HomeMy WebLinkAboutMiscellaneous - 31 FOULDS TERRACE 4/30/2018 i
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e
Date
TOWN OF NORTH ANDOVER
0
a r
PERMIT FOR PLUMBING
s � r
s o r
,SSACMUS�
This certifies that . . . . . . . .
has permission to perform . . �. . ' .
plumbing in the buildings of
at ,1 ��' ���c�.�. � �i-'�-' . . , North Andover, Mass.
Fee. � �. .Lic. No..�1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
s PLUMBING INSPECTOR
Check #
t '
6230
MASSACHUSETTS UNIFOR APPLICATION FOR PERMIT TO DO PLUMBIlP
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date
Building Location v�� G` w/ersName/'/0//W'V 110GO'l Pernut#
Amount-�i
Tyre f Occupancy
New Renovation Replacement Plans Submitted Yes No ❑
FIXTURES
ST.SffitV�
RSR%W v
MNJ"
MFl"
4MR"
5MFUM
7MH-CM
s1HHIM
(Print or type) �� Check one: Certificate
Installing Company Name �/wl TCorp.
Address v' /O� l� Partner.
�a
Business Telephone Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate thtype of insurance cove ge by checking the appropriate box:
Liability insurance policy n/ Other type of indemnity D Bond
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 Agent
I hereby certify that all of the details and information I have submitted(or entered)i above application are true and accurate to the
best of my knowledge and that all plumbing work and installatio performed unde ermit Issued for this application will be in
compliance with all pertinent provisions of the Massachusett ' g a er 142 of the General Laws.
By: igna ure oi Mcenseaum
T pe of Plumbing Licens
Title
City/Town License uper Master ni� Journeyman ❑
APPROVED(OFFICE USE ONLY