HomeMy WebLinkAboutMiscellaneous - 266 GRANVILLE LANE 4/30/2018c') G)
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0 1 toRT" 41, TOWN OF NORTH ANDOVER
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Wj.* W- Al LP PERMIT FOR PLUMBING
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Ihis certifies that .......
s permission io perform ........................
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umbing in the buildings of*
North Andover, Mass.
Fee�$. Lic. No. -';/,"ZS'.
P L U M I:N' G; �I/N S P E C T 0 R
Check it
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS
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NORTH ANDOVER, MASSACHUSETTS
Building Locations
Owner's Name
New F� Renovation r-1 Replacement 0
Date
.� I? & a (�00
PerTn*it A L-& �� /-
Amount S
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Plans Submitted
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Print or type) Check one: Certificate Insialling Company
k-orp.
Name— &Iel' c_ -z:
Li
5 IL r Partner.
Address 16'
J.MA j 61 --R Y,/
Business Telephone e97,6) S.57,7- Firm/Co.
Name of Licensed Plumber or Gas Fitter s- 6R. ---t- / c
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
if vou have checked ves please indicate the type coverage by checking the appropriate box.
Liabilitv insurance policy Othert Bond 0
, M ype of indemnity M
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:
Sianature of Owner or Owner's Agent 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 ofmy knowledge and that all plumbing work and installations performed under Permit issued for this application will be in
compliance with all pertinent provisions of the Massachuse7l-�ate Gas Code ankCha r 142 of the General Laws.
By:
Title
City/Town
APPROVED wi,i--ici-, USE ONLY)
M��nature of Licensed Plumber Or Gas Fitter
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r7 Gas Fitter Lic,--ise i\4urrioe,
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7T 11 FLO OR
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Print or type) Check one: Certificate Insialling Company
k-orp.
Name— &Iel' c_ -z:
Li
5 IL r Partner.
Address 16'
J.MA j 61 --R Y,/
Business Telephone e97,6) S.57,7- Firm/Co.
Name of Licensed Plumber or Gas Fitter s- 6R. ---t- / c
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
if vou have checked ves please indicate the type coverage by checking the appropriate box.
Liabilitv insurance policy Othert Bond 0
, M ype of indemnity M
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:
Sianature of Owner or Owner's Agent 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 ofmy knowledge and that all plumbing work and installations performed under Permit issued for this application will be in
compliance with all pertinent provisions of the Massachuse7l-�ate Gas Code ankCha r 142 of the General Laws.
By:
Title
City/Town
APPROVED wi,i--ici-, USE ONLY)
M��nature of Licensed Plumber Or Gas Fitter
p 11gu mbe, � 1-9 -Lg
r7 Gas Fitter Lic,--ise i\4urrioe,
r7 Nlasie-
PJourneyman
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