HomeMy WebLinkAboutMiscellaneous - 94 MABLIN AVENUE 4/30/2018K
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that (.,e:- "" • ... .
has permission to perform
plumbing in the buildings of .,�P�................
at .. ....... , North Andover, Mass.
Fee /7 —�.. Lic. No. J. A4? .. - ... ...... .
�PLUMji NG INSPECTOR
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Check #
6829
MASSACHUSETTS UNIFORM APPLICAT10N1 FpR pM
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Print or Type} RTO DO PLUMBING
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TOWN OF .NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that -
has permission for gas installation ...................
in the buildings of 7 ... ........... ........................
at
......................... North Andover, Mass.
FeO..*—* ... Lic. ..........
GAS IN6EdT'0R
Check # Z6
5444
C,7
nspecti n of . Gasf tong
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type.)
Mass. Date � to Permit #
Building Location_ 9L% /�riG�b�Jt$', �1-��� ` Owner's Name --A/4 t -f it yl,()
q.7 5,' &'ck& —�7 tr' ..Y Type of Occupancy �,
New O Renovation ❑ Replacement v Plans Submitted: (es❑ No ❑
installing Company Name --C— 7)1 inG
Address_ ��-(�.( "PVO t�0 S �n
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Business Telephone_ ,7 - tq
Name of Licensed Plumber or Gas Fitter
Check one:
Corporation
G� Partnership
O Firm/Co.
Certific e
INSURANCE COVERAGE;
I have a -current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes X No."O
It you have checked yg�, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy Other type at Indemnity O
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:
Signature or O.vner or Owner's Agent Owner O Agent O
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 a ation
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. compiian with all
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flumber or or as itle
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1ST FLOOR
2ND FLOOR
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6TH FLOOR
7TH FLOOR
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installing Company Name --C— 7)1 inG
Address_ ��-(�.( "PVO t�0 S �n
--
4N2 vie vin
Business Telephone_ ,7 - tq
Name of Licensed Plumber or Gas Fitter
Check one:
Corporation
G� Partnership
O Firm/Co.
Certific e
INSURANCE COVERAGE;
I have a -current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes X No."O
It you have checked yg�, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy Other type at Indemnity O
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:
Signature or O.vner or Owner's Agent Owner O Agent O
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 a ation
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. compiian with all
By—
y T e of License.
flumber or or as itle
Title aster �gn r �� �
City/Town aster License iVumber
APP owneyman
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