HomeMy WebLinkAboutMiscellaneous - 104 Cricket LaneN\
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Date. .' - - 1 .'..... c.
N° 2.-667
",O pT :�� TOWN OF NORTH ANDOVER
3: °°�
,0*0 PERMIT FOR PLUMBING
SSAcmus�
This certifies that �...... ?'� .. .........
has permission to perform ...
plumbing in the buildings of .' . !'.. r ?`r C) ^ �
at. ....`. (? .......�........`.......... , North Andover, Mass.
Fee. No..-)/'/ ..... ....... �....ii�,,��......
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept_ PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS ?� S -Olt)
T4&er-s-Cme
Date 3
Building Location Oermit # t- f 3 ` ,
Amount -330
Type of Occupancy
New -0— Renovation Replacement 0 P Submitted Yes No
FTYTITRES
(Print or type) /% Check one: Certificate
Installing Company Name v l ( U' 0 Corp.
Address —LL c - /l G ` `,�Q t�0 GDS- s /L 11 Partner.
Business Telephone 7.3-cp t I I 1 Firm/Co.
Name ofLicensed Plumber. ��G'V tV t S �v S to J t eA
Insurance Coverage: Indicate th type of insurance coverage by checking the appropriate boat
Liability insurance policy �_ Other type of indemnity Bond ❑
Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Mas State,Punbing Cod d Chapter 142 of the General Laws.
By: Signature of rcem ��==�Fluum�~ er
Type of Plumbing License
Title
City/Town rcense NumDer MasterEl Mr
Journeyman
APPROVED (OSCE USE ONLY