HomeMy WebLinkAboutMiscellaneous - 120 Foxwood Lot 37 / �CR0 Foy- C, 0 c \
(� o
I
i
I�
U
(Print of Type) cvlt utiM APPLICATION FOR PERMIT TO DO (3ASFITTiNL3
r NORTH ANDOVERd2 5 c3 j
Mass. Date i 9 6
Building
'/,00 �i � Permit
v location �7 y 12-0 ---,F—
`.? o� ,C1 '� Owner's
Name
New C�� Renovation Cl Replacement fD Plans Submitted:. Yes ❑ No p
h a W = K
a a;
C O
d J H W }0.. v
< Z Z O
a0 Nt- K p o
K a! d y < s 'Z
y y Mal K U Z ~ y W Q 1
D }. X J
E _ r v
J ti
F-
sal
O � J
ti � �. epi W 3 a �
!UA—B=kIT.
SA!!1MINT
1!T FLOOR
IND FLOOR l
SRO FLOOR
4TH FLoon
STH FLOOR
•THFL00A +
7TH FLOCK t
STH FLOOR
Check one: Certificate
I instalil Cam � `
N pant Name.. V .tis �p I VI-C .
0�• a 6
Address - k Zv1
d Partnership
LC, 3 3 nil a- T (S 3-1_ ❑ Firm/Co.
Business Telephone
Name of licensed Plumber or Gas Fitter -S—) CV-9— G ., -►-R'�
INSURANCE COVERAGE: Check on
I have a current liability Insurance policy or Its substantial equivalent. Yes No
If you have checked 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 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 an of the details and Information 1 have submkted ((x entered)in above application are true and accurate to the best of my
knowledge and that anplumbing work and Installations performed under the permit Issued for this application will be In compliance with all
'perunent provisions of the Massachusetts State Gas 6 and Chapter 142 of the GawAl LAWS.
T nse:
Title umber Signature of Lkense4um at or Zas Tiffer
ter
Ctty/Town Master L6nse'Nim�ber
❑
Joumeyman
Ar'P'nOVED(OFFICE USE ONLY)
J
11 2309 Date.�u/. .`�/.�.�.. ....
NORTh
OF TOWN OF NORTH ANDOVER
,n1�0
0 �, PERMIT FOR GAS INSTALLATION
�9SS4CHUSEt R
I
0
This certifies that . , . . !h r ��� �� /
has permission for gas installation . . !.e. . 1p .F
in the buildings of . . fi. . . . . . . . . . . . . . . . . . . . . . . . . .
at �I�U. . .F��?x rr� v�.. . . . . . . . . . . . . Andover, Mai.
Fee. . Lic. No.J.0.
GAS INSPECT
0
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File