HomeMy WebLinkAboutMiscellaneous - 1211 Chickering Road 1211 Chickering Road BUILDING
i
Date
O<t,tORTN
14, TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
"'SACHUS
This certifies that . . . . . . . . . . . . . . . .
has permission to perform . . . . . . . . . . . .. . . .ldl-� °'`. . . . . . . . . . . .
plumbing in the buildings of
at . . . . . . . . . . . . . North Andover, Mass.
. . . . . . . . . . . . . .
'Pee,%b /A . . . . . .
. . . . . . . .Lic No.. . . . . . . . . . . . . . . . . . .
PLU B NMSPECTOR
Check # 4- 3 Z
6643
f
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO'DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date U-/2 4'
Building Location /2/1 C 141 G vz���.- A V Owners Name ✓f9C C •��l DG cac ��P�trtnit# r G
Amountr
Type of Occupancy ca 44jj_h'1Z-C(,�/L
New Renovation Replacement Plans Submitted Yes No
FIXTURES
cr 3
ti
J
SLIMM
)ASMDC
3�D FLlt�It
FIDQt
4M Fl"
SIH FLOQi
s�FLOQt
7M ROM
gm FLOCK
(Print ortype) Check one: Certificate
Installing Company Name 11 Corp..
Address '36 ye1c, <''c2 C51-T, 0 Partner.
✓14 e-_ //zfC-
Business 11elephone ;Z'7.1- Ae-7 `/ ErITirm/Co.
Name of Licensed Plumber. Au)0 A
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity 11 Bond 0
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 11
4
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 Massa to Plu ' g Code and Cha ter 142 of the General Laws.
By: S n i
Type of Plumbing License
Title /L2 rf
City/Town License TNuffiTr?' Master � Journeyman Is
APPROVED romcE USF ONLY