HomeMy WebLinkAboutMiscellaneous - 12 STONINGTON STREET 4/30/2018 12 STONINGTON STREET
210/019.0-6012-0000.0
Date.. �f �X . . . . .. .
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F� TOWN OF NO TH ANDOVER
PERMIT FOR GAS INSTALLATION
9SSACHUSEt -
This certifies that . . . . � S . . . . . . . . f;
has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . .1?1.+!�-. . .<.� . , .
.at �.`.� . . .� ��.�.4 , �.�. . . . . . , North Andover, Mass.
Fee. . v,.'. . Lic. No.. . . . . . . . . . . . .
t GAS INSPECTOR
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6516
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) L/
Mass. Date Permit #
Building Location-19- 11 STON 1 VEL S7 ' Owner's Name Gil NA 112L i;1 1
"h LUl2TNAtis06V6i2 Type of Occupancy_RES i0ait1r�C DGtPLf��('
New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[:] No ❑
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SUB—BSMT.
BASEMENT
1ST FLOOR
a 2ND FLOOR
3RD FLOOR _
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET XJ Corporation 1862
LAWRENCE, MA 018 4 2 - 2312 ❑ Partnership
Business Telephone q 7 IB—6 8,7-110 5 EXT *306 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery �.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability insurance y '
� polis � 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 abo plication are true and accur to to the best of my
knowledge and that all plumbing work and installations performed under the permit iss f r this application will mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/
T e of license:
Plumber Signature of cense Plumber or Gas
Title Gasfitter
Master license Number_374.5
City/Town Journeyman
O IC S.O
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE "
N0. t
APPLICATION FOR PERMIT TO;D0 GASFITTING
" NAME TYPE OF BUILDING
!F Y ••
LOCATION OF BUILDING
PLUMBER-OR GA-SFITTER
LIC. NO.
PERMIT GRANTED
DATE ...�9
I .
€ GAS INSPECTOR