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HomeMy WebLinkAboutMiscellaneous - 1060 OSGOOD STREET 4/30/2018 (2) I 1 31IJ ONIallfiG Date./HANDOVER ' 0 'I . . . ... .. . ,�ORT/y of �` TOWN OF NO PERMIT FOR GAS INSTALLATION ,�o✓• q9 SACMUSE4 This certifies that . . . // r . . , 1 has permission for gas installation . . `!1 ti;!9'r t in the buildings of . �;O f, ,G�c 1.A'.`. .`.`. . . . . . . . . . . . . at . .���a . .QS yo C� Nosh Andover, Mass. Fee. .S , Lic. `pt._ .` GAS IN Check# 666; tNG ;MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITT fi rint or Type) p G Mass. Date_ A �'~ a 6 Permit # Owner's Name • ,Budding Location v Type of Occupanry 0 M New 0 Renovation 0' Replacement . Ptans Submitted: 'YesQ No N Q W {v N x =Cr ¢ ri► uai �: a o U m ca , o: tW- A Y Z = O r z o u < ¢ < o o W < m m t- y m o z z � a cWi W yr < = s t7 ¢ V J W O } 2 F Z t-UA } N m 2 2 a O' W S Y < .W < C < rC < < O O �tl O O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Nam �t►eck one: Certificate e P,AIt NF Pt S- — ©/ Address PO BOX 603 Corporation yt n ivy a [3. Partnership Business Telephone - � L] -Firm/Co. Name of Uceased Plumber or.Gas Filter. INSURANCE COVERAGE: 1 have a current ' Ifty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1 No . If you have checked�L, please 1 icate the type coverage by checking the appropriate box Habil insurance icy 17 Other type of indemnity 0 Bond 0 A liability pa WNER'S INSURANCE.WANER: 1 am_aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass: General haws, and that my signature'on this pemnitappticatiori waives this requirement OwnerC one: Agent 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations_p6dormed under the permit issued for this application 1,,be in'compliance with.all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GenerMliv T of'license: . Plumber gnature of'Licensed _umber orFitter- sr tter — Master License Number City�Town .foumeyman 'hPPRONED( 1. L , - 9.