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HomeMy WebLinkAboutMiscellaneous - 235 GREENE STREET 4/30/2018 235 Greene Street BUILDING Date tak�..[!.i.......................... OF TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION -7: This certifies thaZ................................................. C.......... ......... . .......... ... has permission for gas installation ...V.' pbs -.A..V.AA..C4�....4..P inthe buildings of...............A.......j.-,2r,...................................................................................... at.....2-3�� 9Q"-� S�� ...... North Andover,Mass. ....................................................................................... Fee . Lic. NS. 03 10........ H....14,,.�...................................................... GASINSPECTOR Check# a 7 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK v - CITY I North Andover MA DATE tI , G' PERMIT# W G- JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS I Same TE FAXI TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ® RESIDENTIAL❑ PRINT CLEARLY NEW:F-1 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES[] NO❑ APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1Gas Meter X and Pi ina as Needed INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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 AGENT 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 applicatqwillbempliance with all Pertinent prov!&nthe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE# SI NATURE MP❑ MGF❑ JP❑ JGF® LPGI❑ CORPORATION❑# 3285C HIP❑#0 LLC❑#� COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL (508 832-3295 FAX 508-9264347 CELL 508-832-4614 EMAIL JMarino@RHWhite.com Ur 1 Cel V 1qjl ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �L0 • ti . r 30`iVitV�AL.TH OF MIASS `- UtVj(BERS AND GASP Y_ ~-• '~X' - 17fiER;S. :_ AS'A-M,). TER t'!.i LJM 3 '-t``'r ,y:. '-issues �; .. _ TAE-ABO .UORNS El'O:�- J CI S EPvFi. `tl -m A-R.I No GTON 8T ~Wi7RCEST12 MA 0i _-�!'- 3,C},- 05/'01/14 •C.O tiiM NW AL_TH OR MASSA-N.--, l fS' - :- ISM R-441,41 '- PLUMBERS AMD GASF['I'1' RS:;; l f'CF ISE"d AS A J0LU.RNEYN-AN----LU tt�t'��� ` -- _-=ISSUES THE ABOV�'LICENSE -�D :MAR IN0• _ _ •-� b STS R !A F3 1 F�0:4 :3•I 0 9=' y 05./01/14 ?tea - I • • ,. r • •I , • . *- -,3�_�n.,J ACURD CERTIFICATE OF LIABILITY INSUMNCE Page 1 of z 081 9iaois THIS UFATIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS DEATIFICATE DOES NOT AFF IRMATIVEt_Y OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED RE=PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SU 13ROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A Statement on this cortifleate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT Willim 0£ Massachusette, Inc. PHONE C/o 26 cQxYtuxy Blvd. NO_Rxif: 877-945-7378 FA oI: 886-46_ 78 7-23 P. o. 305191 Ds ce�rt�fiCateaC�w•i11iB.�om Nngk�villOlla, TN 37230-5191 GRF INSURER(-AFFORDING COVERAGE NAICrt INSURED INSURERA: The CbArtez Oak r•'iro Znaurana9 Company 25615-001 R. H, White Construction Company, Ino• INSURERS:Trdvalnro Property Casualty coxAt?any of 3m 25674-001 41 CmntrA3 street INsuRERc:Neti4nal Union Firg yneurnnem Ce P. 0. Box 257 mpaay o£ 19445-001 Auburn, MA 01501 INSURER D;Travelere indmmnity Company 25650-001 INSURER F•; INSURER F; COVERAGES CERTIFICATE"NUMBER:20267680 REVISION NUMB THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INI)ICA7ED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I1719 NSR TYPE Or INSURANCE7LOG POLICY EFF POLICY 11 POLICY NUMBER LIMITS A GENI7iALUAsIL►TyVTC2OCD 977X9940-13 9/1/2015 '9/1/2014 EACHOCGURRENCE S 2,000,p00 X COMMERCIAL GENERAL L 1 TORENTEp ��B Eaoteurtncr _� _ 300 QOp CLAIMS-MADE I T --- MEDEXP(Any one erson Z0�Q00 PERSONAL&ADV INJURY $ 2 000,400 GENERAL AGGREGATE $ 4'0 0 0 0 0 0 RGEN'LAGGREGATELIMITAPPLIES pR¢ PRODUCTS-COMPIOPAGO $ 000 000 POLICY AUTOMOBILELTABILITY $ vTJC.AP 977K955A-13 9/1/2013 9/1/2014OMgI�EDsiNGLELIMir � ANY AUTO •.Fccldent A 2,000,000 ALLOWNED SCHWULED BODILY INJURY(Perperson) & AUT)8 AUTOS BODILY INJURY(Peraceldwi) 6 X HIREDAUTOS X NON-OWNED X co ped X Cvx1GDeA erscolden[ A ^� $ C UMBRELLALIA6 $ OCCUR BE87661.40 /1/2013 9/1/2014 EACHOCCURRENCE $ 91000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE DED I X IRETENTIONZ 10,000 000`040 D WORKERS EMPLOY RS'LIA ILIITION VTRFUB 920SA1a5-13 9/1/207.3 9/1 207.4 X 0 S AND EMPLOYERS'LIABILITY YIN / TOI�Y D ANY PROPRIETORIPARTNFRIEXECUTIVE� NIA 'VTC2xua A203,A71A-13 9/1/2013 9/3./2014 E.L.FACHACCIDENT !$ 1,000,000 OFFICERIMEMBFR EXCLUDED? 1i�Mend�tOrylnNH) E.L.DISEASE-EAEMPLOYP.E 5 1,000,000 Is K1leE�UN UE OF ORATIONS below F,L,DISEASE-POLICY LIMIT IS 1,000,000 )ESC RIPTIBNOFOPERATIONS ILOCATIONSIVE141CLES(AtlpcilAcord 101,AddltonplftemeAceSthodula If more epw la raqulrpd) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN GELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of =awuzance AIJTHORIZI!o REPRESENTATIVE 0011:4197604 Tp1:1694012 Cert:20287680 ©1988-2010ACORD CORPORATION.All rights reserved. CORD 25(2010105) The ACORD name and logo are registered marks of ACORD 0, A RBay State Gas A NiSource Company 55 Marston Street P.O. Box 869 Lawrence,MA 01841-2312 November 21,2008 (978)687.1105 Fax:(978)688.1875 Zhu Junwu Account Number: 701924006 235 Greene St North Andover, MA 01845 Dear Zhu Junwu: This follow-up letter is to inform you that your gas Boiler located at 235 Greene St has been tagged due to a violation of state safety regulations. It is unsafe to use until the following condition has been corrected. Not enough make up air bedroom in basement,left on heat in here The Masachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737 Acts of 1960,requires that the condition be remedied. If you have questions or would like to discuss this issue, please call 978-687-1105 and ask for the Service supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Service or Meter Department Bay State Gas Company CRR: CRR# Q\cisupdatedlettersx236 11/21/08 Glum[L Gas- of Massachusetts A NiSource Company 55 Marston Street P.O. Box 869 September 28,2011 Lawrence, MA 01841-2312 978.687.1105 Fax:978.688.1875 Junwu Zhu Account Number: 10 Green Meadow Ln Andover MA 01810 Dear Junwu Zhu: During a recent visit,our service technician detected a safety problem with your gas furnace located at 235 Greene Street,North Andover,MA. Accordingly,we have issued a Warning Tag because of this situation. Flue pipe needs to be replaced from vent motor to out before gas can be restored to furnace. Under the circumstances, we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737,Acts of 1960,requires that the condition be remedied. If you have any questions, please call our Service Department at 1-800-698-0940 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts CRR: CRR# CAdsupdatedletters1110 09/28/11 Date. . J.. .:.. . . . `.... . of,NOFT e, ti0 3� ° TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SACMUSEt ' This certifies that �� . -- .`�. . . !l . has permission for gas installation . —rj.. .. r in the buildingstof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . •. . . . . . . , North Andover, Mass. Fee.�n /c. �! Lic. No.. . �c,3 , ;.