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HomeMy WebLinkAboutMiscellaneous - 1180 TURNPIKE STREET 4/30/2018N O O V D 0 0 w Y' 0 0 0 0 0 1- a �� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ---., (Print or Type) A/o, XA)�D o1/ Mass. Date 19 _ Perrnll r�, Sy,> Building Location /C20 Owner's Name 6Z_6(!1_6w - A41_L&_ Type of Occupancy/iz< f4/7 New (] Renovation ❑ Replacement Plans Submitted: Yes[] No1Kk Installing Company Nameyanlraa C;aG & ni 1 Check onc: Certificate # Address 140 SO. Main Street It Corporation 103c Middleton Ma. 01949 ❑ Partnership j Business Telephone 5 3_774-971iO ❑ Flrm/Co. Name of Licensed Plumber or Gas Fitter Wi i 1 i am R T-Tarri G INSURANCE COVERAGE: ` I have a current liability Insurance policy or Us substantial- equivalent which meets the requirements of MGL Ch. 142. Yes IR No ❑ It you have ch,6cked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does riot 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: Owner❑ Agent L�] `Signature of Owner or Owner's Agent I hereby certify that all of the details and information 9 havo submitted (or ontered) in above application aro truo and accuralo to the best of my knowledge and -that all plumbing work avid "Installations performed 'under the permit Issued for this application wlil compilanco with all pertinent provisions olahe Massachusetts Slat© Gas Code and Ctiaplor 142 of the Go��l laws/// By ! Te of Ucenso: 1 of Signatu— re of Licensed 15 um er or Gas Filter Title NOV — 41994 Gasfittor Master License Number 3785 City/Town Journeyman 0 _ N T`� N W N x z cc vi N N UCC 0: N O > w x Fz W W N a: O U m F- r n z o Wa D < m N H tl a W O o o N a W z U S N W d W O W F. X tl�) U W z J F F z r= a W F- W O > 2 LL O i z U w -� o x .� a W W y z < W C: =)z. '< , cc 0w d .( O O W a O w h ¢' Z O t7 z U. a SUB—BSMT. ABASEMENT 1STFLOOR 2N.D FLOOR 3RD FLOOR 4TH FLOOR 5TNFLOOR 6TH FLOOR 7TH Ft.00fi 8TH FLOOR ! Installing Company Nameyanlraa C;aG & ni 1 Check onc: Certificate # Address 140 SO. Main Street It Corporation 103c Middleton Ma. 01949 ❑ Partnership j Business Telephone 5 3_774-971iO ❑ Flrm/Co. Name of Licensed Plumber or Gas Fitter Wi i 1 i am R T-Tarri G INSURANCE COVERAGE: ` I have a current liability Insurance policy or Us substantial- equivalent which meets the requirements of MGL Ch. 142. Yes IR No ❑ It you have ch,6cked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does riot 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: Owner❑ Agent L�] `Signature of Owner or Owner's Agent I hereby certify that all of the details and information 9 havo submitted (or ontered) in above application aro truo and accuralo to the best of my knowledge and -that all plumbing work avid "Installations performed 'under the permit Issued for this application wlil compilanco with all pertinent provisions olahe Massachusetts Slat© Gas Code and Ctiaplor 142 of the Go��l laws/// By ! Te of Ucenso: 1 of Signatu— re of Licensed 15 um er or Gas Filter Title NOV — 41994 Gasfittor Master License Number 3785 City/Town Journeyman 0 _ Date. l/. f'�7.. :... of No oT a ,ti TOWN OF NORTH ANDOVER 0 � op PERMIT FOR GAS INSTALLATION 9SSACHUSEt C C+� This certifies that ...!t� has permission for gas installation ............. . in the buildings of .... % ... !:...................... .... . at.. L ..Y .. >r. .....:.... , North Andover, Mass. Fee.. Lic. No.........'.. �:.....-.. {........:.j. „/GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File