HomeMy WebLinkAboutMiscellaneous - 45 Wildwood Circle �lsWidw�,dCSR<I� \
BUILDING FILE
Date. .
Of
"��'" TOWN OF NORTH ANDOVER
� 1,y
'• O
PERMIT FOR PLUMBING
;,SSACNUSE� )
This certifies that .F�f .,:,.f..s�: . . `� . �!�K. . . . . . . . . . . . . . . . .
has permission to perform . . . .P.(7A 0+ -. N* l. :. . . . . . . . . . . . . . .
plumbing in the buildings of . . TVA .... . . . . . . . . . . . . . . . . . . .
at . . North Andover, Mass.
f-G r--
Fee. 'rLic. No../ f !. . !.:� , . . . . . . . .
PLUMBING INSPECTOR
Check # `
MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING
(Print or Type)
Mass. Date Z52 20� Permit #� ( ,gam 01
Building Location l J 6u1 ,ai hr9 j, D—wner's Name_
Type of Occupancy__
New❑ Renovationb�:.r Replacement ❑ Plans Submitted: Yes❑ No❑
FIXTURES
B.P. # SEWER # SEPTIC # .
z
"' `� >- O` a, / z > w
0O W 1¢— w �' �_ Z O z a W
In L0 to 2 ~cl� U w cn u_ z z �-
W w O . w ¢Lr) cn ¢ . w a
¢ _ = a z = Y a o ¢ w IL
¢ ¢ O H Ln
m �n o o LL Uj
oz ¢ o LL I o (D n o a �¢ 0 0
SUB-BSMT
BASEMENT
�. 1ST FLOOR I j I
2ND FLOOR )
3RD FLOOR
4TH FLOOR
3 5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
nstalling Company Name �/�7},/ 1,( �)_ Check ong: Certificate
kddress� 20LZ-Allj �i
>=Qwporation
P61 D &0 o lib
iusiness Telephone / 2 j ❑ Partnership
L j eowu6-7-
- ❑ Firm/Co.
lame of Licensed Plumber or Gas Fitter__
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes No . ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURNACE 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.
Signature of Owner or Owner's Agent Check one:
Owner ❑ Agent ❑
iereby certify that all of the details and information I have submitted (or etere )In above'application are true and accurate to the best of
n
'y knowledge and that all plumbing work and installations performed under t ermit issued r this application will be in compliance with
I pertinent provisions of the Massachusetts State Plumbing Code and Cha 2 of the Gen I Laws.
AA
Title Tigna ur of License Plumber
Tit
City/Town
APPROVED(OFFICE USE ONLY) Type of License: aster ❑Journeyman
License Number_T I