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Date. e�!.: .�. . .`. .`.
NORTH TOWN OF NORTH ANDOVER
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PERMIT FOR PLUMBING
SSACH
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This certifies that . . . . . . . . . . . . . . . . . . . . .
has permission to perform . . . . . //r.l. <. . . . . . . . . . . . .
plumbing in the buildings of . . .C.A/ /I,,?c r
at. . . A X.f . . . . . . . . . . . .,' ., North Andover, Mass.
Fee/ Lic. No—/ '!.! ..
PLUMBING INSPECTOR
Check # S
4975
i
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date
Building Location Owners NV=eto4LAnV Permit hE
Amount �
Type of Occupancy I\� �2—�—
New ® Renovation Replacement ri Plans Submitted Yes No
FIXTURES
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(Print or type) Check one: Certificate
Installing Company NameCorp.
Address JL4. Partner.
Business Telephone Cwt -—tip El Firm/Co.
Name of.Licensed Plumber: {V�
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 0 Other type of indemnity ❑ Bond ❑
Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent F
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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By: Signalure of Licenseariul-noer
Type of Plumbing License
Title i
City/TowniceL nse 1Qum ear— Master Journeyman ❑
APPROVED(OFFICE USE ONLY
Date. . . . .. .. . ..`... .....
AF HONT/y
o� 0 TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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�,SS^CNUSEt�
This certifies that .� � /.: . . . !.j.'!. :. . .,�:`�� . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . .
in the buildings of . !. . %:f: . . : . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . .`. . .'. :. f. . . .'. . . . .. . . . . . . . . . . . .. North Andover, Mass.
Fee. .-7.U . . Lic. No..%f . . . . . . :. . . . . . . . . . . . .
GAS INSPECTOR
Check# � 3 `
3771
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date \ O 1
NORTH ANDOVER,MASSACHUSETTS
Building Locations \ Permit# 3221
ki Amount$ 70
Owner's Name ���'
New 19Renovation ❑ Replacement ❑ Plans Submitted ❑
U
04
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oo a 0w F o
SUB-BASEM ENT
BASEMENT
1ST. FLOOR 1
2ND. FLOOR
3RD. FLOOR 1
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
STH. FLOOR
(Print or ) n one: Certificate Installing Company
Name � ta C.l>. `'�vW1�cM.,� + !AR JI-iVS Corp.
Address LA`s `.-x,- -,X ��ti-�- ❑ Partner.
Business Telephone Ot -IT W E] Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑
If you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy m Other type of indemnity ❑ Bond ❑
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 [3
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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By: Signature of Licensed Plumber Or Gas Fitter
Title ® Plumber i\
City/Town ❑ Gas Fitter License Number
❑ Master
APPROVED(OFFICE USE ONLY) Journeyman