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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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This certifies that .... �M/ S!...... P12,1 ,I.I!h .........
has permission to perform ........ j'..... .........
plumbing in the buildings of ...Md.� 0 .................
at ..,.�..... !�f?!t f Q�1'�'C>........ North A dover, Mass.
Fee -' S. G� . Lie. No.. 1. :�-f 1..
PLUMBING INSPECTOR
Check # LJ L—L—
Z\1-
ACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO
PLUMBING
11
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City/Town-J,DO
vim" _,MA. Date: ll l /
..Permit#
� /`fUA ► pw � OwnersName: I 4.S6VP
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ommercial ❑ Educational ❑ Industrial ❑ Institutional ❑
Residential❑- --
New: ❑
Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No
FIXTURES
DEDICATED
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ST" FLOOR
e FLOOR
7' FLOOR
8T" FLOOR
Installing Company Name• _ Pd'r ('y j p/V,q #9 / ;UG f NaG Check One Only Certificate #
Address: ❑ Corporation
Al�b� �y1�Mctk�l0 City/Town: 1ilAw�A6 4o State: /�!�
❑ Partnership
Business Tel: 403 ,303 d f 73 Fax:
rrm/Company
Name of Licensed Plumber: 90,9Pjejr/ S/
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑
If you have checked Yes, please indica he .type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity nity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the besof my
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Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ll
By Type of License: %
Title ❑ PI er Sl9�ture of �LlcenAdPlu�mber
City/Town aster
APPROVED (OFFICE USE ONLY ❑Journeyman License Number:
FOR-
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YOUR GALL
PLEASE GALL
WILL GALL
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I - f WANTS
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Nurnter Of Feeders and Ampa --Amps r. voits Overhead 01 Und-grd C_j Na. of Met0'3_
Location and Nar'e Of P=Posed Eecuicai
Of9c.11timOutlets INC- of Hot Tut:s
of Ucntfrlg Ftxturesj Move In
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Of ;;0c9Otar_!s Outlets lNc. of --U Burners
Of Switch Outlets INC. of Gas Surnem
of PancesTOTAi
INc_ Of Air Czndltfinne
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No. of Water Heaters Nm of
S;Cr-3 Ballasts
Na. of Hydro Fma-1=90 Tubs
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OTHER:
FRE ALARMS - No. of Z. -nes
No. of L'stec*jcn and
initiating 0evices
NO. Of Sounding Cevcas
No. Of Self Contained
00tec:icn/ScundIng Oevicas
Municipal
LMW nn an ElCt-h--er
_OW Vcftge
410, V %X N
J (ERAGF- Pursuant to the requirements at Gw,,,i Las
I have a =Teu L!ebijity km= -,Cs p.0, W:iuQng
Con`Pk"d OPeradons Coverne, or ib 3tibstantiat
vaad Proof d Sam* to this Offim YES C3 NO C3 -"am YES 0 NO 0 1 hazve
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havo chocked YE& pteaft k.A=ts the -
checkiing ft
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CST BOND—
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Estimated Value of Ejec�j�
- ------ Work 3
Work to
Spied under a! perNrY. Dale F!
FUW HALE— '-
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Date ..A ... ...........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .'....... .. . ..........................................................................
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has permission to perform .......... .............................................................
wiring in the building of.......
...............................................................
at ...... .............
........... .......... North Andover, Mass.
Fee.
�f\.�. .............. Lic. No../'..1.L..................../(-"....
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........................................
ELECTRICAL INSPECTOR
Check #
466-
Commonwealth of Massachusetts
uxrDepartment of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
oil- 'ciul U,c Ot�1y
?cr No. �tO to 2—
p-s-
ccupuncy and I=ce Checked
APPLICATION FOR PERMIT TO pER � ev. 11/99] :t„el��:tn,;) --------
APPLICATION
wurk to t><pertitrmed in accordance with (he MassacltuscttF��cRcMt:�ELECTRICAL WORK
ll'1,EASE PIUAti1N INK UR TYP .ALL INFOfUygTION) U,ite: (ri 527 ���1� lz.un
City or Town of:
Qy this applicatiun the undersigned gives notice o Itis or her intention to perform the electrical wurk d
To the Insnec.lor
Location (Street'& Number) cscribed below.
Owner or Tenant /� G
�N_�%ln� /1/l� 7' i n ,
Owncr's Address
Is this permit in conjunction with a building permit? y�
Purpose of Building N'
Existing Service Am s
Utility
p __—_Vults Overhead ElN=ti+ Service Amos
_Volts Overhead 1-7
Number of Fecders and Atttpacity .
