HomeMy WebLinkAboutMiscellaneous - 19 FERNVIEW AVENUE 4/30/2018 .._ - r---
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NORTH ANDOVER BUILDING DEPARTMENT
400 Osgood Street
SACHus
Tel: 978-688-9545
Fax: 978-688-9542
BUSINESS FORM FOR TOWN CLERg
DATE: S/2-710C
NAME: IA A ` A/V
ADDRESS: 9 q fyj( i u t i01 )
ZONING DISTRICT:
TYPE OF BUSINESS: cf2�n,���
BUILDING LAYOUT PROVIDED: YES NO
AVAILABLE PARKING SPACES:
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ZONING BY LAW USAGE: YE NO
BUILDING INSPECTOR SIGNATURE
Revised 11.5.04
BUNESS FORM FOR TOWN CLERK
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
t (Print or Type)
il
Nor 1 Atiloay , Mass. Date z v _19 5i3 Permit # 3 '
Building Location / rPrrl yei'u.-j A r;t* 5-� Owner's Name— t
,h Type of Occupancy s
New ❑ Renovation ❑ Replacement [ 7 Plans Submitted: Yes[] No ❑
N
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SUB—BSMT,
BASEMENT
1ST FLOOR
IND FLOOR
G1
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR I R
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Installing Company Name 51 /(0 !-/�1114 '''1 b, f" Ncj Z" Check one: Certificate /
Address 9-0 (2 N r V e 9d , ❑ Corporation 1 -72-
Ai- w-F k a vM 6�k q , 2 t � ❑ Partnership
Business Telephone' 9 h�5-- , kc/ S ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter' C^ e i^u�^C'' j-�o
INSURANCE COVE AGE:
I have a current ' ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Ld/ 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 herebycern that all of the details and information I have submitted(or entered)in above application a true nd4 urate to the best of my
certify
knowledge and that all plumbing work and installations performed under the permit i�.subd for this ap cation I( a inn:ompliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G2n`eral Laws.
T e 'G-cense:
lumber 'Sighature of Licesed Plumber or Gas Fitter
Title Gasfitter
aster License Number
City/Town Journeyman
APPROVED OFFICE USE ONLY)
i
ti
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME do TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE 19
GASINSPECTOR
Date.. .
. . . ... .. .
t�
TOWN OF NORTH ANDOVER
" PERMIT FOR GAS INSTALLATION
SACHU
This certifies that ...�,,f9 � ! . . . . . fir. . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . /I?. .
i in the buildings of . . . .... . . . . . . . . . . . . . . . . . . . . . . . .
at . . .� . . . t.�?.wU! f �^- s North Andover, Mass.
Fee. . .3 o Lic. No.. LINSPECTOR
Check# / G /
7 ► 47
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MASSACHUSET'T'S UMORMAPPUCATONFORPERW TODO GAS RnING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS Date- zo'A'a
Building Locations r`'�i✓��, 'r,R.�
Permit#
Owner's Name �Y)Mount$
�� /�✓� �7
New❑ Renovation eA
Replacement Jy
Plans Submitted
U w a O U
ryi H
p 4 jZ x
m Fw- t C F W
o
z N a p a j Q
� � W "�✓ Q' � .rr [. � � o > W F U '3Y' pry fYr
x o w3 A v
SHB-BSEC z p N w
AM ENT a o G cw. C
BASEM ENT i
IST. FLOOR
ZND . FLOOR
3RD. FLOOR
4TH . FLOOR
STH. FLOOR
6TH . FLOOR
7TH - FLOOR
8.TH . FLO O R
(Print or type
Name v t f , ) ea Check one- Certificate Installing Company
Address
0 Corp.
� � Q p( � ��-�' -
n� Partner.
usmess a
-phone *3 X-4
G'Firn/Co.
Name of Licensed Plumber or Gas Fitter �.
Ui
INSURANCE COVERAGE
I have a current Iiability Insurance policy or it's substantial equivalent. Check one:
If you have checked es please indicate the type covera e b checkin Yes u No❑
Liability insurance poli, Other g y g theea■ppropriate box.
❑ type of indemnity Bond
13
Owner's Insurance Waiver. I am aware that the licensee does not have the
Mass.General Laws,and that m signature on this h=rance coverage required b
Y Permit application waives this requirement. Y Chapter 142 of the
Signature of Owner or Owner's Agent Check one:
I hereby certify that all of the details and information I have submitted Owner ❑ Agent ❑
best of my knowledge and that all plumbing work and in (or entered)in above appli n are true and accurate to the
compliance with all ons perfo ed under.Permit Is for is application will be in
Pertinent provisions of the Massac setts tate G
d d Cha 14 f General Laws.
By-
, J /
Signature of Li
Title ed Plumber Or Gas Fitter
Plumber
city/T own 9 9
94001,
Gas Fitter ucense um er ;
APPROVED(omcE usE ONLY) Oast eyman
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Date. . . . . .... . . .�. ./ ... . .
:,
TAORTh TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SS CH
This certifies that . . :. . ...!. . . .. . . . . �. . . . �. . . . !. . . . . . : . . . . . . . .
has permission for gas installation . .r .!�..:.. . . . . . . . :. . . . . .
in the buildings of . . .'/. . . . . .!' .t . . . . ,. . . . . . . . . . . . . . . :. . .
at . . . . . . .A North Andover, Mass.
Fee.
Lic. No. '.:' i t:. .
i .
•r /1 ) ' GAS INSPECTOR
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