HomeMy WebLinkAboutMiscellaneous - 7 Fernview Avenue U-9 7 FERNVIEW AVENUE U-9
210/452.8-0007-0009.0
Date��: �
N° 42- 2 3
4, TOWN OF NORTH ANDOVER
3.�'� - �•hoc
PERMIT FOR PLUMBING
,SSACNUS�
This certifies that . . . . . . . . . . . . .
has permission to perform . . . . . ."� `.`:` �` �� . . . . . . . . . . . . . . .
plumbing in the buildings of . -�'t . . . . . .. . . . . . . . . . . . . . . . . . . . .
at . . 'Z . .`�.-4 .,..�!-��^-`'`� `'�'`e" . . . . . . North Andover, Mass.
i . . . . . . . . . . . .
MB
/., PLUN INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
2
MASSACHUSETTS UNIFORM APPLICATION OR PERMIT TO DO PLUMPING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
9 Date�r
Building Location e l� Owners N "!/� ! �. APermit# �
Amount p�
TypeofOccupancy
New Renovation Replacement031/ Plans Submitted Yes ® No
FIXTURES
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(Print or type) ' Check one: Certificate
Installing Company Name El Corp.
Address Partner.
Business Telephone Firm/Co.
"Name of Licensed Plumber:
Insurance Coverage: Indicate the r of insurance coverage by checking the appropriate box:
4 Liability insurance policy 1 /V Other type of indemnity ❑ 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
Signature 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 instal 'ons performed under Permijdssued for this application will be in
compliance with all pertinent provisions of the Massachusetts a Plu in a and apfer 142 of 1 ws.
By: 7ig—n7pMo kens um er
Type of Plumbing License
Title
City/Town icense Numner Master Journeyman ❑
APPROVED(OFFICE USE ONLY
55 '1 Q Date!. . . ...
HpRTN TOWN OF NORTH ANDOVER
0 � `p PERMIT FOR GAS INSTALLATION
,SSACHUSEt
This certifies that . . . . : �- -f. . . ..-.. ... . . . . . . . . . . . .
has permission for gas instal}ation,,.4/ a......... . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . .
at North Andover, Mass.
Fee% . . . . . . Lic.
40,&2d // 'CTAS INSP;CTwR
WHITE:Applicant CANARY:Buildinlgg Dept. PINK:Treasurer
MASSAZ7IN LFD APV CATON FOR PERNUT TO DO GAS G
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ype or print) .PARCEL Dat G ) 19
NORTH ANDD
Building Locations / rj?L'0 fL / ,4 —
-�`� _ UI I Permit 9 3�/d
A2A elA �� Amount S
Owner's Name
New❑ Renovation Replacement Plans Submitted ❑
A
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B A S E M E N T
I ST F L O O R
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4"r 11 FLOOR
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7T 11 . FLUU R
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(Print or Check one: Certificate Installing Company
Name Corp.
Address l ld ❑ Partner.
Business Telep one Fq-Firm/Co.
Name of Licensed Plumber or Gas Fitter Q
jyj:�_��W a7l
INSURANCE COVERAGE Check one-
1 have a current liability Insurance policy or it's substantial equivalent. Yes ❑/ Nom
Ifyou have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑� 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:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
i herebv 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 ins ions performed under Permit ( sued For this application will be in
compliance with all pertinent provisions of the Massa use S to Gas de a hapter ?of the General ties.
Bv: Signature of Licensed Plumber Or Gas Fitter
Title ❑ Plumber
City/'Town ❑ Gas Fitter License i umoer
��vlaster
Journeyman
APPROVED wFFU-USEONLY) ❑