HomeMy WebLinkAboutMiscellaneous - 3 COLBY COURT 4/30/2018 (2)T
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TOWN OF NORTH ANDOVER
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i �):) PERMIT FOR GAS INSTALLATION
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This certifies that ................... .........
has permission for gas installation ...............
in the buildings of ......
at
..... ............... .. North Andover, Mass.
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MASSACHUSErIS UNIEDRM APPUCATON ]FDRARAW TO DO GAS FrrnNG
(Type or print)
NORTH AND
Building Locations tjoo
MASSACHUSETTS
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Owner'
New RenovationF1 Replacement
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Permit #
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Plans Submitted
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Name of Licensed Plumber or Gas Fitter
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Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co
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INSURANCE COVERAGE ChecL2ny. .
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked 0 . ,Pleai!fndicate the type coverage by checking the appropriate bo
Liability insurance p vleisc 113 Other type of indemnity ED xTBond
Owner's Insurance Waiver: Tam 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:
1-i natu of Owner or Owner's Apent Owner 13 Agent
6
i hereby certify that all of the details and infon-nation I have
best of my knowledge and that all plumbing work and instal.
compliance with all pertinent provisions of the Massachiga—
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed
Plumber
Gas Fitter 71(
Journeyman
-red) in above application are true and accurate to the
er "PI -e. rnut Issued for this application will be in
an Charxer L42-e��l Laws.
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SUB -BASEM ENT
BASEMENT
IST. F L 0 0 R
2ND. F L 0 0 R
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. F L 0 0 R
7TH. FLOOR
8TH. F L 0 0 R
Trint or typel))Z
0,
L)
"- ') A V, �j
Name of Licensed Plumber or Gas Fitter
e,�,J /4\
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co
[^) 0
INSURANCE COVERAGE ChecL2ny. .
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked 0 . ,Pleai!fndicate the type coverage by checking the appropriate bo
Liability insurance p vleisc 113 Other type of indemnity ED xTBond
Owner's Insurance Waiver: Tam 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:
1-i natu of Owner or Owner's Apent Owner 13 Agent
6
i hereby certify that all of the details and infon-nation I have
best of my knowledge and that all plumbing work and instal.
compliance with all pertinent provisions of the Massachiga—
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed
Plumber
Gas Fitter 71(
Journeyman
-red) in above application are true and accurate to the
er "PI -e. rnut Issued for this application will be in
an Charxer L42-e��l Laws.
O� G
34S Ftitter