HomeMy WebLinkAboutMiscellaneous - 141 REA STREET 4/30/2018 (2) STREET
210/09898.6-0-0 013-0000.0
I
I
Date. ... . 3 U�. ....
HORTM
?O;`4..ao ,6. O
3 TOWN OF NORTH ANDOVER
. PERMIT FOR GAS INSTALLATION
• s
SSACHU5Etl
This certifies that . .< C�<�,�la , , . . . . . �'. . . . . . . . . . . . .
has permission for gas installation . . .r!!n h �► ` . . . . . . . . . .
in the buildings of . . . .� . f.1 . ��/. . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . fir. . .11.C . . .�.t". . . . . . ... . . . ., North Andover, Mass.
Fee. 10:v 'Lic. No.. °. . . . . �•� ... . . . . . .
ASINSPECTOR
Check#
6073
M 1.ASSACIAUSETTS UNIFORM APDL ICATION OR PERMIT TO DO GASFITTING u_!
(Print or Type)
' Mass. Date 3� Permit #-1196 7)
Building Location /W —ff Owner's Name
Type of Occupancy_ _ �/J
New ❑ Renovation ❑ Replacement IZ-I� Plans Submitted: Yes❑ No ❑
N
N C
x w vi
N N U Z ¢ vi
N K N K O z N z a
W C: C) U In H 2
w N
X o u < �c Cr o .o N W
< m N } 31 ul O O F-
¢ y V til < = 7: yl O C > W
w z% J x < W x Cr l r¢i! ►- w f X rr
V H X J ! x r W W V O > W r- U J }N. W
m Z O X WW' O UI X -
d w > C W Z. < ¢ <0 X w M � o d s V s > o a F- o
SUB—BSMT.
BASEMENT ,
IST FLOOn
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
aTHFLOOR
TTHFLOon
=6-THFLoOR:H±
Installing Company Name CA LL/±/�j�/� /,� C �—f Check one: Certificate #
Address rl B —Corporatlon
7A— l ❑ Partnership
Buslness Telephone__ �d-�3 ❑ FI r /Co.
Name of Licensed Plumber or Gas Fitter �� �fLf
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes L, No ❑
It you have checked yes, please Indicate the type coverage by checking the appropriate box.
A Ilablifty 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 ❑
1 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 ali
pertlnenl provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene al Laws.
BY Type of Ucense:
Title Plumber Sig to e o c nse Plumber or Gas itter
asfitter //rr
Cily/Town aslcr Ucense Number .3 y7d
/U1f'frf D—�fTT O Journeyman