HomeMy WebLinkAboutMiscellaneous - 1797 SALEM STREET 4/30/2018 (2)N_
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•° TOWN OF NORTH ANDOVER
j PERMIT FOR GAS INSTALLATION
This certifies that A' ...... I.d. f ..................... .
has permission for gas installation .. /-�. 13 ....................
in the buildings of ....P'r.4:.......................... .
at I. 7.`�. ] ... ............... I North Andover, Mass
Fee -3 d.. .. Lic. No...t G.6.. ..... C!--:. _.. c1 -k
GASAINSPECTOR ^
Check # 22 (
4367
MASSACHUSETTS UNIMRM APPLICATON FOR PERMIT TO DO GAS Ffrr]NG
(Type or print)
NORTH ANDOVER,
Building Locations
New ❑ Renovation ❑
/Date
Replacement Plans Submitted ❑
Permit # q 3 002
Amount $ 3 G- —
(Print or type),( Check Certificate Installing Company
Name t Corp.
Address ] ❑ Partner.
Business Telephone h 13 A ❑ Firm/CO.
Name of Licensed Plumber or Gas Fitter
V (
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑
Ifyou have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑/ Other type of indemnity ❑ 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 ❑
1 nereby cemiy tnat au oI the detans and miormation 1 nave submitted (or entered) m above
best of my knowledge and that all plumbing work and installations peria5n��dy,P
compliance with all pertinent provisions of the Massachusetts S e Oras C eh
VED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
❑ Plumberco
❑ G Itter Icense Numoer
aster
❑ Journeyman
curate to the
will be in
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FLOOR
4TH. FLO OR
(Print or type),( Check Certificate Installing Company
Name t Corp.
Address ] ❑ Partner.
Business Telephone h 13 A ❑ Firm/CO.
Name of Licensed Plumber or Gas Fitter
V (
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑
Ifyou have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑/ Other type of indemnity ❑ 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 ❑
1 nereby cemiy tnat au oI the detans and miormation 1 nave submitted (or entered) m above
best of my knowledge and that all plumbing work and installations peria5n��dy,P
compliance with all pertinent provisions of the Massachusetts S e Oras C eh
VED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
❑ Plumberco
❑ G Itter Icense Numoer
aster
❑ Journeyman
curate to the
will be in