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Home My WebLink AboutMiscellaneous - 191 HAY MEADOW ROAD 4/30/2018 (2) 191 HAY MEADOW ROAD 210/1()4.B-0089-0000.0 1 Date.................................. Of &ORT01 -1 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING US This certifies that ......................................................................................... has permission to perform --"........... ...... ................... wiring in the building of................................................................................... at.... ...... ..............7........ .4�1........ .North Andover,Mass. .......... ............... . ........azz�211�... . ................ ELECTRICAL Check # � ,.. . ------•-- oft O�cialUseOnly Department of Fire Services Permit No. r 9� BOARD OF FIRE VPREVENTION REGULATIONS Occupancy and Fee Checked ��` [Rev. 1/07J (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL T All work to be performed in accordance with the Massachusetts Electr�carl'C de(�j,52CMR AL0WORK (PLEASE PRIN7 I11rI1JR•OR TYPE ALL INFO RM14Tj0N) Date: City or Town of: NORTH ANDOVER BY this application the undersigned gives notice of his or her' To the Irtspeclor of Wires: Location(Street&Number Mention to perform the electrical.work 'bedbelow. ` glow. 9/ Owner or Tenant SC077Zos Git-TSgrJ Owner's Address Telephone No. Is this permit in conjunction with a building permit? Purpose of Building S/•U Y es N0 ❑ (Check r Gt.E: ��h%/t.�' Appropriate Bog) Utility Authorization No. Exis6mg'Service Amps / Volts Overhead.❑ Undgrd❑ No.of Meters A New Service mps / Volta Number of Feeders and Ampacity Overhead❑ Undo d No.of Meters Location and Nature of Proposed Electrical Work: �4771400M RZA7tVt5�L Co lesion o the ollowin table may be waived by the Ispector o Wires. NO.of Recessed Luminaires No.of CeL_Sus U.of p.(Paddle)Fates nTotal No.of Luminaire Outlets No. of Hot Tubs Transformers g-rA No,of Luminaires Generators XVA Swimming Pool .Ab dd..e ❑ �- o. o No. of Receptacle Outlets d' ❑ BatteryUnits �� A - 3 No. of Oil Bite . No.of Switches r' ALARMS NQ. of Zones No, of Gas Bum-hers o- of etection an No.of Ranges No.of Air Cond. otal Initis ' Devices No.of Waste Disposers Tons No. of Alerting Devices eat �P umber Tons Totals:. o, of est: ontaiteed No,of DishwashersDetection/Ale Q Devices Space/Area Heating KW ��❑ Municipal + No.of Dryers gear A Connection Other Heating PPliances KOV Secttrfty bystems: Heaters KWNo.of stet o. of No.of Devices or E valent Ballast Data Wim; Si No.Hydromassage BathtubsNo.of Devices or E afvalent No. of Motors Total HP Telecommunications OTHER: No.of Devices or E nivalent Estimated Value of Electrical Work: detail if desire d or as required by the Inspector of Wires. - Workto Start 6• /6 D�,. (When required by municipal policy Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSUI2APCE COVERAGE: Unless waived b the o the licenser provides Yom,no permit for the performance of electrical work may issue.unless Pr proof such insurance including "completed operation"coverage or its substantial equivalent The und-ersigned certifies that such coverage is in force,and has exhibited proof of same to the CHECK ONE: INSURANCE BOND ❑. O� Permit issuing office.. I certify,under the pains and penalties.o er u (S cif),) < FIRM NAME: 0`��/LL fP ! r7',that the information on this aPPlication is true and comp r✓L 2 I C left Licensee: /�A,Q�N /U/y� LIC.NO.: (If applicable, enter exempt to the license number line. Sasture k Address: ) LIC.NO.: GNRILi Lorvt7 a.