Location attd Nature of Proposed Electrical Work:
�IV0. of Recessed Fixtures�
Completion o the
/ No.
Ceil.-Susp.
of (Paddle) Fatts
No. of Lighting Outlets
No. of Hot Tubs
No. of Lighting Fixtures
Swimming Pool A ove ❑ it -
No. of Receptacle Outlets
orttd, rttd
INo. of Oil Burners
No. of Switches
No. of Gas Burners
No. of Ranges
No. of Air Cond. otal
4,40.. of Waste Disposers
T
cat um ons
um er ons
Totals: --
No. of Dishwashers
Space/Area Heating KW
r
No. of Dryer
Heating Appliances
� o• o aler
Kw
Heaters KW
0. ° NO. of
Si 711s Ballasts
No. Hydromassage Bathtubs
No. of Motors 1'oL•tl HP
OTHER
'T'elepltone Nu.
�I (Check Appropriate Box)
,uth067,atlorr No.
Undgrd ❑ No. of Meters _
Lndb rd ❑ No. or N1ccers
towing table May be waived by the Inspector /
I o. it U/ v;res.
TransformersKVA
oral
Generators I<VA
❑mergency tgtttutg
Battery Units
11-0ALARMS No. of Zones
llctcction and
itiatilt Dcviccs Alerting DevicesSe f- ontatned
ion/Aierttn Devices
M crpa
n ❑ Other
ecurity Systerus:
""����uivalcnt
Data Wiring:
No. of Devices or Equivalent
elccomtnunrc�rons
rang:
No. of Devicev or Fgtriv,re.tt
INSURANCE COVERAGL: Unless waived by the owner,tno pe�m'c forldietper;ormance of electrical work may Issue ui less
the licensee provides proof of liability insurance including "completed operation- cove a�
undersigned certifies that such covgrage is in force, and has exhibited pro f of sar-t co the porn i Its sbuingtoRicqutvalettt ?lte
CHECK ONE: INSUI .ANCE� BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Llectrical Work: (lixpintioir Date)
(When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with .',IEC Rule 10. and upon completion.
I ccrrijy, under ME: r rin.r artd peva/lies 14 0 perjury, at the injornation un Alis appUc tiotr 6 trite tarn! complete.
FIRM NAME:
Licensee:
LIC. NO.:
fljapplteable. a ter '•exc pt" Sigtratur to the license rru rl' eIC. NO
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Address: S'"— B 3. TO. No.. �3
OWNF,?,'S 1NSL14L INCE w�.(VER. I am z ware that tate ' tcen. does nor hm�e rltc :iabiltiy msurar,cc cova'age norma v
t. Tcl_ No.:
-equircd by law. 8y my signature below, I hereby waive this requirement. 1 am the (check otty ❑ owner
Owner/Agcnr ❑ owner's.agecc.
�i�naturc
Telep'nonc No. PCKNtifIT FFF• f
'N2
Date...7..�� .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...... . --r .... Z'.` . .
has permission to perform ..J- .................
plumbing in the buildings of ...............
at ..5.� .'.=�'�. l`�� ....... North Andover, Mass.
Feea!cw
o ...... Lic. No.........._ `' .�, ..........
j PLUM8IWGJNSPECTOR
Check # �.-
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 PLUMBING a`
(Print or Type)
IV., Mass. Date
Building Owners Name
Type of Occup
ru
Permit *
New O Renovation O ReplacementStibmkted: Yes O No O
FIXTUREl�� S
Installing Company Name'r�C?r3�,°� ' �,9m.»RTAP7 Check one: CertMkate
Address _ ��r`? l LA H1r1r��' s J 0 Corporation
❑ Partnership
Business Telephone L 1- - 1
Name of Licensed Plumber r'r3 pl' r 4 SAN m,4- re<,eo
INSURANCE COVERAGE:
I have a current pability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes O' No O
If you have checked y". pleasee Indkate the type coverage by checking the appropriate box
A liability Insurance policy 1d Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General taws. and that my signature on this permit application waives this requirement.
Check oone:Gnn�lura of A....a.... A..��.. •�__• Owner O Agent O .
I hereby certity that all of the details and infomnation I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations ormed under the permit twusolfor this application vhll be in compliance with all
Pertinent provisions of the Massachusetts State Plum W'v Pode and r of the Laws.
