HomeMy WebLinkAboutMiscellaneous - 211 Bradford Street Date. .
"pRTM TOWN OF NORTH ANDOVER
pf ,,.o ,•'�ryC
3? ��`.r .••..,• OL
PERMIT FOR PLUMBING
SSACHUSE�
This certifies that . . .. . . . . . . .. ... . . . . . . `. . . . . . . .`. . . . .
has permission to perform . �'-�I. . . . '.
plumbing in the buildings of . . V... . . . . . . . . . . . . . . . . . . .
at. . �� -� . . . . . . , North Andover, Mass.
Fee. � . .�. . .Lic. No..-.fr : ,... / c��, Z.% . . . . . . . . . .
PLUMB�N�GSPECTOR
Check #
5523
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print) ,, '"" ice
NORTH ANDOVER,MASSACHUSETTS
DatJ U�
Building Location c,-,// Owners Name / _ Permit 3 7
c�
Ij icy
Amount
Type of Occupancy
New Renovation Replacement El Plans Submitted Yes El No
FIXTURES
STB-I�1vIC
�I1`DEIt
�kl
Sm
(Prkit.or type) Check one: Certificate
Installing Company Name �U� c2,2 G ) ri Corp.
Address ✓ ^J _ 0 Partner.
Business Telephone El FUMVCo.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity D 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
ignature 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 Massgchusetts Stat hz ing C and Cha ter 142 of the General Laws.
By: Signature ol DcenseorlumDer
Type of Plumbing License
:Title �� '3 }
City/Town icense I1mDer Master D Journeyman
APPROVED(OFFICE USE ONLY