HomeMy WebLinkAboutMiscellaneous - 34 BOXFORD STREET 4/30/2018 (2)Date .7 . %- . .
TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
This certifies that .. Lr-. /. F9!� .� .... ��°�. .............
has permission to perform .... �. ......................... .
plumbing in the buildings of ................
at. �.. f v n c .... North Andover, Mass.
Fee.? A! Lic. No. /.0 3°� .. '..�.�.. ..........
PLUMBING INS R
Check # 3 (((///
5652
�r
1
MASSACHUSETTS UNIFORM APPLICATION OR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS 7 9-03
Date
Building Loc�
ation T G.c � el Owners Name : j I A , �h(/tr/�c/Gr Permit #s'� a" 2
Amount � ;
Type of Occupancy �P� �,L
New Renovation ❑ Replacement Plans Submitted Yes No
FIXTURES
(Print'or type) Check one:
Installing Company Name f ► �.. / iJ --1-� Corp.
LiPartner.
® Firm/Co.
Name of Licensed Plumber c 4A,-
Insurance Coverage: Indicate the type of insuranl5elcoverage by checking the appropriate box:
Liability insurance policy 0 Other type of indemnity El Bond E]
Certificate
Insurance Waiver 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature
I hereby certify that all of the details and infon
best of my knowledge and that all plumbing w
compliance with all pertinent provisions of the
By:
Title
City/Town
APPROVED (OFFICE USE ONLY
have
F1 Agent p
ted (or entered) above appliC
performed u PernAIssuyd;
Type of Plumbing
true and accurate to the
application will be in
General Laws,
cens�O/ 0 e um r Master J--,- ®-