�.u i, . . . . . . . . . . . . f GAS S CTOR Check# I MASSACHUSErI'S UNIFORM APPUCATON FOR PERNIlT TO DO GAS F MNG Date \^ (Type or print) ®f NORTH ANDOVERMASSACHUSETTS Building Locations ��`'�-p - Permit# 53 Amount$ �?6 Owner's Namero I New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ O U F tl o o o $ eW a P a � x Z9 0 3 a °' °a g a°. I OH 1- SUB -BASEM ENT BASEMENT r 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) cc U �M C one: Certificate Installing Company NameyL �—'c�O� t Corp. Address v-2-i�:?z �1�`S��� ��� ❑ Partner. e t Business Telepnone g ElFirm/Co. Name of Licensed Plumber or Gas Fitter CD470 Y`'L INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes � No❑ If you have checked Yes,please indicate the type coverage by checking the appropriate box. ❑ Liability insurance policy JE3f 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: 13Signature of Owner or Owner's Agent Owner ❑ 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 and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse ateGas od=Chapter42 of the General Laws. S' azure of Licensed Plumber Or Gas Fitter By: Plumber Title City/Town ❑ Gas Fitter License Number n-��aster PROVED(OFFICE USE ONLY) ❑ Journeyman 82 i Date..101.A. . . . ...... TIy to 3= ; TOWN OF NORTH ANDOVER O � A t - PERMIT FOR GAS INSTALLATION SACMUSEt 4 This certifies that . .� !. . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . ` in the buildings of . .T/-r . . . . . . . . . . . . . . . . . . . . . . . . at . .-, . . . . . . . . . ., North Andover, Mass. Fee. Z��'. Lic. No../.9.?o . . . ,c'ff�l . . GAS INSPECTOR Check# 377 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: ty� U _, MA. Date: 6—S Permit# Building Location: 3 c s7,' Owners Name: _f� Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Insti utional ❑ Residential/ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES Cd z Y H C Z Q W co)co 0 m = O W W U N I__ 0 = co W Z I— z � W W W R O � � W N W m O F- W 0 Q F- W F CO) 0 Z W z ~ 2 0 W W = X W W N O H p LL' > W W Z 0 J 1— H 0 Z J 0 LL IN = W F LL' W O W IY Q W W m W O Z O N ~ > Z I" 2 D o o u. 0 C7 x Z J 0 aW F- > > > 0 SUB BSMT. BASEMENT 1 FLOOR 2 No FLOOR 3 11DFLOOR 4 TH FLOOR 5TH FLOOR 6 TH FLOOR 7 THFLOOR 8 FLOOR Installing Company me: t 61 1 Check One Only Certificate# 4 Corporation Address: . (y;- �LYZ City/Town: State: 4 7 Q El-Gr Business Tel: ail- �3 Fax: ! ? ��" "�nG 8 Firm/Company Name of Licensed Plumber/Gas Fitter: y INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance poliZER: Other type of indemnity El Bond El OWNER'S INSURANCE Wam 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 0 On A nt Signature of Owner or Owner's Agent Owner ElEl By checking this box❑;1 hereby certify that all of the details d information I hav subgtt (or entere regardi is/application are true and accurate to the best of my Knowledge and that all plumbing w rk and installations p rfornder e p rmit is ed f this application will be in compliance with all Pertinent provision of the Massachusetts tate Plumbing Code d Cr 14 rhe en al La s. By lTy of License: umber Title ❑Gas Fitter tare c nse umber/Gas Fitter aster City/Town Journeyman License Numb r: �Q APPROVED OFFICE USE ONLY ❑LP Installer The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations, 600 Washington Street Boston,MA 02111 'Y www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractorsxlectricians/Plumbers Aipplicant Information Please Print Legib Name(Business/Organizationadividual). 6 Address: City/State/Zip: --1-= oL' Phone#: LEEII n employer?Chec t e appropriate box: _ a employer with 4. ❑ I am a general contractor and I Type of prof ect(required): oyees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction a sole proprietor or partner- listed on the attached sheget. t �• ❑Remodeling and have no employees These sub-contractors have 8. ❑Demolition ing for mein any capacity. workers'comp,insurance. orkers'comp.insurance 5. ❑ We are a corporation and its 9 El Building addition red.] .officers have exercised their 10.❑Electrical repairs or additions a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additionslf. [No workers' comp. c. 152, §1(4),and we have no12.