HomeMy WebLinkAboutMiscellaneous - 232 CANDLESTICK ROAD 4/30/2018/ 232 CANDLESTICK ROAD
210/106.A-0199-0000.0
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7546 Date. ........
. Of NORTH
TOWN OF NORTH ANDOVER
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' PERMIT FOR GAS INSTALLATION
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This certifies that . . . . �i�. . . C.l�
has permission for gas installation . . . . . . . . . . . . . . . . . . . .
in the buildings of : . . .1 1. r. . . . . . . . . . . . . . . . . . . . . .
at . .`.. . . North Andover, Mass.
Fee. , 4. . . Lic. No.. . .�. . . . . . . ... . � �r . . . .
GjS INSPECTOR
Check# Z r� � )��
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
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CityfTown: A/�-tic�� Z MA. Date: / z� Permit#
Building Location:,23, 60o LL 5//Cf Owners Name: 13141?1?E- l,
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential B--
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Et— Plans Submitted: Yes❑ No❑
FIXTURES
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SUB BSMT.
BASEMENT E
15T FLOOR
2 FLOOR
3 FLOOR
4 THFLOOR
5 FLOOR
6 FLOOR
7 1 H FLOOR
_PFLOOR
ITTC Check One Only Certificate#
Installing Company Name: (fAz'I`�'� A&' jtC_
� � )�Cerporation
Address:9l 1�a�D �City/Town:_[U, ('t��l�l�(�� State:
�l /(/ ❑ Partnership
Business Tel:5' ? b 0?re�3 � Fax: j
❑ Firm/Company
Name of Licensed Plumber/Gas Fitter:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Ye$17-Na❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Ld' 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
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
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 plumbing work and installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and C apter 142 of the General Laws.
Type of License:
BY E-Plumber
Title ❑Gas Fitter Signature f I sed Plumber/Gas Fitter
D-Master /e
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Cit /Town []journeyman License Number: 1 Jdd�
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APPROVED LP Installer
OFFICE USE ONLY El