HomeMy WebLinkAboutMiscellaneous - 34 PLEASANT STREET 4/30/2018Date ..? ::A �7.: U 2
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that.'%1.,!e��!`'. �!.................
has permission to perform .../?1.4 ....................
plumbing in the buildings of ... 6 .' .� ` � , A. `................ .
at .P. !.`<*.:. !" . "?` .......... , North Andover, Mass.
Fee.2 ? ,. -... Lic. No.. *..-$.%
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print
or Type) _
A r D j/ . Mass. Date 0q2 Permit #
Building Location, 'T pinausl/- Cv�T / Owners Name i��a LJ�GC l�/ to C /1 d wey—
), A7((tel f ", �,/` Type of Occupancy, 1R F51 -DC N r 1 I -1 L
G
New ❑ Renovation ❑ Replacement
Plans Submitted: Yes❑ No ❑
Installing Company Name :f C ;A g T A . `Am MA T A �Q Check one: Certificate
Address 30 C o A c H m A. ,v - i - NI . ❑ Corporation
M E T H U E lJ Al A D ❑ Partnership
Business Telephone /,�;, g2 - 17 9 "7 f 9--'Firm/Co.
Name of Licensed Plumber or Gas Fitter -f o lj E P T A • 58 M m ►9 r4 kio --
INSURANCE COVERAGE:
I have a current f bilfty insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes IP No ❑
If you have checked Les. please Indicate the type coverage by checking the appropriate box
A liability insurance policy 0' Other type of Indemnity ❑ Bond O
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 ❑
Signature of Owner or Owner's 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 performed under the Vn
for this application ' be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 onoaws.
By T of Ucense: L�
Plumber cen u _ or atter
Title tt1
lar License Number 8333
City/Tovnm Journeyman
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