HomeMy WebLinkAboutMiscellaneous - 585 SHARPNERS POND ROAD 4/30/2018 (3) 7
BUILDING FILE
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N2 94 4 9 Date. . IT-.�`.:.�.Z.
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.1ho TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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_ This certifies that ,. 4�� �. . . � . (—.r? . . . . . . . . . . . .
has_permission to perform . . . !�.�. . . .
plumbing in the buildings of . . .} ��'- ✓; . . . . ul ,. . . .
at. .5.Fs- . Smvp,� -14. ��`'•-�. . ., North An ov r, Mass.
Fee. y,du. .Lic. No../OS.6?.
PLUMBING INSPECTOR
Check # 015,21-)TL
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer ti
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
m CITY �. ��{�_ MA DATE _ld d rh."'11_ PERMIT#
JOBSITE ADDRESS OWNER'S NAME In E 6Aa) f/Y,{r•GGr'/� �
POWNER ADDRESS A/!'I TEL� FAX s
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E RESIDENTIAL
PRINT
CLEARLY NEW[] RENOVATION:Q REPLACEMENT: ;. PLANS SUBMITTED; YES NO.. ; -
FIXTURES-1 „ FLOOR— BSM 1 2 3 4, 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
. ...
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM i
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER .
INSURANCE COVERAGE:
I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[j] NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY] OTHER TYPE OF INDEMNITY Ej BOND
OWNER'S INSURANCE WAIVER: I am aware that the licdnsee does 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.
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER [j AGENT E]
I hereby certify that all of the details and information I have submitted or entered regarding this application are tru and to to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will lin�Cifp i c with II Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Bradford Piesco LICENSE# 10512 SI NATURE
MPED JP[j j p j'/Z CORPORATION Q# 3479-C PARTNERSHIP# LLC[J#
COMPANY NAME Nurotoco of MA d.b.a Roto-Rooter ADDRESS 175 Maple Street
CITY Stoughton j STATE= ZIP 02072 TEL 781-297-7049
FAX 781-341-N36 CELL 774 259-2439 EMAIL Bradford.Piesco rrsc.com
V`�N
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES.-
3 Yes No
1, THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
B ? FEE: $ PERMIT#
PLAN REVIEW NOTES .
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