HomeMy WebLinkAboutMiscellaneous - 108 PRESCOTT STREET 4/30/2018 108 PRESCOTT STREET
210/082.0-0009-0000.0
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Date..,. l+Z...... ..�?........:.........
NORTh,h
o�' TOWN OF NORTH ANDOVER
—goalPERMIT FOR GAS INSTALLATION
HUS�t
This certifies thatQQ-........::.......................................................................
has permission for n ..(V - :: ,....'9:......Ps..�.. ..............as inst latio
inthe buildings (of......:....... . ....................................................................
at......1..L�.56..........T 'f.............................. " ................ North Andover, Mass.
Fee.. ....... Lic. No. A�.�...`{:...`��..... ...H. .................................................
GASINSPECTOR
Check# �
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•` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY MA DATE act PERM # %D
JOBSITE ADDRESS !C7 — r e S ca rt OWNER'S NAME ¢ �,
GOWNER ADDRESS TEIf— :3FAX
TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLFIA,RLY NEW:[Q RENOVATION: REPLACEMENT:[3— PLANS SUBMITTED: YES NO
APPLIANCES 7 FLOORS-
BOILER BSM 1 2T _3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER �—
DRYER
FIREPLACE r
FRYOLATOR
FURNACE - --
GENERATOR r—
GRILLE
INFRARED HEATER Y _�
LABORATORY COCKS _ (�—
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNV�ENTED ROOM HEATER
WATER HEATER
OTHER e rf..% vna✓e oT
INSURANCE COVERAGE
have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES Iwo 13
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
i
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND 0
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.
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CHECK ONE ONLY: OWNER® AGENT �!
SIGNATURE OF OWNER OR AGENT .
hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the Vst of y owledge
and that all plumbing work and Installations performed under the permit Issued for this application will be in com all Pe ' ro ' i of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ��� F, LICENSE# f Shy ` S N URE
MP[3,MGF 0 JP ® JGF Q LPGI® CORPORATION .3(.,( PARTNERSHIP®# LLC
COMPANY NAME: ee_ ro g Sez,, e ADDRESS —
CITY STATE' /1I�. ZIP 2 ! 2 2 TEL G,
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