BY L
Title re of Plur—fibei'
Type of License: Master JoumeyrniM p
tatyltown
license Number �3 3 5
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7TH FLOOR
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Installing Company Name'r�C?r3�,°� ' �,9m.»RTAP7 Check one: CertMkate
Address _ ��r`? l LA H1r1r��' s J 0 Corporation
❑ Partnership
Business Telephone L 1- - 1
Name of Licensed Plumber r'r3 pl' r 4 SAN m,4- re<,eo
INSURANCE COVERAGE:
I have a current pability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes O' No O
If you have checked y". pleasee Indkate the type coverage by checking the appropriate box
A liability Insurance policy 1d Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General taws. and that my signature on this permit application waives this requirement.
Check oone:Gnn�lura of A....a.... A..��.. •�__• Owner O Agent O .
I hereby certity that all of the details and infomnation I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations ormed under the permit twusolfor this application vhll be in compliance with all
Pertinent provisions of the Massachusetts State Plum W'v Pode and r of the Laws.
BY L
Title re of Plur—fibei'
Type of License: Master JoumeyrniM p
tatyltown
license Number �3 3 5
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.,O; The Commonwealth of Massachusetts Office Use Only
—' Department of Public Safety [permit No.BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 wc*f b Fee Check
�` y 3190 (leave blank)
APPLICATION FOR P
All PERMIT TO PERFORMS27 CMR 12=
ELECTRICAL WORK
(PLEASE PRINT IN INK OR TYPE ALL INFORMATIONt' )
Dated )
�v
City or Town of ��r ��� t% --AI—'—'
'The undersigned applies for a permit to perform the
Location (Street
Owner or Tenant
nVIR ee5cacea nomw
To the Insnacrm. „4
Owner's Addresss'�N _i A Q
Is this permit in conjunction with a buildingpermit P yes ❑ no (Ch -;k Appropriate Box)
Purpose of Buildinc,��(y�
Utility Authorization No.
Existing Service SQUO Amps /
CNolts Overhead ❑ Undgrd [91
New Service No. of Meters_,,__
Amps /—Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity No. of Meters
Location and Nat --,e of Proposed Electrical Work—�'u
No. of lichtin 1 Outlets Q
Na. of Hot Tubs
_1 r
TOTAL
No. oftLightingFixtures
Above InKVA
Swimmin Pool
No. of Transformers
(GeneratorsNo.
ofptacle Outlets
No. of Oil Burners
No. of Emergency Lighting�K�VA
No. of Switch Outlets o�
8attery Units
Na. of Ranges
No. of Gas Burners
TOTAL
FIRE ALARMS No. of Zones
No. of Air Conditioners
TONS
No, of Detection and
No. of Disposals
HEAT TOTAL
No. of Pumos TONS
TOTAL
Initiating Devices
No. of Sounding Devices
No, of Dishwashers
KW
No. of Self Contained
Space/Area Heating
KW
Detection/Sounding Devices
No. of Dryers
(Heatin Devices
No.
No.
K4V
Municipal
Local ❑ Connection 711 --
of Water Heaters KW
of No. of
Si ns Ballasts
Low Voltage
No. of H dro Massa a Tubs
Wirin
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
1 have a current Liability Insurance Polley including Completed Operations Coverage or its substantial equivalent. YES O NO ❑ I heave submitted
valid proof of same to this office. YES p NO p
If YOU have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ff BOND ❑ OTHER ❑ (Please Specify) F
Estimated Value of Electrical Work S- 0OU
Work to Sta 1 Inspection Date Requested: Rough
Signed under the pe antes of a 'u
FIRM NAME_ i \re "Gl+cs;,r O:. P, , A
`!
Date)
Licensee i� UC. NO. 01 VI 5 '%
Signature
Address ��� to UC.. . No
Bus. tel. Nao�S��(F��ia }a�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial e 'tv �- �
Massachusetts General taws, and that my signature on this application waives this requirement. Owner q
gent (Please check One)
by
(Signature of Owner or Ar3antt Telephone No.
PERMIT FEF e
M.
Of ,,ORTI, 1ti
0
it e`t%`°..;°•, oL
m
O p
,SSA USEt
I
Date..........'.............. r..
0
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
j
This certifies that ............. k'...�................................. '.......... :...........................`..... o
- o
has permission to perform...............................................................................
wiring in the building of..................................................................................
m
�t
at............................................................................... . North Andover, Mass.
Fee..................... Lic. No......:...'...................................................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Office Use Only
v
u4P (fommonwealth, of Moon �� Permit No.
