HomeMy WebLinkAboutMiscellaneous - 33 EDMANDS ROAD 4/30/2018N
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that T....� .....n.....-, ...........
has permission to perform.. -z,./ .............. .
plumbing in the buildings of .....................
at .,.R? ...1: _10_,'� 2- r.. !.C. �.,,..... , North Andover, Mass.
vrJ
Fee? ..... Lic. No.. 9� .. ........
PL"GMBL G PECTOR
Check # G Od
5202
MASSACHUSETTS UNIFORM APPLICATION
(Print or Type)
Mass. Date
0
Building
New ❑
FOR PERMIT TO DO PLUMBING
2 _ Permit # e
Owner's Name /1
Type of Occupancy L_
Renovation ❑ Replacement R"" Plans Submitted: Yes ❑ No ❑
FIXTURES"'
Installing Company Name k t'�,Ee-r Q m m A T A e -L) Check one: Certificate
Address 7.101
� 0Ct: �4C hi ma&) <- Pj ❑Corporation
VA lr I: TW 0 i` N. M a 0 t,Fcl/ ❑ Partnership
Business Telephone -:7f Z - il? -7 i' 2-riffn/Co.
Name of Licensed Plumber 1�3 F;P T tq 15A mm tq req eo
INSURANCE COVERAGE:
I have a current1' bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes C3' No ❑ '
If you have checked ve, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy ld Other type of indemnity ❑ Bond ❑
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 ❑ 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 installations nerformed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and qapte?l of the eral Laws.
By vL'7i
j9hMre of Licensed Plumbet
Title
Type of License: Master % Journeymah ❑
City/Town
APPIX NED OFFICE US ONLY) License Number ' 33 1
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SUB—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name k t'�,Ee-r Q m m A T A e -L) Check one: Certificate
Address 7.101
� 0Ct: �4C hi ma&) <- Pj ❑Corporation
VA lr I: TW 0 i` N. M a 0 t,Fcl/ ❑ Partnership
Business Telephone -:7f Z - il? -7 i' 2-riffn/Co.
Name of Licensed Plumber 1�3 F;P T tq 15A mm tq req eo
INSURANCE COVERAGE:
I have a current1' bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes C3' No ❑ '
If you have checked ve, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy ld Other type of indemnity ❑ Bond ❑
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 ❑ 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 installations nerformed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and qapte?l of the eral Laws.
By vL'7i
j9hMre of Licensed Plumbet
Title
Type of License: Master % Journeymah ❑
City/Town
APPIX NED OFFICE US ONLY) License Number ' 33 1
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