HomeMy WebLinkAboutMiscellaneous - 62 BLUEBERRY HILL LANE 4/30/2018/ 62 BLUEBERRY HILL LANE
2101098.C-0089-0000.0
I
I
I�
I
I
�.�� . . . . .
Date'. l �
\N° 450
a
TOWN OF NORTH ANDOVER
3jo.,��.0 1tiot
0.
PERMIT FOR PLUMBING
'SSAcmuS� .
This certifies that . . !. . . . . . . . . . .' . : - . . . . . . . . . . . .
has permission to perform . . . . . .' :. . . . . . . . . . . . . . . . . . . . .
plumbing in,the buildings of . ............ ... . . . . . . . . . . . . . . . . . . . . . . .
. . . . .. . . . . . .. North Andover, Mass.
Fee-�' :-' . . .Lie. No.' .'.��'rH. . . , . . . . . . . . . . . . .
CPLUMBING=NTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PE T TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
J '�"`�/ Date
Building Location (R 2 t3 lv ( � -(4,, `/Owners Name Permit#_!�.314�P
If Amount
Type of Occupancy
New Renovation ❑ Replacement ❑ Plans Submitted 4Yes ❑ No ❑
FIXTURES
W
x
F W
Q
A D
S�B;IVIC
BASRWM
1R EUnt
M HIM
ti 3E RM
4M KBM
SIH BDM
6IH RaR
7IH 1FLOCR
SIH ROCK
(Print or type) I r" Check one: Certificate
Installing Company Name V .�1. :l � ] �� 'v'' �d--G ❑ Corp.
Address Sy �� "" ❑ Partner.
Business Telephone p`&'Q $ �� �Firm/Co.
t Name of Licensed Plumber
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat
Liability insurance policy Other type of indemnity ❑ 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
rgnature 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' o performed under Permit Is ued for this application will be in
compliance with all pertinent provisions of the Massdch� P bing a and Ch 1*0 the General Laws.
By: Signature of Mcensouum
Type of Plumbing License
Title 0316
City/Town ri=e Numoer Master ❑'' Journeyman ❑
APPROVED(OFFICE USE ONLY