HomeMy WebLinkAboutMiscellaneous - 18 EMERSON COURT 4/30/2018I.�
Date. 61 - -L } ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that............................ .
has permission for gas installation .(,t_..1`f .....................
in the buildings of �e." ." .t ..........................
at .J. �.. C i?: (4� .......... . . North Andover, Mass.
Fee.z-)...... Lic. No.. 2. (.3 t
4 AS INSPECTOR
Check # 1 4 4
5i6)
MASSACHUSETTS UNN ORMAPPUCATONFORPERNMODO GAS FnTNG
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations 11,4j, '"'e✓gn-, 9&W,7- Permit # G
Amount $ 2 �^
Owner's Name%���, .1.4 �0 ���65
New Renovation Replacement `� Plans Submitted
(Print or
Name1
Address
04 I
1
,l
Name of Licensed Plumber or Gas Fitter I n V t� (,y 1 (so I,
Check one: Certificate Installing Company
11 Corp.
El Partner.
0,Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes D No
If you have checked yes, pleaseindicate the type coverage by checking the appropriate box.
Liability insurance policy El Other type of indemnity 13 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 13 Agent ❑
I hereby certify that all of the details and information I have
best of my knowledge and that all plumbing work and instal
compliance with all pertinent provisions of the Massachu/
(OFFICE USE ONLY)
(or entered) to above application are true ana accurate to the
.° ed under Permit Issued for this application will be in
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