HomeMy WebLinkAboutMiscellaneous - 29 Garden StreetDate..-? .......
JTOWN OF NORTH ANDOVER
P
E!RMIT FOR.GAS INSTALLATION
SAr.1 5
This certifies that .... T... .) ... TP.&'n .-?. �-� ...............
has permission for gas installation ... ..................
in the buildings of .......................
at �-�q (A. `( ........... I North Andover, Mass.
Fee3pow/lov, Lic. No.. c.). f ... .... Ql;,*
/6AS INSPECTOR
Check
5589.
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MASSACIWSETIN UN1MRMAPPUCATDNFDRPERMrrTD DO GAS FrEPING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations /L- Permit # 0/
Amount $ L )-I'-
Owner's Name 0.�'A d
New Renovation Replacement Plans Submitted 1:1
(Print or type)
Name
Check one: Certificate Installing Company
Corp.
Partner.
Dlfii�nl/Co.
Name of Licensed Plumber or Gas Fitter r� 6 6 5 14-1 e 'e" -,
INSURANCE COVERAGE Check one -
I have a current liability Insurance policy or it's substantial equivalent. Yes ff—� No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy a--- Other type of indemnity 1:1 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:
Signature of Owner or Owner's Agent Owner 13 Agent
I liv-FeDy CeRlly Mal. all 01 Ene oeians anu imormation i nave suornittect (or enterea) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Perny't Issued for this application will be in
compliance with all pertinent provisions of the Massachu,4s State gas Code and Chaor 142 oj the General Laws.
(OFFICE USE ONLY)
to
S, nature of Licensed Plumber Or Gas Fitter
Plumber
0 Gas Fitter License Numnr
P-1,4aster
1:3 Jou
ourneyman
!3RD. FLOOR
(Print or type)
Name
Check one: Certificate Installing Company
Corp.
Partner.
Dlfii�nl/Co.
Name of Licensed Plumber or Gas Fitter r� 6 6 5 14-1 e 'e" -,
INSURANCE COVERAGE Check one -
I have a current liability Insurance policy or it's substantial equivalent. Yes ff—� No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy a--- Other type of indemnity 1:1 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:
Signature of Owner or Owner's Agent Owner 13 Agent
I liv-FeDy CeRlly Mal. all 01 Ene oeians anu imormation i nave suornittect (or enterea) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Perny't Issued for this application will be in
compliance with all pertinent provisions of the Massachu,4s State gas Code and Chaor 142 oj the General Laws.
(OFFICE USE ONLY)
to
S, nature of Licensed Plumber Or Gas Fitter
Plumber
0 Gas Fitter License Numnr
P-1,4aster
1:3 Jou
ourneyman
&. �"' - ,-
Date ... ......
TOWN OF NORTH OVER
PERMIT FOR GA� STALLATIC
This certifies that
.Z'L
Af . ........................
has permission for gas installation .......... . ...............
in the buildings of . Ic, -/,-,
........................................
at ...... North Andover, Mass.
...... ....................
1 03 - . -- 'I
Fee .... Lic. No.!�.'�...
6ASINSPECi�/
Check
$824
MASSACHUSETrS UNOVIRM APPUCATON FDR PERNIrf TO DO GAS FMING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date / ,?/, &, /,� (,
-2 c
Building Locations Pen -nit
Amount $
Owner's Name de //0
New Renovation Replacement a Plans Submitted 11
(Print or type Check one: Certificate Installing Company
Name—;e 4'o� A— /-7—/ -E] Corp.
Address
—Z-- --V, 0 e
Partner
13 Firm/Co.
Name of Licensed Plumber or Gas Fitter 6L) b �; I -e, "O.'r --e--
INSURANCE COVERAGE Check one -
I have a current liability Insurance policy or it's substantial equivalent. Yes ff-� No 13
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 13 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 Agent 0
I nereby certity that all ot the details and intormation I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and in per orme4ndeir Pero Issued 11�F this application will be in
,�tql ions f
compliance with all pertinent provisions of the Massa 'useXsStateQ Co�eAndCh r 142 �* General Laws.
ls��Xl
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
_.Signture of LicJnsed Plumber Or Gas Fitter
Plumber
,:;� 6/ ? -t--%
Ga Fitter r-icense Num5er
Master
Journeyman
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(Print or type Check one: Certificate Installing Company
Name—;e 4'o� A— /-7—/ -E] Corp.
Address
—Z-- --V, 0 e
Partner
13 Firm/Co.
Name of Licensed Plumber or Gas Fitter 6L) b �; I -e, "O.'r --e--
INSURANCE COVERAGE Check one -
I have a current liability Insurance policy or it's substantial equivalent. Yes ff-� No 13
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 13 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 Agent 0
I nereby certity that all ot the details and intormation I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and in per orme4ndeir Pero Issued 11�F this application will be in
,�tql ions f
compliance with all pertinent provisions of the Massa 'useXsStateQ Co�eAndCh r 142 �* General Laws.
ls��Xl
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
_.Signture of LicJnsed Plumber Or Gas Fitter
Plumber
,:;� 6/ ? -t--%
Ga Fitter r-icense Num5er
Master
Journeyman