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Date.//-. Z< . G�
MORT/�
�r °„•,�"o TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SS�ICMUSE�
This certifies that .l. . . . . . . . . . . . . . . . .
has permission to perform . . . / �. S c . .f r�.� � < . . . . . . . . . . . . . .
plumbing in the buildings of . .Cl. ! c . .f. t y.. . . . . . . . . . . . . . . . . .
at. . ,/�. -4- r:.<1. .1114.14 . . . . . . . . ., North Andover, Mass.
Fee.3)1Lie. No./.!m. .3.YJ. . . . . . . . .� . . . . . . .
f
PLUMBING INSPECTOR
Check # i r r— /
5024
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date
Building Location 2— Ltr Owners Name $, Permit# -0? y
Amount /
Type of Occu an
I
New ET/ Renovation 0 Replacement Plans Submitted Yes No
FIXTURES
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aCr
a w a w d a s
Ha a H
F d z d Q F
CA
-.14 �' A A a Q `�
SLR1M
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3MFLOCR
alp KDM
six FLOOR
6IR FLOCIR
71H FLOOR
91HH-aR
(Print or type) Check one: (��` Certificate
Installing Company Name 4 11Aacorp. 0
Address vb. aW I1 ❑ Partner.
IM 01 3
Business Telephone Ql . Z ( -`1 U3 Firm/Co.
Name of Licensed Plumber-
Insurance
lumberInsurance Coverage: Indicate theof insurance coverage by( ecking the appropriate box:
aLiability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts:tat�Iu ngC and hapter 142 of the General Laws.
By: lgna 01 LAcensm riumoer mop
Type of Plum i$g-I-icense
Title
City/Town r nse N11niber Master ®Journeyman ❑
APPROVED(OFFICE USE ONLY
Date.�. .".�l.: . .... i
NORTH
3=Oryx...ao ,e 1tiOL
TOWN OF NORTH ANDOVER
O .... 9
• - PERMIT FOR GAS INSTALLATION
�SSACHUSE�
i
�- This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . .e. �. S . . . . . . . . . . . . . . . . . . .
in the buildings of .. .... . . . . . . . . . . . . . . . . . . . . . . .
at ./.�. . . 1�. :: .�. . ���r.,. . . .t. . . . . . ., North Andover, Mass.
Fee.,) r . . Lic. No.��!? .�f. . .'. . .` . . . . . .
GAS INSPECTOR
E
Check#
38 7
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date —Ca
1
NORTH ANDOVER,MASSACHUSETTS
Building Locations _ %ws-_��, t1 Y� Permit# 3 ?/ 7
Amount$
Owner's Name �`�� C La:. ;:X ti
New® Renovation ❑ Replacement ❑ Plans Submitted ❑
" z " 0 o �' N
SUB-BASEM ENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
N 3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type) '�� (� Y J one: Certificate Installing Company
Name P I Corp.
Address �� ��?� \ 1 ❑ Partner.
erect 13Ji_` CG( rn/1 rE'3 G 1 Q-�, 1 ❑
Business Telephone ��4^ —� 3 Firm/Co.
Name of Licensed Plumber or Gas Fitter -o
01
INSURANCE COVERAGE Check one:
I have a current liability Insurance poli or it's substantial equivalent. Yes No❑
If you have checked yes,please in ' e the type coverage by checking the appropriate box.
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: ❑
Signature of Owner or Owner's Agent 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 Massachusetts State Gas Code and Chapt r 142 of the General Laws.
iBy: Xignature of Licensed Plumber Or Gas Fitter
Title Lff Plumber « a l 4
cityrro77' Fitter�L� �ar� Icense Number
/Master
APPROVED(OFFICE USE ONLY) ❑ Journeyman