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HomeMy WebLinkAboutMiscellaneous - 21 Bruce StreetI 3958 Date 3."� ... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING '� This certifies that . `! ...... . has permission to perform ..�7�.......................... plumbing �iin, the buildings of.. '"`'`"�� ............ at=.r,.P/; .--eft................ , North Andover, Mass. er;ox Fee .'� ...... Lie. No G 3 J0,9... . rPLUMBING INSPECTOR 03/09/99 12:18 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING � (Print or Type) L' V OPPOy J57f,p�"t , Mass. Date 3 19 L Permit # Building Location %2 l `� �oc,�' S T Owners Name j,e1 C Type of Occupancy © w -A-r1j-1W New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Ho-F'r1t,4N -j r Check one: Certificate Address J--2 fj 9 RP-YW P .p ❑ Corporation A `U p oy e p-, n A S S o lel o ( Partnership �L Business Telephone L&/ ,) S- 3 ❑ Frm/Co. Name of Licensed Plumber 5' a SW 10 INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes A No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 9 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: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By S+gnature of LAnsed Plumber Title Type of License: Master Journeyman ❑ City/Town APPROVED (OFFICE USE ONLY) License Number Y • • • i��tiii■ �ii��iiiii���ll■ ! ... . .. - i���iiti��iiii��iiiii����■ .. - i���iiii��iiiiiTi�ii�����■ .. - i���iiii��iiii�tiiiii��t�■ IOWA Installing Company Name Ho-F'r1t,4N -j r Check one: Certificate Address J--2 fj 9 RP-YW P .p ❑ Corporation A `U p oy e p-, n A S S o lel o ( Partnership �L Business Telephone L&/ ,) S- 3 ❑ Frm/Co. Name of Licensed Plumber 5' a SW 10 INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes A No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 9 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: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By S+gnature of LAnsed Plumber Title Type of License: Master Journeyman ❑ City/Town APPROVED (OFFICE USE ONLY) License Number 3116 Date. � ...... . ...... . NORTH TOWN OF NORTH ANDOVER pf�.ao ,^1ti0 01- PERMIT FOR GAS INSTALLATION P ui This certifies that '". has permission for gas installation ...... ..`.. . • in the buildings of �- ���..:-."! .................. . -�!... at . C� ..... . , North Andover, Maims. Feet ....... Lic. No.hpz.... .. GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer `� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ✓/ G� fi (i %% yL'to— , Mass. Date '3- 19 i Permit # Building Location , 1 �� V G -% Owner's Name u L L �,' R ed Type of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name 61 o'e'r"Jolu (t Check one: Certificate Address 6^i K#9 f211—ov e D ❑ Corporation A N A o v r pL !i f p 1 P I'9 L9. Partnership �L p Business Telephone �� - Ce ❑ i Firm/Co. Name of Licensed Plumber or Gas Fitter X° S EPfa w�4rF'o�lOI INSURANCE COVERAGE: I have a curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No U If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy J� 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: Owner[:) Agent ❑ Signature of Owner or Owner's 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 the 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. By. TvDe of License: �5�� / �� Plumber SigO5tureof Licensed Plumber or Gas Fitter !`— Title Gasfitter Master License Number City/Town Journeyman APPROVED (OFFICE USE ONLY) son ME BASEMENT age MENNEN NEE 0 MORON IS MONSOON 2ND FLOOR_: MMMIMMEMIMMMMIMI son 7TK FLOOR Installing Company Name 61 o'e'r"Jolu (t Check one: Certificate Address 6^i K#9 f211—ov e D ❑ Corporation A N A o v r pL !i f p 1 P I'9 L9. Partnership �L p Business Telephone �� - Ce ❑ i Firm/Co. Name of Licensed Plumber or Gas Fitter X° S EPfa w�4rF'o�lOI INSURANCE COVERAGE: I have a curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No U If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy J� 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: Owner[:) Agent ❑ Signature of Owner or Owner's 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 the 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. By. TvDe of License: �5�� / �� Plumber SigO5tureof Licensed Plumber or Gas Fitter !`— Title Gasfitter Master License Number City/Town Journeyman APPROVED (OFFICE USE ONLY)