HomeMy WebLinkAboutMiscellaneous - 9 STACY DRIVE 4/30/2018Date. �. —7 :. � 1-'
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This certifies that . ��`!�/t .�? ........ Q� .............
has permission to perform ... f. ........................
plumbing in the buildings of ................
at. C;r.. ............ North Andover, Mass.
Fee ..? .�..... Lic. No../ .. ......Q \. :,. ..........
(PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMFT TO UO PLUMBING
(Print or -type)
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New Renovalion I7
I ype of Occupancy Pf_,S I_bC��tj
Replacement IW flans SUbmined: N'es I I No I]
FIX" US
Building L(lcatiun.._
�_"_..
Owner's
New Renovalion I7
I ype of Occupancy Pf_,S I_bC��tj
Replacement IW flans SUbmined: N'es I I No I]
FIX" US
Installing Company Name STARK & CAONK Check one: Certificate
Address 308 MAIN STREET 1-31"corporation
GROV ,
E. ❑ Partnership
Bysiness Telephone L-1
Name of Licensed Plumber -7s i 1 baa
INSURANCE COVERAGE:
I hive• a (uncut liabilily hsuranee policy or its tiulltilanlial equivalent which nurels the requiremM
ent•; of GL Ch. 1.12.
Ye'' IW No I I e
11 veru have checked yes, please indicate the lype ( overage by chee king; the a1propriale box.
\ li.d,ilily inalrarnc poli(y 4* OIher type nl indenmih' I I Born) I I
OWNLR'S INSURANCE WAIVER: I and await, Ill.il the liren.ee does nut have the iIhLIlancr coverage• required by Chaplet I I., ref the Ma,.
(il'n('lal 1,I.r", arnl Mal Illy tiipmlury on Ihiti p-11110 •Ippli(.Ili(m evaivc� Ibis lequilelnenl.
\ig;n•dmr •.I t )�Ynel rn (?��nel's A};(•nl
Cheek nn.
Owner i I Agent 1!
�� �. I.. ,.-II•I •1..11 .III .•I 1111•.1••1...1. ..na n.l•I. 111, 111..II I h.n.• \III .t 1.111..11 Int .'111.'1 III .:I !h.' "h.1\I
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Installing Company Name STARK & CAONK Check one: Certificate
Address 308 MAIN STREET 1-31"corporation
GROV ,
E. ❑ Partnership
Bysiness Telephone L-1
Name of Licensed Plumber -7s i 1 baa
INSURANCE COVERAGE:
I hive• a (uncut liabilily hsuranee policy or its tiulltilanlial equivalent which nurels the requiremM
ent•; of GL Ch. 1.12.
Ye'' IW No I I e
11 veru have checked yes, please indicate the lype ( overage by chee king; the a1propriale box.
\ li.d,ilily inalrarnc poli(y 4* OIher type nl indenmih' I I Born) I I
OWNLR'S INSURANCE WAIVER: I and await, Ill.il the liren.ee does nut have the iIhLIlancr coverage• required by Chaplet I I., ref the Ma,.
(il'n('lal 1,I.r", arnl Mal Illy tiipmlury on Ihiti p-11110 •Ippli(.Ili(m evaivc� Ibis lequilelnenl.
\ig;n•dmr •.I t )�Ynel rn (?��nel's A};(•nl
Cheek nn.
Owner i I Agent 1!
�� �. I.. ,.-II•I •1..11 .III .•I 1111•.1••1...1. ..na n.l•I. 111, 111..II I h.n.• \III .t 1.111..11 Int .'111.'1 III .:I !h.' "h.1\I
l.d....p.'.II.nur.anvq ylt, I .1 I.
-Eml u I 111.11V Ill Ihr 1r•4 of nn . l tul dl lluvnl,.......
In. Iln. ,gq.hl .m ut Dill L.' m I . •Iq.h.ul. r le'tlh .,It '.'.anti Ileo .l nn of Ihr t.1a«dl hu•.r
. ..,n ..II I.... I I %[A- 1'lunll.inp .. ..I. I,,glp•.
Iq tq!n.lhur nl I a emelt I'lundn•. _ -
I nh' 1 •. In• nl I it rn•.I•: '.Elden i V
V\ Il ruuu•�•nl.ul � I
'•19B( )VI 11 (()1 1 I( 111"I ( )NI YI
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