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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
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Mass. Date 19j3— Permit #
Building Location
Owner's Nam T-1
I -Lij—P & F e V)4 e�L & 67
Type of Occupancy -e_ S—
ri
New o Renovation I I Fleplacenipill X1 Plans Submitted: Yes 1-1, No X
FIXTURES
Installing Company Name 4) Check one: Certl . ficate
ej R Corporation
Address F1 Part I nership
r 1-1 FirmlCo.
Business Te!ephone SOT - 37-.
--?M— — 1 6
Name of Licensed Plumber ( ift��
INSURANCE COVERAGE:
I have a curronVtablllty Policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 0
If you have checked yes, please Indl te the type coverage by checking the appropriate box.
A liability Insurance policy :7 Other type of Indemnity 0 Bond 0
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 of Owner or owner's Agent Owner I-] Agent 0
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 parlor mod under the permit Issuedfor this application will
be In compliance with all pertinent provisions of the Massach its State Plumbin Code a�ndCh,
'umo
Chapter 142 of the General Laws.
Title Signature of Licens d lumber
CltyfTown Type of License: Master K Journeymen f7
APPMVED IOFFIC:--USE �ONLY) Llcense Number
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Installing Company Name 4) Check one: Certl . ficate
ej R Corporation
Address F1 Part I nership
r 1-1 FirmlCo.
Business Te!ephone SOT - 37-.
--?M— — 1 6
Name of Licensed Plumber ( ift��
INSURANCE COVERAGE:
I have a curronVtablllty Policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 0
If you have checked yes, please Indl te the type coverage by checking the appropriate box.
A liability Insurance policy :7 Other type of Indemnity 0 Bond 0
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 of Owner or owner's Agent Owner I-] Agent 0
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 parlor mod under the permit Issuedfor this application will
be In compliance with all pertinent provisions of the Massach its State Plumbin Code a�ndCh,
'umo
Chapter 142 of the General Laws.
Title Signature of Licens d lumber
CltyfTown Type of License: Master K Journeymen f7
APPMVED IOFFIC:--USE �ONLY) Llcense Number
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Installing Company Name 4) Check one: Certl . ficate
ej R Corporation
Address F1 Part I nership
r 1-1 FirmlCo.
Business Te!ephone SOT - 37-.
--?M— — 1 6
Name of Licensed Plumber ( ift��
INSURANCE COVERAGE:
I have a curronVtablllty Policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 0
If you have checked yes, please Indl te the type coverage by checking the appropriate box.
A liability Insurance policy :7 Other type of Indemnity 0 Bond 0
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 of Owner or owner's Agent Owner I-] Agent 0
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 parlor mod under the permit Issuedfor this application will
be In compliance with all pertinent provisions of the Massach its State Plumbin Code a�ndCh,
'umo
Chapter 142 of the General Laws.
Title Signature of Licens d lumber
CltyfTown Type of License: Master K Journeymen f7
APPMVED IOFFIC:--USE �ONLY) Llcense Number
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Date. .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... ............
has permission to perform
plumbing in the buildings of ....... ..........
at . . . ;. �'� �. � .'J I ..... North Andover, Mass.
Fee Lic. No.
.. ...............
PLUMBING INSPECTOR
1112Ae?41 12.50 PAID
WHITE: Applicant CANARY: BLilding Dept. PINK: Treasurer
MIN
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C S C121,298 - Cu 5/1' 1" Q q 3 'G - 1 & Fai�'Y homes
To:
Pai'UrE to Possesss a current edition of
Code
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S H is cause for revocation of tLs license.
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HOME IMPROVEM
ENT CONTRACTOR,
Registrat'
Ion 102097
Type - JNDJVIDUAL:-�
Expiration
A.
JOSEPH P BRADISH
ZAP"
Moulton Drive/ 'Box 448
ADMINISTRATOR E. Haimpstea 1 038-
MASSACHUSETTSUNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) Mass. Date'
Building
Location Permit #
Owner's
-7-
5r, Name 614kke- m
New 0 Renovation 0
Installing Company Name
ReplacementA Plans Submitted: Yes 13. No R
top S F(�f 14, 017 r�
I
Business Telephone
Name of Ucensed Pli
NO
Check one:
0 Corp.
0 Partnership
0 Firm/Co.
INSURANCE COVERAGE- Check One
I have a current liability insurance policy or its substantial equivalent Yes)& No 0
if you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy J6 Other type of indemnity 0 Bond 0
Certificate
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:
Owner [3 Agent 13
Signature of Owner or Ownees Agent
I hereby certify that all of the details and Information I have submitted (or entered) In above application are trueAnd 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 compliancooth all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General La
,2
City/Town
APPROVED (OFFICE USE ONLY)
'J
Type of Ucense:
RL Plumber Signature of Ucensed Pluffiber
0 Gasfifter Ucense Number
Master
,0 Journeyman
MEN
WINMR-1;
top S F(�f 14, 017 r�
I
Business Telephone
Name of Ucensed Pli
NO
Check one:
0 Corp.
0 Partnership
0 Firm/Co.
INSURANCE COVERAGE- Check One
I have a current liability insurance policy or its substantial equivalent Yes)& No 0
if you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy J6 Other type of indemnity 0 Bond 0
Certificate
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:
Owner [3 Agent 13
Signature of Owner or Ownees Agent
I hereby certify that all of the details and Information I have submitted (or entered) In above application are trueAnd 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 compliancooth all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General La
,2
City/Town
APPROVED (OFFICE USE ONLY)
'J
Type of Ucense:
RL Plumber Signature of Ucensed Pluffiber
0 Gasfifter Ucense Number
Master
,0 Journeyman
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Date... ............
tAORTH TOWN OF NORTH ANDOVER
0 PERMIT FOR GAS INSTALLATION
This certifies that ................
has permission for gas installation . .......................
in the buildings of . ..........................
at ..........
.......... I North Andover, Mass,
Fee. "1.2. &eLic. No../(r--C/ .
I., ......................
p63AS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File