Loading...
HomeMy WebLinkAboutMiscellaneous - 171 Foxwood Lot 29 �a a q 1 i Rio Vil yA s P i F 4 •.•„�.•�(PrintotT Type) "J UNWUHfv1 APPUCATION FOR PERMIT TO DO t3ASFITTINt3 NORTH ANDOVER , Mass. Date t9 q 6 ' Build Ing _ Locations �� Permit #_ 1 Owner's Name New ©� Renovation Q ReplacemerA p Plans Submitted:. Yes Q No X >w a IS 0 x .c s: K h x O i! 0 O .4 a « G C w � fa M t S W h A AL C y .� fA Z x v ad N 'Z Z 0Oil > IC '400 81 0 s� i o' d 116 !. tai aoc > a d Clue-asMT. SA31trMEHT 12T FLOOR7-1 , 3HD FLOOR iRaF I ', LOOR 47” FLOOR i STH FLOOR i 4TH FLOOR 7TH FLOOR t 18TH FLOOR Check one: CertNicate Installing Company Name V�i `: 5 Q• �} (\&C orp. _L S 06 !Address _ ,OX Partnership ❑ Firm/Co. Business Telephone 7. Name of Licensed Plumber or Gas Fitter -S—j C v-2 INSURANCE COVERAGE: Check on '.I have a current liability Insurance policy or its substantial equivalent. Yes CEJ' No Q 'If-you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance :pdicy 0iher type of IndemnityD Bond C3 'OWNER'S INSURANCE WAIVER: I sm aware that the.ilcensee 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 of Owners ant Owner 0 Agent ❑ 1 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 the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ai tis T nse: 17i1e R�u�mber na ur•o n um er or as er t Master Lkense Number Ctty/Town Joumeyman AP'T" OVED (OFFICE USE ONLY) 2 3 l Date./ = 5. . . ... .. a NORTIy tiTOWN OF NORTH ANDOVER pF t�eo ,e 10 0 PERMIT FOR GAS INSTALLATION 40 s a a 1 �9 www.�FO✓°�.(�7 I 9SSAC HUSEt ' J 1 This certifies that . . �'. �.1: . .!. .... . . . . . . . . . . . . . . . I has permission for gas installation . . ,/L in the buildings of . . A .7`. . . . . . . . . . . . . . . . . . . . . .. . . . � at . ./."7/. . FP-1 W-&u. Andover, Mao Fee. Lic. S. . . . o. GAS INSPECTOR r. j i WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File