HomeMy WebLinkAboutMiscellaneous - 1875 Turnpike StreetDate ../a, F i19
TOWN OF NORTHZOV
PERMIT FOR GAS INSTALLATION
This certifies that ./??". k?... ;? '�( .....................
has permission for gas installation ...............
in the buildings of
at .�%....7(,rf? - A� ......... , North Andover, Mass.
.. .tel �
Lic. No � f�- S.. ..............
GAS INSPECTOR
Check # /7p7 j
f
5557
MASSACHUSETTS UNIFORM APPLICATON FOR PERMrr TO DO GAS FITTING
(Type or print) Date 1,,7 0-2,7 10
NORTH ANDOVER, MASSACHUSETTS
Building Locations i J'7 V
L44 A/t % '7 Owner's Name
New E3 Renovation D Replacement D
Plans Submitted
Permit #
Amount $
(Print or type)
Name
Address ✓y"�ln ��
4,1,110 ce<
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter �I JCP 11?176
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No�
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 Other type of indemnity 1:1 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 13
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 Massachusetts State Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
PPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
D Plumber :.� 4F 5�s
❑ Gas Fitter License Num5er
ElMaster
❑ Journeyman
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SUB-BASEM ENT
BASEM ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6 T H. F L O O R
7TH. FLOOR
8TH. FLOOR
(Print or type)
Name
Address ✓y"�ln ��
4,1,110 ce<
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
Name of Licensed Plumber or Gas Fitter �I JCP 11?176
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No�
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 Other type of indemnity 1:1 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 13
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 Massachusetts State Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
PPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
D Plumber :.� 4F 5�s
❑ Gas Fitter License Num5er
ElMaster
❑ Journeyman
Date. -.��� . .
MOFTk
' TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..Cl ?�'!' .1. !.v!'��'.... . .
has permission for gas installation ............¢.. ... . .
in the buildings of DAII.1.-1gf..e ,4 .........................
at 7........, ........No Andover, Mass.
Fee. -50,50.. Lic. NoA1.3.... ...
(� 3G -A ;.
INSPECTO.
Check # 13 l='
S 9.1 4
G
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER ,Mass. Date 11/30
Building Location 1874 TURNPIKE ST
Owner Tel# 978 686 9113
New 1:1 Renovationw]
2006 Permit # ~� `Y
Owner's Name JOHN HAGERTY
Type of Occupancy RESIDENTIAL
Replacement E Plan Submitted: Ye[j NOO
FIXTURES
Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate
Address 131 Water Street Corporation
Danvers, MA 01923 Partnership
Business Telephone # 800-322-6628 Firm/Co.
Name of Licensed Plumber or Gas Fitter Ov44 YKy2✓L 1 LL
INSURANCE COVERAGE:
I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes
cve No C3If you have c ecked �, please indicate the type coverage by checking the appropriate box.
A liability insurance policy F( 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:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
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 the permit issued for this application will be in compliance with all
ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.�j
By Type of License: C"-71r'�.-{lam)
• -Plumber Signature of Licensed umber or Gas Fitter
Title s/Mas fitter
-l�21,3
• Master License Number
Cityrrown • -Journeyman
APPROVED (OFFICE USE ONLY)