HomeMy WebLinkAboutMiscellaneous - 1925 GREAT POND ROAD 4/30/2018 (2) 1925 GREAT POND ROAD nd '`ct
210/035.0-0058-0000.0
Date.. . J {
1314
pORTM TOWN OF NORTH ANDOVER "
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PERMIT FOR GAs-=-INS�i'ALLATION,
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SACHUS
This certifies that . .
has permission for gas installation /.`�� ! �'
in the buildings of . . . .`. ! r . . .,;f rf
at �r�. . . . . . :: :1l !} �',•North Andover, Mass.
Fee. ."' . . Lic. No. £ . . . . . . . . . . .
3 •� 1�i GAS INSPECTOR
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WHITE:Applicant CANARY: Building Dept. PINK:Treasurer. GOLD:File
.' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFtTT1NC z-- -
(Print or Type) t
NORTH ANDOVER Mass. OateL/
�uilding Location 3 �a ��
Z. Permit #
Owners Name
• New '—t Renovation D Replacement Plans Submitted
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BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TR FLOOR
STH FLOOR -
(Print or Type) Check one: Certificate
Installing Company Name_^Y14ej,-1,ee:jt� ftp'! 6O 1 Corp.
Address W � 'j
G11Vj Partner.
zc�60 T� I�y F-1 Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter
Insurance Coverage. Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity 0 Bond E
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 coverages.
Signature of owner/agent of property OwnerAgent
I hcteby 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 perfomied undo Permit isseed fo: this application will-be in oompliance with all pertinent
provisions of the Massachusetts State Cas Code and(Iuptcr 14I of the General Laws,
By TYPE LICENSE:
(Plumber
Title Gasfitter Sig ature of Licensed
City/Town:
Master Plumber or Gasfitter
APPROVED (OFFICE USE ONLY) Journeyman /95 e `7
License Dumber
Date. . . . .
N2 4451
�.". aoT '�a TOWN OF NORTH ANDOVER
° PERMIT FOR PLUMBING
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This certifies that > 1: . . ":" . . . . . . . . .f'. .
has permission to',perform ....: .f .. ... . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing i'n the buil ings of- . . . . . . . . . . . . . . . . . . .
at. . . . . . � c `'{ . . , North Andover, Mass.
Fee.f,3. . . . . .Lie. No.. . . . . . . . . .: . . . . . . . . . . . . . . . .
/J PLUMB) G INSPECTOR
Check # oz-�-'W !/
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
t or Type)
Mass. ate 55 :—%sQ Permit
Building�catlorl---Lq ' `�� '
Type of Occupanry
NOW ❑ Renovation ❑ Replacement Plans ad: Yes O No ,A-
FIXTURES
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S UZ—B S MT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR .
eTH FLOOR
7TH FLOOR
STH FLOOR
Inst1)lling Company Name TCheck one:. Certificate
Address ❑ Corporation
O Partnership
Business Telepho , ihaiFirrrh/C0.
Name of Licensed Plumbers
INSURANCE COVERAGE:
I have a curreM liability insurance policy or as substantial equivalent which meets the requirements of MGL Ch. 142:
Yes X3, No O
If you have checked M. please Indicate the type coverage by checking the appropriate box
A liablky Insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance average required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
nature of Qwer or Qww-a#aent
Owner O Agent O
I hereby certify that all of the details mW information I have wWnKW(or entered)in above application are true and accurate to the gest of my
IavtWp and that all plumbing work and installations performed under the permit issued for this application will be m compliance with alt
Pertinent provisions of the Massachusetts State Plumbing Code T#Y of the General taws.
By de ,
jure of Licensed Fiun*w
rrUe - •
Rown Type of License:Master j (QJourneyman❑
License Number�t.�`i"-I _.