HomeMy WebLinkAboutMiscellaneous - 156 CHESTNUT STREET 4/30/2018 / 156 CHESTNUT STREET U-1
J 210/060.0-0071-0000.A
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3? TOWN OF NORTH ANDOV
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PERMIT FOR GAS INSALLATION
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This certifies that . . . ,r !!t. . .!'.
,,,nas permission for gas installation . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . .
at ... . . . . . . . .. North Andover, Mass.
Fee.3.L '�r . Lic. No.. 3�,� �. . . �. . .C.•J.e
F- GAS INSPECTOR
Check# �f
5955
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FTrnNG
(Type or print) Date 1,
NORTH ANDOVER, MASSACHUSETTS
Building Locations k5c, C,�(1 S��� �� /
Permit#
Amount$
Owner's Name'
Newt Renovation D Replacement D Plans Submitted
D
cW7 a w O v x N
a' x C7 u w m z F a� C x > w
Z �" w d F w O > w w x x
> F o
SU B-BASEM ENT
BASEMENT
IST. FLOOR
2N D . FLOG R
3RD . FLOOR
4TH . FLOOR
5TH . FLOGR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
r (Print or type)
Name NE-��-N �b �s S S `��� k one: Certificate Installing Company
Corp. QC
Addre s ���
\ o.NVQC Q \C7= Partner.
Business Telephone
Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE
Chec one:
I have a current liability Insurance policy or it's substantial equivalent. Yes
If you have checked Les, ase indicate the g y No❑
type covers e b checking the appropriate box.
Liability insurance policy Other type of indemnity Bond
D ❑
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:
Signature of Owner or Owner's Agent Owner 13 Agent D
hereby certify that all of the details and information 1 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massa State GakCode a d hapt 142 of the General Laws.
By: Signature of Licens umber- r Gas Fitter
Title Plumber 3`�3`J
City/Town Gas Fitter License Number
Master
APPROVED(OFFICE USE ONLY) 13 Journeyman