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HomeMy WebLinkAboutMiscellaneous - 255 Bridle Path Road'` t �� r- -. ._.. h Date../:.�?/: -<'. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that...... ............. has permission to perform .. . .... ...-' ................ • • .. . plumbing in the buildings of !............. . at. - `'S`�...�.:..?�-�.,. , ... , North Andover, Mass. Fee//%,l..... Lic. No........... .... //✓� Tr / iUMBINGA$PECTOR Check x ��`y� L 5875 MASSACHUSETTS UNIFORM APPLICAT ,N FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS i Date O L Building Location Owners Name Permit #_____95 q � Amount Type of Occupancy ReS New Renovation ©' Replacement 1:1 Plans Submitted Yes D No ❑ FTYTT1uFc (Print or type) /�/�Check one: Certificate Installing Company Name _/ ''! �% p/(f M hi gorp. 11 Partner. rIFirm/Co. 3 Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0- Other type of indemnity 11Bond 11 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 Signature Owner D Agent I hereby certify that all of the details and information I hav ubrni ed (ore re in above application are true and accurate to the best of my knowledge and that all plumbing work and in/e;, tions erf u ermit Iss d fo hi application will be in compliance with all pertinent provisions of the Massa StaP o „ and Chal3e General Laws. By: OVED (OFFICE USE ONLY Type of Plumbing License License ium er Master r-1 I--- Journeyman ❑ ......nmammm...... .. .....MMMMM ---- �. nMnMM------------------m .,�- Nmmnr�mm�nmmmmmmm0��MMMMMMMMMMMMMMMMMM ■� MM 107MMEI®MM mmimmmmmm MMMMMMMMMMMMMMMMMMMM ����� MM 0 F1=9 .. - MMMMMMMMM MMM MM M�� 167-momm M������������������ (Print or type) /�/�Check one: Certificate Installing Company Name _/ ''! �% p/(f M hi gorp. 11 Partner. rIFirm/Co. 3 Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0- Other type of indemnity 11Bond 11 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 Signature Owner D Agent I hereby certify that all of the details and information I hav ubrni ed (ore re in above application are true and accurate to the best of my knowledge and that all plumbing work and in/e;, tions erf u ermit Iss d fo hi application will be in compliance with all pertinent provisions of the Massa StaP o „ and Chal3e General Laws. By: OVED (OFFICE USE ONLY Type of Plumbing License License ium er Master r-1 I--- Journeyman ❑