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HomeMy WebLinkAboutMiscellaneous - 357 Holt RoadDate. �:' ......... No rV7a TOWN OF NORTH ANDOVER o o;..tio p PERMIT FOR PLUMBING This certifies that ......k ...... .. .... :,.,. -..... • • has permission to perform .. '' r `-� ` • ............ • / : y plumbing in the buildings of .. `. �`.{ t �• • ." ``1'? • . • • • . • ��...f / {' 4V. ............... North Andover, Mass.at. ...... Fee . .�`�. .... Lie. No( ... ................ / PLUM61NG INSPECTOR Check # � �� � WHITE: Applicant CANARY: Building Dept. PINK: Treasurer S9') - S MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS p,� Date 11 ^ aq - 00 Building Location 351 T Rom) cm) Owners Name Ou-)M- �:v� Permit # Amount Type of Occupancy �)q2 , o o Sc New Renovation ® Replacement Plans Submitted Yes No 1z FIXTURES (Print or type). /^ Check one: Certificate Installing Company Name T� �%'�� G ® Corp. s o a3 Address 'j ` LJ Partner. . Business Telephone %'7-- (9PG t -700r Firm/Co. Nige ofUcensed Phrmbcr. \0"J 1 rl� R;�T 2 Insrrrance Coverage: Indicatethe type of insurance coverage by checking the appropriate bos~ LiAllity insurance policy m( Other type of indemnity 0 Bond ❑ 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 7 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 ' ons performed under Permit Issuedthis application will be in compliance with all pertinent provisions of the M State Plumb' a oral Laws. 4 i BySignao Type OfLcease Title� S l a City/Town cense Sumoer Master ® Journeyman APPROVED lotticE USE ONLY Date ..i..... ........... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9 This certifies that ..'.�!-..... /- I/ ../.. ! � :...........:.... . has permission for gas installation . :......... `........ ....... . in the buildings of .. .... ............ ................. at ............. ......r ...... �.......... , North Andover, Mass. Fee. !....... Lic. No.. .... s..... ......... ........ .... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSAMUSE7" IS UNUORM APPUCATON FOR PONUTO DO GAS F1=G NOR Hprint)DateDate , MASSACHUSETTS � \\�,,a• :uilding Locations 3.5 1 WoLr f0 Ar Owner's Name 'ew ❑ Renovation ® Replacement ❑ Permit 3 40 Amount S �Q p �uJZ�TNt-Z�2T CEJ � Plans. Submitted ❑ rint or type) Check one: Certificate Installing Company trnc �1�1r1.�6i�s Ee . l ►J C. Corp. o�ba3 (dress S4 1 ►.� Po em 400 11 Ij ❑ Partner. oZ�40 siness Telephone 11 (,��, l—'?Obi ❑ Firm/Co. me of Licensed Plumberor Gas Fitter �CC�v tNs SURANCE COVERAGE Check one: ave a current liability Insurance policy or it's substantial equivalpnt. Yes ®, No ❑ lou have checked Yes. please indicate the type coverage brcheckking the -appropriate boat. tbility insurance policy ❑ Other type of indemnity ❑ gond ❑ rner's Insurance Waiver. I am aware that the licensee does- not have the Insurance coverage required by Chapter 142 of the Lss. General Laws, and that my signature on this permit application waives this requirement. Check one: ' :nature of Owner or Owner's Agent Owner ❑ Aserit ❑ ereby terrify that all of the details and information I have submitted (or entered) in above application are true and accurate to the t of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in npliance with all pertinent provisions of the Massa tate Gas Code�tfd�3tapter I ett=1 Laws. le y,Tuwn 'PROVTED tt)FF]CF USE c)nt_Y) Signatu Vccnsed Plumber Or Gas Fitter Plumber - 10 51 ❑ Gas Fitter License i umoer Master. .., ❑ lourneyrrmn !!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!! rint or type) Check one: Certificate Installing Company trnc �1�1r1.�6i�s Ee . l ►J C. Corp. o�ba3 (dress S4 1 ►.� Po em 400 11 Ij ❑ Partner. oZ�40 siness Telephone 11 (,��, l—'?Obi ❑ Firm/Co. me of Licensed Plumberor Gas Fitter �CC�v tNs SURANCE COVERAGE Check one: ave a current liability Insurance policy or it's substantial equivalpnt. Yes ®, No ❑ lou have checked Yes. please indicate the type coverage brcheckking the -appropriate boat. tbility insurance policy ❑ Other type of indemnity ❑ gond ❑ rner's Insurance Waiver. I am aware that the licensee does- not have the Insurance coverage required by Chapter 142 of the Lss. General Laws, and that my signature on this permit application waives this requirement. Check one: ' :nature of Owner or Owner's Agent Owner ❑ Aserit ❑ ereby terrify that all of the details and information I have submitted (or entered) in above application are true and accurate to the t of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in npliance with all pertinent provisions of the Massa tate Gas Code�tfd�3tapter I ett=1 Laws. le y,Tuwn 'PROVTED tt)FF]CF USE c)nt_Y) Signatu Vccnsed Plumber Or Gas Fitter Plumber - 10 51 ❑ Gas Fitter License i umoer Master. .., ❑ lourneyrrmn