HomeMy WebLinkAboutMiscellaneous - 42 Kingston Street 42 KINGSTON STREET
210/023.0-0006-0042.R
Date. L, a U
} NpRTM TOWN OF NORTH ANDOVER
o41 PERMIT FOR PLUMBING
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,SSACHUSE� p
This certifies that /� . . . . . . . . . . . .
has permission to perform . . . q x.1,4 r u
. . . . . . . . . . . . . . . .
plumbing in the buildings of . .1J Q . . . . . . . . . . . . . . . . . . . .
at . . . .L�,1 . . �C!H. .s .,�u�. . . . . . . . . . . . . k North Andover, Mass.
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Fee. �. . .:.Lic. No.,� 1. �� . . . . . ....
.-" �LUMBING INSPECT R
Check # � � �
8578
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Mass. Date_
>E� 20 Permit#
.� Building Location 71 Owner's Name
Type of Occupancy
New ❑ Renovation [ Replacement ❑ Plans Submitted Yes ❑ No ❑
FEATURES
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SUB-BSMT.
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BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR.
Installing Company Name / A-1 e r ✓rn Check one: Certificate
Address 27,, fillizrl'lh Corporation
j, ,A- of- ❑ Partnership
Business Telephone c21 9 ❑ Firm/Co.
Name of Licensed Plumber
INSURANCE COVERAGE:
I have a Curren lability 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.
/ i
A liability insurance policy li4lOther type of indemnity ❑ Bond ❑
OWNERS 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 inform ion I have submitted (or entered) in above application are true and accurate to
the best of my knowledge and that all plumbi w rk and installations performed under the permit issued for this application will
be in compliance with all pertinent provision of th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j
I
By igna re OT Licensea
Title Type of License: Master Journeyman ❑
City/Town License Number rb
APPROVED OFFICE USE ONLY)