HomeMy WebLinkAboutMiscellaneous - 62 Matthews Lane �f;�
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Date. .
1 34.43, ,
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Of �� TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
,SSAGMUS�
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This certifies that . .C ".i?��/. Fl�''• • • �•��
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� has permission to perform . . . . . . . .e. . . . . . . . . . . . .
plumbing in the buildings of . . . ./. . . . . . . . . . . . . . . . . . . .
at. . . . • . . . . • • • . . , North Andover, Mass.
/Fee� Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
03/17/98 14:23 200.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFARM APPLICATION FOR PERMIT TO DO PLUMBING
Ir" (Print or Type)'
041cl! Mass. Date 19 1p 7 Permit # �y3
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Building Location - Owner's Namene
?I M4719e,&A Type of Occupancy Sf.
Newly Renovation 0 Replacement 0 Plans Submitted: Yes 0 No O
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FIXTURES
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SUB•BSMT.
BASEMENT
1st FLOOR 211311 1
,2nd FLOOR 1
3rd FLOOR
4th FLOOR
Sth FLOOR
6th FLOOR
7th FLOOR
8th FLOOR
installingCompan Name � S Check.one: Certificate
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Address d 1 �t Vtorporation
O Partnership _ -
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Bus.r, -s:i Telephone f
Narv, r i' Licensed Plumber
IN,U . CE COVERAGE:
I h,av; ! irrent try insurance policy or its substantial equivalent whK h arch ow requirements of MGL Ch. 142.
No 0
it you checked yes, please i icate the type coverage by checltns the awnwlate 60%.
A liability Insurance policy e Other type of indemnity 0 Bclnd t
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not haw*Ilw m,utance coverage required by Chapter 141 r+r It-Me-
General Laws, and that my signature on this permit application waives thea rrgUlreereenl. Check rxw
Owner D AWN
5it;r+a.ture of Owner or Owner's Agent
40
I hrr•tr•cen!ty that alt nt dv daalls and mtonnown 1 have wbrmned la enreredl In ahrlye r arrw ar► old ar the Mow to 0*hest
of my Sure N wd ode PW&VII*.0 r�+ar ^a�'•
a^d!rmallarwm performed rndef the perms issued for this appl!callon wl1 Ee m c ante all .
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Ir tt. Ira of ticenv.Mayen
L,cemr Numbrr .
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