HomeMy WebLinkAboutMiscellaneous - 68 Kingston Street105
CO
rc.
`"t�i
FEB
Date. �. .
04 40R7M TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
41
SSACMUSEt
This certifies that . . . . . . . . . . . . . . . . .
has permission to perform . .� `" . . . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at. . . . . ./.`.'.`. . . ... `. . . .�. . . . . . . . . ., North Andover, Mass.
Fee. Lic. No.g 3 3 3. . . . . . . ���-a .... . . . . . . . . . .
PLUMBING INSPECTOR
Check #
6853
nll/aSSACHUSETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING
(Print or T pe)
Al
, Mass. Da 2010r It # ���
Building L cation rG
Ok %
wner' m
Type of Occupancy [•(~
9 41 0j
New 0 Renovation 0 Replacement
Pians Submitted: Yes 0 No 0
FIXTURES
B.P. # SEWER # SEPTIC # .
l� r"
cn N rr`O Q >ct ��— U,
Ln Z �W:
Ln < W �� U z N i W
W w O , F W Q � W z ¢ z a 0 lam—
Q ¢ _
En Lr) H z 0 O z z . 0
J w
o o =
Q
Lu_ 0 ¢ w I—
SUB-BSMT o = ¢ m o 0
BASEMENT
1ST.FLOOR
2ND FLOOR
i 3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOG
stalling Company Name . Check one: Certificate
idreess
01101 0 Corporation
isiness Telephone t0a2 ❑ Partnership
ime of Licensed Plumber or Gas Fitter 'ff Pirm/Co.
V .
NSURANCE COVERAGE:
have a current II bllity Insurance policy or Its substantial equivalent, which meets the requirements of MGI-Ch. 142.
Yes 1 No 0
f you have checked jjs please Indicate the type of coverage by checking the appropriate box. '
liability Insurance policy Other type of Indemnity 0 Bond 0
iWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter
42 of the Mass.General Laws, and that my signature on this permit application waives this requirement.
ignature of Owner or Owner's Agent Check one:
Owner 0 Agent 0
,eby certify that all of the details and informatlon 1 have submitted (or entered)In above'appilcatlon are true and accurate to the best of
knowledge and that all plumbing work and Installations perfor41jed
r the permit Issued for thi a Ilcation will be In compliance with
ertinent provisions of the Massachusetts State Plumbing Codeal Law .
Bio of Licensed Plum er
0ity/Town
4PPROVED(OFFICEUSEONLY) Type of Licenser UAlfster 17Journeyma:n
License Number--I "]3
"1
BELOW F011 OFFICE USE ONLY
FINAL INSPECTIONS 11«[TCIIEs
FEE lIIOONEs!INSPECTIONS
N0.
A►►L.ICATION FON rt11MIT TO 00 PLUMBING
NAME A TWN OF amm"0
LOCATION OF BINLDINO
FLrMNM
'EIIIMT GRANTED `
DATE — , lq
PLUMBING Nlf/ECTOII
TOWN OF NORTH ANDOVER NoRTk'4
Q ,�tttD br ti�
0
O T
Building Department «
1600 Osgood Street "4
^e
Building 2- Suite 2-36 Building Dept "SSgCHU f A5
North Andover MA 01845
Tel: (978) 688-9545 Fax (978) 688-9542
COMPLAINT FOR INVESTIGATION
DATE: ``� �/o TEL #: / �0 0 o9
NAME OF COMPLAINTANT: '�'�
ADDRESS.:._..
ll
COMPLAINT TYPE:
Electrical:
Plumbing:
Gas:
Building:
Property Owner:
Address:
Other:
L� �
fi�Al t/� GGA u�� g- &"s
�"l P P ass j;C S�jo s of��
Signed:
Complaint Form-Revised 6.2007