HomeMy WebLinkAboutMiscellaneous - 146 Gray Street I
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Date. A.
f NORTH 1
3?�,.� •�,;.,�ooL TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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,SSACNUSE�
This certifies that .. . . . . . . . . . . . . . . . . . . .
has permission to perform..*�' �` `.:.�!. .
plumbing in the buildings of . . . . . . . . . . . ... . . . . .
vat ./'yo. . . . . . . . . . . . . .A- -��";: . . . . , North Andover, Mass.
Fee . - . . . .Lie. No.. . . . . . . . . / �. ! . . . //// . . . . . . . . . . . . . .
��- PLUMBING INSPECTOR
Check .7 ✓U/� (/
6495
i
MASSACHUSETTS UNIF7sName
PPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date
Building Location G/1 of ra ST Own r lae-11 Permit#— ff,�5z�)
Amount
TypeVfAccupancy
New Renovation ❑ Replacement Plans Submitted Yes No
FIXTURES
8d VA
%BMW
&��1VII�iT
1ST Fl"
L
DID MOM
2M MOM
41H KOM
SIH HDQt
6IR KOM
71H HJOM
gm MOM
I
(Print or type) Check one:
Certificate
Installing Company Name JTG7 �14/�h Corp.
Address P19 ta
Partner.
Business Telephone It G Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicat the type of insurance coverage by checking the appropriate box:
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 Massac tate Plumbing Coda and Chapter 142 of the General Laws.
By: 7pature oi Lic—e—ns-e"Mer
Type of Plumbing License
Title 2,70! '> '
Cit /Townic1- ense um er Master Journeyman
APPROVED(OFFICE USE ONLY � y
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