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OTOWN OF NORTH ANDOVER
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WA wqw-w PERMIT FOR PLUMBING
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This certifies that /. . . . . . . . r
has permission to perform .A.< . <.. . .�. • • • • • • . . . . . . . . • • . . . . • • . • .
plumbing in the buildings of . . . . l t .l�. . /... !. . . . . . . .
. . . . . . . .. North Andover, Mass.
Fee. . ... .Lic. No.. �: . <�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
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MASSACHUSETTS UNIFORM APPLICATION FOWP£ TO DO GASFITTING.
(Print or Type).
l n 1.-)0V�-'I� . Mass. Date 3 - 2Q 0 Permit #
Guiding L`oestioa 5 f(' t�✓ c;09S owner's Name- /l LT7
/C G✓�/�
Type of Occupancy
New p Renovation. p R place* Plans Submitted: Yeap No p
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BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR -
4TH FLOOR
STH FLOOR
0TH FLOOR
TTH FLOOR
0TH FLOOR
Installing Company Name- �Adcl�.rz�� `s �l N.b,nc . Cheek one:: CertiRatef
Address 5u4
�pt ,t _ ❑ Corporation
1604" (VIA . n,'4t<1 p Partnership
Business Telephone -Ss i- a&-q - -Q�'-;t to P Firm/Co.
* Name of Ucensed Plumber or Cu Fltter.. S eL�-ev) -:T / cAA,-,2ta �T e .
414SURANCE COVERAGE.-
f have a cunr6liaNky,inmurance,policy or Its substantial equivalerrt•which-meets the requirements of..MGL-•CtL.142..
Yes pq No ❑
If you have checbsd-IM�::pbsm*xncata&a+ ml*v=W by c xxft g the sppiropdate.box
AIWAIty Insurance-policyX Other-typeflfmindemnity❑. Bond ❑
OWNER'S INSURANCE WAINER:l am-aware that the ficensee.does.not have_ the insurance.coverage required by
Chapter. 142 of the.Mam Generic Laws. and that my signature on this�pernit application waives this requirement
Check one:
Signature of.Owner.or:Owrwrs Agent•, Owner❑ Agent ❑
1 hereby certify that all of the details and information I have submitted(or entered)inabove application aro trand accurate to.the best of my
knowledge and that ail plumbing work and installationsperformed under the permit iue ssued for this will be in
compliance with all
Pertinent provisions of the Massachusetts State Cas Coand Chapter 142 of the General Laws.
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By
Tvoe of License: `
Plumber §gnature-of Licensed Kirfiber or Gas itter
Title IGasfittw
City/Toam
Master License Number Z aCv,
Journeyman
ONLY)
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BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
N0.
APPLICATION FOR PERMIT TO DO OASFITTING
NAME A TYPE OF BUILDING
_LOCATION OF BUILDING
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PLUMBER OR OASFItTER
Lie.No.
GATE 20_
, OAS INSPECTOR r