HomeMy WebLinkAboutMiscellaneous - 40 MILK STREET 4/30/2018 (3) 40 MILK STREET
210/096.040043-0000.0
Date. .Z: . .': .
HORT� TOWN OF NORTH ANDOVER
01
- PERMIT FOR PLUMBING
40
SSACMUS�
� J
t,
This certifies that . . . . . . . . . . . . . .
has permission to perform . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . .
at . . . . . -.<?!. =.`. . . . . . . . . . . . . North Andover, Mass.
Fee--l�—,. . . . .Lic. No. . . . . . . . . . . ... -a.- . . . . . . . . . . . . .
PLUMBING INSPECTOR
Check # �� /
MASSACHUSETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING
(Print or Type /
'�
Mass. Date G 20S-1— permit # L
Building catio
Owner's am
t
Type of Occupancy
New 0 Renovation 0 Replacement 6e,
Pians Submitted: Yes 0 No p
FIXTURES
B.P. # °SEWER# SEPTIC #"
z
i— Z Y
Y Q � �' .� to j O W w
O
,Z� (n Z C/) W Of
UO t1J N _ {n (n LL Z Z a
U U W Z m '!Y W ?- Q i- 0 Z (7 � 3:
U 3: S ca Z z Q.0 O z z w LL Y ? LLi
Q on =O .N-� Q O Q JO -j Q '� Q O U o z
�S Y
on cn 0 = cn u- C7 D Q � m O
SUB-BSMT
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
RFLOOR
FLOOR
FLOOR
nstalling Company Name 11
Check ong: Certificate
4ddress
o Corporation
3usiness Telephone rp O v ` r ❑ Partnership
flame of Licensed Plumber or Gas Fitter v<rm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes ��. No .0
If yoil have checked Yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy P--' Other type of indemnity 0 Bond 0
OWNER'S INSURNACE 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.
Signature of Owner or Owner's Agent Check one:
Owner 0 Agent ❑
-iereby certify that all of the details and information I have submittedentered)in above-appiication are true and accurate to the best of
y knowledge and that all plumbing work and installations performe nd r the permit iss for this application will be in compliance with
I pertinent provisions of the Massachusetts State Plumbing Code a t 142 of the eras Laws.
By
Title
Si na ure of Licen ed lumber
Ciry/Town ��
APPROVED(OFFICE USE ONLY) Type of License: Waster ❑Journeyman
License Number__
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) t
NORTH ANDOVER Mass. Date a d
kuilding Location �/i��,/,� C f Permit # 2. 2_
Owners Name
New -7 Renovation Replacement p Plans Submitted
FIXTURES
a
W (A
N o9 U x
cc
ut
a of p t) td r S tN
I. 4 O l-
x kff - w w a cc
w w 0 yo^� a a w 4 r
rh rr w z W x to w cc Q a �' °t
O N Z j H Z t.. N W d > U- h V
z Q W G CC r }• tQ W
a ,ra > to W = z < x a d o o W '� o w IZ-
B�T t= x O 0 1' LL � � Q t9 «s t) W � ct a t- 0
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
TTH FLOOR
STH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name l6 Corp.
Address�1�� So /Z�,� i Partner.
`,> Firm/Co.
Business Telephone: ZI - --71 r,6
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnityF-1 Bond El
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 coverages.
Signature of owner/agent of property Owner u Agent
i hereby certify that all of the details and information 1 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 tho Massachusetts State Gas Code and Chapter 142 of tho General Laws.
By - TYPE LICENSE:
Plumber
Title Gasfitter- Sig Lure of Licensed
City/Town: Master P1t2l}ber or Gasfitter
Journeyman
APPROVED (OFFICE USE ONLY) Llcens;eNumber
_ Date. . . .. . . . .. . .. .. . .. . ..
IVSD PAYMENT
Of p10RTM "TOWN OF NORTH ANDOVER
cc)PERMIT FOR GAS INSTALLATION
} ^�4
SAC� ��MUS #ver Collector
9
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee. . . .. . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File
