HomeMy WebLinkAboutMiscellaneous - 88 Kingston Street (2)Of HORTM q1.
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,SSACHUS�
Date ..-'� .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that jam' : �.!---�:°'' 1.,.. ?`. ! ........
f
has permission to'perform ................
plumbing in the buildings of . .... ...- -"................... .
•-���"-�'"�
.......... North Andover, Mass.
at .:off ../.� ... ........!`.
Fee. `la . ... L c. No./r,:'.r .'�. _�v- ..............
C PLUMBIN,dINSPECTOR
Check #
51/36
MASSACHUSETTS UNIFORM APPLICATION FO
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location n V-
Owners Name
of Occupancy
New 1:1 Renovation ri Replacement
FIXTURES
TO DO PLUMBING
Date .3 — % -o �f
Permit # 3
Amount i
Plans Submitted Yes No ❑
(Print or type)Check one: Certificate
Installing Company Name LLJ'=- i 11 Corp.
Address efD -'e"� Partner.
/nr%
Business Telephone y7,P' %373 3 y E Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicat&thea of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ 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
aSignature Owner El Agent
t 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 Massachusetts Plumbing C e Chapter 142 of the General Laws.
By: Signature or7rnsectriumDer
Type of Plumbing License
Title /dap �d'
City/Town icense NumDer Master 3— Journeyman ❑
APPROVED (OFFICE USE ONLY
.4
Date.....................
TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
This certifies that 4 6.. ..........
................
has permission for gas installation,-, ................
in the buildings of ...... ........ ...........................
at ........... North.Andover, Mass.
Fee. Li"c'. Nol'-!.2-. ........
Check # As INS �56T6
MASSACHUSETTS UNIFORM APPUCA
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
Owner's Name
New ❑ Renovation ❑ Replacement ®'
TO DO GAS FTTMG
Date 3— g - 0 d -1 -
Permit #
Amount $� S'27
Plans Submitted ❑
(Print or type) nao'� 6
Name �L
Address
•7
Name of Licensed Plumber or Gas Fitter
Chec one: Certificate Installing Company
Corp.
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [a--
No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
t
Liability insurance policy Other type of indemnity ❑ Bond ❑.
ti 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 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 Massachusettsate Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
nature of Licensed Plumber Or Gas Fitter
Plumber jO�Fs B
Gas Fitter icense um er
Master
Journeyman
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SUB -BASEM ENT
BASEMENT
1ST. FLOOR
/
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
4TH.
5TH. FLOOR
6TH. FLOOR
7TH . F L O O R
FLOOR
(Print or type) nao'� 6
Name �L
Address
•7
Name of Licensed Plumber or Gas Fitter
Chec one: Certificate Installing Company
Corp.
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [a--
No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
t
Liability insurance policy Other type of indemnity ❑ Bond ❑.
ti 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 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 Massachusettsate Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
nature of Licensed Plumber Or Gas Fitter
Plumber jO�Fs B
Gas Fitter icense um er
Master
Journeyman