HomeMy WebLinkAboutMiscellaneous - 105 FARNUM STREET 4/30/2018 (2)N
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that... if
has permission for gas installation
in the buildings of ......................... .
at ... .... F......' �.... �?��! ...... , North Andover Mass.
Lic. No. 13 f (.. f. (::.j.�.
GASINSPECTOR
Check #
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: X)04111 A jd.er MA. Date: KS o?,3
Permit#
Building Location: 105-- Afmko, Owners Name:
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Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
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New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Vj-," Plans Submitted: Yes ❑ No ❑
Mvr"13
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 5]Ao ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ED,,— 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
❑
-Signature of Owner or Owner's Agent Owner ❑ Agent
By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) renardina this aoolicatinn nra trim nnrt
-� •w • � .,wo.w my mwwiruye anu inai au piumomg work and installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
❑ Plumber
Title ❑ Gas Fitter
❑ Master
Cityrrown ❑Journeyman
APPROVED (OFFICE USE ONLY) ❑ LP Installer
Signature of Licensed Plumber/Gas Fitter
License Number: 13yd—/
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Check One Only Certificate #
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Fax:
❑ Partnership
Name of Licensed Plumber/Gas Fitter: ac �r
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❑Firm/Company
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 5]Ao ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ED,,— 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
❑
-Signature of Owner or Owner's Agent Owner ❑ Agent
By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) renardina this aoolicatinn nra trim nnrt
-� •w • � .,wo.w my mwwiruye anu inai au piumomg work and installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
❑ Plumber
Title ❑ Gas Fitter
❑ Master
Cityrrown ❑Journeyman
APPROVED (OFFICE USE ONLY) ❑ LP Installer
Signature of Licensed Plumber/Gas Fitter
License Number: 13yd—/
90t��
Date.. !l: (- < < ...
�'<: •.:�ti TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...?.. P ....`r..� `�?- �^..':......
has permission to perform ...lit
plumbing in the buildings of ...0 t....4T ..............
at .. IP 57. . (~G ! ..S f.`—e% , North Andover, Mass.
Fee -b9'00. . Lic. No. X YZ I( . ..............................
PLUMBING INSPECTOR
Check # 1 cl �?
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EE��� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
fftilding
wn: 0,,�
MA. vpermit#
Location: �0J`Fccv
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wners Name:p�£� re7`
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Type of Occupancy: Commercial ❑ Educational ❑
Industrial ❑ Institutional ❑
Residential [4 --
New: ❑
Alteration: ❑
Renovation: E]—Replacement.- Plans Submitted: Yes ❑ No ❑
FIXTURES
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Fax: �"'_'—
❑ Partnership
Names a of Licensed Plumber
l�/� �` 9 �`yJ�
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❑ Firm/Company
INSURANCE COVFIzar�•
Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes U,IQo E]1 have a current liabilitlr
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy. Other type of indemnity ❑ Bond ❑ -
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does_ not p have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Sicinature of Owner or Owner's A ent Owner ❑ Agent ❑
hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and rcurate
Knowledge and that a!I plumbing t:ork and
installations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 742 of the General Laws, a- to the bas` o. my
By
Type of License:
Title
❑ Plumber
:'-ity/Town ❑ Master
kPPROVED (OFFICE USE ONLYI ❑Journeyman
– til ( / ..
Signature of Licensed Plumber
License Number: /3 41d
1
CONTROL # . G 019 9 9 9
a 'IMPORTANT
If Ibis license is lost or destroyed, notify your Board at the:
Division of Professional Licensure, 1000 Washington St.,
7th Floor, Boston, MA 02118:
If your name or address shown is changed, notify your board
of correct name or address to insure proper maili f
COMMONWEALTH OF MASSACHUSETTS
l
N- M'BE'�-iAIV AS ITT -ERs
i LICENSED AS A MASTER PLUMBER
I -
ISSUES THE ABOVE LICENSE TO: '
! WILLIAM J DIGIUSEPPE III
Mai-
o next 7 BROOKSIDE LANE
Renewal Application. Always refer to your license number.
This license is subject to the provisions of the General Laws I ; i
as amended. It is a personal privilege, and must not er loaned I NEWTON N H 0 3 8 5 8- 3 2 3 6, k
or assigned to any other person. Keep this license on your ; "
person or. posted as required by law. 13421 05/01/12 787692 3 t3
r"iai..Id;G +Yi •, a i'
CONTROL # e9
�000
i
If this license is lost IMPORTANT
I Division of Profe
( 7th Floor,Boston Mq 021, ce Buren 1p� our Board at the:
na!
If your 8. Washington
' Warne or address St.,
Of correct ss shown is
Ren name or addressthan
This I- al Applicenseation. Alwa sp insure propenotify Your board
amendedas s su feet to t Y refer to your license
of next
or assi . It is a personale Provisions of the ease number.
Person or ed to any other privilege and must General laws
Posted as required by lawKeep this license onnot be oyoud
t++.
r ----.COMMONWEALTH OF MASSACHUSETTS !I
I
IPPPTLUIERS�1=1NDG=SFITT=E`R�S
i LICENSED AS A JOURNEYMAN PLUMB
ISSUES THE ABOVE LICENSE TO:,
� I.I
t WILLIAM J DIGIUSEPPE III
I� 7 BROOKSIDE LN "SII
NEWTON NH 03858-3216
23062 05/01/12 787693
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Date ....Z. ��.. 9; ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .:.....:.,...--l.,o w G�
..................................... .........:...............
has permission to perform ' ..................
wiring in the building of�-�
.......................... ..../..............................
r�z5
at ...................----r?� -1' ................ , North Andover, Mass.
Fee'36......... Lic. Nom
aTRICAL INSPE R
Check # _-41w U
8344
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 4 Byy
Occupancy and Fee Checked
[Rev. 1/07] (jpavr hlankl
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9— /�_ 0 ap
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) %QS
Owner or Tenant 12_1'f L54
/-/ 4 4 Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 17` No ❑ (Check Appropriate Boa)
Purpose of Building e, j) Jnn Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
('n 7.":..n ..l 4.- r n....___._zr
No. of Recessed Luminaires 3
I ... � vyw&& J
No. of Ceil: Susp. (Paddle) Fans
tuute may oe walvea Dy the Inspector o Wires.
No. of Total
Transformers KVA
No. of Luminaire Outlets ---
No. of Hot Tubs
Generators KVA
No. of Luminaires �/Swimming
Pool Above ❑ In- ❑
nd. nd.
o. o mergency Lighting
Battery Units
No. of Receptacle Outlets 9
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiatin Dir'vices
No. of Ranges
I
Nf Totali
o. oAr Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
,Number ,.Tons
_
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal [I Other
No. of Dryers ----
No. of WaterNo.
Heaters KW
Heating Appliances KW
No. of al of
Signs Ballasts
Security Systems-*
of Devices or Equivalent
Data Wiring:
No. of Dvices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:_ (When required by municipal policy.)
Work to Start:9_40v_Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: fj 9KM QIrya Signature LIC. NO.: 315az)3 �
Addble, ente"exempt 11 in the Ii ense nu er line.)
ress Bus. Tel. No. - ,6 /J' o73S3�D 7
E c-- Z' Alt. Tel. No.:
*Per M.G.L c. 147, s. 57 61, secunTy work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent ti
Signature Telephone No.
I
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official UseOnly
Permit No.
Occupancy and Fee Checked
[Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -9-/J- op
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 19t �1 t�.�
Owner or Tenant AkI! �Q �� -- r Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 'P� No ❑ (Check Appropriate Boz)
Purpose of Building esJe., J�J , Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Co m�lntinn nftho f n ,.d. t l / .« t__ _rL_..�__ .____
No. of Recessed Luminaires ,3
—
No. of Ceil: Susp. (Paddle) Fans
u�« .nuy ae rvuweu u cnc Jw eeror o rvires.
No. of Total
Transformers KVA
No. of Luminaire Outlets --
No. of Hot Tubs
Generators K -VA
No. of Luminaires 4/
Swimming Pool Above ❑In- ❑
o. o Emergency Lighting
rnd. rnd.
BatteEy Units
No. of Receptacle Outlets 9
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Dbvices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers r•
Heat Pump
Number
I.Tons
KW
No. of Self -Contained
Totals:
Detection/Alertina Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems: *
No. of Water
No. of No. of
N o. of Devices or E uivalent
Heaters KW
Signs Ballasts
DataNo.
ofitinDevices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
furacn aaairionai aetau zj desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: �!Zw, (When required by municipal policy.)
