HomeMy WebLinkAboutMiscellaneous - 106 MILLPOND 4/30/2018 WMILLPOND
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NORTh f;
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TOWN OF NORTH ANDOVER
1 i PERMIT FOR GAS INSTALLATION/
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This certifies that . , A l l . !s./c A . . . . . . . . . . . . . . . . .
has permission for gas installation . . W. IVY . . . . . . . . . . . . . . . . . .
in the buildings of . . . Y 1.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . .. North Andover, Mass.
Fee.a2.4. - . . Lic. No. L: . . . . . . . . . . . . . . .
G4S INSPECTOR J:
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5774
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MASSACHUSETTS -UNI,FORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) 1 ele-
/ Mass. Date _ 2( 06 Permit # J 77Y
Building Location 404 �� Owner's Name
Type of Occupancy /'] $
New ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑
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BASEMENT
1ST FLOOR
2141) FLOOR
3RD FLOOR
i
ATH FLOOR
STti FLOOR
6TH FLOOR
7TH FLOOR
LO-0TH FLOR
Installing Company Name �'L.G ��9%s7Check one: Certtlicate #
Address ❑ Corporation
Gam'
&W, 0 ,FWG ❑ Partnership
Business Telephone t -/Firm/Co.
Name of Licensed Plumber or Gas Fitter r�L IJiS1G
INSURANCE COVERAGE:
I have a current IJablitty Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes [' No ❑
If you have checked yes, please
eIIndicate the type coverage by checking the appropriate box.
A Itabllfty 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 Ctivner 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 �ba�l
urate to the best of my
knowledge and lhat all plumbing work and Installations performed under file permit I ue for this appiicatlo will ompllanm with all
pertlnent provisions of the Massachusetts Stale Gas Code and Chaplet 142 of th4G 'h aiLa s
Te of Ucense:
Title Plumber Signalure of Ucenseder r Gas filer
WQ_>Sfi(lor //,:.v
City/Town aster Ucense Number
M(i1C7Vf n O C C Journeyman
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION
SKETCHES PROGRESS INSPEC ION
FEE
N P.
APPLICATION FOR PERMIT TO DO OASFIT T ING
I
NAME b TYPE. OF BUILDING
LOCATION Or- BUILDING
PLUMBER OR GIASFITTER
LIG NO.
PERMIT GRANTED
DATE-2O
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GA31USPECTOR