HomeMy WebLinkAboutMiscellaneous - 85 BRENTWOOD CIRCLE 4/30/2018 (2)Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
111000.00
m
$ -
$
132.00
Plumbing Fee
$
16.50
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
16.50
Total fees collected
$
265.00
85 Brentwood Circle
426-16 on 10/5/15
Bath Remodel
Date.
+ TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .............................
has permission to perform
plumbing in the buildings of
at
....... North Andover, Mass.
Fee s .... Lic. No/��-�V ..4 -* .........
PLUMBIV6�SPECTOR
Check ISIL
6967
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'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print o/r/Type)
(� �v 'V''Qak4,1 . Mass. Date�S�12
� Permit , /J
Building Locatkxt _ JL 7�✓00/� Owner's Name / &/Z:io"I
Type of Occupancy 431 D£ M zll
New O Renovation O Replacement G' Plans Submitted: Yes ❑ No
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FIXTURES
Installing Company Name
Business Telephone '
Name of Licensed Plumber
Check one:. Certificate
❑ Corporation
,13 Partnership
4J��ifnVCo.
INSURANCE COVERAGE:
rl have a current lialaNitq-�insurance policy or Its substantia) equivalent which meets the requirements of MGL Ch. 142.
Yes C�`' No ❑
If you have checked yrj, plea the type coverage by checking the appropriate box
A liability insurance policy Other type of Indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General taws, and that my signature on this permit application waives this requirement.
Check one:
Stanature nt cwnwr nr r u,ne.•.... # Owner ❑ Agent ❑
knoMAed
nareoy c ww mai an of tme details and information 1 have submitted for entered) in above application are true and accurate to the best of my
go and that all plumbing worts and installations perforated under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter-of-twGi4ral Laws
_ gnature of Ucensed Plumber
City/Town Typa of License: Master ( � .. bumeyman ( __ --_--------
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Installing Company Name
Business Telephone '
Name of Licensed Plumber
Check one:. Certificate
❑ Corporation
,13 Partnership
4J��ifnVCo.
INSURANCE COVERAGE:
rl have a current lialaNitq-�insurance policy or Its substantia) equivalent which meets the requirements of MGL Ch. 142.
Yes C�`' No ❑
If you have checked yrj, plea the type coverage by checking the appropriate box
A liability insurance policy Other type of Indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General taws, and that my signature on this permit application waives this requirement.
Check one:
Stanature nt cwnwr nr r u,ne.•.... # Owner ❑ Agent ❑
knoMAed
nareoy c ww mai an of tme details and information 1 have submitted for entered) in above application are true and accurate to the best of my
go and that all plumbing worts and installations perforated under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter-of-twGi4ral Laws
_ gnature of Ucensed Plumber
City/Town Typa of License: Master ( � .. bumeyman ( __ --_--------
O License Number �y
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Date ... 4!.. .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
J 4
This certifies that .. .....r......���..,.4�..........
has permission for gas ins allation.- -r- -''..... .
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in the buildings of ... :......�. ......................
at .. . . ...... , North Andover, Mass.
. Lic. No. .. ........... .Fee`a�//"',
GAS INSPECTOR
Check #l-� 9/
5576
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Business Telephone
(lame of Licensed Plumber or Gae puma.
Mass. Date d�
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�k% E74Uo/� [ Owner's Name
&�IrZIO
Type of Occupancy-- &J/ 2.,711E
Replacement Plans Submitted: yes[) IVa
Check one: Certificate
13 Corporation
❑ . Partnership
1 hereby certify that all of the details and infomu(ion I have submitted (or entered) in it i above aPPlication are true and accurate to the best of my
knowledge and that all plumbing work and mstallabOrs Performed under the
Pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of theGeneral tlDI a this application will be m cpMp[iancejtiLal
Of License
Title
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mer S 9na ureofJcensd Plumber or Gas atter
GtY/To`vn License Number
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