HomeMy WebLinkAboutMiscellaneous - 50 BERKELEY ROAD 4/30/2018 / 50 BERKELEY ROAD
J 210/047.0-0075-0000.0 \`
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type
A , Mass. Date-
19—fL Permit # ro �✓
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AfBuilding Location f� Owner's Nam
Type of Occupancy i S -0 C-.".' ti
New ❑ Renovation ❑ Replacement N? Plans Submitted: Yes ❑ No ❑
FIXTURES
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SUB-BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing.Company Name �20Y3Ee7 Q- SP(r MA'TAei7 Check one: Certificate
Address -- �o ` L Rt 4/ t4k) Pi ❑ Corporation
/r E%N4 U i_-_A)- fO A 0 r fi VL/ .❑�� Partnership
Business Telephone �1�7 Z-i97 1 I-Fimn/Co.
Name of Licensed Plumber 7- fry 15,4 rM ,4 rr4er"'
INSURANCE COVERAGE:
I have a cu ent jability Insuni ce policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes p' No
If you have checked ve, please indicate the type coverage by checking the appropriate box.
A liability insurance is Other f
policy type o 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 C3
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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' gode and C
_�apter/lj of the oral laws.
BY L
re o Licensed Plumber
Title
Type of License: Master % Joumeymah❑
City/Town
APPROVED O 1 NL License Number �3 3 5
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE -
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
s
NAME A TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE __._19
PLUMBING INSPECTOR
Date. .
!` 3665
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SSACMUS� N
This certifies that . . ... .56� i.�z,.,s� a�f�.�t .G. . . . . . . . . . . . . . . . . .
has permission to perform . . .Z)1,. . . . . . . . . . . . . . . . . . . . . . . . . . . .
r;
plumbing in the buildings of . Z o.U.1.'!=. 4. . . . . . . . . . . . . . . .
at. .-57:-�'. 4. . . . . . . . . .. North Andover, Mass.
Fee. Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer