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HomeMy WebLinkAboutMiscellaneous - 20 BEECH STREET 4/30/2018 f 20 BEECH STREET 210/033.0-0045-0000.0 i 78 6 Date. A4-1A . . . ..... NORTH TOWN OF NORTH ANDOVER i - X PERMIT FOR GAS INSTALLATION SACMUSEtt s This certifies that . /QQ Ir�'�¢. . .4 1.?J1U.e . . . . . . . . . . . . has permission for gays installation ./I, in the buildingspf ..!�!c . . . . . . . . . . . . , O, at 7. !� .p.�. . . . . . . . . . . . . . . . North ndover Mass. Fee.�&4?4? . Lic. No.�-?$rl. . �. . . . . GAS INSPECTOR Check# Z019p MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING 1V City/Town: 7) 14tdd0✓-j MA. Date: JD `� Permit# Building Location: 7� y[� C fT G Owners Name: f v Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES le w ui W N QZ' ~ co co V = O Z F- O O W } W Z w p n w ix Z o w W w iz0 a m 55 w W W g m 0 a a w o 0: 111X to U ZwLu LLJ tY O W CO O a W = > WWZOJ OH = W W w W _U = = Oa W > >ti O SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR Vu FLOOR 4 IHFLOOR 5 FLOOR 6 1H FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: ,� )) El Corporation Address:-, Cv(gii City/Town: w!/ State: � ) ;Firm/Company artrship Business Te Z 3y_ ` Fax: Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please ind' ate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner [:1 Agent E] By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this 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 provision of the Massachusetts State Plumbing Co hapter 142 of the General Laws. By Type of License: ❑Plumber Title 9 Gas 'as Fitter Si ture f ensed umber as Fitter City/Town []journeyman License Number: -5/ APPROVED OFFICE USE ONLY ❑LP Installer �OM n JRL7iI ©F --SETT } LlLENSED AS A MASTER PLUMB 1' ISSUES THE ABOVE LICENSE TO: ,y i \ { s RAYMOND P LABBE � , 35 COLBY RD NH 03819-510 _ f DA.NVILLE t 78.7671 12451 05/01/12 9 .. I -1 MASSACHUSETTS U141FORM APPLICATIOWFOR PERM 1. T0.D0'PI.0 gl (Type or Print) NORTH ANDOVERMa/ss. ••�-<.: .•`• • Oate:'• • Building Location e c vc Permit kL62z Owners Name i v New D Renovation r] ' Replacement [ Plans Sybmitted FIXTURESi. .. z os ;,/► a • N 07 O O Z Z ,. W W P1W Y J P ••' � V � O Z OI 4 Q COC• h U W x d W < a < 0. ~ O W h W Q W o) z a � K O Z 0 7 a < rst Q W Cl Q m z x a cr, J• w I W S ~ F W O O .J O OC F- Q iC 9C j O O Is. IC 14 a O < W k !< W ;•.� < h- �' F' O h N 7 N 1- x O O al _z Z W 1 O V Y SUB-%BSMT. I T • BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STN FLOOR 6TH FLOOR 7TH FLOOR ' BTH FLOOR (Print or Type) Check one: Certificate Installing Company Name Corp. Address• YD 0- ox FdVLJ Partner. �!J• �// a ✓...P2 �zz 0 1 � o� Firm/Co.� Business Telephone (y ,f_(0 -Q r20 Name of Licensed Plumber: ay ,b�S�/� „zg . .�_ Insurance Coverage: Indicate the type of insurance coverage by checking the i . appropriate box: Liability insurance policy Other type of indemnity El Bond 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. 'i Signature of owner/agent of property Owner U Agent% 0 •r ' I hemby eestify that all of lbc details and infornsalion 1 have submitted(or enlacd)in atwr.e application a1c ant and�alt to dw beat of a I �•- kjowkdgs wd that all plumbing work and installations tierformcd under Pcratil issued for this application will be M 1-k so follow pwo tisiosu of Ow Masachutells State Plumbing Code and Chapter 142 of the(:ens .w ` Title • Signature of Licensed Plumber City/Town: Type of Plumbing License ; I ! f2 C' — r n_� r-, te-?�. 9-�� , a 337 Da TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SS/1Cows� This certifies that ' . : ^`- . . . ?1 ,.- has permission to perform,,. . . . . . . . . . . . . . . . . . . plumbing in the buildings of . -^�. . . . . . . . . . . rt-'. . . . . . . . . at.�. k t-�' . . . . . . . . . . ., North Andover, Mass. . Fee-' ? . . . . . .Lic. No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer