HomeMy WebLinkAboutBuilding Permit #2930 - Fountain Drive 9/2/1998 930 �`,�`>
Date /, •••••
it
HORTM TOWN OF NORTH ANDOVER
't'O
3? °� a PERMIT FOR GAS INSTALLATION
7SSACHU`'ES
This certifies that .: . .�, . . . . . . . . . . . . . . . • • • • •
has permission for gas installation . . . . . . . . . . • • • •
in thg buildings of A. F 1� ��c. �.+:. . !.1< <; s�:.. . . . . . . . . . . . .
at . . h Andover, Mass.
Fee. . . . . . . . . 15: �p
�� Gi4INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
I Y
1 d
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING
Type or print)
Date �� 19
NORTH ANDOVER, MASSACHUSETTS p c�
Building Locations �/tU/� 7Z�/ �i\ Permit# / '3
Amount$ �-
Owner's Name
[l Q,
New❑ Renovation ❑ Replacement ❑� Plans Submitted ❑
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SU B-BASEM
ENT
BASEMENT
1ST. FLOOR
2N D. FLOG R
3RD . FLOOR
4T 11 . FLOOR
5TH . FLOOR
TT-11 . FLOOR
7T 11 . FLOOR
8T 11 . FLOOR
(Print or type) Check one: Certificate Installing Company
Name 0 "' i n 7.n ❑ Corp.
Address V ❑ Partner.
(�'��
Business Telephone pa rm/Co.
Name of Licensed Plumber or Gas Fitter J
INSURANCE COVERAGE Check one•
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked Les,please indicate the type coverage by checking the appropriate box.
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:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
ri 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 Pe it Issued for this apt
Pica will be in
rompliance with all pertinent provisions of the Massachusetts State Gas od and Cha er 14 a Gene aws.
By: /Signature of L' ensed umber Or Gas Fitter
Title lumber
City/Town ❑ Gas Fitter License Mmber
❑ Master
APPROVED(OFFICE USE ONLY) ❑ Journeyman