HomeMy WebLinkAboutMiscellaneous - 1607 SALEM STREET 4/30/2018 (2) / 1607 SALEM STREET
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TOWN OF NORTH ANDOVER
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' PERMIT FOR GAS INSTALLATION
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This certifies that /�i��l. f_. .1. . . .7� `..:�
has permission for gas.installation4d 7l�.,. .
in the buildings c . . . /. . ... � . . . . . . . .
at . .�F� �}. .C.Q/f1.� . ,!. . . . ., North Andover, Mass.
Fee. '4..U Lic. No.,,_ 7, a". . . . . . . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOR
Check#
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"4700
F MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
60
_1UORM A 1JDOUEi2 , Mass. Date 13 Permit # —30
Building Location SA�.� 5T Owner's Name_ 761) f%A7EJA
/LICoType of Occupancy RESl1� 1U�jA
New ❑ Renovation ❑ Ae cement [ Plans Submitted: Yes❑ No ❑
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SUB—BSMT.
BASEMENT
)ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET �O Corporation 1862
LAWRENCE, MA 01840 ❑ Partnership
Business Telephone .687-1105 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery .
INSURANCE COVERAGE:
I have a current liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
5 Yes
If,you have checked res, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy P< Other type of Indemnity 11 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:
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 abo plication are We and accu�gte to the best of my
knowledge and that all plumbing work and Installations performed under the permit iss f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gee s.
Ely__ T of Ucense:
Plumber Signature of lucense Plumber or Gas
Title GasGtter �, 5 •
Master License Number
City/Town Journeyman
APPROVED(OFFICE USE ONLY
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPEC710H
FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
,►
LIC. NO.
PERMIT GRANTED
DATE .19
GASINSPECTOR
Y