HomeMy WebLinkAboutMiscellaneous - 32 CRICKET LANE 4/30/2018 32 CRICKET LANE
210/107.A-0213-0000.0
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ii
T. .
N° 42 `9
40 TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
,SSACNUS�
This certifies that . . . !�—. . . . . . . . . . . . . . .
has permission to perform . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of-.
at3 '. . . . . . . . . . . Noah Andover, Mass.
Fee?: Lic. No.. /.� . . . . . . . . . . .
G4 PLUMBING NS ECTOR
Sze u'
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION R PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS � / Date do
Building Location CaLkL � wners Namdr, W y $ennit#
2-
Amount
Type of Occupancy
New El Renovation Replacement ®/ Plans Submitted Yes No
FIXTURES
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Ln 0
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a
a zrA� a Q E a s
�+ Z F Q fsi W
Cn a H
SIM
WSEM ru'
M FIDOR
FLOOR
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4IH FIIOOR
5M HBM
6IH FLOOR
Mi FLOOR
SIH HOOK
(Print or type) Check one: Certificate
Installing Company Name , Corp.
Address Partner.
Business Telephone Xp IF I a_ 13Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity M 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 El 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 of my knowledge and that all plumbing work and ins llations performed under Prit Issued for this application will be in
compliance with all pertinent provisions of the Massach State Code d Chapter 142 of 14ie General Laws.
By: Signature of Licenseaerr
Type of Plumbing License
Title
Ci /Town
�' icense Num5er Master Journeyman ❑
APPROVED(OFFICE USE ONLY