HomeMy WebLinkAboutMiscellaneous - 107 SECOND STREET 4/30/2018 107 SECOND STREET
210/019.0-0055-0000.0
I
Date. !. . . n. .... ..
,aOR TM ,.,.
j �Oya
3 TOWN OF NORTH ANDOVER
O � 9
• PERMIT FOR GAS INSTALLATION
4 i
. 9
�7SSACMUSEtS
This certifies that . . . . . . . . . . . . . . . . .
has permission for gas installation .. :*4: . _. . . . . . . . . . . . . . .
in the buildings of .. . . tt . . . . . . . . . . . . . . . . . . . . . . . . . .
at Z:' 7 . . . . . .. North Andover, Mass.
Fee. i-. . Lic. No.!' ...3 . . . �;: ...� '�!'✓ . . . . . . . . . . .
a GAS INSPECTOR
Check# a 23
6566
MASSACHUSETTS UNIFORM APPLICATION FOR"PERMIT TO DO GASFITTING
(Pri t�)
i ,Mass_ D tE 20 Permit
Bul ding L ation Owner' Otte
(� 'type of occupancy
Newo Renovation 0 '-Replacementgl"', Plans Submitted_ Yes 0 No 0
�c ) chi p
t�t O Q m E , to
z O w o;
O
3
o
W .o > ;
z < _ z ; . >
, 9 z z M z C)
W _
3RD FLOOR.
4TH FLOOR
STH FLOOR .
5TH FLOOR
7TH FLOOR
8TH FLOOR 1
installing Company Narn�(/RQb� rT t_ Check one: Certificate
Add s l3 Corporation
1
,r 0 Partnership
Business Telephone
p l
f
rm1C o.
Name n�fLicensed Plumber_orGas Fitter
Fyou
OVERAGE:
rents bllity insurance policy or its Substantial equivalent, which meets tie requirement of MGL Cly. 142.
No 0 ��.
IF checked yes,please indicate the type of coverage by checking the appropriate bow
A liability insurance policy Other type pf indemnity 0 Bond 0
OWNER'S INSURNACE WAIVER: 1 am aware that t1j.e licensee does not have the Insurance coverage required by Chapter
142 of the Mass.General Laws, and that my sig)ature on this permit app3lcation vtiraives this requirement
Check one.
Signature o Owner or owner's Agent Owner 0 Agent 0
I hereby certify that all of the detalis and information(have submitted for entered►in above application are true and accurate to the best of
my knovNedge and thataii piumbina work and Installations performed under the per sued for this appilcatic ti be in complia ce wltt,
all pertinent provisions of the Massachusetts State Gas_Code and Chapter'142 of the CAneGN L _
Type of License:
By 0 Plumber kMore of Lice i ber or Gas Fitter
Title DG -,_ter !�
citytrown ter License Number
APPROVED(OFFICEUSE GN'LY 1 0 J ourneyman
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
/ 1/(�/ Mass. Date �"� 19
CityTown
Permit # / 3�
Building ((�� /' Owner's
AT: Location �Q 7-/0 9 tJG�Lo�I/l U Name 1A0 2 Q
Type of Occupancy:
GNew Renovation El Replacement
Plans Submitted Yes [] No
N
Y W N
N N V = W. to
tr
W I—
0
W W t. 0
J N
w (7 O W ~ < CC 0 0 0 Z W
W N H Q ¢ 0 0 O W F
W Q W W F, N d Q Q
N C7 Y Z O >
Z W W W J z Q Z W cc W M W f W r s N cc
a h- Z y F- Z f W W O > LL h V J H W
Z a W 6 oc f' r 0 0 Z O Z W O N Z
C 4 W > W 0 2 Q K Q
¢ OC S O O Z W 3 0 C7 J 0 W > p 6 H O
3 SUB—BSMT.
e
m BASEMENT
m
I 1ST FLOOR
v 2ND FLOOR
N
E 3RD FLOOR
0 4TH FLOOR t
U.
STH FLOOR
6THFLOOR
7TH FLOOR
STH FLOOR
(Print or Type)
heck ;CneCertificate
Installing Company Name ( ( orp. ���
Address [] Partnership
❑Firm/Company
BusVnss Telephone s09 F-65,9/Name of Licensed Plumber or Gasfitter
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 Gas Code and Chapter 142 of the General laws.
By TYPE LICENSE:
Plu ber
Title -fitter S 'gnature of icensed
City/Town:
Master Plu ber or Gasfitter
APPROVED (OFFICE USE ONLY) Journeyman Wim
Licensee tuber
z
y BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME& TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE 19
GASINSPECTOR
:.3
Date..
F NORTq TOWN OF NORTH ANDOVER
4p
0 ' PERMIT FOR GAS INSTALLATION
s i
♦ o'"''+CGCG �--- 'a ,
SACMUSEtty
This certifies that . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee. . . . . . . . . Lic. No.!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
; ' ',, GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File