HomeMy WebLinkAboutMiscellaneous - 39 ALCOTT WAY 4/30/2018Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,ts CHUS
This certifies that t. .........................................
has permission to perform .................
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . .
at. .North'Andover, Mass.
.... .......
. . . . . . . Ute`
9e)
Lic. No ......c,2r-.> ..v... ........
Fee�
PLUMBING INSPECTOR
Check
7599
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
S Date �ay�
Building Location !l(. ,j Owners Name Gn Permit #
% Tvue of Occunancv Amount
New Renovation Replacement Plans Submitted YesNo ❑
(Print or type) __ 11
Installing Company Name G� Ca '1 e__
Address RD, d }'t �1��5� /u if
Check one: Certificate
Corp.
Partner.
Firm/Co.
Name of Licensed Plumber: "�->L e" (90 —�
Insurance Coveraee: Indicate the ty insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond
!�I
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 1:1 Agent E]
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 installati erfon en -nit Issued for this application will be in
compliance with all pertinent provisions of the Ma od er 2 of the General Laws.
By: Signature 01 LiSptoMrwrnber
Title
Type ofD c� mbing License
���
City/Town tcense um eii r Master ❑ Journeyman
APPROVED (OFFICE USE ONLY
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(Print or type) __ 11
Installing Company Name G� Ca '1 e__
Address RD, d }'t �1��5� /u if
Check one: Certificate
Corp.
Partner.
Firm/Co.
Name of Licensed Plumber: "�->L e" (90 —�
Insurance Coveraee: Indicate the ty insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond
!�I
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 1:1 Agent E]
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 installati erfon en -nit Issued for this application will be in
compliance with all pertinent provisions of the Ma od er 2 of the General Laws.
By: Signature 01 LiSptoMrwrnber
Title
Type ofD c� mbing License
���
City/Town tcense um eii r Master ❑ Journeyman
APPROVED (OFFICE USE ONLY