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HomeMy WebLinkAboutMiscellaneous - 27 WILSON ROAD 4/30/20187 6,- Date..f , r' (45'° TOWN OF NORTH ANDOVER A 2 PERMIT FOR GAS INSTALLATION This certifies that ..... t.l A . !..fv .?.1.. .. . . Aon �- has permission for gasAitall tion ................. in the buildings of . ..... ................. . at ...! S....... f-:........ , North Andover, Fef OAU, 0(J Lic. No.. a U3. .. .. GAS INSPECTOR Check # (U a 10 •!C `i 1 ti f 'A " . f ' , N' it f f IN II CType or print) NORTH Ai DOVEk MASSACRuSLPTTS Building Locations % A J %SOA/ /ip O" 's Name Date 3 lZ -- // New rl Renovation rl R pb(:,ment rjq Plans Submitted 0 Permit ir Amount S ;IIB-BASEM 7 IA SEMEi•IT .ST. FLOOR tND. FLOOR RD. FLOOR. TH. FLOOR TH. FL.00R TH. FLOOR TH. FLOOR TH. FLOOR (Ptint or4,pe)one: Cerin"cate%start;nga Campany T Name yr'r � L O /AD -q OV /V Corp Address - O- G X S 7,R, 0 e_�wlt er✓ CP &I* rr /? 5�Z j Business Telephone ?7 f Y:5 9 5-0 `�' FmnIca Name of Licensed PIumber or Gas Fitter 771/10.4-r gas ,i/'* j% eq r+f INSURANCE COVERAGE Check one: I have a current liability insurance policy or it's substantial equivalent. Yes No 13 Ifyou have checked vees. please indicate the tyke cov erage by checking the appropriate box � - Liability insurance policy -0 : Other typeofindemnity. ri Bond Owner's Insurance Waiver. I an aware that the licensee does not have the bsarance coverage required by Chapter 142 ofthe Mass. General laws, and that my signature on this permit application waives this . requirement. _ Check one: Sigaatuue of Owner or Owner's Agent I Owner A Dent I hereby certifythat all ofthe details and information I have suhmitted tnr ,;—+;.,s, s,b+-.'- —., .._. a best ofmy knowledge and brat all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts State Gas Code au}t Chapter 142 ofthe General Laws. (OFFICE USE ONLY) Signature ofLicensed Plumber Or Gas Fitter Plumber el Cj g 33 ri Gas Fitter Li' cens lee Number rl Faster W Journeyman - Go u z vt EO+ L w m Gl Sa Li] Z U rj_ir+ 0 C 4 N ca ;IIB-BASEM 7 IA SEMEi•IT .ST. FLOOR tND. FLOOR RD. FLOOR. TH. FLOOR TH. FL.00R TH. FLOOR TH. FLOOR TH. FLOOR (Ptint or4,pe)one: Cerin"cate%start;nga Campany T Name yr'r � L O /AD -q OV /V Corp Address - O- G X S 7,R, 0 e_�wlt er✓ CP &I* rr /? 5�Z j Business Telephone ?7 f Y:5 9 5-0 `�' FmnIca Name of Licensed PIumber or Gas Fitter 771/10.4-r gas ,i/'* j% eq r+f INSURANCE COVERAGE Check one: I have a current liability insurance policy or it's substantial equivalent. Yes No 13 Ifyou have checked vees. please indicate the tyke cov erage by checking the appropriate box � - Liability insurance policy -0 : Other typeofindemnity. ri Bond Owner's Insurance Waiver. I an aware that the licensee does not have the bsarance coverage required by Chapter 142 ofthe Mass. General laws, and that my signature on this permit application waives this . requirement. _ Check one: Sigaatuue of Owner or Owner's Agent I Owner A Dent I hereby certifythat all ofthe details and information I have suhmitted tnr ,;—+;.,s, s,b+-.'- —., .._. a best ofmy knowledge and brat all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts State Gas Code au}t Chapter 142 ofthe General Laws. (OFFICE USE ONLY) Signature ofLicensed Plumber Or Gas Fitter Plumber el Cj g 33 ri Gas Fitter Li' cens lee Number rl Faster W Journeyman 89'1/ Date . /C TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that has permission to perform ..Y ...!-�lL--......... . plumbing in the buildings V.�IZI�*?-.­ 7. at ..c]! 1,�,�! �i1✓1............ , No h Andove , ss. F •CSU.. Lic. No !.&.?. .... 1714 -dr -44,/j. . PLUMBING INSPECTOR Check # i�� 5 .j MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location 4� 7 /X// /SOW /20 Owners Name Permit # Amount TypeofoccupancyQ tU& L,A-) 6 New Renovation Replacement ® : Plans Submitted Yes ❑ No ❑ MTTFTD C r+ (Print or type),, a Check one: Certificate Installing Company Name f � 1.x.0 RAA) P1 -V M 9 ! 4i 6 ❑ Corp. Address ! tJ 4LtfS T -4#1©.46T`! 41,00 de-.❑ Palmer. ❑ Business Telephone (Q 97& _' ��—_ �-� y Firm/Co. Name of Licensed Plumber. Zo-v InsuranceCoveMN: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy ® Other type of indemnity ❑ Bond Insurance Waiver. L the undersigned, have been made aware that the licensee of this application does not have arty one ofthe above three insurance Signature Owner. ❑ Age ❑ I hereby certify that all ofthe details and information I have submitted (or entered) in above applic ation 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 ofthe Massachusetts State P� band Chapter 142 ofthe General Laws, By 5191, nr n ,cen 1�t rlumnp.r Y D (oma USB ony Type OfPlumbing Incense 4a4k-7-7 accaseNUM371 Master ❑ Journeyman 'A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ; l , Mass. Date 13 19_�d— Permit # R29 Building Location d 2 Lam, ) � Owner's Name 0 Type of Occupancy. RESIDENTIAL New ❑ Renovation X Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-687-1105 Name of Licensed Plumber or Gas Fitter Check one: �] Corporation ❑ Partnership ❑ Firm/Co. Certificate # 64C INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 131 No ❑ If you have checked Vis, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® 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: Owner❑ Agent ❑ Signature of Owner or Owner's Agent 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the By T e of License: /�tslh Plumber Signature of Licensed Plumber or Gas Fitter Title _ Gasfitter Master License Number M-429 City/Town Journeyman ArPROVED (of r ICE USF ONIAI ISI • ' • • ■������������������t�■ MEN tom•• ■�� �������������������iu� Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-687-1105 Name of Licensed Plumber or Gas Fitter Check one: �] Corporation ❑ Partnership ❑ Firm/Co. Certificate # 64C INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 131 No ❑ If you have checked Vis, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® 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: Owner❑ Agent ❑ Signature of Owner or Owner's Agent 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the By T e of License: /�tslh Plumber Signature of Licensed Plumber or Gas Fitter Title _ Gasfitter Master License Number M-429 City/Town Journeyman ArPROVED (of r ICE USF ONIAI Y- J z O w N w U LL LL O a O LL 3 O J w N c� w :L U f - w NC cr) w w tL 0 z_ F - h LL_ N t7 O 0 O h h o a W M Ir 0 LL z O h Q v CL IL Q 0 z 0 J n LL .0 w a z LL N a d m D IL Q W h z a r a w IL U • 1p Date. ', .......... NORTH G� TdWN OF NORTH ANDOVER OF ttco eft st p tidy PERMIJA GAS INSTALLATION ArEo SSACHUSE NQ• This certifies that .......................................... . has permission for gas installation ... ........................ in the buildings of .......................................... at .................................... North Andover, Mass. Fee......... Lic. No...: ....J.. .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File