❑Roof repairsce required.]r employees. [No workers' COMP,insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insur ce for my employees B low is the polic and job site information, t Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: . City/State/Zip: Attach a copy of the workers'compensation p on policy declaration page(showing the policy number and expiration date). Failure to secure required coverage as r e under Se g q Ghon 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fie up to$1,500.00 and/or one-year imprisonment, ell as civil penalties in the form of a STOP WORK ORDER and a fie of up day against the violator. Bea ise that a copy of this statement may be forwarded to the Office of Inv stigations of the for ins ce cov eve ' c ion. Ido z eby certify nder the i p na ' ofp ury that the information provided above is true and correct. Si nater 6 Date: Prone#: Official use only. Do of write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Ins e 6.Other g ctor P Contact Person: Phone#: t �w Information and Instructions coons Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartinents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)andphone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised thatthis affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,;please call the Depai lment at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CoM11nomweal`h of 10'assachusetts Department of Industrial Accidents Office of InVestigatlions 600 Washington Street Boston;MA.02111 Tel. #617-727-4900 ext 4406 ox 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.iass.iZovfdia Columbia Gas- TAG COPY 1� M�J]aSssaGchfusetts A NiSaurce Company � WARNING NOT ICE — AVISO LLT ATA-' OWNER TELEPHON E C E ✓ rAg}CCIUTDAD r- lPROPIETARIO TELEFONO CUSTOMER "{4y Mr" SUITE TELEPHON6Q 7t4 ADDRESS CUENTE AP,ARTAMENTO TELEFONO DIRECOON THE FOLLOWING PROBLEM MUST BE CORRECTED IMMEDIATELY: ❑ PIPING AIR SUPPLY � TUBERIAS ❑ SUMINISTROS OE HIRE LOS SIGUIENTES PROBLEMAS DEBEN SER CORREGIDOS IM.M, APPLIANCE VENTING iS D ` ❑ APPLI ACTOtDEGAS ❑ VENDUCT,OS,D.E�VENTILACION EXPLAIN: F1 iAG ` ige r Ft>uc41i , �5o�+Ct G �n�I QC 1J t. � =9c ' EXPLIQ�74 V IL4µ r YOU MUST CONTACT A QUALIFIED CONTRACTOR FOR REPAIR: COi 7UNIQUESE CON UN CONTRATISTA ESPECIALIZADO PARA EFECTOS DE LA REPARACION: PLUMBER ELECTRICIAN CHIMNEY CLEANER PLOMERO ❑ ELECTRICISTA ❑ PERSO A OUE LIMPIA EL CANON ❑ OTHER: ••• O HUMERO DE CHIMENEA OTRO: ' THIS WARNING NOTICE IS FOR YOUR SAFETY AND PROTECTION. AFTER ESTE AVISO ES PARA SU SEGURIDAD Y PROTECCION. PARA LA RE- REPAIRS ARE MADE CONTACT COLUMBIA GAS COMPANY OF MASSACHUSETTS STAURACION DEL SERVICIO COMUNIQUESE CON COLUMBIA GAS FOR RESTOARTION OF SERVICE. COMPANY A AN NY HEMASSACHUSETTS DESPUES DE DUE LAS REPARACIONES �! GAS LEFT PON-CONECTADO METER LOCKED ❑YES-SI CONTADOR APPLIANCE LOCKED /Ne YES-SI EL GAS SE CERRADO ARTEFACTO CERRADO ENCUENTRA ❑OFF-DESC NECT DO CON LLAVE NO-NO DE GAS CON LLAVE ❑ NO-NO CUSTOMER SIGNATURE: 1 TENANT OWNER FIRMA DEL CLIENTE: J INOUILINO ❑ PROPIETARIO I DATE r✓' r TIME )Z>s 3 ✓ EMPLOYEE EADO 4 5,35 HORATG205 10/10 I jjI HMOs WARNING DO NOT TAMPER WITH LOCKING DEVICE. REMOVAL SHALL ONLY BE MADE BY A BAY STATE GAS/NORTHERN UTILITIES SERVICE REPRESENTATIVE. AVISO NO MANIPULE LA CERRADURA. EL REPRESENTANTE DEL BAY STATE GAS/NORTHERN UTILITIES ES LA UNICA PERSONA AUTORIZADA PARA REMOVERLA. "CONDEMNED" DECLARADO INUTILIZABLE B HEPA60HEM COCTOAHOW, HE nO11b3OBATbCA FOR UNBENUTZBAR ERKLART DECLARE INUTILISABLE c, ro WHEN YOU HAVE REMEDIED THIS CONDITION AND WANT THE GAS TURNED ON, CALL COLUMBIA GAS COMPANY OF MASSACHUSETTS Brockton Division: 1-800-677-5052 Lawrence Division: 978-685-6382 Springfield Division: 413-781-3610 Springfield Division: 413-586-2400 (Northampton Area)