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Home My WebLink AboutMiscellaneous - 8 ARDMORE COURT 4/30/2018N Date... .......... 11188 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Thiscertifies that .......................... . j ................................................................................ ............ has permission to perform ...... (?.�za4 gn .... V4.a ... 2. ......................................... plumbing in the buildings of J"'. a, S, ,, , ....... : ... I ............ ............... ................................. at ........43....... . A,(e- !Cn.A,.A .. .... Cll� ........................ North Andover, Mass. Fee.� . ....... Lic. No. S .................................... ............................................ PLUMBING INSPECTOR Check # S MASSACHUSETTS UNIFORM APPLICATION T TO PERFORM PLUMBING WORK POWNER TYPE OR PRINT CLEARLY 4FORAR CITY f1hh Gt MA DATE PERMIT#- JOBSITE ADDRESS AWNER'S NAME ADDRESS �� GUDa�- �c�! �. TEL FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO 8' 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 GAS/01USAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current khirfir insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 YES ❑- NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BYCHECIQNG THE APPROPRIATE BOX BELOW LIABILITY gVSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information 1 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 co with all Pe' p on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME t> LICENSE #t€j�� SI RE MP JP [91r CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME _ 0 � Me- S . 9 ADDRESS Aadw, CITY-4ave-(-�aa [ STATE ZIP TEL FAX CELL�� s` C� ' EMAIL S TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that A- .......... ............. ,has permission for gas instaVatioO�Ale--4— in the. building of ... \NJ ..................................... r JQ VY\ eA,9— at..; ........ z ... A .. ........................................................... . North Andover, Mass. .... .. ........... Lic. No. k ........ ..... qL-65 ....... ........................................ ............................ .... GASINSPECTOR Check-& S&-\ MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK CITY MA DAT rRMiT # JOBSITE ADDRESS -__ _ WNEWS NAME - - OWNER ADDRESS` _ -- TE . FAX ------ TYPE IR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIALB— CL9A.RLY NEW: E__1 RENOVATION: (,� REPLACEMENT: E.T� PLANS SUBMITTED: YES O N09— APPLIANCES 7 _• FLOORS -4 ON 1 2 3 4 6 6 7 a S 10 11 12 13 14 BOILER _ :._i __'__-_I t 13300STER -- CONVERSION BURNER _-I COOK STOVE - DIRECT VENT HEATER _ .. -1, 7__, -_�. i I -�1 .. DRYER FIREPLACE FRYOLATOR- FURNACE GENERATOR GRILLE__-�._I INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN(- �� POOL HEATER -,� _ �. . _� i ,.t . - (- T ROOM t SPACE HEATER ROOF TOP UNIT TEST_._.I ..____:I UNIT HEATER _ UNVENTEp ROOM HEATER _ i , - I I� , I -:__r . fes_ _ . ..- _._, i 4 WATER HEATER_ - 1`. (�._ - 1��,T,1 _ _ �— t - ---IF- -__=t_ INSURANCE COVERAGE I havea current liability insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 YES i NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAG Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNEWS 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 Wales this requirement. CHECK ONE ONLY: OWNER 0 AGENT �I SIGNATURE 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 knowledge and that all plumbing work and installations performed under the permit issued for this application Will be in compli ce Ph all Pertinent pro 0 of the Massachusetts State Plumbing Code and Chapter 942 of the General Laws. PLUMBER-GASFI ITER NAME LICENSE # _,=cVY R _ MP _ MGF VW' JP t JGF bd LPGI CORPORATION D#� � PARTNERSHIP Ej#[__-LLC t- I COMPANY NAME: N . ADDRESS - p CITY _..._ - �AV� 1 — STATE - _ IPS.- l FAXCELL 1'lL _ - - J y