Elevurttneitt of Pubiit _Attfetq Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 0eave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 4g",�'s
(M* or Town of NORTH MOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) Qo2� 1n6Af7(&7/fD t1
WA
Owner or Tenant r TQC
Owner's Address "tom
Is this permit in conjunction with a building permit: Yes No C (Check Appropriate Box)
Purpose of Building t -(o d-5er Utility Authorization No.
Existing Service Amps —J Volts Overhead Li Undgrnd L -I No. of Meters
New Service Amps Volts Overhead Undgrnd — No. of Meters
Number of Feeders and Amoacity
Location and Nature of Proposed Electrical Work
INSURANCE COVERAGE: Pursuant to the regwrements of MasSacr.users general Laws
I have a current Liability Insurance Policy inc(ucin me:etee Operations Coverage or its sucstanfial eeuivaien : Y `5 _ NO _ I
have suomirted valid proof of same to the Office �E NO = if you have cneckee YES. please indicate the type of coverage oy
checking the acpryriate box. �^�ST
INSURANCE Z� BOND = OTHER = (Please Scec:` f �<r/�galGf
(Expiration Datei
Estimated Value of E!ectncal Work S �oQr �� Final
ry
Work :o Start Insoec:ion Date �.ecues:ec: Roucn ,
Signed under the Penalties of per]%ry
LIC. NO.
FIRM NAME
L %m.� r✓ Sigr.at re LIC. NO. —711 �
Licensee
Sus. :el.No.
Address ,2S`- tJ9/Z7719 41,174S' % h✓ Wlms ew 1 6 / P ice/ Alt. Tel. No.
OWNERS INSURANCE WAIVER: I am aware that the Licensee goes not nave the insurance coverage or its suostantiat equivalent as re-
ouirea by Massachusetts Generai Laws. and that my signature on :his permit application waives this requirement. Owner Agent
(Please check one)
(Signature of Owner or Agents
Teteonone No. PERMIT FEE S
X-6565
INo.
Total
No. of Lighting Outlets I
u
No. of Hot ' cs
I
of Transformers KVA
i
ng Fixtures I
No. of Lighting
Swimming Pool grro. _
in-r
crno. _ I
1
Generators KVA
No. of Emergency Lighting
No. of Recectacie Outlets
No. of oil Furriers
Sattery Units
No. of Switch Outlets I
No. of Gas Surrers
FIRE ALARMS No. of Zones
No. of Detection and
Totat
No. of Ranges
No. ct Air Conc.
I ;Fns
Initiatinc Devices
No. of Sounding Devices
No. of Self Contained
No. of Disoosals
INHeat Total Total
o.of Pur:cs Tons KW
No. of Dishwashers
Space/Area Hleatina
KW
Oetecnon/Souneing Devices
— Munic!pai
Local _ Connection _Other
'
No. of Dryers Heating Devices KW
No. of No. of
Low Vcttage
No. of Water Heaters KW
Signs 3ailasts
Wirinc
No. Hvdro Massage Tubs
i No. et Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the regwrements of MasSacr.users general Laws
I have a current Liability Insurance Policy inc(ucin me:etee Operations Coverage or its sucstanfial eeuivaien : Y `5 _ NO _ I
have suomirted valid proof of same to the Office �E NO = if you have cneckee YES. please indicate the type of coverage oy
checking the acpryriate box. �^�ST
INSURANCE Z� BOND = OTHER = (Please Scec:` f �<r/�galGf
(Expiration Datei
Estimated Value of E!ectncal Work S �oQr �� Final
ry
Work :o Start Insoec:ion Date �.ecues:ec: Roucn ,
Signed under the Penalties of per]%ry
LIC. NO.
FIRM NAME
L %m.� r✓ Sigr.at re LIC. NO. —711 �
Licensee
Sus. :el.No.
Address ,2S`- tJ9/Z7719 41,174S' % h✓ Wlms ew 1 6 / P ice/ Alt. Tel. No.
OWNERS INSURANCE WAIVER: I am aware that the Licensee goes not nave the insurance coverage or its suostantiat equivalent as re-
ouirea by Massachusetts Generai Laws. and that my signature on :his permit application waives this requirement. Owner Agent
(Please check one)
(Signature of Owner or Agents
Teteonone No. PERMIT FEE S
X-6565
Date ........
.. .. ...........
2337
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... ....................
has permission to perform ........................... ........ ........... I ........................
wiring in the building of ......... —.! ......... ....................... I...........................
at .......... ..... . .................... ................ . North Andover, Mass.
V...................
