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Date.
G .� .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .... e14 L k/. .
has permission to perform ... R e t"t P. � M
plumbing in the buildings of . —Fc c �`�'. .
at ... YLr.:��.y .r1.%/�............ , North Andover, Mass.
Fee 1�4 . .. 1-1 c. No. � ...... , L ................
PLUMBING INSPECTOR
Check # t,/ �7 G
7408
'4.
MASSACHUSETTS UN FORM TPLICATION FOR PERMIT TO DO PLUMBING
),pe or print) k6o-k1 NtA\0 t.�
MASSACHUSETTS _
building Locations S (,S tto
Date
Permit 4
Amounts p
Owner's Name S( o i
New ❑ Renovation 0 Replacement 0 Plans Submitted n
FIXTURES
(Print or type)
Installing Company Name Galinsky Plumbing & Heating
Address
P.O.Box 1701
Check one: Certificate
1.::.� Corp. l n h
M Partner.
Haverhill MA n]Rol
Business Telephone 978-374-1743 Finn/Co.
Name of Licensed Plumber: Stephen C. Ga l i n s k y
Insurance Coverage: indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond11
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 1:1 Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing de a ba 42 of the General Laws,
By: igna ure o icenseo riunTer—
Type
erType of Plumbing License
Title �y
City/Town' icensL um er Master 13 Journeyman 1
APPROVED {OFFICE USE ONLY
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1 f e •
-.mm-m-.mmmm.momm-o-mm-m�
(Print or type)
Installing Company Name Galinsky Plumbing & Heating
Address
P.O.Box 1701
Check one: Certificate
1.::.� Corp. l n h
M Partner.
Haverhill MA n]Rol
Business Telephone 978-374-1743 Finn/Co.
Name of Licensed Plumber: Stephen C. Ga l i n s k y
Insurance Coverage: indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond11
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 1:1 Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing de a ba 42 of the General Laws,
By: igna ure o icenseo riunTer—
Type
erType of Plumbing License
Title �y
City/Town' icensL um er Master 13 Journeyman 1
APPROVED {OFFICE USE ONLY