HomeMy WebLinkAboutMiscellaneous - 20 MORNINGSIDE LANE 4/30/2018 (2)7 7i J Date .. T/ 7. f.. ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .N .t.V :f... /i° !w. f' . A.'.q.......
has permission for gas installation .5,1a V .-e ................
in the buildings of ... �=!!' �G� ...........................
at .2: �? .. 01,11.v Se.(° ...... North Ajidover, Mass.
Fee. ) U Lic. No l� . .. .
GAS INSPEC
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTJNG
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City/Town.--)l d, dj 411(1L<� MA. Date:
Permit#
Building Location: '? -,L) Owners Name: _kp l cJ
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Type of Occupancy: Commercia ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [4-� Plans Submitted: Yes ❑ No ❑
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SUB BSMT.
BASEMENT
1 FLOOR
2 Nu FLOOR
-3'FLOOR
4 THFLOOR
5 FLOOR
6 FLOOR
7 IH FLOOR
8 IHFLOOR
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Installing Company Name:
Sly-/.'o�m
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Check One Only Certificate #
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Address:_, .O, dX -517 y City/Town: -)- U ,� ate: � _�
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�'rporation
Business Tel: 2 7f tf � D j�Zv
Fax:
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Name of Licensed Plumber/Gas Fitter:
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes P3"No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy all- 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 El Agent El
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 Dlumbina work and instanatinn¢ —F--1 ,,.,,1....1.
e witn all Pertinentprovision of the Massachusetts State Plumbi od and Chapter 142 of the General Laws.
Type of License:
By Plumber
Title ❑ Gas Fitter Signature of Lice Plumber/Gas Fitter
Q'Master
it❑Journeyman
ALicense Number: �_
APPROVED OFFICE USE El LP Installer
///931
Date.....................
TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION
This certifies that%/lL-.!�f.L .......
has permission for gas installation .Pj ............
in the buildings of . /� r ......................
at..'//, 2t Forth Andover Mass.
Fee.vg0'6Z?. Lic. No.. 7 l� . ..........................
GGAS INSPECTOR
Check # 0 /�
MASSACHUSETTS UNIFORM APPUCA
--_ (Print or Type)
&CI -W 14^,,8Qw AQ , Mass. Dat //
Building
New ❑ Renovation Zj---
FOR PERMIT TO DO GASFITTING
Permit * `'f'9-39
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!/��' Owner's Name � C 64%/� C. L
Type of Occu, P"nS: -o'g ,�vA L
4acement ❑ Plans Submitted: Yap No
Installing Company Name YANKEE GAS Check one: Certificate
Address 140 SOUTH MAIN STREET 13 Corporation 103C
MIDDLETON, MA 01949 0 Partnership
Business Telephone 978-774-2760 C! Firm/Co,
Name of licensed Plumber or Gas Fitter WILLIAM R. HARRTS
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 13 No ❑
If you have. checked js. piease tndi: to the type coverage by checking the appropriate box
A liability Insurance policy 0 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:
Owner) Agent ❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and information 1 have submitted (or entered) in above app5caticn are true and accurate to the best of my
knowledge and that all plumbing work and installations performed underthe pe for this r will be in cc ph with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of tha Ge s
Laws.
gy Tof License:
Plumber §gature cTljcmsw PWmbWor mer
Title jGasftter
Master License Number 3785
City/Town Journeyman
APPROVED( 1 NL '
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$US—BSMT.
BASEMENT
1STFLOOR
2ND FLOOR
3110 FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name YANKEE GAS Check one: Certificate
Address 140 SOUTH MAIN STREET 13 Corporation 103C
MIDDLETON, MA 01949 0 Partnership
Business Telephone 978-774-2760 C! Firm/Co,
Name of licensed Plumber or Gas Fitter WILLIAM R. HARRTS
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 13 No ❑
If you have. checked js. piease tndi: to the type coverage by checking the appropriate box
A liability Insurance policy 0 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:
Owner) Agent ❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and information 1 have submitted (or entered) in above app5caticn are true and accurate to the best of my
knowledge and that all plumbing work and installations performed underthe pe for this r will be in cc ph with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of tha Ge s
Laws.
gy Tof License:
Plumber §gature cTljcmsw PWmbWor mer
Title jGasftter
Master License Number 3785
City/Town Journeyman
APPROVED( 1 NL '