HomeMy WebLinkAboutMiscellaneous - 642 TURNPIKE STREET 4/30/2018 (4)MASSACHUSETTS UNIFORM .APPI_ICATION. ;FOR.PERMIT. TO DO LUMBI G
(Type or Print)
NORTH ANDOVER ,Mass.. Date:
I.Suilding Location Ke --r. _Permit
Owners Name
New D Renovation Replacement 0. Plans Submitted .❑
FIXTI IRFS
(Print or Type)
Installing Company
Address
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:,
Liability insurance policy IN Other type of indemnity F__j Bond ;; r
Insurance Waiver: I, the undersign
tK application es not have any 1
CAryw
Ignature of owner/agent of proper
1 hcccby ccaify that all of the details and infocmalion 1 leave
knowledge and that all Plumbing wock and installations lvccfocnscd
risions of the Massachusetts State Plumbing Code and Chaptcc 142
By
Title.
City/Town:
APPROVED (OFFICE USE ONLY)
Signature of vLicensed Plumber •.._ ,,.,.�
TTv$e of Plumbing License
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License Number ❑ Master Journeyman,,;
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BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7THFLOOR
8TH FLOOR
(Print or Type)
Installing Company
Address
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:,
Liability insurance policy IN Other type of indemnity F__j Bond ;; r
Insurance Waiver: I, the undersign
tK application es not have any 1
CAryw
Ignature of owner/agent of proper
1 hcccby ccaify that all of the details and infocmalion 1 leave
knowledge and that all Plumbing wock and installations lvccfocnscd
risions of the Massachusetts State Plumbing Code and Chaptcc 142
By
Title.
City/Town:
APPROVED (OFFICE USE ONLY)
Signature of vLicensed Plumber •.._ ,,.,.�
TTv$e of Plumbing License
Cr
License Number ❑ Master Journeyman,,;
4J i y Date! .D
L 3514
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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This certifies that :.. :::. .. ...... .. :. .
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has permission to perform
lit'
plumbing in th buildings of . :. , .. �-'{'�,'--...: .--....... .
at,North Andover, Mass.
Fe6-�. .Lic. No ......:....
PLUMBING INSPECTOR
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WHITE: Applicant CANARY Building Dept. PINK: Treasurer "'
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ITTING
NORTH ANDOVER , Mass. Oate 0 tg�
BuAdingI.
PermR *— 2C.S _
locationAl
Owner's
Name _ � A1.461 r Je& I,,-/- I%eJ11
New ❑ Renovation ❑
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Replacement Plana SubmMed:. Yea 0 No ❑
Check oni.
Ins.tallino Company Name W7— Corp.
Address
r<
Business Telephone
Name of licensed Plumber or Gas Fitter AN trRP�r �7-2� f f
INSURANCE COVERAGE: Checko e
1 have a current liability Insurance policy or Its substantial equivalent. Yea l 0
If you have checked ye, please Indicate the type coverage by checking the appropriate boxr NoO
A liability Insurance policy tl< Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the Ilcensee does not have the Insurance coverage required by
Chapter 142 of the ass. General Laws, and that my signature on this
permit application waives this requirement.
UJ'
ua
nature o Ormet or Owner's ant Owner Agent ❑
Certificate
( hereby certify that an of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my
knowiedps and that all plumbing work and Installations performed under the Per
mit
pertinent provisions of the Massachusetts State Oas Code and Chapter 142 ofpllanca with all �l
T of se; O
THIO umber Gasntler s er
CttyRown Master License Number
Q Q
Journeyman Ll j�
ArMOWED (OFFICE USE ONLY)
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Check oni.
Ins.tallino Company Name W7— Corp.
Address
r<
Business Telephone
Name of licensed Plumber or Gas Fitter AN trRP�r �7-2� f f
INSURANCE COVERAGE: Checko e
1 have a current liability Insurance policy or Its substantial equivalent. Yea l 0
If you have checked ye, please Indicate the type coverage by checking the appropriate boxr NoO
A liability Insurance policy tl< Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the Ilcensee does not have the Insurance coverage required by
Chapter 142 of the ass. General Laws, and that my signature on this
permit application waives this requirement.
UJ'
ua
nature o Ormet or Owner's ant Owner Agent ❑
Certificate
( hereby certify that an of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my
knowiedps and that all plumbing work and Installations performed under the Per
mit
pertinent provisions of the Massachusetts State Oas Code and Chapter 142 ofpllanca with all �l
T of se; O
THIO umber Gasntler s er
CttyRown Master License Number
Q Q
Journeyman Ll j�
ArMOWED (OFFICE USE ONLY)
p 665
Date %`7
1-1-.
NORTH 1TOWN OF NORTH ANDOVER
pry` .ao ,e tiOL
p PERMIT FOR GAS INSTALLATION
19 Q
�SAcwUSEt
This certifies thai .. ... ` . .... ................. .
has permission for gas installation ...................
in the buildings of 'f .... !? - : �: '�! • . • • • • • • • • •
at X 1-1�-.-2-.. �`l :�- �:j.� � !.. , North Andover, Ma,&
Fee=�"S..L . No..c.� � ;�V .........................
.41
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer "'