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'AORTH
4, TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SS CHUS
This certifies that ........
has permission to perform ... (�" �!z!Gi�', /�1:..
plumbing in the bufldings-o,f'/—
a
Fee-g:�. Lic. No., f ........
Check #
6462
.......... North.,An/dover, Mass.
PLUMBING INSPECTOR'
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MASSACHUSETTS UNIFORM APP
(Print or Type) �1 1
& Q CI- H� ham.[ D Vl�Mss.
Building
New ❑
SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH.FLOOR
8TH FLOOR
- 15
Renovation 1 ❑
FOR PERMIT TO DO PLUMBING
Permit #
&,Owner's Nam
—Type of Occupancy Re s irl tz"
Replacement 99 Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage Htg. &Pig.. CO. Inc.
Address 35 Pleasant Street
Stoneham; Ma 02180
Business Telephone '781 —438-7776
Name of Licensed Plumber Gordon Switzer
Check one:
IX Corporation
❑ Partnership
n Firm/Co.
Certificate
714
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy IS 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 Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ 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 the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142
22jof the General laws.
By nP . ,�j 1-4i
•SignatulfTof LicerisenFluFf1�
Title
Type of License: Master [X Journeyman ❑
City/Town 13 3 2 2
APP ) License Number
%2" Watts 9D KI) on water line to water boiWr
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Installing Company Name Heritage Htg. &Pig.. CO. Inc.
Address 35 Pleasant Street
Stoneham; Ma 02180
Business Telephone '781 —438-7776
Name of Licensed Plumber Gordon Switzer
Check one:
IX Corporation
❑ Partnership
n Firm/Co.
Certificate
714
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy IS 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 Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ 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 the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142
22jof the General laws.
By nP . ,�j 1-4i
•SignatulfTof LicerisenFluFf1�
Title
Type of License: Master [X Journeyman ❑
City/Town 13 3 2 2
APP ) License Number
%2" Watts 9D KI) on water line to water boiWr
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