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HomeMy WebLinkAboutMiscellaneous - 386 Salem StreetDate..` TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING r� ,SSACNUSE� This certifies that ........ has permission to perform ..!�f��! �*'.� .� ................... . plumbing in the buildings of .. �`�. f. L ...................... J-.7.1 .............. , North Andover, Mass. Fee .3 Lic. No.. . �....... . PLUMBING INSPECTOR Check # � L i 5347 �\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date 3 - t 19 g Permit # i .' Building Location G L %= �1�1 % Owner's Name�)4 New ❑ Renovation ❑ Replacement I FIXTURES -7,7— .I:FS u o L S- i-1 of OScupancy._ IF L Plans Submitted: Yes ❑ No ❑ i • Y • • • • Installing Company Name #oA%17Pf, T heLi-= r Check one:. Certificate Address �� i ❑ Corporation 19/.)PC V1rA 1114.. S G l �l C-OPartnership L .Business Telephone y 3V-2 41— ❑ Frm/Co. Name of Licensed Plumber ��o ` l�G� �'' ` �f e- !-F�i1�� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes IX No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box A liability Insurance policy )Ef Other type of Indemnity ❑ 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: Owner ❑ Agent ❑ Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code�Chapter 142 of the General Laws. By �' i'✓ Signature of tensed Plumber Title Type of License: Master Journeyman ❑ City/Town APPROVED (OFFICE USE ONLY) License Number Date. .14--..t .(� :. .L... . o� TOWN OF NORTH ANDOVER ti P ;� PERMIT FOR GAS INSTALLATION This certifies that ...//. !'. /..e� .'� .f .K�......... has permission for gas installation .. �A't4.................... in the, buildings of .... V.,!t % .s. `............................ at . ? . /......` ........................ , North Andover, Mass. Fee. .'....... Lic. No...`. 3. .... ....... GA INSPECTOR Check # 4111 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) U i�P jk- 20 Permit M �� �% —,Mass. Date Building Location 5 P i -1C1-; S %' owners Name 9"C, Ai L,�� -, L'A41^ s � Type of Occupancy New Renovation ❑ Replacements i Plans -S bu mitted: Yes ❑ No ❑ Installing Company Name jj0rr MqN 4 k r:— ,u—,i—Address. -' T 1 c-7!9 2 / Z.%Z. D t-9tuoG L'�Gl-, )IP SS GiF/v Business Telephone � 1 f `f S' Ye Z `ior' Name of licensed Plumber or Gas Fitter tt n`d( C -- INSURANCE - Check one: Certificate ❑ Corporation Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent; which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy ,K Other type of indemnity ❑ Bond ❑ OWNER'S INS URNACE 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 is permit application waives this requirement Signature o wner or Owners Agent Check one: 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 installations performed under the 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. Type of License: By ,dumber Titic ❑ Casfitter City/Town 1�(*aster APPROVED (OFFICE USE ONLY) ❑ Journeyman S gnature of Licensed PlumbLar or Cas F Iter License Number '�' 34f- 3 s s � F411.1-1 MMMMMMMMMMMMM MM � mmmmmm MMMMMMMMMMMMMMMMMM Installing Company Name jj0rr MqN 4 k r:— ,u—,i—Address. -' T 1 c-7!9 2 / Z.%Z. D t-9tuoG L'�Gl-, )IP SS GiF/v Business Telephone � 1 f `f S' Ye Z `ior' Name of licensed Plumber or Gas Fitter tt n`d( C -- INSURANCE - Check one: Certificate ❑ Corporation Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent; which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy ,K Other type of indemnity ❑ Bond ❑ OWNER'S INS URNACE 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 is permit application waives this requirement Signature o wner or Owners Agent Check one: 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 installations performed under the 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. Type of License: By ,dumber Titic ❑ Casfitter City/Town 1�(*aster APPROVED (OFFICE USE ONLY) ❑ Journeyman S gnature of Licensed PlumbLar or Cas F Iter License Number '�' 34f- 3