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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
4 i _ •
SSACHUS�
This certifies that
has permission to perform . . . . .PC . . . . . . . . . .
plumbing in the buildings of . . .e"'?.Z7/3. r-"'q l
, North Andover, Mass.
Fee.G. !1. ". . .Lic. No.?.('11. . . . . . . T. . .�
/ PLUMBING INSPECTOR
Check # /6. k/
56305
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
, Date -0
Building Location O's —0/7 Owners Name 9,-> A6F-le O Permit#�f
Amount q,
Type of Occupancy )e es
New Renovation Replacement ® Plans Submitted Yes No
FIXTURES
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(Print'or type) J J Check one: Certificate
Installing Company Name `'� ,:7- D'•U D Corp.
Address I 3 Ha m - 0 Partner.
Business Telephone C%? („ -V,? 6 o!,' l Firrn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ® Other type of indemnity Q Bond p
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
ignature 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 Phnmbin ode and Chapter 142 of the General Laws.
By: ligna o s er
T o umbing License
Title
City/Town icense Num5er Master ® Journeyman Lai
APPROVED(OFFICE USE ONLY
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RETURNED DEPOSITED ITEM NOTICE
Fla' j 8/18/2003 Acct. Number
14102612
Advice Number 95
This advice contains 2 item(s) being returned•toAmount RC R==
your account
14102612 for a total of $1;069.00, plus a service fee of $10.00. $69.00 NSF 0005000178-a''
This list also indicates the diPpoeition of the item(s) and amount $1,000.00 NSF 000500022522
charged to your account. :r. e;'`
TOWN OF NORTH ANDOVER
DEPOSITORY
PO.BOR 124
N ANDOVER MA 01845
Totals: 2 $1,06.9..00!"-
1-410.26.1
1,069.00!<`1410.26.L 2112 ..'aoflfiflnnno
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RETURNED DEPOSITED ITEM NOTICE
Flee]rj 8/18/2003 Acct. Number 14102612
Advice Number 95
This advice contains 2 items) bein returnedatoAWO� Bin moi,-+�"
g your account $69.00
14102612 for a total of $1;069.00,•plus aservice fee of $10.00. NSF 000500017871,5
This list also indicates the disposition of the item(s) and amount $1,000.00 NSF 000500022522
charged to your account.
Tom OF NORTH ANDOVER
DEPOSITORY
PO-BOX 124 _.
N ANDOVER MA 01845
1
Totals: 2 $1,069.00 t:, `
. :,. 1:6'Sl65 6565 • �6 y 2
TOWN OF NORTH ANDOVER
P.O. BOX 124
NORTH ANDOVER, MA 01845-0124
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