HomeMy WebLinkAboutMiscellaneous - 11 MINUTE AVENUE 4/30/2018 ` ® :3 f Q
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o 3? �` TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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�9SSACHUSEt
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This certifies that . . . . . . . . . . . . . .
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has permission for gas.installattion 1.6?d t�!
in the buildings o �. . : .. . . . . . . . . . . . . . . . .
i at . . . . ., North Andover, Mass.
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kFee. Lic. No: . . . . . . . . . . . . . . . . . . . . . . . . . .
l GAS INSPECTOR
Check#
10 , 4899
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) ,l
)J Do V C —. Mass. Date I C 20 21')n4 Permit # `7 ( / —3(D -
Building
Building Location__ (,I T I= ST Ow er's Name F k A Q t� Cy/ /)y
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ype of Occupancy_ R L_ 1 n I)((R
New ❑ Renovation ❑ Replaceme Plans Submitted: Yes[] No ❑
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SUB—BSMT,
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
4ddress 55 MARSTON STREET RC1 Corporation 1862
LAWRENCE, MA 01840 El Partnership
Business Telephone -68.7-1105 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
AL Yes K No ❑
f you have checked yes. please indicate the type coverage by checking the appropriate box.
k liability Insurance policy Other
type of Indemnity❑ Bond ❑
3WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
:hapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
'ignature of Owner or Owner's Agent Owner❑ Agent ❑
hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and acc urAte to the best of my
nowledge and that all plumbing work and Installations performed under the permit Issu f r this application will n mpliance with all
ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (j i
T of License:
itle Plumber Signature of<Jcensed Plumber or Gas
Gasfitter 4
aty/Town Master License Number 31
f'PFiONED O FIC S_ONLY Journeyman
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BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
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APPLICATION FOR PERMIT TO ADO GASFITTING
.s• NAME TYPE OF BUILDING
LOCATION OF BUILDING
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PLUMBER OR GASFITTER
LIC. NO.
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PERMIT GRANTED
DATE ...�9
GAS INSPECTOR