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HomeMy WebLinkAboutMiscellaneous - 8 ALCOTT WAY 4/30/2018N \< ...... 2 6 U fAORTf, OF TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING C This certifies that. - .......I....L . .... . ..................... ......................................................... has permission to perform ...... ......... k.�? ........................................... ......... ..... ....... plumbing in the build' gs Of SA� . ....... .. .......................................................................... r . at .................. . ...:7:1. VL .. ........ North Andover, Mass. Fee3v.-....... Lic. No. .. ................................................................................. PLUMBING INSPECTOR Check # MD I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY . !Y V (MA DATES ( PERMIT # _ )b JOBSITE ADDRESS AJ-4aU OWNER'S NAME G L POWNER ADDRESS_ �.i _ { TEL �,n GQG11FAX TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: Ell REPLACEMENT: Eq PLANS SUBMITTED: YES Q NOW FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ( ._ ( { F _ { ( J —j j1= 1 _.J DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHER { DRINKING FOUNTAIN FOOD DISPOSER i _-.. __.__.J ----J._.....-(.-___J _( FLOORIAREADRAIN INTERCEPTOR (INTERIOR) ------1 KITCHEN SINK I 1—_1 -_{ -_ -- I E-7€ ^_ LAVATORY ROOF DRAIN SHOWER STALL { _I ( .--. _ _ { SERVICE I MOP SINK TOILET URINAL 1= f -WASHINGMACHINE CONNECTION I 1 WATER HEATER ALL TYPES I J==== I _. I _.. _ ._.J WATER PIPING OTHER ----------- ----..._-__I -j_--__{ _ - -..{ E7711 1 ED 1 ---1 INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES []I NO Q IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 01 BOND 'OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. _ ) CHECK ONE ONLY: OWNER [.V AGENT "SIGNAT-URE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Peril t pro ' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _G/1 Q��j _ ( LICENSE # 77 SIGNATURE MP © JP � CORPORATION DQ #©PARTNERSHIP Eb ( LLC DO lam! COMPANY NAME/�Jj 1 um��rlyq ADDRESS 0!� f CITY ..___.STATE '� rJ ZIP G/&yiy TEL )9 FAX CELLEMAIL IT H O z - O H U W l w r 4► O Z d ❑ Q F- �Z) WO I CL ft z u LU F- U) U) a O > PW 3 � a 0 o a w ca a U J a a Q cn w z w F- li H O z 0 U a co z c� a a �7 p a° ' Date..).) .-till .................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION -D Thiscertifies that ..........................-............G........'...:..... .................. .................................................. Ls permission for gas installation . e -lz_ ... 41 ............................ (� � A . ..................... ............ inthe buildings of ........................................................................... at .......... 4. (A- ..................................... . ......... I ..... ,North Andover, Mass. Fee, ......... Lic. NoA.ko.01.1 ......... .................................................................. .... ...... .. GASINSPECTOR Check #-t�3-7 kid G TYPE OW PMT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 1 p"J�C�� 2�-?�(_ MA DATE ^ 7 / / PERMIT # I t LI 2- JOBSITE ADDRESS _ L 6 %i .� �OWNER'S NAMEt S/,I d'.,41 A OWNER ADDRESS s TE ..... $ Z L pL JFAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL 4 NEW: D RENOVATION: ® REPLACEMENT: D] APPLIANCES'l FLOORS- BSM 1 2 3 4 BOILER I �--- BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER�-- FIREPLACE FRYOLATOR FURNACE GENERATOR �— J GRILLE INFRARED HEATER LABORATORY COCKS �_ MAKEUP AIR UNIT F- IF— OVEN�--- POOL HEATER (—` ROOM / SPACE HEATER ROOF TOP UNIT (f i t I I— UNIT HEATER UNVENTED ROOM HEATER WATER HEATER PLANS SUBMITTED: YES 0 NO [�]I 5 1 6 1 7 1 8 1 9 1 10 111 12 13 14 INSURANCE COVERAGE have a current liability -Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES [] NO [� I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY © BOND r OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that at my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER W AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with I Pertin t pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME /Cl/ (1 LICENSE SIGNATU MP Q MGF JP [i JGF F -j LPGI [71 CORPORATION ©# = PARTNERSHIP ©#L= LLC 0# COMPANY NAME L&A ,nom I�/1� .SRT Lyra D1 it ADDRESS CITY /%1 ��I�vF, STATE ®ZIP a! $ L/ TEL %T lY- FAX �� CELLS EMAIL lz W H z z 0 H U W a o ED z 0 }. d 4 'v , IV* 4L