HomeMy WebLinkAboutMiscellaneous - 113 SECOND STREET 4/30/2018 113 SECOND STREET
210/019.0-0022-0000.0
Date.. . ......... . ........
MORTH TOWN OF NORTH ANDOVER
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�' PERMIT FOR GAS INSTALLATION
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SACHUSEtAh
This certifies that: . . . . . .. . . . . . . . . . . . . . . .. . . .: . . . . . . . . . . . .
has permission for gas installation :.". :. . . . .: . . .:R . . . . . ... . . . . .
in the buildings of . . . . . . .: . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . . . ... . . . . . . .:. . . . . . . . . . . North Andover, Mass.
Fee. . . . . . . Lic. No../o.. . . . . . . . ': . . . . . : . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Mass. Date_ / Permit # 430
Building Location_ //� n��d t/Q Sr Owner's Name%C�j OL/C,o7l <cw
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Type of Oc uc panty_ reS/�f
New Renovation ❑ Replace ent ❑ Plans Submitted: Yes❑ No ❑
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BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET DC7 Corporation 1862
LAWRENCE, MA 01840 ❑ Partnership
Business Telephone -687-4105 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSWRANCE COVERAGE:
I have a`current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
yes K No ❑
If yo�j have checked Yes, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy JK Other type of Indemnity❑ Bow ❑
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'sAgent owner-0 Agent El
I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and aaxu�gte to the best of my
knowledge and that all plumbing work and installations performed under the permit Issu to r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. U i
Type of License: .
Title Plumber Signature o Licensed Plumber or Gas
Gasfitter
City/Town Master License Number 8697
APPROVED O IC S O L Journeyman
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME TYPE OF BUILDING
'' <^ LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE r19
GAS INSPECTOR