Loading...
HomeMy WebLinkAboutMiscellaneous - 12 FIELDSTONE COURT 4/30/2018 � �a�rrj �/vo.� s cam/-� `�l � L: j. 7Date... ... .. . .. ........ r NpRTM TOWN OF NORTH ANDOVER pF4t.ao ,^,ti0 0 ' `p PERMIT FOR GAS INSTALLATION SgA�NUSE r This certifies that has permission for gas installation,. ,:-. . .' ! `e. '�'. . . . . . . . . . in the buildings of . . .... . ... ` . `'' at . . . . .. North Andover, Mass. Fee. `, . .. . . . Lic. No.. . . . :.'. . . . . . . . . . . . .. `' .. . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer 1 > MASSACHUSETTS UMFORM APPLICATON FOR PERMIT TO DO GAS MTING Type or print) to NORTH ANDOVER, MASSACHUSETTS �- = - Building Locations � Permit# Amount S •�,i Owner's Name =; New❑ Renovation ❑ Replacement Plans Submitted ❑ IA n v z - vi c W a c z sua -aASE .NI ENT - - - - - - - - - - ~�` BASEMENT 1ST. FL0OR 2ND . FLOUR 3RD . FLOOR .x: 1'r ii F L O G R Sill . FLU O R 6 T II . F L U O R 7T If FLUOR IST If FI, OU R (Print or type) ' w�I n O Check one: Certificate Installing Company Name (/I% `� ( ❑ Corp. Address 'c�� �`Gy✓ ❑ Partner. fit � l✓11 � S�'� Business Telephone — 72123 _ Firm/Co. '7 Name of Licensed Plumber or Gas Fitter -+ INSURANCE COVERAGE Check on . I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes, pleas dicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ 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 installatio pertormed under Permit Issued For this application will be in compliance with all pertinent provisions of the Massachusetts St e d Chapter 142 of the General Laws. -i 'J By: Signature of Licensed Plumber Or G i er Tide Plumber City/Town Gas Fitter Icense ivumoe, Master :APPROVED wi i--ICi:USE ONLY) Journeyman Date. ! .. . .`.'. :�.!.... .. NORTH pf .ro ,ti0 or ° TOWN OF NORTH ANDOVER '• PERMIT FOR GAS INSTALLATION SACHUSES 1 This certifies that . . . . . . . . . . . . . . . . . has permission for gas installation . . .1). n .r.7. . . . . . . . . . . . . . . . L in the buildings of . . . .I.?. . . ...`. . . . . . . . . . . . . . . . . . . . . . . . . . at ! .�. . . ... . .'. . .. . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. % ! ' . . Lic. No.. . .. . . . .. . . . . . . . . . . . . . . . . . . . . .�. . . . . GASINSPECTOR Check# 3 � : 0 59 I ; MASSACHUSETTS U>VT'ORM APPLICATON FOR PERMIT TO DO GAS FITTING ��Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations �� �ield5tl�r,2 �',t�.� Permit 9 3 If f--� Amount S e- Owner's Name KU� h ► NreAt4 New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ n iZ Z r Z Cn Ld SUB -B:► SE .v1EN 'r — BASE .v1 E y "r I`s,r. F L 0 0 R 2-:ND . FLOUR 3 R D . F L U O R 4T I1 . FLOG I2 sTu . F1. 00R 6T 11 . F L U O R 7T II . FLUO It PT 11 . F L O O R (Print or type) Cl= ne: Certificate Installing Company Name Andover Plbq. & Htg. Co. , Inc. DCorp. 21.22 Address 20 AoQaan nr IInit-10 ❑ Parmer. Methuen MA, 01844 Business Telephone (978) 685-8383 ❑ Flrn/Co. Name of Licensed Plumber or Gas Fitter G(2nr9P I aRnsp INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. YesNo❑ If you have checked yes, please I dicate the type coverage by checking the appropriate box. Liability insurance policy , Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: l 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 ❑ herebv certify that all of the details and information l 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 ofthe Massachusetts State Gas Cy4e and Chapter 142 of the General Laws. Bv: ienature of Licensed Plumber Or Gas Fine.- Title itterTitle Plumber CItv/Town ❑ us Fitter (cense Ivumoer Master 4PPPWVED )NI•YI ❑ Journeyman