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HomeMy WebLinkAboutMiscellaneous - 35 Mathews LaneMM m 3446 �..�}� "Y„� � u fir' Ji ,{y, -v�..�• .��^.'/-- ,,,., � ' �„� Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .(�- %�F. l!! f /k�Y... !..off. ............... has permission to perform .. Al. r-.yt.. A/o ............... plumbing in the buildings of .. , /tt !:� ................ at ..�tr�,�%?..f,� ................ North Andover, Mass. Fee . ,t :` (., .... Lic. No..10). Y f. .............................. PLUMBING INSPECTOR 03/17/48 14:21 180.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS. UNOORM APPLICATION FOR PERMIT TO DO PLUMBING (t. (Print or Tyk) . �AY6V Mass. Date I y 191. Permit #G Building Location Owner's Name Type of Occupancy New( Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES InsUdling Compan Name LL'64 W6 Address (( &)c .')t Bui r.,s:s Telephone Nar 1,, r Licensed Plumber �4 Check one: Certificate corporation i Q � ❑ Partnership ❑ -- IN 'Li 11 COVERAGE: I hIV! Vlrenty tity insurance policy or its substantial equivalent whKh m," the requirements of MGL Ch. 142. i of No 0 If ti-ou ' .. -eked yes, please i icate the type coverage by cheat klnR ppr the anpreate hox. A liability Insurance policy If Other type of indemnity ❑ Ntnd f OWNER'S INSURANCE WAIVER: I am aware that the licensee does not haw* ow ,mm•utance coverage required by Chapter 142 .A Ih- M-4 General laws, and that my signature on this permit application waive+ thl'. re'qulrwr+eoi Check cxw• Owner CJ AWt 5i ;nature of Owner ci'Owner's Agent I iw r, emote ohm all nt"Mads and tntormalron 1 have subrmtled ln,= entered) In aMwe • auan r,► and sr the MnY[hLwri Sate Vlu Eonit� � Wool � Pod Ow 40 �' a a- nd ane! —1,1llai,om ved.011 wale+ the permit mquld for this &WIC111 .rill bt m t once Mau LNe Ivor of licetw' Maw" n io%' Mar L,ct*se Numbrt .IwROV(D 1OFFICt USE oNLn ■■■■■■■■■■■■■■■■■■■■■■■■■ FLOORKMM ■1■'��■■■■■■■■■■■■■■■■■■■■■ InsUdling Compan Name LL'64 W6 Address (( &)c .')t Bui r.,s:s Telephone Nar 1,, r Licensed Plumber �4 Check one: Certificate corporation i Q � ❑ Partnership ❑ -- IN 'Li 11 COVERAGE: I hIV! Vlrenty tity insurance policy or its substantial equivalent whKh m," the requirements of MGL Ch. 142. i of No 0 If ti-ou ' .. -eked yes, please i icate the type coverage by cheat klnR ppr the anpreate hox. A liability Insurance policy If Other type of indemnity ❑ Ntnd f OWNER'S INSURANCE WAIVER: I am aware that the licensee does not haw* ow ,mm•utance coverage required by Chapter 142 .A Ih- M-4 General laws, and that my signature on this permit application waive+ thl'. re'qulrwr+eoi Check cxw• Owner CJ AWt 5i ;nature of Owner ci'Owner's Agent I iw r, emote ohm all nt"Mads and tntormalron 1 have subrmtled ln,= entered) In aMwe • auan r,► and sr the MnY[hLwri Sate Vlu Eonit� � Wool � Pod Ow 40 �' a a- nd ane! —1,1llai,om ved.011 wale+ the permit mquld for this &WIC111 .rill bt m t once Mau LNe Ivor of licetw' Maw" n io%' Mar L,ct*se Numbrt .IwROV(D 1OFFICt USE oNLn