HomeMy WebLinkAboutMiscellaneous - 38 MOUNT VERNON STREET 4/30/2018NW
00
o m
o
z
g�
m
m
z
Z
m
m,
41
3
Date ell
TOWN OF NORTH ANDOVER
1 PERMIT FOR PLUMBING
This certifies that ... FR. Ix.t. .....4 .....................
has permission to perform ..... A116 ... ...............
plumbing in the buildings of ... 11 �.4j.o .....................
at. ........ North Andover, Mass.
Fee.,.). ...Lic. No../).(/'4 . ....... ...... ... ........
uMBING INSPECTOR
Check .7? 2 ? S
7079
�O
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location m� y�e-►P'l Owners Name)2
of
New 11 Renovation 1:1 Replacement
RTYTTTD VC
Date 0 b
Cam Permit #_2 %f
,� �) Amount �� L
,1)q A TTA):°v�_
Plans Submitted Yes ❑ No
(Print or type) -,� Check one: Certificate
Installing Company Nam (e -,c ig, pt),n' 9Ji�
� d� ❑Corp.
Address_I4� 1 ridgy
c►✓T iI 16Ig'' Q 10artner.
Business i erepnone _ U
.
U
F)rm/Co.
:Name of Licensed Plumber: Mqr�— 0, (ate
Insurance Coverage: Indicate tfLe type of insurance coverage by checking the appropriate box:
Liability insurance policy El 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 Owner Agent ❑
I hereby certify that all of the details and information 1 have submitted (or entered) in above :application :ire true and accurate to the
};cst of my knowledge find that rdl plumbing work and installations perf,.)rmed under Permit Issued IiJr this ;application will he in
compliance with all pertinent provisions of the Maqachtasctfs St;it)Pl r ing &de and Chanter 1.h of th � e'en -al I
13 y:
Title
City,Town
APPROVED (OFECF USE ONLY
�'ype '`f Plumbing License
icense i um er Master
Joumeyman
....................'
=1129100-1 '
mmmWNm�
��Mm
Wj1:10i1I-6;A
WN
MMM
UMN
(Print or type) -,� Check one: Certificate
Installing Company Nam (e -,c ig, pt),n' 9Ji�
� d� ❑Corp.
Address_I4� 1 ridgy
c►✓T iI 16Ig'' Q 10artner.
Business i erepnone _ U
.
U
F)rm/Co.
:Name of Licensed Plumber: Mqr�— 0, (ate
Insurance Coverage: Indicate tfLe type of insurance coverage by checking the appropriate box:
Liability insurance policy El 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 Owner Agent ❑
I hereby certify that all of the details and information 1 have submitted (or entered) in above :application :ire true and accurate to the
};cst of my knowledge find that rdl plumbing work and installations perf,.)rmed under Permit Issued IiJr this ;application will he in
compliance with all pertinent provisions of the Maqachtasctfs St;it)Pl r ing &de and Chanter 1.h of th � e'en -al I
13 y:
Title
City,Town
APPROVED (OFECF USE ONLY
�'ype '`f Plumbing License
icense i um er Master
Joumeyman