HomeMy WebLinkAboutMiscellaneous - 51 MOODY STREET 4/30/2018 51 MOODY STREET
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09807
Date . . . .
• �KtCL$�li iQ�d�:a
TOWN OF NORTH ANDOVER
E PERMIT FOR PLUMBING
This certifies that . . .
has permission to perform
plumbing in they buildings of 5�AeA-z . . . . . . . . . . . . . . . . . . . . . .
at . . . . . j . . .r"� . . . . . . . . . .North Andover, Mass.
Fee . . . . Lic. No. . . .6.kafj.C,4. lM . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
Check# �
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY .. _ MA DATE[ _1 2_ PERMIT# /
JOBSITE ADDRESS OWNER'S NAME
POWNER ADDRESS ------------- ---_ --- ---------------� -- TEL qFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL
PRINT
CLEARLY NEW:® RENOVATION: REPLACEMENT:0 PLANS SUBMITTED: YES NO
FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1777
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOILISAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN __J _ —. -__-_-- -._ ._ _-- _ __-- _-- -....-_--- •-__.-..__ __-_. _ -.--- ---------
FOOD
---- _--FOOD DISPOSER
FLOOR IAREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK P„ / __—. — -- -. __ — EE
LAVATORY
ROOF DRAIN
l
SHOWER STALL
SERVICE/MOP SINK _ -_-_._._J _____
TOILET
URINAL
WASHING MACHINE CONNECTION
Je WATER HEATER ALL TYPES
WATER PIPING —
! OTHER r ..
INSURANCE COVERAGE:
I have a current(lability Insurance policy or its substantial equivalent which meats the requirements of MGL Ch.142. YES NO
IF YOU CHECKED YES,PLEASE INDICATE THEE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY[9 OTHER TYPE OF INDEMNITY E] BOND
OWNER'S INSURANCE WAIVER:I am aware that the licensee dge s not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER El AGENT--B--
SIGNATURE
GENT !SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurst to the best of my knowledge
and that all plumbing work and Installations performed under the permit Issued for this application will be In opthpllanpe with a ertinent r 4lslon the
Massachusetts State Plumbing Code and C apter 142 of the General Laws.
PLUMBER'S NAME ... _. _._._.. - LICENSE# / SIGNATURE
MPJP,00" CORPORATION E1# PARTNERSHIP[._ # LLCQ#
COMPANY NAME A_. ..__ ADDRESS - ,c,A 71
-
CITY :STATE L�Lr%( 11 ZIP — �j� TEL
FAX CELLEMAIL
02
a;.
COMMONWEALTH OF MASSACHUSETTS �
P'i UMBER: AND GASFITTER.S
LICENSED AS A JOURNEYMAN PLUM I ;
ISSUES THE ABOVE LICENSE TO: I.
`RA.IMONP... C HECK
`9 BIRCHV?C0D TERR
GR0 'ELAN I MA 01834`-'16 D 7
206`66 05,'11/14 168236 :
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