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HomeMy WebLinkAboutMiscellaneous - 156 WATER STREET 4/30/2018This certifies that Date ... JV3. �•el ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION has permission for gas nstallation ..... � .............. . in the buildings of ....1� `........................... at No Andover, Mass. Fee..30. Lic. No.. 2.. Y ... .... AS INSPECTO� Check # MASSACAUSErTS UNIFORM APPUCATON.FORPERMIT TO DO GAS Frrn NG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations Permit # +� _ Owner's Name Amount $ New 0 Renovation 0 Replacement Plans Submitted D (Print or type) Name Name of Licensed Plumber or Gas Fitter —7oAl Che k one: Certificate Installing Company Corp. ® Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity 1313 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 ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. awn COVED (OFFICE USE ONLY) Mwn Signature of Licensed Plumber Or Gas Fitter ems. Plumber Gas Fitter License -Number Master ® Journeyman w Qd a y o a U <= w a > e y e d x W a W 0> F N a z e w Cc �,, c, w > t7 v, O m > z is. O u w y W e m w x > o r� x Q 3 a .4 v a z > p x o SU8-BASEM ENT a 90 6 Ew- BASEM ENT 1ST. FLOOR 2N D. FLOG R 3RD. FLOOR 4TH. FLOOR. STH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOORILL] (Print or type) Name Name of Licensed Plumber or Gas Fitter —7oAl Che k one: Certificate Installing Company Corp. ® Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity 1313 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 ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. awn COVED (OFFICE USE ONLY) Mwn Signature of Licensed Plumber Or Gas Fitter ems. Plumber Gas Fitter License -Number Master ® Journeyman 0 0 � O N .q N a m A ti Z C 0 U z� O O O F d Aa C> �� o tv 'V c4 0 v o N d oxw��.� o F c " w � tCC U� amo 3 N Q N N > � ss 04 c UdAU�p4AV 0 � O N .q N a m A ti Z C 0 U z� O O O F d tv 4 L Q Vii � Q a `o U V� CC a A N o w O . C � v bA a `o U V� CC a A N o T CL O O u � E _ 0 U u 'ca r Oa = O u aj is o 0 o � u E u CG o1°. c Q Y cc y N F. at U = 3 y E v a L � N a ti p C o N b U u$ E_ W a o y O .L ti d Oa Q O � d F O v 0 •C� O N 00 � 0 c�C O �O"' � � c ui O ¢ O fn O w 0o � w C Q N E,.E � ¢ O m J u O N E O D y T O N C N u , > ,�• N C t �da�c�aA� w O . v bA a `o U ^L_ I --I T CL O O u � E 0 U u 'ca r Oa = u aj o � u E u CG o1°. c Y cc F. at = 3 a L � N a p C u a u$ E_ a o y d Oa Q d F O 0 u O N c s a y N cc � � c ui O ¢ O fn � a ¢ O m J u O N E O D O N C N Searchbug Company Finder - Search Results Page 1 of 2 r • -, ,; TH Lexington Law - Credit Repair Services Join the 80,000.clients whoh Sea• EJt service to clean u their credit reports. Unlimited disputes and deletions, top n Your Pt'o Ie &Com n Finder support, full refund policy and cancel anytime. BBB member. 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