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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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This certifies that .. 71q /. - /.:.. .... A -r. ............
has permission for gas installation ..?.t. ;� ................
in the buildings of ...�!.. �.19..�� /-.- .....................
at ...? .1. , �.��.�.� ! t. -.............. North Andover, Mass.
Fee.../ 3.... Lic. No.. %�,.? C.`.' ......` �....t...1 �.:.. =� �... .
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
Print or Type) r
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Building
Date �j a-��j
Permit # 3
Owner's
Name A J,A 6,
Type of Occupa
New ❑ Renovation Replacement
Plans Submitted Yes ❑ No
(Print or Type) Check One: Certificate
Installing Company Nam peg %j�� i"+-� � 1:1 Corp.
Address A& 6 1Jg ,�&.1 ?z ED Partnership
/Y/�--? Pum/Company
Business Telephone 1�3- �'� Name of Lic�e�nsf d Plumber or Willer
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I hereby 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 performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of OwnerfAgent
I have a current liability insurance policy to include completed operations coverage. B�
By
Title
City; Town
APPROVED (OFFICE USE ONLY)
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TYPE LICENSE:
lumber
❑ Gasfitter
❑ Master
Journeyman
signature`oflicensed
Plumber or Gasfitter
License Number
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Date. .7"�y
6093
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SSACHUS�
�► This certifies that .. ��!....
?! {'.:`.�......... ........... .
has permission to perform...............
-...............
plumbing in
............... .
at ..,: .............................. , North Andover, Mass.
Fee...... Lic. No.l//9�
... , '. �
'"PLUfv�8I INSPECTOR
Check #
6093
J .I,
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PL
UMBIN
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location'0(
New Renovation
I Owners Name 114.4 00/014t,
Type
of Occupancy
Replacement
FIXTURES
Date 17 -IV -6 `7
' Permit #
Amount
Plans Submitted Yes 0 No
(Print ore) Check oCertificate
InstallingName� lk,.5 Cm
Address q Tpot a-
Partner.
f Z
Business a ep o _ pVYFirm/Co.
Name of Licensed Plumber: 4�')-r l — "to s $�o.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ® Other type of indemnity E 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
Signature Owner 0 Agent
I hereby 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 an5kqttallations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Mass �utts5tumbing Code and Chapter 142 of the General Laws.
Type of PluMng License
own USE ONLY ice se NumDer Master Journeyman r-1ZOVED (oma
A
Or--
NIASSACHUSE
... "�:�MIVIOfVrNEAL"frH
• • • ii Jill Joe
•GASFITTERS
IN PLUMBERS AMpSTER PLUMBER
LICENSE D A S ES THIS LICENSE TO
KARL E JACOBSON
5 INA AVE 2616 9315
HAMPTON NH 03842—
11180 05/01/06 •
COMMONWEALTH OF MASSACHUSETTS
✓ K
GASFITS
IN PLUMBERS JANRNEYMANTPLUMBE
ICENSED AS.
ISSUES THIS LICENSE TO
KARL E JACOBSON
� N
5 INA AVE
HAMPTON NH 03842-2616
21616
05/01/06 9315®
Claim # 033569556
Advantage Claim Services Adjuster Assigned: Glenn Guarente
522 Chickering Road #B
North Andover, MA 01845
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec. 3B
To: Building Commissioner Board of Health or
Inspector of Buildings Board of Selectmen
Town Hall Town Hall
North Andover, MA 01845. North Andover, MA
Re: Insured: Pierre Bernadeau
Property address: 21 Fernview Ave. #71
North Andover, MA 01845
Policy #: 66621400004
Loss of: 2015/03/24
File or Claim No. AD 1733
Claim has been made involving loss, damage or destruction of the above
captioned property, which may either exceed $1,000.00 or cause
Mass. _ Gen. _ Laws,_Chapter_143,Section_6 to be applicable. If any
notice under Gen—Laws,—Ch.-139—Sec.-3BMass _ is appropriate please
direct it to the attention of the writer and include a reference to the
captioned insured, location, policy number, date of loss and claim or
file number.
Glenn Guarente
Title: Adjuster
On this date, I caused copies of this notice to be sent to the persons
named at the addresses indicated above by first class mail.
�. % 03-30-15
Signature and,date