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HomeMy WebLinkAboutMiscellaneous - 1490 GREAT POND ROAD 4/30/2018 (2) 1490 GREAT POND ROAD 210/062.0-0029-0000.0 i I 7490 Date../.�.?..'!.!.G....... HORr pF ,.ao ,°,tip , .i TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACHUSEt This certifies that . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation V. . . . . . . . . . . . in the buildings ofJ. O.Or'.�e.°`1. . . . . . . . . . . . . . . . . . . . . . . . . . at �/.�?a. �!�/�� . . . . . . . . . . .... North Andover, Mass. Fee. . . . . . . Lic. No.. . . . .!. . . . . i GAS INSPECTOS�i Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: 6 MA. Date: • /6 Permit# f1 Building Location: © ? Owners Name`.'�a!j A�BDLLAH _ Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES co Cd LU LIJ H N U) Q x Q HOld m 2 O w W U co Fes- O x ac W Z H ~ Z J W W z W W O H M x C W Lu m �0 a a o w w x ac > U) v z U) w O w W o 1- w w _z x � > v w z O � H 1- O z -1 0 LL � � w w W w z W tY N J Q Q m w O z O N > z x SUB BSMT. ' BASEMENT 1 FLOOR t 2 Nu FLOOR ' 3 FLOOR C FLOOR 5 FLOOR 6 FLOOR f—FLOOR 8 FLOOR Installing Company Name: C (�,, n Check One Only Certificate# lu �� .�:('�� /r /-L4— �L /� ❑Corporation Add ress,2�it-f�?ty/YY� L�k4C t�� City/Town:ep-&_Jk6e_ State: f — n ❑ Partnership Business Tel:7�^ 3-977� Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please md' a the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. IL a Type of License: By ❑ Plumber 'A�. Title ❑Gas Fitter igna ure of Licensed Plumber/ as Fitter El Master l City/Town ❑ a Journeymn Li se Number: t/ APPROVED OFFICE USE ONLY El LIP Installer