Fee..................... Lic. No : ............. .............................................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
r
Gov`
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
N. ANDOVER , Mass. Date 5-26 19 95 Permit # zG
Building Location 25 MONTEIRO WAY PETER ALDER
Owner's Name
Type of Occupancy DWELLING
New Renovation ❑ Replacement ❑ Plans Submitted: Yes[] 1 Non-
mom
on-
Installing Company Name Avotte Plumbing - Heating & A. C.
Address 108 Middlesex Street, Unit#10
N. Chelmsford, MA 01863
Check one:
❑ Corporation
❑ P rtnershi
Certificate #
P
Business Telephone (508) 251-1000 Firm/Co.
Name of Licensed Plumber or Gas Fitter Harry Avotte
INSURANCE COVERAGE:
have a current blllty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes W No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy V r 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, and that my signature on this permit application waives this requirement.
Check one:
Signature o Owner or Owner's Agent Owner❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or enter4Nu
pplicalio are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the pr this a IlcatIon II be In compliance with all
pertinent provisions of the Massachusetts Slate Gas Code and Chapter 14280 s.
T f License:
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Installing Company Name Avotte Plumbing - Heating & A. C.
Address 108 Middlesex Street, Unit#10
N. Chelmsford, MA 01863
Check one:
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Certificate #
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Business Telephone (508) 251-1000 Firm/Co.
Name of Licensed Plumber or Gas Fitter Harry Avotte
INSURANCE COVERAGE:
have a current blllty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes W No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy V r 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, and that my signature on this permit application waives this requirement.
Check one:
Signature o Owner or Owner's Agent Owner❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or enter4Nu
pplicalio are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the pr this a IlcatIon II be In compliance with all
pertinent provisions of the Massachusetts Slate Gas Code and Chapter 14280 s.
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-, Date ......................
f ,,pRTH , TOWN OF NORTH ANDOVER
FOr h` .a L9
PERMIT FOR GAS INSTALLATION
This certifies that ......................................... .
has permission for gas installation ............................
in the buildings of ..........................................
at ......
... ........................... . North Andover, Mass.
Fee......... Lic. No. ..... ......' ...........
Cs/M/S 14:33 Gdl§.(NBPECT-,dh
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
0
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r J• �
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING �yMSrO
(Print or Type) °o
! by -+T 1 Andiye y- Mass. Date � 19 96 Permit# a &-3
Building Location 25 HO [I L_ I IbD WBU Owner's Name?4ff_(f Rd1�'�
�Ifn, Type of Occupancy
New ❑ Renovation ❑ Replacement X Plans Submitted Yes ❑ No ❑
FEATURES
Installing Company Nam/ee i—i7-i 1 rin !t a)ni✓i u�i bi 1,91
Address 6rifef t m f�cbw
M a (019b2.
Business T
Name of Licensed PI
Check one: Certificate
❑ Corporation
❑ Partnership
Firm/Co.
INSURANCE COVERAGE:
I have a curr7nt liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes M No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy 521 Other type of indemnity ❑ Bond ❑
OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to
the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will
be in complianc6-with alh pertinent pr isAare
assa usetts State Plumbing Code and Chapter 142 of the General Laws.
By
FE ? ' �gtah icense um er
Title I C Type of License: Master ❑ Journeyman I/
City/Town License Number
APPROVED OFFICE USE ONLY)
•
••-
■■■■■■■
■■■■■■■■■■■■■■■■■■■■
11
Installing Company Nam/ee i—i7-i 1 rin !t a)ni✓i u�i bi 1,91
Address 6rifef t m f�cbw
M a (019b2.
Business T
Name of Licensed PI
Check one: Certificate
❑ Corporation
❑ Partnership
Firm/Co.
INSURANCE COVERAGE:
I have a curr7nt liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes M No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy 521 Other type of indemnity ❑ Bond ❑
OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to
the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will
be in complianc6-with alh pertinent pr isAare
assa usetts State Plumbing Code and Chapter 142 of the General Laws.
By
FE ? ' �gtah icense um er
Title I C Type of License: Master ❑ Journeyman I/
City/Town License Number
APPROVED OFFICE USE ONLY)
71 233.
-ti• _ .. �.-. ,..-.Y-.y . ,y - .. v.. moi. � -.... �. ..+. .•
Date.A . 9..e
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .. ... A S .............
has permission to perform ......13. F. P .......................
plumbing in the buildings of ... Px.-F X.n .. "qd.1 e !.Z ........
at .. y...... North Andover, Mass.
Fee. .14t :".Lic. No.-,23/3.,Ks ............................
PLUMBING INSPECTOR
02/27/96 14:46 15.40 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File