HomeMy WebLinkAboutMiscellaneous - 23 Belmont Street/ z3 BUILDING FILE
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Date.y -��. . .. . . . ... ...
Of.NORTH 14,
6
6
TOWN OF NORTH ANDOVER
' PERMITFOR GAS INSTALLATION
This certifies that .^. V--, . G",! . . . . . .
has permission for gas installation . . . .� . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . .
at . ..%. . . . . . -- , North Andover, Mass.
Fee. 'L.�f. Lic. No. dS�.4'. . . � � . . . . . . .
GAS INSPEC TO
U
Check#
5533
%ASSAcHuSEI'I'S Ulf' omi Appuc TON FOR PERNIlT TO DO GAS nTnNG
(Type or print) Date
NORTH ANDOVER,MASSACHUSETTS
Building Locations Permitit#
��---�
Amount
Owner's Name O S
New Renovation Replacement Plans Submitted
I �
z o F
z�
g a E. c
SUB •BASEM ENT
B A S E M ENT I
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4 T H . F L O O R
5TH . FLOOR
6TH . FLOOR
7 T H . F L O O R
8TH . FLOOR
(Print or type) f C e one: Certificate Installing Company
Name ��� P ff Corp.
Address �-3 0 Partner.
' Business p one 7 A-jo X-Z, /' g"�iJCo.
Name
Name of Licensed Plumber or Gas Fitter ����/, (� �✓� /'� ��^-�—�
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial,equivalent. Yes M;,; Noll
If you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy [ Other type of indemnity 0 Bond 13
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 [3 Agent 13
t 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 pork and inst , ns performed undo Permit Issu'd for this application will be in
,_C'mpliance with all pertinent provisions of the Massae sett State Gas ode and hapter 14 of the G Nal Laws.
v
ature of Licensed Plumber Or Gas Fitter
,ignBy. Plumber
Title
Citv.Town Gas Fittererase . um er
A-PPRO`'ED;OFRCE USE IDNLYj
7ager
urneyman