HomeMy WebLinkAboutMiscellaneous - 18 WOODBRIDGE ROAD 4/30/201800
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0 LOW4 OF NORTH ANDOVER
41
PERMIT FOR GAS INSTALLATION
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This certifies that... ,Rv , .'. . 4 - r -
has permission for gas installation .)5
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in the buildings of . ..R o ...............................
at ......North Andover, Mass.
Fee. Lic. No.. '!� ..
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GASINSPECTOR
Check# / T(011
5355
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
iidR'TN AMD 6 r69- , r Mass. Date
i ( Permit # J/^3 J J/
` Building LocationQGF
Owner's Name Pip �H.
"" .. Y•`,. - ��0 2 T �-I A Q i OV f -& Type of Occupancy_
New ❑ Renovation ❑ Replacement 0 Plans Submitted: Yes[] No ❑
Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET }C7 Corporation 1862
LAWRENCE, MA 01840
❑ Partnership
Business Telephone q 7 $-68,7-1105 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked Ye, please indicate the type coverage by checking the appropriate box.
11
A liability insurance policy X 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'sOwner[]Agent ElAgent ,
1 hereby certify that all of the details and information I have submitted (or entered) in abo
knowledge and that all plumbing work and installations performed under the permit Iss f r this appl'rat on will on are true d a cu�gte to the best of nn mpl ante with all my
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U ;
T e of License: f2
Title Plumber Signature of cense Plumber or Gas
Gasfitter
City/Town Master License Number 374.5
APPROVED 0 FIC SF 0 Journeyman
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Installing Company Name BAY STATE GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET }C7 Corporation 1862
LAWRENCE, MA 01840
❑ Partnership
Business Telephone q 7 $-68,7-1105 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked Ye, please indicate the type coverage by checking the appropriate box.
11
A liability insurance policy X Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner'sOwner[]Agent ElAgent ,
1 hereby certify that all of the details and information I have submitted (or entered) in abo
knowledge and that all plumbing work and installations performed under the permit Iss f r this appl'rat on will on are true d a cu�gte to the best of nn mpl ante with all my
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U ;
T e of License: f2
Title Plumber Signature of cense Plumber or Gas
Gasfitter
City/Town Master License Number 374.5
APPROVED 0 FIC SF 0 Journeyman
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This certifies that ..A !`y�.*....................
has permission to perform ...
................
plumbing in the buildings of .. ! -u 9 ....................
at. . %!.a a �. �./'. -�....... , North Andover, Mass.
Fee......... Lic. No..//i.....
PLUMBING INSPECTOR
Check //0 y
664
TOWN OF NORTH ANDOVER
•
PERMIT FOR PLUMBING
MS'S
y U5E
This certifies that ..A !`y�.*....................
has permission to perform ...
................
plumbing in the buildings of .. ! -u 9 ....................
at. . %!.a a �. �./'. -�....... , North Andover, Mass.
Fee......... Lic. No..//i.....
PLUMBING INSPECTOR
Check //0 y
664
l
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
J o,( Date �Q ' — � O o .$r
Building Location / g W °o� �-� °Owners Name T� 4 ti V" S -/ �y o Permit # �(�
Amount �,3^
3-6
Type of Occupancy
New 1:1 Renovation 0 Replacement 0 Plans Submitted Yes No
FIXTURES
(Print or type)/) �S � J , n -J f d�S C- heck one: Certificate
Installing Company Name js V V -3E'- /J v'- 9oS Lam, J Co
%�, rp.
Address `v O /a �c ` 9 �/ pf 0,/ Partner.
�n5SV9aVC5
Business a ep one .�' e/ d 1-1 Firm/Co.
Name of Licensed Plumber. %� 9 f u �" S c S S
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy El Other type of indemnity 11 Bond D
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent 1-1
I 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachus tt St�Plumbing we.a dChapter 142 of the General Laws.
By Signature o � i�ns�/�
Title
Type of Plumbing License
,'�
City/Town I-luelibc INUIliverMaster® Journeyman 13APPROVED (OFFICE use ONLY