HomeMy WebLinkAboutMiscellaneous - 90 SECOND STREET 4/30/2018I
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Date.. . �... e . ... l
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .... .... '.' .... !` �... � .... � ..�..`7
has permission to perform .....
.................
plumbing in the buildings of ... ........�........
at .. ��G.. �'�' s. <, :.. ... �. �............. North Andover, Mass.
r
Fee. :... Lic. No.. l .�. `.. 5 . �. ` ......... ........
PLUMBING INSPECTOR
Check #
5287
F A
I I&
Installing
Address
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
NU h Mas Date ,y 19� P rmit #
Building Lopation U v `�, Owner's+Name
LA
1 Type of Occupancy
New E)Renovation El Replacement Plans Submitted: Yes ❑ No ❑
FIXTURES
Business Telephone
Name of Licensed Plumber
Check one: Certificate
❑ Corporation
❑ Partnership
Firm/Co.
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 ❑ 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 ❑
nature of -Owner or
I hereby certify that 4 of the details and information I have milted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations p rfor ed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbinj Co e and Ch a 142 of the General Laws.
By
gna re lJcensed Plumber
Title
e of License: Master Journeyman ❑
City/Town � /
APPROVED OFFIC ONLY License Number G
NINE
MENNENEENOMENOMMENE
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A
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Business Telephone
Name of Licensed Plumber
Check one: Certificate
❑ Corporation
❑ Partnership
Firm/Co.
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 ❑ 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 ❑
nature of -Owner or
I hereby certify that 4 of the details and information I have milted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations p rfor ed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbinj Co e and Ch a 142 of the General Laws.
By
gna re lJcensed Plumber
Title
e of License: Master Journeyman ❑
City/Town � /
APPROVED OFFIC ONLY License Number G
Date.. ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .. !-. ! .:... �. .:...... ! .. .............
has permission for gas installation ...1. `...................... .
in the buildings of.............�-........................ .
at ...`.: s:.....- ...................... North Andover, Mass.
Fee......... Lic. No..! ! ....... ..... 1`:......... .... .
GAS INSPECTOR
Check #
MASSACHUSETTS UN'LFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
- JQ�.� b - Mass. Date �l j, Z.l 1 �2
City, Town Permit #J
Building — Owner's
AT: Location dame__
4
NeW ❑
Renovation ❑
Plans Submitter] Yes ❑ No ❑
Typef Occupancy
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INSURANCE COVERAGE: Chene
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If you have checked yqj, please Indicate the type coverage by checking the Appropriate box
A liability bvwrance policy tf Other type of indemnity 0 eon
Certificate
N
OWNER'S INSURANCE WAIVER: I am aware that the licensee does r.n 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:
Skmahn of Owner Owner O Agent ❑
« : ant
I Neteby certify that all of the deWls and kdormation I haw submitted for entered) in avow application are true and acanste to the best or my
knowledge and that all pkunbkV work an installations performed under the permit or this aWlea0m wig be in oorrrpliwce with d
pertinent ptovisiam of the Massachusetts State Plumbing Code and Chapter 142 of7TA:lm
tjy �
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Number
City/Town
APPROVED (OFFICE USE ONLY) Type of f ltxnbkmp License: Ma : an ❑