HomeMy WebLinkAboutBuilding Permit #Exception - Fountain Drive 3/18/1990 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
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Mass. Date 3 _ 19 _ Permit #
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Building Location '011,0-T19/N 46 Owner's Name � � rI
n V 5/sit
W
/qhs Type of Occupancy
5�0 New ❑ Renovation O Replacement ❑ Plans Submitted: Yes ❑ No 0
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SUB-BSMT.
BASEMENT
j 1ST FLOOR
2ND FLOOR
3RD FLOOR
14TH FLOOR i
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name ICIeAA Check one: Certificate #
Address 3 I/9C La S? Corporation
G/'9 w rH jt sf, Partnership
Business Telephone ��j� E Firm/Co.
Name 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 r
If you have checked ries, please indicate the type coverage by checking the appropriate box.
A liability insurance policy. 0 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:
Owner ❑ Agent ❑
Signature of Owner or Owner's 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions
of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License:
Plumber
Title Signature asfitter of LicePlumber mber or Gas Fitter
City/Town Master License Number
APPROVED (OFFICE USE ONLY) �7 s
Journeyman
f
A
Y
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES NO. PROGRESS INSPECTIONS
MERCURY TEST
FEE
FINAL INSPECTION
APPLICATION FOR PERMIT TO DO GASFITTING
NAME & TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE 19
GAS INSPECTOR
Cit} of Lawrence
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�+�•t Inspectional Services Department
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Tel.794-5950 200 Common Street
Office Hours:8:30 A.M.To 10:00 A.M. —1 TO 2 P.M.