HomeMy WebLinkAboutMiscellaneous - 3 COLBY COURT 4/30/2018G',
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Date. S.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SACKUS
This certifies that Ad -10 . . . . . . . . . .
has permission to perform . . lob. 114�qc. .
plumbing in the buildings of . . X(11Y e,( .....
at .... 7—
North Andover, Mass.
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Fee Lic. No.2. ....... �Q- ........
A * * * *
Check LUMBING INSPECTOR
6974
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMIiING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS Date
Building Lo (,"A ( b N� r
Owners Name- tA6Z ielTe-,,2 /40&jLSPermit# Y
Amount
Type of Occupancy
New At Renovation Lj Replacement ��– Plans Submitted Yes No
FIXTURES
M614010-4-1.,
MWMMWMWMMMMMMWMMMMMMMMMMMM
W-5,151,11 :zMMMWMMMMMWMMMMMMMWMMMNMMM
(Print or type) Check one: Certificate
Installing Company Name Corp.
Address Partner.
Business Telephone'
Name of Licensed Plumber: C -
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ELI -----Other type of indemnity 11 Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the abo e
three insurance
Signature Owner Agent
I hereby certify that all of the details and information I have submitted (or enter4d -p above a]�plication ar;AfD-- and accurate to the
,ue
best of my knowledge and that all plumbing work and installations perfo d Wf Per%it is,, r rs 4cat' n will be in
io
fn Vh �1 ,,_..e General Laws.
r
compliance with all pertinent provisions of the Massachusetts State PI 6. 4 of' S
on
By: 71`gna ure 01 LIM157 =um e r
Type of Plumbing License
Title r_2 (/ � -51 — Master Journeyman
City/Town Icense lNumDer
APPROVED (OFFICE USE ONLY