�t� l�y' N`y Bus.Tel.N, �6ea *Per M.G. c. 147,s.57-61,security work requires D 030 S3 Alt TeL No.:J�8-7� OWNER'S INSURANCE W Department of Public Safety"S"License: required by RIVER: I am aware that the Licensee does not have the liability Lic.No. Owner/Agent� By my signature below,I hereby waive this requirem� I am the(check one) °overage normally Signature ❑owners agent Telephone No. PER1tljj'F'EE:,��" zq A _M 1� . ,`� ` 1 i� Com►nan wets` of Marsachrrsetts . 4Department Of Industrial Accidents °. ice o 'Q ,11117 f Avesd adonc . MIT / 600 Washingfan Street Bo"oft r , MA 62111 Workers' Compensation lasurease' www-r2=S-9,o vldia A licant InformInformationAfF><d$ .guilders/CoaizactQrsj ect.icia IPl=bers Please .Print Lt>Qib Name iBmin=0�iza6onnnaviauala; L E', tc Address: S Chl.9.[Tw cL ei City/S /Zip: LO/U /d,Y R/ry Phone#:. �� Are you no employer?Check the appoopriate•box: I I:aun a employer with Z 4. ❑ I am a TyPe'Of Project(required): general contractor and I. .. i'e4 �: 2•❑ employees(foil and/or Pm't-tune).* have hired the sub-contractors 6 []Naw construction .I am.asole propriet r.or partner- listed ship and have no empjoy eeson the sheet I. 7• Remodeling working for me in any capacity, These u&contracton have work � mp. g• Q�oiition (T10 war}cars'comp,iasluanatj �. ❑ We.ares orporation and ifs 9. ❑Boding addition required_] office have i0 3•❑ lam a homeowner doing all work ri exeretsed their •❑Electrical repairs m add}tions myself;. of exemption Per MQL I I.❑Piumb' insurance °reqn�.tcamp c I�Z. §I(41�and we have no 12 nng TePairs or additions employees,[No workers' ❑:Roofrepairs�Y appiicantther cb COmP• insurancerequired_): 13.❑. er ecics boy?#I moat also fill out the section Wow showin 3 g their workers'ooi�enoetioe policy information (imrreowners who submit this a$'udavrt se indicating they_living all work Carrtrscmr,that rhealc this box mustzftched an additioasl shectsho end than hcrouraide conmetm must submit a new affidavit indica tingnmiL wing the imine of the a&-��a^d»air wo f art emP � .isiUrov%arworkeff A coensayrs camp.poticy infonmtion. information tiot�insurance or �'•=F&Yt'es: Below it.the policy and job site ". Insurance Company Name: �2E.Ce'ryp�/ 1A1561,eY6I/e--e Policy#or Self-ins.Lic.#: Job Site Address: ExPiration Date: 6 ,03 Attach a copy ofthe.workers'compensationCity/Stat�-ip: i9/ >;lit/lJ�l/cIi >�p policy decFsratioo sho Failure to secure coverage P ( wing the polity number and expiration dafej: fine to g required under Section 25A of MGL c. 152 can lead to the imposition of criminal up $1,5012;00 an one-year imprisonment;as well as civil Pesos of a 01P m 5250.00 a day against-the violator. Be advised that penalties in the form of a STOP 1WQRIC p}� and a fine investigations of the DIA for a copy of this statement may be forwarded to the Ofitce of insurance coverage verificatit3rl. I do hereby certify an the pains and penalties o fP Yifiar the ,rfarmatioAPIVI; aGove is hrtte Si � ' and correct Phone#: Date.- Do ate:Do nal.Wille iii this area,in he contpfet�d afty or town.ofuigL . City or Town: Issuing Authority(circle one): Permit/Liceuse# I. Board of Health 2- au"'M 5eatent 3.City/Town Cerk4Eleeticai Inspectori.Other 5 Plumbing Inspector Contact Person: Phone#: Information. and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.orai or written." An employer is defined as"an individual,partnership,association,corpomtion or other legal entity,or any two ormore ofthc%mgoing engaged in a joint enterprise,and includireg the legal representatives of deceased employer,or the receiver or trust—m•of an individual;partnership,amociatiarr or other legal entity,employing employees.'1-loweverthe owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons.to do ma-1ntecrance,construction orn�pair wink on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also slam that"every state o►;- focal licensing agency shag withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidenmof compliance with the insurance coverage required." Additionally,MOL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until-acccptable evidence of compliance with the irrsrutace requiremmrts of this chapter have been presented to tine carttraatirng authority." Applicants Please fill out the workers'compensation•affidavit completely;by checking the boxes that apply to your situation and, if necessary, supply slab-contractor(s)name(4 addresses)arsd phone mimber(s)along with their certificates)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partrets,are not required to cavy workers'cQrnpensation insurance. if an LL.C.or LLP does have employees,a policy is required. Be advised#hat this affitlavit.may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign.and date the affidavit The affidavit should be returned to the city or town that the application for the P camit or license is being requested, not'the Departrnant of Industrial Accidents. Should you have any questions regarding the law or if you.are required to obtain a workers', compensation policy,.plessrcall the Department at the manber listed below. Self-insured companies should entertheir seif-inscnance ncensc arrncer on tiro appropriate line. City or Town Officials A Please be sure that the affidavit is complete and printed lcg%ly. The Department has provided'a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applim m x Please be sure to fill in the permit/Iicense number which%%-M be used as a rzfzrence number.. In addition,an applicasrt that.must submit multiple permit(license applications in any given year,need only submit one affidavit indicating-current policy infonnaion(if necessary)and under"Job Site Addi-ess"the applicant should write I"all locations in (city or town)."A copy of-he affidavit that has been officially stamped or marked by the city or town may beprovided to the appiicarit as proof first a valid-affidavit is on file for future-permits or licenses. Anew affidavit must be filled out each year.When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit ti)brim leaves etc.)said personis NOT required ta.complet:e this affidavit The Office:of investig#ions would like to thank you in advance for your cooparmtion and should you have any questions, please do not.hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Dcpat-tmcnt of IM&Stdal Accid=ts Office of Iaueadg2fauns " 600 Wash.inghon Street Boston, MA 02111 TeL#617-7274900 ext 406 or 1-977-WASSAF£ Revised 5-26-115 Fax 4 617-727-7744 www.azass. rov/dia Date. r`. . "°RTM TOWN OF NORTH A DOVE p PERMIT FOR PLUM _IAS s a i ,SSACMUSE� -- t This certifies that . . .tJ. . . . .:. . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . ...". . . . ..' .' . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . at North Andover Mass. � e . f Fee.` .X', . Lic. No.. .. fr. '.``. . . . . `t. �. . . . . . .� °. : . . . . . PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location �- Ieal--Owners Name �� Permit# ��_ Type of Occupancy Amount New Renovation Replacement ED Plans Submitted Yes No FIXTURES Zrn x 0 0 0 �7� a ca ST''L�**ii� Rfm 411111J CIR 6M F . r ff-OM FLOOR (Print or type) Check one: Certificate Installing Company Name-A4Corp. .-77 Address W 4,�' 0 Partner. usmess Telephone E] Fitm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type.of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have an one of the above three insurance y Signature Owner ❑ 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 ins on erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa se g Co e and Chapter 142 of the General Laws. �-c By: ig e icense um er Title Type of Plum ' g License City/Town APPROVED(OFFICE USE ONLY censeum er Master Journeyman Date.J6. ..9.:.. °<..... NORTH TOWN OF NORTH ANDOV R PERMIT FOR GAS INSTALLATIO t � r • ' a SACHUSES This certifies that . . . . .. . . . . . . .., has permission for gasstallationl. in the buil ,7s of .f�, le?L '� ,,.,. . . . . . . . . . . . . . . . . . at ./J/. Zi t�.