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HomeMy WebLinkAboutMiscellaneous - 38 COTUIT STREET 4/30/2018N J CQ O N W Q Q Oop O O Date HpRTq , TOWN OF NORTH ANDOVER 3? are .. • OL PERMIT FOR PLUMBING This certifies that ... /!.: /'..i. -...t . U:C ................... has permission to perform ... ..". c:: ............. plumbing in the buildings of ... (........ . at ......�..?.....�.... .................. . North Andover, Mass. Fee. Lic. No.. .......� :..:..�.,.-•..... . PLUMBING INSPECTOR Check # ' ' t b MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location 3 q G' 7 4,117 S % Owners Name permit # p T pe of Occupancy Amount /,S / - (=�1i� / � New Er Renovation 1:1 Replacement 1:1 Plans Submitted Yes 1:1 No (Print or type) Check one: Certificate Installing Company Name_ /tw6 v TG- ❑ Corp. Address il'/ /3ifiGM�a/> /�/% %F�/'�Sf3G' 'Pity, El Partner. Business Telephone q 7 _ g s / 4� -4-6 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of Insurance coverage by checking the appropriate box: Liability insurance policy a Other type of indemnity ❑ 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 IOwner 1:1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code d Chapter 142 of the General Laws. By: Igna ure o cense um er ' �� Title Type of Plumbing License / City/Town S -41e 2 Icense um er Master ❑ Journeyman n APPROVED (OFFICE USE ONLY L.�d� /' • .J .4t i ilI -------------------ON -- MMMMMMMMM=NNWMMMW©MMMM MM 11 ©0M -©®0--O--------------- ' 1 11' "MWM"M--0.--.-M---.---.-- .,1 11.' ----------------M-------- --------------------.--.- 11' MMMMMMMMMMMM mmmm MMM-MM- MMWNWMMWWMMMWWMMMMMM----- W.11' 1 11 ' W------------------------ (Print or type) Check one: Certificate Installing Company Name_ /tw6 v TG- ❑ Corp. Address il'/ /3ifiGM�a/> /�/% %F�/'�Sf3G' 'Pity, El Partner. Business Telephone q 7 _ g s / 4� -4-6 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of Insurance coverage by checking the appropriate box: Liability insurance policy a Other type of indemnity ❑ 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 IOwner 1:1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code d Chapter 142 of the General Laws. By: Igna ure o cense um er ' �� Title Type of Plumbing License / City/Town S -41e 2 Icense um er Master ❑ Journeyman n APPROVED (OFFICE USE ONLY L.�d� Date. .`....... . TOWN OF NORTH ANDOVER PE MIT FqA"S INSTALLATION SSACMUSEt1 This certifies that .... ..... . ` ..... / ........... . has permission for gas 14 installation ...�!t. {: t�` °... �`.... • . o in the buildings of ................... at ............ North Andover, Mass. Fee—! P'..°. Lic. No.. i ....... ,......... GAS INSPECTOR Check # / 6 " ((, MASSACHUSETTS UNIFORM APFUCATON FOR PERM TO DO GAS RUING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date l • 3 . r%'Ll Building Locations 3 c% G' G %'v l T S/ Permit #_ S l U Amount .$ `Q!% /-f 4,4,(1,0fQ)IT Owner's Name � ffri; New � Renovation ❑ Replacement 1:1 11 Submitted ❑ (Print or type) C e one: Certificate Installing Company Name Aoy e TTF / 6 r H TG Corp. Address `� / If 'd Ghwoo/] 14e Z'2"e15-PV14y/ Mil ❑ Partner. Business Telephone q 7 9 - V ,.i'/ y(11 So ❑ Firm/Co Name of Licensed Plumber or Gas Fitter Ci_;p17Gr 4f o a 4;1-14 INSURANCE COVERAGE • Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1No❑ If ou have checked yes please indicate the type coverage by checking the appropriate box. y13Liability insurance policy 13Othertype of indemnity 13Bond 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 hereby certify that all of the details and information 1 have subnuttea (or enterea) in above application are true ana accurate to me best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. BY: Title City/Town OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber i S—"o — ❑ Gas Fitter License Numoer Master Journeyman '3RD. F-LOOR (Print or type) C e one: Certificate Installing Company Name Aoy e TTF / 6 r H TG Corp. Address `� / If 'd Ghwoo/] 14e Z'2"e15-PV14y/ Mil ❑ Partner. Business Telephone q 7 9 - V ,.i'/ y(11 So ❑ Firm/Co Name of Licensed Plumber or Gas Fitter Ci_;p17Gr 4f o a 4;1-14 INSURANCE COVERAGE • Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1No❑ If ou have checked yes please indicate the type coverage by checking the appropriate box. y13Liability insurance policy 13Othertype of indemnity 13Bond 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 hereby certify that all of the details and information 1 have subnuttea (or enterea) in above application are true ana accurate to me best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. BY: Title City/Town OVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber i S—"o — ❑ Gas Fitter License Numoer Master Journeyman