HomeMy WebLinkAboutMiscellaneous - 520 DALE STREET 4/30/2018 520 DALE STREET
210/064.0-0149-0000.0
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HORTM TOWN OF NORTH ANDOVER
0 p PERMIT FOR PLUMBING
ACHUS�
This certifies that . . . . . . . . . . . . . . . . . .
has permission to perform . . . . . .k/. . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . .L/Le/-,�.�. .I. f: .5=. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee.3 . . . . .Lic. . . . . . . . . —t.. . . . . . . . .
PLUMBING INSPECTOR
Check # )C
54 : 8
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date_ /® 114-;,--
Building Location 51(o 2, Owners Name FtA•r,Ki— ()i -I�C Permit# STS U
Amount
Type of Occupancy
New ❑ Renovation ❑ Replacement ,�/ Plans Submitted Yes ❑ No ❑
FIXTURES
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(Print or type) Check one: Certificate
Installing Company Name Andover P1bg. & Htg. Co. Inc. ❑ Corp. 2122
Address 20 Apgpan nr 11ni t-1 fh ❑ parhier.
Methuen, MA 01844
Business Telephone (978) 685-8383 ❑ Firm/Co.
Name ofLicensedPlumber-. rpnrnp I aPneP
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver. I,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 ❑
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 P mbing Code d C ter 142 of the General Laws.
By igna of EicenseqWunloer
Type of Plumbing License
Title 9983
City/Town icense Numoer Master Joumeyman
APPROVED OFFICE USE ONLY .
Date. �' .`.. .. ..
NORTH
o� TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SACHUSEtt
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This certifies that . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . 0 -t',. . . . . . . . . . . . . . . . . . .
in the buildings of . . . !
at . . j. t.v. . l)/,f.(n . . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee. Lic. . . . .INSPECTOR
Check7# 2�r
41 / 0
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MASSACHUSETTS UNIFORMAPPUCATON FOR PERMPI'TO DO GAS FITTING
(Type or print) Date ��--
NORTH ANDOVER,MASSACHUSETTS
Building Locations �20 :Sk- Permit# Z1170
70
Amount$
Owner's Name �r0-,�K f�
New❑ Renovation Replacement Plans Submitted E f
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SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND . F L O O R
3RD . FLOOR
d 4TH . FLOOR
5TH . FLOOR
1 6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) i Check one: Certificate Installing Company
Name An&uer- P11AMk). S IL,,,►. Co-,Ino— Corp. 2IzZ
Address 10 neAPfAn ( )Y)4 � 10 Partner.
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Business Te ep one t cj-7 'N LN5_c�� Firm/Co.
Name of Licensed Plumber or Gas Fitter ��P�ca 2 Rhe P
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes by No
If you have checked yes,please i dicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 0 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
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 G Code an C)�142 of the General Laws.
_ Signature o icensed Plumber Or Gas Fitter
Title
By Plumber C A
City/Town Wma3tv.j
as Fitter License Number
APPROVED(OFFICE USE ONLY) Journeyman