HomeMy WebLinkAboutMiscellaneous - 1492 Turnpike Street MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFIT IU- G t
r,. (Print or Type)
NORTH ANDOVER Mass. Date
Ituilding Location 1 !4 9 2 Permit # 7 CJ L-2 `
S \ Owners Name
New Renovation Replacement Plans Submitted D
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(Print or Type) Check one: Certificate
Installingmpan6 Name19 -/ fd`{(' �� Corp, 10
Address _U- � (10 f Partner.
Firm/Co.
Business Telephone: 7 Y3
Name of .Licensed Plumber or .Cas Fitter SST Cc•� ���
Insurancr- Coverage: Indica-_e ;^e type of insurance coverage by checking the
appropriate box:
Liability_insurance policy Ctner type of indemnity 6and.�,. .
Insurance Waiver: I , the undersic.n.e4, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.-
Signature of owner/agent of property. Owner. = Agent Q
I hcreby certify that all of the details and information I haeme submitted (or entered)in above application are time and accurate to the best of my
k-10-ledge and that alt plumbing work and lastaUatioes ;ciorstcC undo t rr..it iva d Io: this sppiiatan will be in wmplunce with aR peroneal
provisions of the WA&saa'tuactts State Car Cadc sod C%apte.14-"of tha Gc:e i Laws-
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Title ( Ga =itte Signature of Licensed
City/Tcwn: Master Plumber or fitter
journeyman
APPROVED (OFFICE USE ONLY) Li License Number
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2085 Date. ./.1. � S.t. . ... ..
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HORTM TOWN OF NORTH ANDOVER 8
0? op PERMIT FOR GAS INSTALLATION
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This certifies that . . . . . . . . . . . . . ..�,
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has permission for gas installation . -__7-1'C --.. . . . . . . . . . . . >
in the buildings of . .` 1R?�`` . . . . . . . . . . . . . . . . . . . . . . . .
at-. . . 1 L/. tic�':� r' . . . . . . . . ., North Andover, Mass.
Fee. .�v,. Lic. No..l.v 3.`r.�. ��.
/GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD: File