HomeMy WebLinkAboutMiscellaneous - 3 OAK AVENUE 4/30/2018CYI
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MAS�ACHUSETTS UNIFORM APPLICATION FOil PERMIT TO DO GASFITTJ
(Priint or Type)
NORTH ANDOVER Mass. Date
�uilding Location 4 A te Permit
Owners Name_SL�Z�# 4
New LTr Renovation 0 Replacement Plans Submitted
FIXTI.IR' Q
(Print or Type)
Check one: Certificate
Installing Company Name
_,A- ///27
[ —1
Corp.
Address V/ R ny
1,c e-0
Partner.
I -e- Ir
5, /J./,,0M,/ /
Au. F-1
Firm/
Business Telephone:
-0
Name of Licensed Plumber
or Gas Fitter
A 4 69�e
Insurance Coverag Indicate
the type of
insurance coverage
by checking the
appropriate box:
Liability insurance policy
Wole0ther type
of indemnity 0 Bond
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BASEMERT
1ST FLOOR
2ND F LOOR
3RDFLOOR
4TR FLOOR
STH FLOOR
6THFLOOR
7TH FLOOR
V-1
(Print or Type)
Check one: Certificate
Installing Company Name
_,A- ///27
[ —1
Corp.
Address V/ R ny
1,c e-0
Partner.
I -e- Ir
5, /J./,,0M,/ /
Au. F-1
Firm/
Business Telephone:
-0
Name of Licensed Plumber
or Gas Fitter
A 4 69�e
Insurance Coverag Indicate
the type of
insurance coverage
by checking the
appropriate box:
Liability insurance policy
Wole0ther type
of indemnity 0 Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
gnature of owner/agent of property Owner I—] Agent n
I hereby certify that A of the deuils and Infotmation I haye tubmitted (or entettd) In above application are true and accuilte to the be'( of my
knowledge and that aU plumbing work and tnttAtladoni petfornicd under re(mit itseed to.- this application wW be In cornpUsnoe with, &H pcitlinent
provisions of tho Missachusetts State Gas Code and chapter 142 of tha Cknczal Laws.
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE.- �,,, �_ �2 .
Plumber 6e - - , /,X
Gasfitter Signature of Lic�-ens4�
Master Plumber or Gasfitter
7:r
,-courneyman
License number
Date. . ..................
ORTH TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ............................ I ..............
has permission for gas installation ............................
in the buildings of ..........................................
at ..................................... North Andover, Mass.
Fee......... Lic. No ........... ..........................
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File