HomeMy WebLinkAboutMiscellaneous - 52 BREWSTER STREET 4/30/2018 52BREWSTER STREET
210/023.0-0058-0000.0
i
Date./-.. .
No 4 6 65
NORT►,
:��,��•�;.:;�oo� TOWN OF NORTH ANDOVER
Smoak, PERMIT FOR PLUMBING
�Sswcwusf�
This certifies that L �Y.
�t. . . .),� .(? . . . . . . . . . . . . .
has permission to perform . . . . �.w. . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . . .1. . ., North Andover, Mass.
Fee. )'4)�. �-Iic. No.1 U`.(. �. �. . . . -�.-t �?-,•�. :. . . . .
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
/r6ii�OW,0`f .Mass. Date /.7—17 �y9�'0Permit
Building Location fa c� lAf 51 • Owner's Name -,WAI/J�lf1f 4
Map: Lot: Zone: Type of Occupancy / `r,
New ❑ Renovation ❑ Replacement Plans Subm' ed: Yes❑ No ❑
FIXTURES
Fee:
Z y Z
N Z Y
F tll N N O ZQ W W
J � W
W Y J N �' U Q N 2 O W M
Nz z a; O
N W F' W y H V ¢ N Q y o Z
a Z ~
M N N x Q W N Y Q: 6 Q � Q 3 X
W O > W 4 N Q W y O Q� 0 = C a O OLU
LL
r
V Q x 3 = 1 ¢ LL
Z 2 3 Y y g
O ~ Z Y Q W LL Y W
Q ~ Q Q 2 N N F.
Q 4 O a 4 S ¢ 2 4. O Q H
3 Y J m rn o o J 3 x y LL o o Q 3 m m o
SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name r 4,
` , ,` G • Check one: Certificate
Address eS �rporation
Estimate Value of Work: ❑ Partnership
Business Telephone - - ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE:
I have a current li 'nty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked Les, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy �^ 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:
Owner❑ Agent❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and information I have submitted(or entered)in above application are nd accurate to the best of
my knowledge and that all plumbing work and installations performed under the ued for this on will co pliance with
all pertinent provisions of the Massachusetts State Plumbing Code and pt Ge \
i
B _
Signature
Title
Type of License: Master Jo ney
City/Town g
APPROVED OFFICE USE ONLY License Number
Revised 5/2752
e 1
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE
NO.
a
APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 1g
PLUMBING INSPECTOR