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HomeMy WebLinkAboutMiscellaneous - 11 MOODY STREET 4/30/2018 11 MOODY STREET ` 210/081.Ga44-0000.0 5�tgj1,5 Date.................................................. °�r►ORT/1,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION `S3gCHU5fc Te- ThisP . S certifies that ................................................................................................................. has permission for gas installation ...... ... :.....P?e ............. in the buildings of........ 5,/tll�c.�C� ............................................................................................ at.............1.1........... .�.. A.'4 ...., NorthAndover, Mass. Fee. ............ Lic. No. ............ ..`�...... ....��................................................. GASINSPECTOR Check# 3 2 #J 7 �, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATEMIT# G1A 14 JOBSITE ADDRESS (� OWNER'S NAME OWNER ADDRESS TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL p�T RESIDENTIAL CLEARLY NEW:E1 RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES Q NO R— APPLIANCES 7 FLOORS—► BSM 1 try 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER �— CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS �J MAKEUP AIR UNIT OVEN POOL HEATER MOM/SPACE HEATER ROOF TOP UNIT TEST - UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER MITE dJ _ _ I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES WO 13 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Eg-- OTHER TYPE INDEMNITY ® BOND F 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. CHECK ONE ONLY: OWNER 0 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 accura to the bes my edge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance Perti isi the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 52 £ LICENSE# i Shy SIG E MP DMGF© JP ® JGF Q LPGI CORPORATION .3(,( PARTNERSHIP®# LLC i COMPANY NAME: ee 8rog fuSes ADDRESS CITY STATE' /►►� ZIP 2 ( Z2 TEL (/ FAX CELL s �d6-144Q�EMAIL 3e e p ; -MMONW • ALTH OF • • . • PLUMBER ISSUES �5FITTERS THS -FOLLOWING -E NSAS A MASTER P1rENSE LUMBER DAVI Q: W GARFIELp> r 21 WILLOWT ` z ORO." CKTON rd \� L W 1564 o o/301"1 6I1k .- 226442 COMMONVIIEALTH OF MASSAGH,USETTmmumlS • • ' • • BOARD QF PLUMBERS 'AND' GASF ITTERS�- ISSUES THE FOLLOWINCa 'LIGEN'S E RE: STARED AS A PLUMB I'NC�CORP DAVIp;W GARFIELD'' t�l x. IEENEY BROTHEft5 SERVICE, VC C 21 WILL: WV �ROCKTON MA 02301 36 V o5/Q 111:.6 •221413 ' i i Date./?..-.�.2 `ri..... .. MORTh TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION h �,SSACNUSE�t This certifies that . . .,I.4' . r. . K has permission for gas installation .('(. . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . at -: � .:... . . . . . . . . . . . . . .. North Andover, Mass. Fee.2U Lic. . . . . . . . GAS INSPECTOR' Check# 2 L 4242 NIASSAMUSErIS UNIFORM APPUCATON FOR PERNUr TO DO GAS FTITNG (Type or print) f Date a/� Q aL NORTH ANDOVER,MASSACHUSETTS Building Locations t• Permit# L- Y �' Amount$ Owner's Name A w F'-,g k a0.c L,% New❑ Renovation Replacement 12 Plans Submitted x w rn U C) W F W W O O� ] O W F W Z U W a W < a O a F Wx� C7 F z F Z F F W 0 O > 1-4 LT+ F V .7 H Qz WW� CG z a Q O O A o0 F O c4 O x O 3 A C7 a U F4 SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name Ar%Aoue-- Vibg. f Uf-4. Co., =,n c. Corp. 2122- 0 i Address 20 'A4.ez-VIV "Dr, OYI;4- tk 10 Partner. Business Te ep one j q I Firm/Co. Name of Licensed Plumber or Gas Fitter Q INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes Q No If you have checked}_es,please indicate the type coverage by checking the appropriate box. Liability insurance policy 119 Other type of indemnity ❑ Bond 13 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 Owner 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 and accurate to the best of my knowledge and that all plumbing work and installations performi)d under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Xde and Chapter 42"e General Laws. By. Signature of Lice ed Plumber Or Gas Fitter / Plumber Title Qga°j' City/Town Gas Fitter License NumBer RMaster APPROVED(OFFICE USE ONLY) ❑ Journeyman Date. 01 40 RT:'4o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 i • sSACHUSi- �f This certifies that .1 has permission to perform . . . . .//- LA . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . at. . . .r. ,/ .e-.T r., .< .e. Ct.. . . . . . . . .... North Andover` , Mass. i� C- Fee. .71 .". .Lie. No..2j.?.`. . . . . . . . . . -. . . . . ... .. . . ?.. . . . PL WING INSPECTOR Check # 1 1 5464 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) — NORTH ANDOVER,MASSACHUSETTS I Datev?/� Building Location �� r�( ,�y Owners Name Anne- �- � Permit# Amount Type of Occupancy New Renovation Replacement d Plans Submitted Yes No FIXTURES H w14 W4U ~ O Z H U z a W d H x a+ a a p W w 0 A x a A A w x a z x w r a A0-4 H A a x 0.0 SL]3.BM BASEVINr MHM 210 HIM 3M H—" 4MFOCIR 5M ROM sMFLOCR 7MHfM sM FLOCR (Print or type) Check one: Certificate Installing Company Name byia u8r �Iba, c lac.. Co., w,@. Corp. 2122 i 'j 12r Address 20 4tQ-e n In Partner. t8y Busmess Te ep one 6,F35_$3$3 El Firm/Co. Name of Licensed Plumber: \7eor9 c LARm e Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 10 Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner ❑ Agent ❑ 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 Massachus s State PI b* gCo and Chapter 142 of the General Laws. By i a ure o1 1;,W11Se0 rJUMDer Type of Plumbing License Title ORS 3 City/Town License m e'> r Master Journeyman ❑ APPROVED(OFFICE USE ONLY