HomeMy WebLinkAboutMiscellaneous - 1915 Osgood Street 1915 OSGOOD STREET
BUILDING FIL
Date `r. ... . .. .
Of.NORTH
o? TOWN OF NORTH ANDOVER
ti F
PERMIT FOR GAS INSTALLATION
�9
. 9
�,SSACNUSEtS
This certifies that . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . ��.� :. 'e?�� •:: . . . .
in the buildings of . . . . . ": 'f Ir ,F`:n . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . . . .. North Andover, Mass.
Lic. No. ? . . . . . . . .Fee.
GAS INSPECTOR
Check# ` '
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MASSACHUSETTS UNIFORM APPUCATON FOR PERM TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations l q Permit#
Amount$
Owner's Name 11C j
New Renovation D Replacement D Plans Submitted
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SUB-BASEMENT
BASEM ENT
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type)
1
Name / 1 ` Che k one: Certificate Installing Company
[ CS L=� 7
� Corp.
Address Partner.
Business Telephone 9 —� C�^y�0� Firm/Co.
Name of Licensed Plumber or Gas Fitter 'l\a V�� ��)`tSC,'y-,
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No�
If you have checked Les,please' dicate the type coverage by checking the appropriate box.
Liability insurance policy N Other type of indemnity 13 Bond D
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
hereby certify that all of the details and information 1 have subm' entered in above application are true and accurate to the
best of my knowledge and that all plumbing work and instal ons perfo ed u er Permit Issued for this application will be in
compliance with all pertinent provisions of the Massa ch tt . tate G Co and Cha a 42 t eneral Laws.
By: ignature of Licensed Plumber Or Gas Fitter
Title 0 Plumber /6j n0--?-
City/Town [3 Gas Fitter License Numner
® Master
APPROVED(OFFICE USE ONLY) 11 Journeyman