HomeMy WebLinkAboutMiscellaneous - 167 COVENTRY LANE 4/30/2018 2 167 COVENTRY LANE
J 10/104.60137-0000.0
Date. .
NORT01
pf ,oto ,°1ti0
of TOWN OF NORTH ANDOVER
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" PERl IT FOR.GASANSTALLATION
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' �,SSACHUSEt
This certifies that . r. . . .S Z/'o�... . .. . .. . . . . ! . . .
has permission for gas installation . . f
in the buildings of A L)6':P4. . . .S';e �.c(.-.°."`.'.O�.�. . . . . . . . . . .
at . -7 (-'0 L/ - ` .. . . . . . , North Andover, Mass.
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Fee.3 Q ,U.°. Lic.
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N GAS INSPECTOR
Check#
6627
MASSACHUSETTS UNIFORM APPLICA'TON FOR PERMTT'PO DO GAS FITTIlVG
eo
(Typ r print)
NORTH ANDOVER, MASSACHUSETTS DateI �` C U
Building LNations (D `� Cjr
Permit#
Owner's Name Amount S
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New Renovation DReplacement
Plans Submitted
mined
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y (~ C O G Z F
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SUM
MENT 3 U � U C >
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4TR
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7THR.
8THR.
(Print or type)
Name_ t �iPGv7/�i Check one: Certificate Installing Company
0 Corp.
Address S U 00
�'J `?, 4 D Partner.
usin sl a ep one f �v
9-firm>Co.
Name of.Licensed Plumber or Gas Fitter L)rJ
FINSUR7ANCEVERAGE
bility lnsurance•policy or it's substantial equivalent. Checkone:
d des,please indicate the a cov Yes type coverage by checking the appropriate box.
ty insurance policy Other type of indemnity D
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.
Signature of Owner or Owner's Agent Check one:
er
i hereby certify that all of the deudis and information 1 have submitted(or entered)in above appect 13 are a and accurate
best of my knowledge and that all plumbing work and instal�tatef
' ormed under Permit Issued for this application will be to in the
compliance with all pertinent provisions of the MassachusCode Chapte 142 of General Laws.
C
BY Signature of License Plumber Or Gas F' r
Title Q Plumber //
City/Town, 3 L
Gas Fitter icenseNumber '
um er
Master
APPROVED(OFFICE USE ONLY) D Journeyman