HomeMy WebLinkAboutMiscellaneous - 417 RALEIGH TAVERN LANE 4/30/2018 417 RALEIGH TAVERN LANE -�
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TOWN OF NORTH ANDOVER
° PERMIT FOR PLUMBING
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SACMUSES Tl /
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . .
*has permission to perform
plumbing inthebuildings of•.' . . . . . . . . . . . . . . . . . . . . .
at . ��!.7. . . � - . �. . . . . . . . . . . .. North Andover, Mass.
Fee,
PL INSPECTOR
Check # R?���
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BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES FEE PROGRESS INSPECTIONS
NO.
APPLICATION FOR PERMIT TO 00 PLUMBING
UNDERGROUND ROUGH
COMPLETE ROUGH
FINAL INSPECTION
PERMIT GRANTED
DATE
PLUMBING INSPECTOR
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 2P
(Print or Two)
Mass. Date 71.1.4 19�� Permit # 2 3 9
Building Location -1'12 AXE V I A� 'i _wner's Name � sync
Type of Occupancy ?�`
• New (gam' Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ ' No O
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ul 4 W W N a c >Cr �
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SUB—$SMT. ( i , I I '
BASEMENT
I ST FLOOR
/� /ice- ��- I I I I I I I I I • I
3Rd FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
87H FLOOR
Installing Company Nam / Check one: Certificate 7
Address y lrorporaticn
❑ Partnership
Business Telephone Fi /Co.
Name of Licensed Plumber or Gas Fitterow
INSURANCE COVERAGE:
I have a current11a5lilty insurance poiicy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes gyp"' No 0 '
If you have checked Yes, piease indicate the type coverage by checking the appropriate box _
A liability insurance policy Other type of indemnity❑ Bond O
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 an of the details and information I have submitted(or entered)in Bove application are true d accurate to the best of my
knawiedge and that all plumbing work and Installations performed under the permi ssued for s applicatlo '19
1 in ante with all
Pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the eneral to
T f Ucense:
Title tuber Psignatute oi Uce&e_d_PFu-m5ercr G
Fater
s
aster Ucense Number 1/46�
City/Tcwn Journeyman
Arf'tiCr/F, r 0 .
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s ,Eo229 Date.7. /s"'`��� . .....
,NORTH TOWN OF NORTH ANDOVER
pF t„ao ,•,�O
0 PERMIT FOR GAS INSTALLATION
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This certifies that . .Gp.tR�.C�e�4 � . . 7 � . . . . . . . . . . . . . . . .
w
has permission for gas installation .�.4 pts.'q f .'e . . . . . . . . .
..
in the buildings of . . I3fgA t./.� . . . . . . . . . . . . . . . . . . . . . . .
' •3
at . .L/./7 . . ,R./4!g i9'-4. .,.4!"1„r ? ., North Andover, Maj`g.
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Fee. . `. . . Lic. No.. `/. ? .; . .
ASINSPECT
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