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C
Date .... K . ,, . ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ............................... I .............
.4as permission for gas installation
in the buildings of ..............
'7 V - - ..............
at ................... North Andover, Mass.
Z'V
Fee. ..... Lic. No ...........
'-'�:-'6AS I NOE;:f(O'R'
Check #
3821
MAP
4ASSAC ILASMIMEORUA2P ICATON FOR PERMIT TO DO GAS F='G
or print) Date 11h1,61
PIUK I rl AINUVyr-11, IVIA33Ak_11U3L 1 13
Building Locations 30 13uCW^i5H;4 k-, P 4 -
Perin it 9
-Owner's Name
New Renovation Replacement 71
Plans Submitted
Amount S
(Print or ty e)
Address
om
Business Teler)hone
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
Niame of Licensed Plumber or Gas Fitter _7"_Wd *f e
INI"SUR.ANICE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent.
Yes NoEj
If �,ou have checked ves please indicat the type cc erage by checking the appropriate box.
Liability insurance policy Other type of indemnity
R] , Bond 7
Owner's Insurance Waiver- .1 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:
Slanature of Owner or Owner's A -ent
Owner Agent
i hereby certify that all of the details and information I have ' hmirted (nr entererf) in ihnve nnnlirnrinn nrf- trif-nnd Irriuntp. in the
Su I
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 of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
F7 P I umber . 2 �Aly 3 '?
r7 Gas Fitter License Nurnoer
FMaster
ZJoumeyman
-WON,
Date .............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
. ..........................
has permission to perform ....................................
plumbing in the buildings of .
....... ..................
at :,� . ..... .
............ North Andover, Mass.
Fee!��.Tll Lic. No.Aly-�4.
6INSPECTOR
Check # S//
5029
MASSACHUSETTS UNIFORM APPLICATION FOR PERMITJO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date //h/a/
Building Location 3o duchivpy4m /?�,OwnersName
Amount
TypeofOccupancy
New M Renovation 1:1 Replacement El PlansSubmitted Yes M No E]
�Print or type) Check one:
Ltalling Company Name 7�141104tq^,' pzc'mlf"'-)g� - El Corp.
Address 1,56K 572— Partner
*&I,e 01Y �4 4-
502-2*570V
1:1 Firm/Co.
Name ofLicensed Plumber. rw.- ,q -f S' hl;ro-110 /I
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy P Other type of indemnity F1 Bond
Certificate
Insurance Waiver- L the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
i Signature 1. Owner r-1 Agent F1
I 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Prlu bb* g C -ode and Chapter 142 of the General Laws.
By: =Tpawre of Eicensea Plumoer
Type of Plumbing License
Title y- 93 3'
City/Town License 114umoer Master r-1 Journeyman
APPROVED (OFFICE USE ONLY