HomeMy WebLinkAboutMiscellaneous - 150 Water Street r_a,�,..
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Date. . . .700.
NORTH
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TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
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This certifies that . . . . . . . . . . . . . . . . . . . . . . . . .
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has permission for gas installation . . . . . . .. . . . . .
in the bui�lding�s`of . .. . . /. . . . . . . . .
at , . . . . . . . .. North Andover, Mass.
Fee,. Lic. No..� -�3 . . . . . . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOH
Check# U 7
X4644
MASSACHUSETTS UNIFORM APPUION FOR PERMIT TO DO GASFITTING
(Print or Type)
4 ow. Mass. Date Zc0,-4 Jermit #
Building Locat
ion G.IJ Owner's Nam ,
U < <I R. Type of Occupanry__ ReSI ,--> N T1 rq
New ❑ Renovation ❑ Replacement 2, Plans Submitted: Yesp No p
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SUB—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name :2r;Pk-7 g T A :54(n MA T A�Q Check one: Certificate
Address 3 L'(� [H�h A ry �rJ. ❑ Corporation
M E 7 H U E 1 ) r11 rl • 01 k q q ❑ Partnership
Business Telephone lo gZ -179"7 f 2--'Firm/Co.
Name of Licensed Plumber or Gas Fitter -i r jjE P T A- 5 A M m 14 TA Pr D
INSURANCE COVERAGE:
I have a current f bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142..
Yes No ❑
If you have checked Les, please Indicate the type coverage by checking the appropriate box
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 Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Owner[] Agent ❑
Signature of Owner or Owner's Agent
I 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 pe i ed for this application be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. _
By T of License: G�
Plumber n ure of cen u or Fitter
roue tte< 9333
t er License Number
City/Town Journeyman
07FIC NL
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASPITTING
NAME d TYPE OF BUILDING
LOCATION OF BUILDING _
PLUMBER OR GASFITTER
• i
LIG NO.
PERMIT GRANTED _
DATE 19
GAS INSPECTOR