�".�"Y'!��1 ? f%,G. . ., North Andover, Mass. Fee�S .fes Lic. No. :55 . . . . . . . . . . . . . . . GAINSPECQp�n TOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File 2, � mtaaaAt�nuat I I.--, uMll'uHM AlrruCATION FOR PERMIT TO DO GASFITTING (Print or Type) is fic/— w.i!/. fY`�✓� Mass. Date ( 19-fLPermit# Building Location ,/!/ /✓/��/�9,�/��CJI Owner's Name Type of Occupancy__ �s New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N14 cc y W N x z cc !A � W y 0 N CC W O z O N cc N -< cc 0 O = a 1 H Q m PI1 N tl W < = z E... fn d j Q W µr N J '� < S Cr W W O W m N =O O wVz Q W J - z < -1Ma¢ = O tl 3 a tlQ > Q O 3 SUB—BSMT, BASEMENT 1ST FLOOR 2ND FLOOR ' 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET }❑ Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone 508-687—'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 O If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy K Other type of indemnity❑ Bond El . 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 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 pphcation are true and accu�ie to the best of my pertinent provisions of the Massachusetts State Gas Codand Chapter 142 oft he Ge eu f r this application will n� mpliance with all � T e of License: f Title Plumber asfiiter Signature o licensed Plumber or Gas G Master license Number 8697 City/Town Journeyman APPR0W OFFICE SE ONLY) I i rt, Date. 13 2 ORT„ TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING ,SSACMUSEt This certifies that . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . ,firth Andover, Mass. Fee).5. -. . . .Lic. No. � Z. . . . . . . . . . . . .. . . . . . . . . . PLUMBING INSPECTOR 03/05/97 11:37 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) 110Mass. Date 0 C�7- 19 Permit # �J Building Location Owner's Name Type of Occupancy /�'f New ❑ Renovation ❑ Replacement-E Plans Submitted: Yes ❑ No ❑ B .P.# SEWER# FIXTURES SEPTIC# z Z Y W o z y OZ Vf Q ft a ~ Z O Z (n a J N W H !- W N h U [L Y Q N LL Z �. z Q) X . . V = ¢ m N y W } dl h m Z = a O -:t a a 3 E rt W 0 7 Q y Q 1 Q W " c a N Z tt 4 0: O � ut x ►' h ut 3 o c 1! LA. c� 4 x z = �G a h a Y su u x r u s h O S U) o N I O z O a 1 N = Z w h o �' �' a a, a J JI a x x rr, a f- N LL O O O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR ' 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name ��/ �� LG e eck one: Certificate # Address ` /��/ ` Corporation /C _ ❑ Partnership Business Telephone S-A 6 S( 5 7 SJ ❑ hrm/co Name of Licensed Plumber s A) INSURANCE COVERAGE: I have a current Ddbility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked.yt-g, please /indicate the type coverage by checking the appropriate box. A 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 ggent Owner ❑ 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State P 'ng Code anfVhaM of the General Laws. BY Title ' S n e of Licensed Plum er Type of License: Maste� Journeyma ❑ City/Town �c APPR01/FD OFFICE USE ONLY) License Number 7 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO.- APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR `� �•. Date. !.'' - .. ...... . . HpRTN ti TOWN OF NORTH ANDOVER 3? ' • pp` PERMIT FOR GAS INSTALLATIOR ,SSA�HUSEt This certifies that . . f .F. . . . { f has permission for gas installation . :.!. ` . . !:. . in the buildings of . -P4 . . . . . . . . . . . . . . . . . . . . . . . g r at .. . . . -. . . No ndover, Mases Fee. /s-,.