HomeMy WebLinkAboutMiscellaneous - 227 PLEASANT STREET 4/30/2018 -727P STREET
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210/085.0-0046-0000.0
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' 978
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NOeTIy TOWN OF NORTH ANDOVER
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3? '� PERMIT FOR GAS INSTALLATION
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,SSACHU`�ES
This certifies that . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation :- . . . . . . . . . . . . . . . . . . . . .
in the buildings of . ?. f�4,. t . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . .. North Andover, Mass.
Fee.A ?. : . . Lic. No.�3 LZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASF1TTiNG
(Print or Type)
--7--i-=— /' l�P/d✓ Mass. Date 19 Permit #
Building Location. wners Nam
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UVType of Occupancy i�E51 T L_
New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No p
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SUB-BSMT.
BASEMENT I
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6THFLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name r'ji;(e T A ` )In MA T r1 X20 Check one: Certificate
Address 30 CoA C H/vA ra ry i_ff.. ❑ Corporation
nl� 7 H U e tJ r)l ►j U 1 ?q ❑ Partnership
Business Telephone to:-�72 —5 S 7 ( (�irrn/Co.
Name of Licensed Plumber or Gas Fitter -i r)j3E P.T A• ->A M rYl ll 7A&L
INSURANCE COVERAGE:
I have a current jobility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes fid" No ❑
If you have checked Yes, please indicate the type coverage by checking the appropriate box
A lifibility insurance policy id , 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 Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent owner[] Agent C3
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 underthe pe I ued for this application be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws.
BY T of License:
Plumber k-qiThbiture of Ucbnsed Plun:ZWor Gas Fitter
Title tter
er License Number
City/Town Journeyman
N
BELOW FOR OFFICE USE ONLY
FINAL_INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME A TYPE OF BUILDING
LOCATION OF BUILDING --
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE �9
GASINSPECTOR