HomeMy WebLinkAboutMiscellaneous - 136 COVENTRY LANE 4/30/2018 (3) OVENTRYLgNE `
210/104 C 0122_0000.0 `
Date.I?Z c,/U .... ..
NORTH
°f ��ao 16,ti0
TOWN OF NO H ANDOVER
• PERMIT FOR S INSTALLATION
SACHUSEt
This certifies that . . �. 1.9 A., G . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . I .�'�. . . . . . . . . . . . . . . . . . . .
in the buildings of . .siG ./. c. . . . . . . . . . . . . . . . . . . . . . . . . .
at . .j . . � L. j.!t.;! .l.� . . . . . . . . . ., North Andover, Mass.
Fee.3v. . . . . Lic. No..I.)i:.(. . . . . . . �•� . �. -�!` .� . . . . . . .
GASINSPECTOA
Check#
5822
yL� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
G� 9 Permit # L
�j(J _. Mass. Date
Building Location Cd(JQ tl 9M e— Owner's Name Uie
_T
Type of Occupancy,
New ❑ Renovation ❑ Replacement E]� Plans Submitted: Yes❑ No❑
s
• N � y
Y z Q y
y 2 N ¢ O N S t—
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C7 ¢ F- < Z Z O
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O C C O Y
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1 W O cc UJ> LL F- U J
Z < W ¢ W Z < OC < < O O ul O W P
cr
SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR tt
3RD FLOOR 1
i 4TH FLOOR I
STN FLOOR
6TH FLOOR
7THFLOOR
8TH FLOOR
Installing Company NameADQA<10'.S PL6 .t. WICK U-c, Check one: Certificate
Address c7Z C,00 Y I RG L Corporation
rn i'�1�t o6 ❑. Partnership
Business Telephone .�9 0 D Firm/Co.
Name of Licensed Pfumber or.Gas Fitter _
INSURANCE COVERAGE:
I have a curren,�`liability insurance policy or its substantia) equivalent which meets the requirements of MGL Ch. 142.
�Q
Yes • No ❑
If you have checked rimes, 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:
Owner❑ Agent ❑
Signature of Owner or Owner's 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 installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General laws.
By T of License: _
Plumber Signature of Licens V
�ttTitle GasfitterMaster License Number 4 l
City/Town Joumeyman
APNXYVED( 1C US . NL
BELOW FOR OFFICE USE ONLY
PROGRESS IHSPECtlON
FINAL INSPECTION SKETCHES
FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME d TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR OASFITTER
LIC. NO.
PERMIT GRANTED
DATE 19
GAS INSPECTOR