HomeMy WebLinkAboutMiscellaneous - 47 Mathews Lane a
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7777777
Date
3445
�'<"��TM 1�0 TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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This certifies.that A .1�. . . . . . . . . . . . . . g
has permission to perform . . . . < . . . . . . . . . . . $
IV e w n d d
plumbing in the buildings of .
at-1/7.X11 , North Andover, Mass.
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Fee ,' . Lie. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLUMBING INSPECTOR
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WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
A
`�. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
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19 Permit #
t'. uI Mass. Date 1----
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Owner's Name
Building Location
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( M C��d: M 11-. T of Occupan
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New/ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑
FIXTURES
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3S � No3S3 � �� � 03ONi0
SUB•BSMT.
BASEMENT
lot FLOOR
,2nd FLOOR 1
1 11h
3rd FLOOR
4th FLOOR
Sth FLOOR
6th FLOOR
7th FLOOR
Sth FLOOR
�t� S Check one: Certificate
Inst,--(ling Comp an Name
Address VCorporation
❑ Partnership
e„t1.1 Telephone 7 /7 ❑ --
Nar i r' licensed Plumber 11
ltd ,t1. :; E COVERAGE:
I have , .qrientJaWity insurance policy or its substantial equivalent wheth mow” rhe requirements of MGL Ch. 142.
1 „ No C1
if you ._ °,.-eked yes, please i icate the type coverage by checklnit the gVnprl-"box.
A liability Insurance policy t� Other type of indemnity O flnnd t
olvNER'S INSURANCE WAIVER:I am aware that the licensee does not hav*ow-n,ufance coverage required by Chapter 142 r'1�► `
General laws, and that my signature on this permit application waives this mgwlrf wqN. Check orw-
Owner 7 Anent
Si;r,mure of owner or Owner's Agent
I hr.�rr ceenfv 1hN all nl d»deudl and mformalw"1 have tubf�mlled la a wgvilll In A .~ale ud X rale to II+e he'll d mr krwT.lal�e AW ^'
and r.�alluom perfMmld under die perms neued for this application will be m c 1MKe M NI
the MalWhuMnl Stale fRwnbm*Code am 1�� t,1 •..r
Signatute Lic uid um"
irpe of tice+.le Mauer I� bwMrnan 7
RiCrr1W NumbM
r tr.n
rtPPRONIO 10FKt USE ONLY
613 Date11�zzel-x
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,�ORTM TOWN OF NORTH ANDOVER
Of •,,co ,^1ti0
PERMIT FOR GAS INSTALLATION
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�,SSACHUSES
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This certifies that . ./`.:r. ./. . '`• l . • • . . • • • • • o
has permission for gas installation . .Al. L.!� . ""'• e
in the buildings of . le':lf.'' -(: . . `. . . . . . . . . . . • . • • . • • • • •
at .��?. l .?' P•`'` • �• • • • • • • • • • • • • •, North Andover, Mai.
Fee. . 742, . Lic. NoJ U� V t . . . . . . . . . . . . . . . . . . . . . . . .�.
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTIN' G
• (Print or Type)
NORTH ANDOVER Mass. Date ;/ '
4uilding Location t-/ `� rb1.=V3 a0 ns Permit # 0PC/3
Ie vary Owners Name
> New '"L/Renovation Replacement Plans Submitted D
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ul Q7 C O V
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tII N 11 < C O O^ A, O W 1—
W d W W F » s Cr. y 4
N C W = O W
v: a W Z v �, Q r. er
W W 07 1 d w C7 W W
W W O T LL F� W
Q Q t7 U. .1 V G� y Q O. O
SuH—aS*1IT.
BASEMEXT I I I ( I I I I I
IST FLOOR
2ND FLOOR
3RM FLOOR
4TH FLOOR Ll I I I` I I I I I I I
STH FLOOR
6TH FLOOR I I I I I I
TTI{ FLOOR I I I I ( I
8TH FLOOR ( I ( I
(Print or Type) Check one: Certificate
Installing Company Name ,✓V Corp. j �
Address E!.-0, 6
a q� ['7D i Partner.
�� >� I A4 a �� � � Firm/Co.
Business Telephone: 5-a�
Name of Licensed Plumber or Gas Fitter (ry,,Z-,�
Insurance Coverage: Indicate ti%e type of insurance coverage by checking the
appropriate box:
Liability insurance policy her type of indemnity Q Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 17 Agent Q
1 huebY certify tlut all of the details and information 1 have submitted (of entered)in above application are true and accurate to the best of MY
knowtedge and Mat all plumbing work and WEALLatioes 7e forazed under Permit ivaed for this spptication wiU-bc ist compiiaaoa With ail pertiaeat
provisions of tho Massachusetts State Gas Cade and Qaptet 142 of=0 i+eaeral L►ws.
_PE LICENSE:
By Plumber
Title Gasfitter Signature of Licensed
...aster Plumber or Gas 2. ter
City/Town: Journeyman S
APPROVED (OFFICE USE ONLY) License 1,1umber