HomeMy WebLinkAboutMiscellaneous - 25 MILLPOND 4/30/2018This certifies that ... ,F?l!`�!.�!l�f'G
.......................
has permission to perform .....?. 1�-�......................... .
plumbing in the buildings of ... ..................
at .... )-S- - y1�,.C..(.. / .11 .� ........... ,North Andover, Mass.
Fee. Lic. No.. G.1.3. .. .....Cly. rr vy.. ........... PLUMBING INSPECTOR
Check # &% 7 2
Date. .
o'<".� RT :A
TOWN OF NORTH ANDOVER
° n
PERMIT FOR PLUMBING
'4 "°,,r.° .x•,15
This certifies that ... ,F?l!`�!.�!l�f'G
.......................
has permission to perform .....?. 1�-�......................... .
plumbing in the buildings of ... ..................
at .... )-S- - y1�,.C..(.. / .11 .� ........... ,North Andover, Mass.
Fee. Lic. No.. G.1.3. .. .....Cly. rr vy.. ........... PLUMBING INSPECTOR
Check # &% 7 2
4%
MASSACHUSETT-1 UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING 3
(Print or ype)
Mass. at 20 P it #
Bui ding L ation k Owner's am
• Type of Occupancy
New 0 Renovation 0 Replacement"" Plans Submitted: Yes 0 No O
FIXTURES
B_P.4 ASEWER # -SEPTIC # -
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nstalli1ng Company. Name
A" _
1 kddr
3usiness Telephone
flame of Licensed Plumber or Gas Fitter
,>f
0 Corporation
0 Partnership
y�rm/co.
Certificate
INSURANCE COVERAGE:
I have a current liability insurance policy or its sbstantial equivalent, which meets the requirements of MGLCh. 142.
Yes E&,," No . 0 t
If you have checked yes, please indicate the type of coverage by ctrecking the appropriate box.
A liability insurance policy P__*1_ Other type of indemnity 0 Bond 0
OWNER'S INSURNACE WAIVER: I am aware that th.e licensee does not have the insurance coverage required by Chapter
942 of the Mass. General Laws, and that my signture on this permit application waives this requirement.
Check one:
Signature -of Owner.or_Owner's Agent Owner p Agent 0
hereby certify that all of the details and -information I have subin ltted enteredj In a b.,e-application are true and accurate to the best of
.y knowledge and that.all plumbing work'and ihstallatio'bs'performe nd r the, permit iss�pj for this' application will tie in coinpliance'Mth
.1 pertinent provisions`of the Massachusetts State Pfumding Code a pt 142 of the a era1 Laws.
t A 111 WAoVI /VA
By Si nalure of Licensed lumber
Title � �
Ciryr]own I Type of License: b0fViaster ❑Journeyman
APPROVED (OFFICE USE ONLY)
t
License Number
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MORE Mie
nstalli1ng Company. Name
A" _
1 kddr
3usiness Telephone
flame of Licensed Plumber or Gas Fitter
,>f
0 Corporation
0 Partnership
y�rm/co.
Certificate
INSURANCE COVERAGE:
I have a current liability insurance policy or its sbstantial equivalent, which meets the requirements of MGLCh. 142.
Yes E&,," No . 0 t
If you have checked yes, please indicate the type of coverage by ctrecking the appropriate box.
A liability insurance policy P__*1_ Other type of indemnity 0 Bond 0
OWNER'S INSURNACE WAIVER: I am aware that th.e licensee does not have the insurance coverage required by Chapter
942 of the Mass. General Laws, and that my signture on this permit application waives this requirement.
Check one:
Signature -of Owner.or_Owner's Agent Owner p Agent 0
hereby certify that all of the details and -information I have subin ltted enteredj In a b.,e-application are true and accurate to the best of
.y knowledge and that.all plumbing work'and ihstallatio'bs'performe nd r the, permit iss�pj for this' application will tie in coinpliance'Mth
.1 pertinent provisions`of the Massachusetts State Pfumding Code a pt 142 of the a era1 Laws.
t A 111 WAoVI /VA
By Si nalure of Licensed lumber
Title � �
Ciryr]own I Type of License: b0fViaster ❑Journeyman
APPROVED (OFFICE USE ONLY)
t
License Number
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