HomeMy WebLinkAboutMiscellaneous - 60 WAVERLY ROAD 4/30/2018 (2)N
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT T4 DO GASFITTINiv
(Print or Type)
NORTH ANDOVER Mass. Date
!wilding Location —� Permit # �J
Owners Name
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• New -w' Renovation Replacement Plans Submitted =j
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(Print or Type)
Installing Company N
Address
Business Telephone:
"lame of Licensed Plumber
Insurance Coverage:
appropriate box:
Liability insurance policy
PM
Check one: Certificate
Corp.
Partner.
Firm/Co.
Indicate the type of insurance coverage by checking the
1-1
Other type of indemnity Q 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 coverages.
Signature of owner/agent of property Owner 17 Agent
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my
knowledge and tint all plumbing work and Installations performed under permit itsued for this application -be In compliance with all peltinent
provisions of tho Massachusetts State Cas Code and Qapter 142 of the General L►ws.
TYPE LICENSE:
Plumber
Gasfitter- Signature of Licensed
Master Plumber or Gia atter
Journeyman
License Number
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(Print or Type)
Installing Company N
Address
Business Telephone:
"lame of Licensed Plumber
Insurance Coverage:
appropriate box:
Liability insurance policy
PM
Check one: Certificate
Corp.
Partner.
Firm/Co.
Indicate the type of insurance coverage by checking the
1-1
Other type of indemnity Q 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 coverages.
Signature of owner/agent of property Owner 17 Agent
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my
knowledge and tint all plumbing work and Installations performed under permit itsued for this application -be In compliance with all peltinent
provisions of tho Massachusetts State Cas Code and Qapter 142 of the General L►ws.
TYPE LICENSE:
Plumber
Gasfitter- Signature of Licensed
Master Plumber or Gia atter
Journeyman
License Number
Ir- To
2535
Date ......... I .......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATIONR
This certifies that ... .. ... ...
has permission for gas i allation ......
t.ion.
in the buildings of .
at ... � 0. . V114'4Z 4 ..... . North Andover, Mass,
FeeRs�'—, Lic. N 1'10P ..........................
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
I
j"Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
Building Inspector
Div. Public Works
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MORDENeft
CLAIM smvICB, INC
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec. 3B
TO: Building Commissioner or
Inspector of Buildings
Board of Health or
Board of Selectmen
Town Hall ) or ( Town Hall
(
North Andover MA ) ( North Andover MA
RE: Insur--d: Ka'tnieen F. Henry
Property address: 60 Waverly Road
North Andover MA
Policy No. FP0129125
Loss of 2/20/93
File or Claim No. LW16786
Claim has been made involving or destruction of the above captioned
property, which may either exceed $1,000.00 or cause Mass. Gen. Chapter
143, Section 153, Section 6 to be applicable. If any notice under Mass.
Gen. Laws, Ch. 139 Sec. 3B. is appropriate please direct it to the
attention of the writer and include a reference to the captioned insured,
location, policy number, date of loss and claim or file number.
deductible.
Insurance Ad-iuster
Title
On this date, caused copies of this notice to be sent to the persons
named above at the address indicated above first class mail.
3/12/93
Signalture and date
65 MERRIMACK STREET, LAWRENCE, MASSACHUSETTS 01843
FAX N0: 508-687-7246.
(508) 686 - 4163
A Member of the Morden and HeWg Group `