HomeMy WebLinkAboutMiscellaneous - 616 CHICKERING ROAD 4/30/2018 616 CHICKERING ROAD
2101084__0-0026-0000.0
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NORTIy
.'4, TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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S SSACMUSEt
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This certifies that . . . . . . . . . . . . . . . .
has permission to perform . .-D.lti . . . . . ./. . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of //�'Ph/. . . . . . . . . . . . . . . . . .
r
at. l ��!c,Lc/ ./.lq.S. . �� j. . h Andover, Mass.
Fee a?vr. . . . .Lic. No..9.3. 3.?. . . . . . . . . . . .
k LUMBING INSP
12/10/98 13:34 20,04
PAID
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WHITE:Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 00r
(Print or Type) -�
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,/V a % fl //�ll , Mass. Date19� Permit #__,�
Building Location / Owner's Nam�� s�Q �e /fir
Type of Occupancy t 5 D r= v t
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New ❑ Renovation ❑ Replacement P/ Plans Submitted: Yes O 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
InstallingCom /�f'1
c
Company Name f�?r3EeT 41, - `>r4mmj4-rA,e7 Check one: Certificate
Address
c H
�r. /Y1r1 n s-Pi 0 Corporation
W E l N o F_ n 1 YY1, y I L/ ❑ Partnership
Business Telephone 'F Z-i97 1 9-A"/Co.
Name of Licensed Plumbed v3 r=�?r h� -,4 CM MDQ rr4►?r``
INSURANCE COVERAGE:
1 have a current Ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes a No ❑ '
It you have checked ves, please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy ld Other type of indemnity ❑ Bond ❑
OWNER'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:
Signature of Owner or Owner's Agent 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 pajormed under the permit issu for this application will be in compliance with all
'
pertinent provisions of the Massachusetts State Plum g e andP
pter of the eral Laws.
By
Title re of Licensed Plumber
City/Town Type of License: Master Journeyman ❑
•
APPROVED OFFICE USE ONLY) License Number Y33 I
a r
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR