HomeMy WebLinkAboutMiscellaneous - 84 Belmont Street-i
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Date
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TOWN OF�NORTRANDOVER
PERMIT FOR,,PILUMBING
This certifies that ?:It. .... ................
has permission to perform ... ...... ...
..... .........
liplumbing in. the buildings o
................
.......... il�Norih'Andover, Mass.
at . IZ4-4—�
Fee?T�� . ..Lic. No..70-9.,ks��
PLUM BING.INS PECTOR
J
WHITE: Applicant CANARY: Building Dept. .,PINK' Treasurer
'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO* DO PLUMBING
(Pf int or Type)
Mass.
Date 12--/ �/ - Pe(MIt #
Building 5>1- Owner's Name-jd— 44�a ��=- �Iq-
Type of Occupancy_/V��s
New 0 Renovation 0 Replacement 99 Plans Submitted: Yes 0 No 0
FIXTURES - -./� i,<5— .
Installing Company NaMeMAIC Check one:. Ceffificate
Address to
Corporation
W—& j AJ
0 Partnership
13141-il 4ess Telephone—L-4Z2--2-7-1--_2 9,349 1] hmi/co.
' Lensed
I —of Lj�
YS Le'R A N C E COVE
I have a current liability insurance Policy or Its substantial equivalent which meets the req
Yes go No 0
uirements of MGL Ch. 142.
If YOU have checked yes. Please indicate thte type coverage by checking the appropriate t>ox.
A liability Insurance policy 0 Other type of Indemnity 0 Bond 0
6WNER-S INSURANCE WAIVER: I am aware that the licensee 92!�s _nOthave the Insurance coverage required by
Chapter 142 . of the Mass. General Laws. and that MY signature on this Permit application waives this requirement.
Check one:
-ynature of Owner or owner' Agent Owner [:1 Agent 0
I hereby certify that all of the details and information I have
11howiedge and that all plumbing work and installations
Pertinent P(oyisions of the Massachusetts State Plumb! g C
Title Signature
led (or entered) in above application are true and accurate to the best of I my
underthe Permit issued for this application will be in compliance with all
d Chapter, 142 of the Gener5l�ws.
vna� 7W
-� I fulliVer
City[Town Type of Ucense: Wster Journeyman E]
NTPOVED—TO—FACE �USE ONLY)
L—I Ucense Number
EME
ON
Now.
0
01010100110010
No
NOWNION
a
0
No
Ems 11
i ---
4T-H FLOOR
GTH FLOOR
MEN
OMNI
Installing Company NaMeMAIC Check one:. Ceffificate
Address to
Corporation
W—& j AJ
0 Partnership
13141-il 4ess Telephone—L-4Z2--2-7-1--_2 9,349 1] hmi/co.
' Lensed
I —of Lj�
YS Le'R A N C E COVE
I have a current liability insurance Policy or Its substantial equivalent which meets the req
Yes go No 0
uirements of MGL Ch. 142.
If YOU have checked yes. Please indicate thte type coverage by checking the appropriate t>ox.
A liability Insurance policy 0 Other type of Indemnity 0 Bond 0
6WNER-S INSURANCE WAIVER: I am aware that the licensee 92!�s _nOthave the Insurance coverage required by
Chapter 142 . of the Mass. General Laws. and that MY signature on this Permit application waives this requirement.
Check one:
-ynature of Owner or owner' Agent Owner [:1 Agent 0
I hereby certify that all of the details and information I have
11howiedge and that all plumbing work and installations
Pertinent P(oyisions of the Massachusetts State Plumb! g C
Title Signature
led (or entered) in above application are true and accurate to the best of I my
underthe Permit issued for this application will be in compliance with all
d Chapter, 142 of the Gener5l�ws.
vna� 7W
-� I fulliVer
City[Town Type of Ucense: Wster Journeyman E]
NTPOVED—TO—FACE �USE ONLY)
L—I Ucense Number
1 0
7
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