HomeMy WebLinkAboutMiscellaneous - 21 DEVON COURT 4/30/2018356: 1_�
Date..%�� .............
NORTH TOWN OF NORTH ANDOVER
'. Qyf,f0 ,O,tiOL
PERMIT FOR GAS INSTALLATION
9
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This certifies that . z:'. :r.... .... ........................
has permission for gas installation, -,o � - '.. !.... �.......... .
in the buildings of .. .....`. � ,{/.,A ....;............... .
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at ;/ .. ..... ............... . North Andover, Mass,
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Fee .... Lic. No . ` Z/4...
GAS INSP,96df
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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lit
Y MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS
�Type or print) Date 3
NORTH AINPOVER, MASSACHUSETTS
Building Locations 6><�/ ( 14V411 "v IV?, Permit # sol -61,5-
s Name
New r-1 Renovation F� Replacement
DouDS
P
Plans Submitted 11
address -�, 71' d( e/ J/9 &�/ --� _
3usiness
vame of Licensed Plumber or Gas Fitter
P
Check one: Certificate Installing Company
Corp.
F] Partner.
Firm/?(
NSURANCE COVERAGE Check ne
have a current liability Insurance policy or it's substantial equivalent. Yes No�
fyou fi'ave checked ves, pleas i icate the type coverage by checking the appropriate box.
_iabiliry insurance policy Other type of indemnity Bond
Dwner`s Insurance Waiv . I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
vlass. General Laws, and that my signature on this permit application waives this requirement.
signature of Owner or Owner's Agent
hereby certify that all of the details and information I have sub
)est of my knowledge and that all plumbing work and installati
:ompliance with all pertinent provisions of the ylassachusetts S
Check one: ❑
Owner
ON
(or,Antei-0) in above application are true and accurate to the
to ednder�Re�rnit Issued for this application will be in
and
By: Signature ohicensed Plumber Or Gas Fitter
Tide Plumber ! 9
�itviTown Gas Fittertcense Numoer
Master
kPPRO`'ED I()Fncl- [ISE ONI.Y) loumeyman
.R
j.
address -�, 71' d( e/ J/9 &�/ --� _
3usiness
vame of Licensed Plumber or Gas Fitter
P
Check one: Certificate Installing Company
Corp.
F] Partner.
Firm/?(
NSURANCE COVERAGE Check ne
have a current liability Insurance policy or it's substantial equivalent. Yes No�
fyou fi'ave checked ves, pleas i icate the type coverage by checking the appropriate box.
_iabiliry insurance policy Other type of indemnity Bond
Dwner`s Insurance Waiv . I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
vlass. General Laws, and that my signature on this permit application waives this requirement.
signature of Owner or Owner's Agent
hereby certify that all of the details and information I have sub
)est of my knowledge and that all plumbing work and installati
:ompliance with all pertinent provisions of the ylassachusetts S
Check one: ❑
Owner
ON
(or,Antei-0) in above application are true and accurate to the
to ednder�Re�rnit Issued for this application will be in
and
By: Signature ohicensed Plumber Or Gas Fitter
Tide Plumber ! 9
�itviTown Gas Fittertcense Numoer
Master
kPPRO`'ED I()Fncl- [ISE ONI.Y) loumeyman