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This certifies that
Date. L./. 1.� .�v z.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
has permission to perform -... ff � 7 ...........................
plumbing in the buildings of..�.%sf'? :~ S.l��.% `.................
at.. �.A).?...t``'C' .1 •�`. `• • • • • • • • • • •, North Andover, Mass.
Fee.). !:.:.. Lic. No.. .. .............
PLUMBING INSPECTOR
Check #
5221
0
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO" PLUMBING
—\ (Print or Tyoe) do 9
-�('R1ass. Date �r Permit # .S~G..2
P / /
Building Location � J 7 &)aad/ 6/I _Owner's Namb.�/ /Aerf SpdsX h
Type of Occupancy Residential
New [J Renovation LJ Replacement 4 Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage Htg . &P.1g . Co. Inc.
Address 35 Pleasant Street
Stoneham, Ma 02180
Business Telephone781 3 8- 7 7 7-6 _-
Name of Licensed Plumber Gordon Switzer
Check one: Certificate
[X Corporation 714
l -J Partnership
I-) Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No t_l
It you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy LX Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVEft: 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 ❑
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 Plumbin_(Co�de and Chapt 142 4f the General Laws.
By _--------OA
ignatwe- of Lice
Title
Type of License: Master IX Journeyman ❑
City/Town 8322
APPROVED(OFTCE l3SE ONLY) License Nurnber___.___„__.___
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BASEMENT
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8TH FLOOR
Installing Company Name Heritage Htg . &P.1g . Co. Inc.
Address 35 Pleasant Street
Stoneham, Ma 02180
Business Telephone781 3 8- 7 7 7-6 _-
Name of Licensed Plumber Gordon Switzer
Check one: Certificate
[X Corporation 714
l -J Partnership
I-) Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No t_l
It you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy LX Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVEft: 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 ❑
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 Plumbin_(Co�de and Chapt 142 4f the General Laws.
By _--------OA
ignatwe- of Lice
Title
Type of License: Master IX Journeyman ❑
City/Town 8322
APPROVED(OFTCE l3SE ONLY) License Nurnber___.___„__.___
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