HomeMy WebLinkAboutMiscellaneous - 58 Kingston Street 58 KINGSTON STREET
210/023.0-0006-0058.S FO 4
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1
Date. .
°�."0FtTM,1° TOWN OF NORTH ANDOVER
° U00
PERMIT FOR PLUMBING
SSACHUSE�
This certifies that . . . . . . . .` !.-. . . . . f. C:' *!i. . . . . . . . . . . . . . . .
n
has permission to perform . . . . J:� Y- :,F�c�✓. . . . . . . . . . . . . . .
w plumbing in the buildings of � . . . . . . . . . . . . . . . .
at.'.g+! . . : . . . -^'!�- ' . . . . . , North Andover, Mass.
Fee,Z !' . M 'LidNo. 9.,z?.' . . ,!f . . . . . . . . . . . . .
PLUMBIN9 INSPECTOR
Check # ( 7
5188
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print for Type) /JJ
—. Mass. Date 26c 2 _ Permit #
Building Location l �1/��`/� Owner's Nam4�( L f li'e!2 'I
Type of Occupancyt- S+ DEN _rt r--)L_
New ❑ Renovation ❑ Replacement M!d 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 'A , t3Ee'7 _� 'S'Pm M14TAe-0 Check one: Certificate
Address 7j r) 00AC H man) �pj ❑ Corporation
IY) E l N U C-N, YO(4 0 d ❑ Partnership
Business � r
Telephone r� �/Co.
p ��L- r9
Name of Licensed Plumber 2n►��;�r f>t SAr�rvlr9 tr4�
INSURANCE COVERAGE:
I have a current I�'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes a No ❑ '
If you have checked ve, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy 1� Other type of indemnity ❑ Bond ❑
rOWNER'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 C3 Agent❑
Signature of Owner or Owner's 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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the oral Laws.
BY
SOAre of Licensed Plumber
Titre
Type of License: Master Joumeymab❑
AF'PRONED OFFIC U ONLY) License Number_ 133 .
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME h TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED `
DATE 19
PLUMBING INSPECTOR