Check one_
Owner ❑ Agent p
slurs a Owner or Qwnw s ens
1 hereby artily that alt of the details and Infermailon 1 have submitted for enter" In above application sm true and accurate to the bast of my
knowledge and that all plumbing "it and Installations performed undo the p�rm�! I for this appkation rn be In compiianc• with aA
pertinent provisions of the Massachusetts State Plumbing Code and thapter 4i 2 d ai lives
lit S
nal •
Plumber—
This
License Number
Oty/Town
Type of Plumbing License: Master
Ai'1' IOWD (OFFICE USE ONLY) Journeyman 0
31
w
�' j
e►
a:
°u
tic
s
<
M
J
a
'w'
M
s
s
a
s
sa
"
s
s
a
s
o
"
at
x
x
a
�,\
(J
.+
uX
»
M
w
i
►-
u
•
s<
<
"
�
Xo�>t
O
Y<
r
��03
s
>s
r
O
<
30
o=
soon
O
Si�M°
sH
s
it
OY
s•
<
O
sua-esWT.
s�saaastvT
teT FLOOR
2ND FLOOR
Z
Z
1 I
>tA0 FLOOR
4TH FLOOR
STH FLOOR
IT" FLOOR.
YTH FLOOR
tL—
aTH FLOOR
—
D9
i
I
I
1_1
A
V
I
I-
Installing Company Name
Address rte. �S
Business Tel
Name of licensed Plumber
IWA
Check one: Cartlacata
❑ Partnership__..
❑ Firm/Co. 4
INSURANCE COVERAGE: Qbacx one
1 have a current habil y Insurance policy or Its substantial equtvaler;t. Yes No -Cl
It you have checked y", please
/indicate the type coverage by checking the appropriate box
A liability Insurance pcilcy Itd Other type of indemnity ❑ Bond O r�
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. -General L.sws. and that my signature on this permit application waives thls_reGuirement.
Check one_
Owner ❑ Agent p
slurs a Owner or Qwnw s ens
1 hereby artily that alt of the details and Infermailon 1 have submitted for enter" In above application sm true and accurate to the bast of my
knowledge and that all plumbing "it and Installations performed undo the p�rm�! I for this appkation rn be In compiianc• with aA
pertinent provisions of the Massachusetts State Plumbing Code and thapter 4i 2 d ai lives
lit S
nal •
Plumber—
This
License Number
Oty/Town
Type of Plumbing License: Master
Ai'1' IOWD (OFFICE USE ONLY) Journeyman 0
Date.. 117A6 -.!'A'
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...(
has permission to perform ......, .. ,����LG .......
plumbing in the buildings of . : �./. J/� ..� .........
at r—>?.7 5 . North Andover, Mass.
Fee. j. ;J. W . Lic. No. % d ............................ .
6:"k
5 0
" PLUMBING INSPECTOR
IA/9s 14:18 130.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
C NORTH ANDOVER Mass. Le /;0'/ j DateIle/
lhuilding Location SysC44 (.J Permit # Z/
Owners Name V,
• Y - New ^L Aenovation D Replacement Plans Submitted D
-j' FlXTU0=c
(Print or Type)
Installing Company ,N/ame K�15i
Address f., to 0<C
ft N I!f Q
Business Telephone: t--,03-- 1"
Name of Licensed Plumber or Gas Fitter
Check one: Certificate
yK�j� Q Corp.
Partner.
[-rm/Co.
2� 3
ro crr"
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policyer type of indemnity 0 Bond Ej
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 17 Agent El
I hereby certiry that all or the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowtcdge and fiat all plumbing work and Installations performed under PLrmit iuced for this application will -be in compliances with all pestles t
provisions or the Massachusetts Slate Cas Cade and Qsaptcr 14: of the General Laws.
By TYPE LICENSE: `
Plumber
Title Gasfitter- Signature of Licensed
City/Town- Master Plumber or Gasfitter
Journeyman
APPROVED (OFFICE USE ONLY) License Number
m
�
stl
N
_
N
trs
x
v
z
c
rz
r
q;
es
-
a
�
Z
m
w1-
w
w
FO-
sn
sW
4
C*
w
Gr
w
z
Q
Q
=
Y
a
WW
2
ac
Q
Q
w
0
w
Cf
C
yt
,
1.
W
r
to
l7
o
>
sL
t-
--
CJ
w
t-
w
z
Q,
a
Gi
w
>
C
-d
W
cc
d
,.
G
rR
4
m=
<
O
o
O
W
Q
CC
o
O
us
us
s
t—
O
c�
u.
O
G
t7
. t
U
>
Q
a
t-
O
SU$—BS?.LT.
j
BASEMENT
I
IST FLOOR
2ND FLOOR
4
3RD FLOOR
4TH FLOOR
I
5TH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
(Print or Type)
Installing Company ,N/ame K�15i
Address f., to 0<C
ft N I!f Q
Business Telephone: t--,03-- 1"
Name of Licensed Plumber or Gas Fitter
Check one: Certificate
yK�j� Q Corp.
Partner.
[-rm/Co.
2� 3
ro crr"
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policyer type of indemnity 0 Bond Ej
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 17 Agent El
I hereby certiry that all or the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowtcdge and fiat all plumbing work and Installations performed under PLrmit iuced for this application will -be in compliances with all pestles t
provisions or the Massachusetts Slate Cas Cade and Qsaptcr 14: of the General Laws.
By TYPE LICENSE: `
Plumber
Title Gasfitter- Signature of Licensed
City/Town- Master Plumber or Gasfitter
Journeyman
APPROVED (OFFICE USE ONLY) License Number
' 1353 Date ......................
,,OFT#
py
TOWN OF NORTH ANDOVER
4ao ,e 7.t.O .,.
p PERMIT FOR GAS INSTALLATION .
This certifies that f / f ......:.:.....:. .......:........
has permission for gas installation . ....................... '
in the buildings of.....1..........::j:.....................
at ....:- ....................... !. , North Andover, Mass.
Fee..:: .... Lic. No..'X... ..........................
I I/ .— GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File