- . . Lic. ?. . . . . ... . . . . . . !`'a ?!'; AS INSPECTOR , l WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File s„ w' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Prin or Type) Of-7 M r//"Or4e oa"Mass. Date +� tri Permit # -(ep 4-- Building Location 2zv--Owner's Name Type of Occupancy � l��J/�� New ❑ Renovation ❑ Replacement. }— Plans Submitted: Yes❑ No ❑ N N wuj Y N Z 1= N N V h CC F- oc to WN cc ci U 4y- x S W _ z J ¢ F E r >•' _ '.Z. .O Cr Y 0 O O w < m N {- :31 ul o - 0. W < r y W w °C c: W z U W a W W Or w }— T, ¢ -+ cl N W O > tl t V J W OWt. O � X d W > cc W :32. < Cr < < O O W O F- [t: S O tl Z tt. O SUB—BSMT. BASEMENT 1ST FLOOR 2140 FLOOR 3RD FLOOR 4TH FLOOR ` STH FLOOR eTHFLOOR 7TH FLOOR STH FLOOR ' / Installing Company Name /' ,/I� _ C eck one: Certificate # Address C�/Corporation C A/ ❑ Partnership Business Telephone Qk3 / S p Firm/Co. Name of Licensed Plumber or Gas Fitter 0 Pj INSURANCE CO Ell AGE; have a current ability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O If you have checked ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy tx Other type of Indemnity O 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 0 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 ped for t i$3pur-liation w111 be In compliance with ali pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 ofi w . T e f Ucense: Title _ lumber Signature o cenm Plumber orGas titer stiltar aster Ucense Number City/Town Joul neyman N'f'f1-AT-. )FO FC S BELOW FOR OFFICE USE ONLT PROGRESS INSPECTION FINAL INSPECTION SKETCHES FEE N0. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING LOCATION OF BUtLOtNG PLUM13ER OR GASFTTTER LIG NO. PERMIT GRANTED DATE 19 GAS IRSPECTOR 77Z 7: • 2299 Date.. .. �. .� � ✓�. NORTH TOWN OF NORTH ANDOV '0 '� ° op PERMIT FOR GAS INSTALLATIO ��SS�CMuSE� This certifies that . has permission for gas i tallat' n in the buildi g of . . . . . . . . . . . . . . at .� - , North Andover, Mass. Fee. 0 — 30.00 i� �C. ' . . . . . . . . . . . . . . . . YEE, �i�9964E '�� GA PECTOR WHITE:Applican CANARY: Building Dept. PINK:Treasurer GOLD:File C MASSACHUSETTS. FUNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN. _ (Print or Type) 4 = .• %� �1/� Mass. Date 19 ?-z�_ Permit # I tl. Building Location /4 Owner's Name � �� O//e,Z Type of Occupancy New / Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No i . . rn U) ccW Y In pU a cc W � ¢¢ O U m Z W mrn FW– t~tJ ZO _ 00 Z ~ rn uj Cry U W cn w cc O W r 0 W Z J z = W W U' cr > u-. � U -j W Q W > W j Z Q Q fn .O W O W E-. .. 2 0 0 2 W C7 U > d F- O SUB-BSMT. BASEMENT 1 ST FLOOR ` 2ND FLOOR I 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR . , 8TH FLOOR Installini ' Company Name iD ,0 � Check one: Certificate # Address'` �� CJS/� ' �� ✓ f� Incorporation G ❑ Partnership Business Telephone ❑ Firm/Co. Name o,' Licensed Plumber or Gas Fitter L6�� JP•�i� 14 INSUR:It l NCE COVERAGE: I have currenability.1insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No. ❑ If you ;ave checked yes, please indicate the type coverage by checking the appropriate box. ii A liability insurance policy. ❑. Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that tl a 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 installation performed under the 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 — I Type of License: 0 Plumber Title Gasfitter Signature of Licensed Plumber or Gas Fitter City/Tow rj Master License Number APPROVED (OFFICE USE ONLY) U Journeyman -- -- --- - -----BELOW-FOR--OFFICE USE-ONLY--- -- -=--- --- -- FINAL INSPECTION SKETCHES NO. PROGRESS INSPECTIONS MERCURY TEST FEE FINAL INSPECTION APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 GAS INSPECTOR