HomeMy WebLinkAboutMiscellaneous - 148 WATER STREET 4/30/2018Date.....................
OR T
TOWN OF NORTH ANDOVER
o PERMIT FOR GAS INSTALLATION
This certifies that .. .....................
...................
I has permission for gas installation -rr .......
in the buildings of . .......................
t- at /I/ IZ . .......... I North Andover, Mass.
Fee ....... Lic. No . :�r .7./ . .. . . . . . .
GAS INSPE&Off
Check
4', 337
MASSACHUSETTS UNN ORM APPUCATONFORPERWr TO DO GA��S--Fr,rrING
(Type or print) Date , '—A 1-"70%
NORTH ANDOVER, MASSACHUSETTS
Building Locations
Bey 11 a I' a E k n Owner's Name
New Renovation Replacement
Plans Submitted
Permit #
Amount $''
(Print or type)c�
M.-
one: Certificate Installing Company
Corp.
Address C Partner.
Business Telephone u'—
(Name ofLicensed Plumber or Gas Fitter
INSURANCE COVERAGE – Checff—N00 I have a current liability Insurance policy or it's substantial equivaleamt. Yes
Ifyou ;have checked .M .p1inditie coverage by checking the appropriate box.
Liability insurance policy ErOther type of ir4wmnity 0` Bond 0
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 Q Agent 0
I hereby certify that all of the details and information I have submitted (or entered) m above application are true and accurate to the
best of my knowledge and that all plumbing work and installations =Yand fider
Permit Issued1�'s a lication will be in
` compliance with all pertinent provisions of the, Massachusetts State Cly er l42 of eral Laws.
(OFFICE USE ONLY)
Signore ofLicensed .Plumber i9r B'as Fitter_
0 Plumber 3 � -(
EZj_Cmg-Fitter Licenise Number
�0 TMaster
LTT �
„
(Print or type)c�
M.-
one: Certificate Installing Company
Corp.
Address C Partner.
Business Telephone u'—
(Name ofLicensed Plumber or Gas Fitter
INSURANCE COVERAGE – Checff—N00 I have a current liability Insurance policy or it's substantial equivaleamt. Yes
Ifyou ;have checked .M .p1inditie coverage by checking the appropriate box.
Liability insurance policy ErOther type of ir4wmnity 0` Bond 0
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 Q Agent 0
I hereby certify that all of the details and information I have submitted (or entered) m above application are true and accurate to the
best of my knowledge and that all plumbing work and installations =Yand fider
Permit Issued1�'s a lication will be in
` compliance with all pertinent provisions of the, Massachusetts State Cly er l42 of eral Laws.
(OFFICE USE ONLY)
Signore ofLicensed .Plumber i9r B'as Fitter_
0 Plumber 3 � -(
EZj_Cmg-Fitter Licenise Number
�0 TMaster
LTT �