HomeMy WebLinkAboutMiscellaneous - 285 Marbleridge RoadDateA
TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
CHUS
This certifies that ...
has permission to perform ...
plumbing in the buildings of ... i2,>� ...................
at . -�, :7� --3 ...... 0� r-� Q.jX- North Andov�er, Mass.
Fee.6PI .. Lic. No...03.Vf ...... Q �.. . ., .......
PCLUMBING INSPEC'rOR
Check# 67,3 Z-
6785
C
14
MASSACHUSETTS UNIFORM APPLICA
We or print)
building
_..Owner's Name
New Renovation ri Replacement 1:1 Plans Submitted
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PERMIT TO DO PLUMBING
Date
Permit # 'A?
Amount /– 9
(Print or type) Check one: Certificate
Installing Company Name Galinsky PluMbing & Corp. 1 Qnfi
Address P.O.Box 1701 Partner.
Hnggrhill MA niR-41
Busintss Telephone 978-374-1741 Finn/Co.
Name of Licensed Plumber: Stephen C. Galinsky
Insumnce Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
0 . 13 11
Insurance Waiver: 4 the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
r7ature,/ / Owner 0 Agent 1:1
I hereby certify that all of the details and information I have submitted (orAntipfid) in above application are true and accurate to the
best of my knowledge and that all plumbing work and install4ns?b nder Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachus P I e and Chapter 142 of the General Laws.
By: Ti7afure omicensea riumfor.—
Title I Type of Plumbing License
City/Town Llceih;4137- Master Ox Journeyman [j
APPROVED (OFFICE USE ONLY
Date. x ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that I I
( ............................
has permission for gas installation ... H:,�- .......
in the buildings of
at ........ North Andover Mass.
-I N-S-PECTOR
FeeJ6.0 ... Lic. NoA 'P�.Tf..
Check # 613 Z, -
54U9
MASSACHUSErIS UNIFORM APPUCATON FOR PERNUr TO DO GAS FfrnNG
(Print or type)
Name
Address ts
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes Noo
If you have checked Yes, please . d' te the type coverage by checking the appropriate boxP
Liability insurance policy Other type of indemnity 0 Bond 0
I 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 1—_3 Agent 0
i nereDy ceruiy mat an oi ine actans ana iniormation I nave submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations perform"ed/nder Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat9j G_V Co nd Chapter 142 of the General Laws.
I By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Mn- Signature of Licensed Plumber Or Gas Fitter
LL:F — Plumber / 02 VF
Gas Fitter License Number
Master
Journeyman
6
(Type or print)
Date
NORTH ANDOVER, MASSACHUSETTS
0"
Building Locations
Permit
#
&-P7
Amount
lee)
Owqg,�'s�Namlie
New Renovation
"O"�-Ilegriacement
Plans
Submitted
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0
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U
4
Z
0
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0
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0
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0
0
0
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C6
U
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F4
0
0
U
0
9z
0
U
0
UB -B A SEM EN T
BASEMENT
IST. F L 0 0 R
[S
22ND. F L 0 0 R
3R D. FLOOR
4T H. F L 0 0 R
5TH. F L 0 0 R
6 T H . F L 0 0 R
7TH. F L 0 0 R
8 T H . F L 0 0 R
(Print or type)
Name
Address ts
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes Noo
If you have checked Yes, please . d' te the type coverage by checking the appropriate boxP
Liability insurance policy Other type of indemnity 0 Bond 0
I 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 1—_3 Agent 0
i nereDy ceruiy mat an oi ine actans ana iniormation I nave submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations perform"ed/nder Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat9j G_V Co nd Chapter 142 of the General Laws.
I By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Mn- Signature of Licensed Plumber Or Gas Fitter
LL:F — Plumber / 02 VF
Gas Fitter License Number
Master
Journeyman