HomeMy WebLinkAboutMiscellaneous - 28 WAVERLY ROAD 4/30/2018 (2)C0
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,SS.�ICMUSi
Date ./:!�?
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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This certifies that .`s ... �� ��-� -- .� ` ................... .
has permission to perform ..r�'�..11 ..................
plumbing in the buildings of ............
at . '� . �? ..1.- 1� -.../. :. .... , NorthAihid—p-ver, Mass.
Fee .. Lie. No...?' . ??3. �..f fir!.-•
...
/ PLUMBING INSP R
Check # ��� V
IVopSSACHUS.ie*r,'TS UNIFORM APPL ICA t 1CN. ,' F ,Mi �' TO UO �-WK1 sING
(P'rint or Type
Mass. Date _ n
:�2L'01 Permit #
Building Location I Owner's Nam�U�
TyperofOccupancy_ �t 5 + D E '�J' it F1 r _
I_■
New ❑ Renovation ❑ Replacement P"" Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name_/'AOt3Ee7 ¢1m,-yIATAe-0 Check one: Certificate
Address '� o f^o �q(hi mt4n) ❑ Corporation
Ml E l N40 Fn) M r� (� �,��I� J C]Partnership
Business Telephone /• �_ _ 1-/ c7 7 1 �rm/Co
Name of Licensed Plumber 2'
L r3 _r !Yf SA rna�i'1 �q rrCJl�r"`
INSURANCE COVERAGE:
I have a current I' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ( No ❑ 10
If you have checked yes, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy fid" 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:
Sianatura of rkwmar nr —'. A,,,,... Owner ❑ Agent ❑
I nereby 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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
Title
re of Licensed PluMer
Qbtfrown Type of License: Master % Journeyman ❑
APPROVED 0 FIC US ONL License Number--YL-5—
Y
•
•
•
MENNEN��l��■
IMMEMEMEMEME
MENNEN
No
ON
MEMNON
..
NONE
MEMNON
INS
0nMEN
0
MEN
Installing Company Name_/'AOt3Ee7 ¢1m,-yIATAe-0 Check one: Certificate
Address '� o f^o �q(hi mt4n) ❑ Corporation
Ml E l N40 Fn) M r� (� �,��I� J C]Partnership
Business Telephone /• �_ _ 1-/ c7 7 1 �rm/Co
Name of Licensed Plumber 2'
L r3 _r !Yf SA rna�i'1 �q rrCJl�r"`
INSURANCE COVERAGE:
I have a current I' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ( No ❑ 10
If you have checked yes, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy fid" 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:
Sianatura of rkwmar nr —'. A,,,,... Owner ❑ Agent ❑
I nereby 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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
Title
re of Licensed PluMer
Qbtfrown Type of License: Master % Journeyman ❑
APPROVED 0 FIC US ONL License Number--YL-5—
D
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No. 6 Date Z/?-?
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
• ; ' Building/Frame Permit Fee $
Foundation Permit Fee $
� stcaus <
Other Permit Fee $ /0,0-0
Sewer Connection Fee $
� 4 J�LUAM ,ction Fee $
TOTAL a
FEB 2P
/®. Andover Building Inspector
500• "�r
Div. Public Works
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