Work to Start: -ply Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: h~11 or n e Signature LIC. NO.: 3saZ)3
(If applicable, enter "exempt " in the li ense nunlker line.) Bus. Tel. No.: f)3 a� 353 2
Address: E f C{� Y N_N% � Z$i Alt. Tel. No.:
*Per M.G.L C. 147, s. 57461, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent t�
Signature Telephone No. PERMIT FEE: �'-
0
P-tts ate, A -d- 11-499-14
4
I
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLFibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: AJ 4 (D -V (� Phone #: _ 6 03a 35 337 Z
Are you an employer? Check the appropriate �bx:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2.G11am a sole proprietor or partner- listed on the attached sheet. I
ship and have no employees These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
workers' comp. insurance.
❑ We are a corporation and its
officers have exercised their
right of exemption per'MGL
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11 - [:1 Plumbing repairs or additions
12-❑ Roof repairs
13-❑ Other
f • uv err= ��_= u=aI —ll UV,. "1 MUM also 1111 UUL me section ueiow snowing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company N
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Phone #: �--�
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Issuing Authority (circle one):
Permit/License #
r
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
Date. f�... .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
�'$ACMUSE
This certifies that .. ........
has permission to perform .........
plumbing in the buildings of ......_n. Yt� �i ........
�r
at.
, North Andover, Mass.
�D / %
!`.... .Fee. .. . Lic. No..
7;.'TCheck# v PUMBING l OR
7828
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location M �~ Fc-el�Clkn & Owners N
14-k 2eAJCN e /" Type of Occup
1
i
New ri
ee•
� ee�
.� gee
i ee�
i ee�
o ee•
i er.
Renovation Replacement
FIXTURES
/ Date ll
Permit # a
Amount
Plans Submitted Yes 1:1 No ❑
(Print or type) f Check one: Certificate
Installing Company Name i/y� i�h r .�"�, c�� ❑ Corp.
Address __ 7 ' . %'rxil�ef ! e—t n e
❑ Partner.
Business Telephone ��17,�lam_ 9 77 7 ff Firm/Co.
Name of Licensed Plumber: A i / ( a,( G<
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy rif `�' 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
Signature Owner ❑ Agent 0
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 State Plumbi Code d Chapter 142 of the General Laws.
Sf c
By: [ ���
ig a u e o icense um PT
APPROVED (OFFICE USE ONLY
Type of Plumbing License
/'?'-/2/
ice seum er Master
Journeyman ❑
40RTH
p
1
o S�
Date.........<�..
TOWN OF NORWAN OVER
PERMIT FOR GAS INSTALLATION
This certifies that ......J. �-�.
has permission for gas installation- 'G" .- ..............
in the buildings of ....... Q�-'��U................. .
y
at .. ..... .... , North Andover, Mass.
Fee ....
Lic. No.. J?�a1.. ... .11 ...........
GAS INSP„EOR
Check # 241,:5-7
6522
MASSACHUSETTS UNIFORM APPUCATON FOR PERNUr TO DO GAS F rl] NG
(Type or print) Date 41_6/ COP,
NORTH ANDOVER, MASSACHUSETTS
Building Locations _ l G S�tii!��1�m /L%
Permit # �6
Amount $$
�..5
Owner's Name
New D Renovation Ell" Replacement Plans Submitted
D
(Print or typ
Name
Name of Licensed Plumber�or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE
I have a current liability Insurance, policy or it's substantial equivalent. Check
Yes � .
If you have checked Les, please indi to the type coverage by checking the appropriate box. NoO
Liability insurance policy � Other type of indemnity D 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.
Signature of Owner or Owner's Agent Check one:
OwnerAgent13
I hereby certify that all of the details and information I have submitted (or entered) in above application are true
best of my knowledge and that all plumbing work and installations performed under Pand accurate to the
ermit 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:
Title
City/Town,
'APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber
as Fitter License Number
er
[B -Master
DJourneyman
3,9,SD
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SU B-BASEM ENT
BASEMENT
1ST. FLOOR
2N D. FLOO R
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
BT H. FLOOR
(Print or typ
Name
Name of Licensed Plumber�or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE
I have a current liability Insurance, policy or it's substantial equivalent. Check
Yes � .
If you have checked Les, please indi to the type coverage by checking the appropriate box. NoO
Liability insurance policy � Other type of indemnity D 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.
Signature of Owner or Owner's Agent Check one:
OwnerAgent13
I hereby certify that all of the details and information I have submitted (or entered) in above application are true
best of my knowledge and that all plumbing work and installations performed under Pand accurate to the
ermit 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:
Title
City/Town,
'APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber
as Fitter License Number
er
[B -Master
DJourneyman
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