HomeMy WebLinkAboutMiscellaneous - 24 Kara DriveR,
Date .. .......' ..... `.... .
°' TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
Th;s certifies that ...:.. /5� e�' < .............. /.......
has permission for gas installation ... %.t..'...'. ,.l ::............ .
in the buildings of ....! : .........................
at .. <'..`!...`". ! :`:. ? .! ............. . North Andover, Mass.
Fee.. ... Lic. No. 1 ..:. ' . .
Check # S' e C ?
37
..........................
GAS INSPECTOR
?a,
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
TOWN OF �toa'A A#-CN\JVL-
BUILDING LOCA
OWNER'S NAME �JWT-u =
NEW Of RENOVATION ❑ REPLACEMENT ❑
FIXTURES
,3 7k z
COMMERCIAL ❑
PLANS SUBMITTED: YES ❑ NO ❑
COMPANY NAME
VALUE OF GAS WORK $
LICENSED GASFITTER—
Sd�FS� rs1�l- TELEPHONE#S�^31`T' I��3
LICENSE # IC 3 Ld.'�E _ MASTER Er JOURNEYMAN [] GASFITTER ❑ PLUMBER B'
INSURANCE COVERAGE;
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes [3 No ❑
If you have checked yes, please indipoe thwtype coverage by checking the appropriate box:
Liability Insurance Policy 15 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
1 Mass. General Laws, and that my signature on this permit application waives this requirement.
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all the
knowledge and that all piu
pertinent provisions of the
and Information I have submitted or entered in the above application are true and accurate to the best of my
vork avtpteoas
stall��ns performed under the permit Issued for this application will be in compliance with all
I.huse Code and Chapter 142 of the General Laws.
of Licensed Plumber or Gasfitter
HAX�cz->-,�NOZOMZ58N=
0
m
Z
M
S
m
m
n
M
GM
�
cZn
m
Cn
�
n
=m
D=
M
2
O
G
m
0
m
M
0
0
0c
p
rn
-�
z
z
M
M
M M
p
n
C
=i
=
n
'm
Z
M
Ll
M
;
BASEMENT
j
1e1 FLOOR
2°d FLOOR
3'd FLOOR
41" FLOOR
COMPANY NAME
VALUE OF GAS WORK $
LICENSED GASFITTER—
Sd�FS� rs1�l- TELEPHONE#S�^31`T' I��3
LICENSE # IC 3 Ld.'�E _ MASTER Er JOURNEYMAN [] GASFITTER ❑ PLUMBER B'
INSURANCE COVERAGE;
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes [3 No ❑
If you have checked yes, please indipoe thwtype coverage by checking the appropriate box:
Liability Insurance Policy 15 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
1 Mass. General Laws, and that my signature on this permit application waives this requirement.
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all the
knowledge and that all piu
pertinent provisions of the
and Information I have submitted or entered in the above application are true and accurate to the best of my
vork avtpteoas
stall��ns performed under the permit Issued for this application will be in compliance with all
I.huse Code and Chapter 142 of the General Laws.
of Licensed Plumber or Gasfitter
Date ,..... "f
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that /i. e' �.6 t/ /.I/
has permission to perform ... A! � ! ..A�'.::. s
plumbing in the buildings of .... 13�'. !'.1' .................
at .. ? . <. , .i?!<< l'.. ��.!? ................. North Andover, Mass.
r
Lic. No.. /. , ?.".1 . ........ ......
PLUMBING INSPECTOR
Check # t ��
4;03
MASSACHUSETTS UNIFORM APPLICATION FOR PERMITiTO DO PLUMBING
('Type or print) W04 A,% -L-0 Date 1
MASSACIiUSETIS
19Building L�oeations ���,..V �. �=� Permit
Amount --
Owner's Name
New Renovetion R.eplacentent ❑ Plans Submitted
FTXTTTRit.0
LSC
20
41H
(Print ar type) Check one; CertiftraLe
installing Company Name Uluk Corp.
Address P. 0. B o x 17 01 ❑ Partner.
usiness Telephone q 7 8 — 3 7 4 -- 7 i 't -- ❑ FiratICo.
Name of Licensed Plumber: Stephen C. G a l i n s k y
jUVSWe a W.tig Indicate the type of insurance coverage by checking the appropriate box:
Band
Liability ittsurance policy Other type of indemnity
_ s_�t�aivet. i, the undersigned, have been made aware that the licensee of this appiication does not have any one of the above
three Insurance
gn re 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 Massachusettsu
and Chapter 142 of the General Laws.
'Aa.V
-Type of Plumbing License
tICenSe!NUMUOU `Master U
>D (OFFICE USE ONLY
Journeymen