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HomeMy WebLinkAboutMiscellaneous - 15 PHILLIPS COURT 4/30/2018 -15 PHILLIPS COUR}T�µ��� 2101095.0-0042-0000.0 i Date. RIX �.. .. . ... =a _ g NORTM Of o? °` TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION �9SSACHUSEt ` This certifies that . . . 441?41�. . . . . . .S. . . . . . . . . . . . . . . . . . . n has permission for gas installation . �. .�. ..� .�. . . . . . . in the buildings of . titt at . . . '/�l�� � . . . . . . Norah Andover, Mas. Fee. ©" Lic. No. -�/. 75 GAS INSPECTOR Check# 3 1- 8282 8282 s MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFiTTING -- _� (Print or Type) T _1�0�1 J A1Jnny�� Mass_ bate Permit # C Building LocationJ -� _� ' j / �� -�� Owner's Name_ �A`TNR��,I_ / Type of OccupancyF/ ( { �j -- Netr r--i Pent>vation (_j Remacemen4 ^ rlarsS atibmitt.ni: YES[' No I € I r WL) x ( ) t n rz rn M 0 W i c w W F- O z W r a � z z 0 ti cc a m d c O D a z w N o r W d N K W d V W = Z ~ W Oa > W W W V) J Z Q x tt i W Q W h W F- 2 Z a W J Q H pW W Q > 4. I W J �+ W r m z Q z a Q fq x a w > a w z. a x a X .x O d S U. n 3 a d J U > a Fes- o SUB—BSMT. BASEMENT 1STFLOOR Q 2ND FLOOR I �. 3RD FLOOR tv� 4TH FLOOR 1 ^ 5TH FLOOR • Q 6T H-FLOOR *: 7TFt FLOOt� 4 4 STH 'on qC k Installing Cornpany,Name :COL.UMBIH SAS GF MASSACHU.SETTS Check one:.. . ,Certfficate Address 55 MARSTON STREET X`7 Corporation 1862 LAWRENCE, MA 01841 - 2312 rr�U El Partnership,., Business Telephone 7�' rd0 - 640 6 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGI_ Ch. 142. Yes K � No O If you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity O 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 'his permit application waives this requirement.- Check one: Signature of Owner or Owner s.Agent Owner0j Agent C 1 I hereby certify;that all of the details and inforr ation I have submiYed(or in&n0e f ation are true and accutr to the I est of my k;nwiedge and that alrblumbifij-work and irrstallaticns:performed under the permit pplication vi!I; r,,compiiancv :,iti;all , f r tinent provisions of:the tJassachusetts State Gas Cade and.Chapter 142.of the Ge BY __ T e of ucense: - Title Plumber Signature of Licensed Plumber or Gas f -- Gasfitter City/Town Master License Number APPROVED OFFICE S 0ONLY) Journeyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES i N �. PROGRESS INSPECTION 10/1 ob Z -rA4S FEE NO. APPLICATION FOR PERMIT TO,DO GASFITTING L ' = NAME & TYPE OF BUILDING LOCATION OF BUILDING _ f r't PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED .1 [SATE X19 �� GAII INSPECTOR