HomeMy WebLinkAboutMiscellaneous - 265 BEAR HILL ROAD 4/30/2018I
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TOWN OF NORTH ANDOVER
PERMIT FOR. -GAS INSTALLATION-
SACHUS
This certifies that ... f/�� ......
has permission for gas installation ....... t-� ....................
in the buildings of ... ...........................
J' 13c /,I /t 4,
at .................................... North Andover, Mass.
Fee. 34P� .... Lic. No..../.,I ... .......
GAS PECTOR
Check #
6 0 7
f
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MASSACHUSETr'S UNIFORM APPUCATON FOR PERMrr TO DO GAS FrrrING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Loqations _r�&5
--Owner's Name
New 0� Renovation Replacement
SID H -BA SE MEN
WASEM ENT
IST.
F L 0 0 R
2 N D
F L 0 0 R
FR D
F L �OO R
4 T H
F L 0 0 R
5 T H
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STH
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7TH.
FLOOR
ITH.
FLOOR
Plans Submitted
(Print or type)
Name ertificate Installing Company
000e. - C
Address _(9�_ -Tiltel-066tv
na
Partner.
Business j elephone
Firm/Co.
Name ofLicensed Plumber'or Gas Fitter I ) ^_ In 1/7 D 11%4Po-. t t A. .0
0111
Date Ho 5',(Z) �r
Permit#
Amount $
INSURANCE COVERAGE Check one;/
I have a current liability lnsurancepo�fipy or it s substantial equivalent. Yes
-e coverage by checking the approp ate box.
If you have checked Yes, please in0ate the typ Ey No[:3
Liability insurance policy rr-21, rl� ri
I ther type of indemnity E3 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
I hereby certify that all of the details and information I have submitt 13 Agent 13---
e (or entered) in above application —are true_a_n__d_�ac
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
curate to the
compliance with all pertinent provisions of the Massachusetts Atate G e and Chapter 142 of the General Laws.
_U I ?IYM
By:
ity/Town�
PPROV, ED (OFFICE USE ONLY)
of Licensed Plumber Or Gas Fitter
19umber
Gas Fitter License NUMber
aster
Joumeyman
W
z
C9
U
z
(Print or type)
Name ertificate Installing Company
000e. - C
Address _(9�_ -Tiltel-066tv
na
Partner.
Business j elephone
Firm/Co.
Name ofLicensed Plumber'or Gas Fitter I ) ^_ In 1/7 D 11%4Po-. t t A. .0
0111
Date Ho 5',(Z) �r
Permit#
Amount $
INSURANCE COVERAGE Check one;/
I have a current liability lnsurancepo�fipy or it s substantial equivalent. Yes
-e coverage by checking the approp ate box.
If you have checked Yes, please in0ate the typ Ey No[:3
Liability insurance policy rr-21, rl� ri
I ther type of indemnity E3 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
I hereby certify that all of the details and information I have submitt 13 Agent 13---
e (or entered) in above application —are true_a_n__d_�ac
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
curate to the
compliance with all pertinent provisions of the Massachusetts Atate G e and Chapter 142 of the General Laws.
_U I ?IYM
By:
ity/Town�
PPROV, ED (OFFICE USE ONLY)
of Licensed Plumber Or Gas Fitter
19umber
Gas Fitter License NUMber
aster
Joumeyman
ZDate.
IAORTH
0 TOWN 001( N ANDOVER
'�O
PERMIT FOR GAS INSTALLATION
This certifies that Nw:�
.............
has permission for gas installation
in the but Idins of
atC7��?—
................... './ .......... North Andover, Mass.
Fee�.'�.. Lic. No.4-YPM30
S CTOR
Check 4 �elpo
6564
MASSACHUSETrS UNNURMAPPUCATONFORPERMTO DO GAS FTrDNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Lqqations
LZQ1%A)eMrC CotLer ' Owner's Name
New Er�" Renovation 1:1 Replacement 1:1
Plans Submitted
Date
Permit # 1!5�6 �/
AmountT 77
(Print or type)
Narne— Z e�.c� Check Certificate Installing Company I
Corp.
Address Zn-femeg-JQP7,4�
Partner.
Business I elephone
I 972r UW2— 9-7-7/ 0 Firm/Co.
Name of Licensed Plumber'or Gas Fitter
INSURANCE COVERAGE _7 Check
I have a current liability Insuranceppdy or it's substantial equivalent. Yes
If you have checked yes, please in I
,.Xcate the type coverage by checking the appropriate box.
Liability insurance policy 10 Other type of indemnity 10
r No[3
Bond 1:1
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.
Signature of Owner or Owner's Agent Check one:
I hereby certify that all of the details and information I have submitted Owner Agent 13
ente 1) in above application are true and accurate to the
best of Ty 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 Massachusetts Stati d6s Code A Ehapter 142 of the G_caeral Laws.
By:
Title
City/Town,
1APPROV, ED (OFFICE USE ONLY)
Sig re jo Licensed Plumber Or Gas Fitter
,R Mumb 4149 //, C)
Gas Fitter License Number
Master f
Journeyman 11-5�0
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SU B-BASEM ENT
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TASEM ENT
IST. F L 0 0 R
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3 R D . F L 0 0 R
4 T H F L 0 5 R
5 T H F L 0 0 R
6 T H F L 0 0 R
7 T H F L 0 0 R
8 T H F L 0 0 R
(Print or type)
Narne— Z e�.c� Check Certificate Installing Company I
Corp.
Address Zn-femeg-JQP7,4�
Partner.
Business I elephone
I 972r UW2— 9-7-7/ 0 Firm/Co.
Name of Licensed Plumber'or Gas Fitter
INSURANCE COVERAGE _7 Check
I have a current liability Insuranceppdy or it's substantial equivalent. Yes
If you have checked yes, please in I
,.Xcate the type coverage by checking the appropriate box.
Liability insurance policy 10 Other type of indemnity 10
r No[3
Bond 1:1
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.
Signature of Owner or Owner's Agent Check one:
I hereby certify that all of the details and information I have submitted Owner Agent 13
ente 1) in above application are true and accurate to the
best of Ty 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 Massachusetts Stati d6s Code A Ehapter 142 of the G_caeral Laws.
By:
Title
City/Town,
1APPROV, ED (OFFICE USE ONLY)
Sig re jo Licensed Plumber Or Gas Fitter
,R Mumb 4149 //, C)
Gas Fitter License Number
Master f
Journeyman 11-5�0