HomeMy WebLinkAboutMiscellaneous - 122 PLEASANT STREET 4/30/2018 (2) a��. P� Ery SA 1VT STREET
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN�
- (Print or Type)
C NORTH ANDOVER Mass. Date 7 /"7 ) 4_7,
lhuilding Location Pl PA^SGi.dL c5 Permit
Owners Name_� �S C I M ar7,
• New Renovation Replacement Plans Submitted
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SUR—BSPdT.
BASEMENT
1ST FLOOR
2ND FLOOR
3110 FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TK FLOOR
8TH FLOOR
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(Print or Type) I- Check one: Certificate
Installing Company Name 80 oche_ r PJba , Q Corp.
Address Q e- -Ort V Partner.
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F-1 Firm/Co.
Business elephone: Cj^_$) (T_- ®77
Name of Licensed Plumber or Gas Fitter / t p or,ker'
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond ED
Insurance Waiver: I , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 0 Agent M
I hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my
knowledge and tint all plumbing work and Installations petformcd under'Permit isseed for this application will-bein compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General LAWS.
By - TYPE LICENSE:
er lumbb
Title PPlumer Signatur of LicenseGasd
Master Plumber or Gasfitter
City/Town: G� B
Journeyman
APPROVED (OFFICE USE ONLY) License Number
592ate:
Date.. . . .of� .�
MORTM TOWN OF NORTH ANDOVER
16
PERMIT FOR GAS INSTALLATION
E �9SSACMUSEt -
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This certifies that -!. . . .-. .... . . . . . . .
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has permission for gas installation <: cc!
in the buildings-of -� .. .:-t -.-F--:- ,.�. . •�•
att? . .�% -
�� -r . .,,North Andover, Miss.
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Fee.p,. ` . . Lic. No.. .Z. :dl.. . . . . . . . . . . . . . . . . . . . . . . .
A3 97 GAS INSPECTOR c
t v^� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
s- • NORTH ANDOVER, Maas. Oaie
eundlna n
Location .� Y Permit ! f
Owners
Name_,
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S:t
New Renovation
O Replacement Q Plant Submitted: Yet Q : Np ❑
FIXTURE$ .........
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i SAe�a1SNT
1ST FLOOR
tN0 FLOOR
11110 FLOOR
_.. STM FLOOR
tTN FLOOR
j STM FLOOR.
3'TM FLOOR -
STNFLOOR _
Check Ona: Cerivicals "+
Installing Company Name er U C bin O Corp.
:. Address t
. — er
q ❑Porinahip -
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Business Tle ephone ( ...
Name of Licensed Plumber - dqnt ckcLr _
INSURANCE COVERAGE:
1 have a current Iiabl Insurance
�Y policy or Ita substantial equivalent. Yet No 13411& .-
N you have checked y", please Indicate the type covert
pe by checking the appropriate box
` A liability Insuranep cY - Other type d Inde Bondy - O
s .�.
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OWNER'S INSURANCE 1IbANEAt t im aware that the 11cenies dost not ham,the Insurance covers
go by
i Chapter 142 of the Masa. General Laws. and.that my signature on No permit appltcaUon..wabes.thla.
Check onw.
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:... a ure 0 ar or N.a on Owner Q
...
i I booby arlly,that al of the detalls and Information I have twbrnllted for enferso in above application aka fru•aad.aoarrataso lsa.4a4fti Ry'
Inowiedpa and the a1 ph�mbinq�rork and Inrlallattona Wcxffwd under the perrM Issued for Wa application Will be.ln
j pertinen provislons of the Massachusetts State Plumbkq Code and Chapter 142 of the Genemt tows. oort�pllarKe Wi
1 This t
City/Town Uasnse limber neorrGurs
nsN� um er
�l 8
Type of Plumbin lkenso: Marler ss f
IIF'r'rIk7VED(OFFICE USE ONLY) q
Journeyman ❑
i
Date. .
34 to
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".O R7:''� TOWN OF NORTH ANDOVER
O0
AL
PERMIT FOR PLUMBING
« _ •
,SSACMUS�
This certifies that f . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . .
has permission to perform .'lv . ... . . . . . . . . . . . . . . . . . .
,plumbing to the buildings of ' . . . . . . . . . ... . . . . . . . . . . . . . . . .
at. . : : . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass.
kFee. ,. . . .Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
PLUMBING INSPECTOR
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WHITE:Applicant CANARY: Building Dept. PINK:Treasurer