HomeMy WebLinkAboutMiscellaneous - 35 Brightwood Avenuea
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-T ACNUS�
Date../z. � . `'
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .... . .......... ...... . ..............
has permission to perform:-.:-: ...!5'.......... .
plumbing in the buildings of . �- .....................
at ._..�.....`'�... , North Andover, Mass.
f
Fee.---,-). Lic. No../ f ......`�. ��t............. .
"PLUMBING INSPECTOR
Check #-
5043
MASSACHUSETTS UNIFORM APPLICATION FOR
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
--ccvG69,0 'wners Name
TO DO PLUMBING
Date6 �
0 Permit #
Amount r.
Type of Occupancy /PLS
New Renovation Replacement ®/ Plans Submitted Yes No
F4'%"T'.#RES
Wells,
-------------------------
(Print or type) \ Check one:
Installing Company Name D4 fl)EL-.5 � L / i' ❑ Corp.
MPartner. ,
1-3 Finn/Co.
Name of Licensed Plumber: q?,?
,?
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy � Other type of indemnity ❑ Bond ❑
Certificate
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 ❑ 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 andinst lations performed under Pe t Issued for this application will be in
compliance with all pertinent provisions of the Massach e s State P g Code C apter 142 of the General Laws.
By: 'Signature o Der
Type of Plumbing License
Title
City/Town ice�nse 11Cru er Master Journeyman ❑
APPROVED (OFFICE USE ONLY
Date. e . . '
TOWN OF NORTH ANDOVER
s PERMIT FOR GAS INSTALLATION
This certifies that ................. ............ ...:........ .
Chas permission for gas installation ........ ........r�I :.... .
in the buildings of ..........................................
at ........ '. �-� :: North Andover, Mass.
Feer........ Lic. Noz/l.'.........
GAS INSPECTOR
Check #
3,-35
MASSACHUSETTS UN'IF'ORM APPLICATON FOR P0R.MIT TO DO GAS FITTING
Y
Type or print)! ate % 1961
NORTH ANDOVER, MASSACHUSETTS
Building Locations J� 3/���r�Tal/o ef'3 /"-//z Permit #
Amount S f
- - Owner's Mame
New ❑ Renovation ❑ Replacement Plans Submitted ❑
(Pant or, pe) _
Check one: Certificate Installing Company
Name— ❑ Corp.
Address � y
Business Telephone ?.2- 2
T°
Name of Licensed Plumber or Gas Fitter T! /
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
Ifru have checked Nes, please Indi to the tvpe coverage by checking the appropriate box.
Liability insurance policy � Other type of indemniry ❑ 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:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
i herebv certifv that all of the details and inion -nation I have submitted (or entered) In above application are true auu L"ULkL« LU tl—
best of my knowledge and that all plumbing work and installations pertormed under Permit Issued for this application will be in
compliance with all pertinent provisions or -the Massachusetts ate Gas Coded Chapter I ' the General Laws.
By:
Title
City/Town
APPROVED IUI:I-Irl: uss ONI.Y)
Signature of License tuber Or Gas Fitter
❑ Plumber / `
❑ Gas Fitter Icense Numoer
Master
❑ Journeyman
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7 11 FLOO It
3T It FLOOR
(Pant or, pe) _
Check one: Certificate Installing Company
Name— ❑ Corp.
Address � y
Business Telephone ?.2- 2
T°
Name of Licensed Plumber or Gas Fitter T! /
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
Ifru have checked Nes, please Indi to the tvpe coverage by checking the appropriate box.
Liability insurance policy � Other type of indemniry ❑ 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:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
i herebv certifv that all of the details and inion -nation I have submitted (or entered) In above application are true auu L"ULkL« LU tl—
best of my knowledge and that all plumbing work and installations pertormed under Permit Issued for this application will be in
compliance with all pertinent provisions or -the Massachusetts ate Gas Coded Chapter I ' the General Laws.
By:
Title
City/Town
APPROVED IUI:I-Irl: uss ONI.Y)
Signature of License tuber Or Gas Fitter
❑ Plumber / `
❑ Gas Fitter Icense Numoer
Master
❑ Journeyman