HomeMy WebLinkAboutBuilding Permit #4610 - Fountain Drive 10/26/2000Z- �_.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
a
a
/rOOLQ'N /4N1Do1�tK_. Mass.
City, Town
Building
AT: Location rVIV rgiA/ �AI W
New ❑
Renovation El
Date_ /0 - L 9040
Permit�p/�
Owner'
Nam _ / 1oArM
�e vS �•✓ C r�v T��cw QTY
Type of Occupancy: ce.,nn Vv iry
Replacement ❑ G40 ~TdW'%-
Plans
FIXTURES Submitted: Yes ❑ No
(Print or Type) Check One: Certificate
Installing Company Name 7i�QREIR-T W 718VI t4L a lJS,_'tic - [1 Corp. 2 QS lo C
Address 'R-?- ALLEY S'i
❑ Partnership _ _
LY MA OIgO?. - 444 ( ❑ Firm/Company
Business Telephone -7 a 1 - 5%f - oq(p4 Name of Licensed Plumber or Gasfitter
'CERRANa M -hrMONI�
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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
ltgnature of Owner/ Agent
I have a current liability insurance policy to include completed operations coverage.
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber
Type of Plumbing License
1C(A2, [Z Master ❑ Journeyman
License Number
..-■■■�■■■■■■■■■■■■■■■■�■�■■���
(Print or Type) Check One: Certificate
Installing Company Name 7i�QREIR-T W 718VI t4L a lJS,_'tic - [1 Corp. 2 QS lo C
Address 'R-?- ALLEY S'i
❑ Partnership _ _
LY MA OIgO?. - 444 ( ❑ Firm/Company
Business Telephone -7 a 1 - 5%f - oq(p4 Name of Licensed Plumber or Gasfitter
'CERRANa M -hrMONI�
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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
ltgnature of Owner/ Agent
I have a current liability insurance policy to include completed operations coverage.
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber
Type of Plumbing License
1C(A2, [Z Master ❑ Journeyman
License Number
vi
z
0
m
m
m
T
m
O
O
m
N
N
z
N
T
m
A
0
z
0
Date A.- -�
N2 4610
TOWN OF NORTH ANDOVER
0
po to PERMIT FOR PLUMBING
•SgACMUgE`
This certifies that .. /�� .�� • • . •�-E
has permission to perform .f.?. �_._ -�1-// -!�... • • ..... • • • • • • • •
plumbing in the buildings of .?'L� .:--a�rY-a • .�-�
at ........ ......N96rth Andover, Mass.
Fee. `.�� ..... Lic. NA. ...........
PLBI INSPECTOR
Check # 1.?1 G 2 --
WHITE
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer