HomeMy WebLinkAboutMiscellaneous - 130 Foxwood Lot 36 ��d ���u�ad�
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ivJL , + � UNli-QHM APPLICATION FOR PERMIT TO DO QASFI ING
(Print of Type)
FORTH ANDOVER -Z ;
, Mane, Date 19 4�j
BuildingPermit # -7, 30
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Name
New Renovallon Q Replacement p Pians Submitted:. Yes Q No
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Check one: Certificate
Installing Company Name �G `. S I�n.c
Address •O .�X- :� °�• '
j d Partnership
fi±au Z�t iVf IA 3!
❑ Firm/Co.
Business Telephone
Name of Ucensed Plumber or Das Fitter_ s c!- G -►-s
INSURANCE COVERAGE: Check on
1 have a current flablifty Insurance policy or ffs substantial equivalent. Yes No p
If you have checked yes. please Indicate the type coverage by checking the appropriate box.
A IIaf;Ahy Insurance poilc ;
y Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General haws, and that my signature on this permit application waives this requirement.
Check one:
14griature of Owner ❑ Agent ❑
I hereby certify that an of the details and Information I have submitted((x entered)In above application are true and accurate to the best of my
knowledge and that ail plumbing work and Installations performed under the permK issued for this application wilt be M compliance with all
pertinent provisions of thhe Massachusetts State Das Dods and Chapter 142 of the al la
T nse: ..
Tftte umber na ure o can um of
or as elT r
tef
MMaster License Number > ? t p
CttylTown ❑Joumeyman
4'r"OVED (OFFICE USE ONLY)
23
68 Date./ ". ...g .. ..
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HOFTM TOWN OF NORTH. ANDOVER
opt, ��
i �? �.,• `p PERMIT FOIINSTALLATION
49
�9SSACHU`'ES l
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This certifies that . . '9/e?!`.!!' f �.`/. . . .�.� :`. . . . . . . . . . .
has permission for gas installation .. . .F
in the buildings of . . u .)Z.T.. . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . Andover, Mass.
Fee. . . :.'. Lic. No.. . . . .. . . . . �
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File o