HomeMy WebLinkAboutMiscellaneous - 32 MILLPOND 4/30/2018 322 MILL
210/095._ A�-0000.0 -�- ---
Date e�o/Z .G.
"ORT
M TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SSACMUSE� tt
This certifies that . . . C l . . . . . . . . . . . . . . . . . . . . . . . .
I
has permission to perform . . . . . . .1.. . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . .
r
at . ..2. ,hhy . . . . . . . . . . . . . . North Andover, Mass.
Fee.3. e Lic. No.,lh . . . . . �. r
PLUMING INSPECTOR
Check # U
s.
7128
i
Inspection of Plumbing
..aate� MASSACHUSETTS UNIFORM APPLICATION..FOR PERMIT TO DO
T PLUMBING
,i
b o�o ve-i' , Mass: Date Per It #
Building oration 3 t ,�O I+I/' G�s� �f Owner's Name. S a��ao
L e M a�jA r t
(y?g) LOS-- 126,3
s j h
Type of Occupancy_ e
New ❑ Renovation O Replacement Plans Submitted: Yes 0 No ❑
i
FIXTURES
O 2 ti ti V1
W X J N
Y J m' N Q Q :d :;- := h N IL V .: W 41C
�. O
sue.-BSMT.,
i
BASEMENT .
iST,FLOOR.
2NQ4LO,ORp.
3R0-FL0.'OR
4TH Ftr.0°OR
STM FLQO,iq
eTH FLOoR.
7THRLOOR
STH.FLOOR
Installing Company Name `
/ Check one: Certificate.
A
ddress
54 � Corperaticn a_ ao
❑..Partner hip
Business Tele ho
ne
p ��..
_❑ Ffrm/Co:
Name of Ucensed Plumber �.or
JSURANCE OVERAGE..
I have a current liability Insurance policy or Its substantial equivalent which.meets the requirements of MGL,Ch. 142. a
Yes No;!~
If you have c ecked y"; please indicate the,type coverage by checking the appropriate box.
A.IlabQft Insurance surance
Y policy Y � Other type.of Indemnity O. Bond O
OWNER'S INSURANCE WAIVER: t 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.thls permit application walves this requirement.
Check One:
nature o Owner or net's.—Agent
Owner Q Agent❑
thereby certify that all of the details and.information t have submitted for entered)in above` cation I e and accur to to the best of my
knowledge and that all plumbing work andAnstallations performed under the permit issue r if ap trnll be i mptiance.with all.
pertinent proviSW 3 of the Massachusetts.State Plumbing Coda and C hapter 1 2 ot.t al to
9y
gnatuit o LicensedPlumber
Title
Ci /Town �— Type,of license Master Journeyman❑
Ucense Number �fJ
f
o&Luw run urrm ust unT
PINA4IwlPEt hO'N IKEETCHU FEE RROQOII ti INs>pRQTtQ.N6
N0. ..._.._ _,
A"MCATION,FOR PERMIT TO 00 PLUMONb'
UNDEROROUND ROUGH
r
COMPLETE OWN:
RENAL INSPECTION
'PEIIMIT GIUNTEO
• DATE •
PLUMBI . INtI ECTOlI,