HomeMy WebLinkAboutMiscellaneous - 1557 SALEM STREET 4/30/2018 1557 SALEM STREET
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NOR7M TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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SACHUSEI
This certifies that . . . . ./. .� . . . . . . . . . . . .
has permission for gas installation . it . r . .j. . . . . . . . . .
in the buildings of . . .D :;. . . . . . . . . . . . . . . . . . . . . .
at . .,1.S� :.?. . .3f7.Z.'.... . . . . . . . . . . North Andover, Mass.
Fee., Q,. Lic. No.."-7- .?. !��! . �. . . . . . . .
P&INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
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gj, , MASSACHUSETTS UNIFORM AP
(I'rinl or Type) DO FOR PERMIT TO O
GAS
FITTING
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Mass. Dale 3 19 er qq Permit # 3 j
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Building Location_ �
' Owner's Name_ �3J� V1 I
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Type of Occupancy
tr New [] Renovation (� Replacement �a
t� ❑ Plans Submttled: Yes[:) ' o
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SUB—BSMT.
BASEME14T
IST FLOOR
VID FLOOR
3RD FLOOR -
4TH FLOOR
6111 FLOOR
6T11 FLOOR
7TH FLOOR
aTll FLOOR
Installing Company Name :LLr±H
Address 1AYU I It PLUMBING - HEATING Check one: Certificate III
❑ Corporation
P.O. Box 218 Cl Partnership
Business Telephone � -
Name of Licensed Plumber or Gas Filler f7 Firm/Co.
INSURANCE COVERAGE:
I have a currentablllly Insurance policy or fts substantial equivalent which meets the requirements of MQl_ Ch. 142.
Yes fel'" No 171
If you have checked yen, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy L- Other
YPe of Indemnity❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that Ilia licensee does hot hate Ilio Insurance coverage required by
Chaplet 142,of the Mass. General Laws, and Ihal my signature on this permit application waives this requirement.
Check one:
Signature 01 Owner or Owner's Agent Owner❑ Agent ❑
I hereby certify that all of the details and Information I have submitted(or entered) n above appllcallon a e tr a and accurate to the bell of m
knowlodge and (hat all plumbing work and Installations pe(formed under the perm(issued for r s ppll 11 will b n compliance with r�U
porilnen provlsiorhs ul Ilio Massachusetts State Gas Colo and Chapter 142 o1 a on hal La y
F(Cllitr,/Town
T e o license:
umb°r rgn' ure o e 'se
um e
slillor r as II er
Master Llcenso NumbofiiT��UfiF om Yj--- Journeyman - r o�f
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIOH SKZ7--xES PROGRESS INSPECTION
FE. -
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APPLICATION FOR PERMIT TO DO GAS;=ITING
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NAMES TYPE OF QUILDINO
LOCATION OF BUTLDtNO s '
PLUMBER OR GASFiTTER
UG N0. ,
PERMIT GRANTED
DATE 12
aA3 INSPECTOR -