HomeMy WebLinkAboutMiscellaneous - 31 FERNWOOD STREET 4/30/2018 l.,l
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o? TOWN OF NORTH ANDOVER
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• PERMIT FOR GAS INSTALLATION
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This certifies that . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . .. .. . .. . . . . . . . . . . . . . .
in the buildings of !.!!.,/.': :. . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . .. North Andover, Mass.
Fee. . !. : . . . Lic. No..�. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
Check#
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
l. /1 fJ , Mass. Date 2t:o2- , Permit# d
Building Location, 3 rGr0Owner's Nam& i /�i; ffY0l7Gl/Gl�'f
/V .. zYGt� NO Type of Occupancy__ RES! DUN TI P i—
New ❑ Renovation ❑ Replacement Pians Submitted: Yes❑, No❑
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SUB—BSMT.
BASEMENT
!ST FLOOR
2ND FLOOR
• 3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name ('j Ae&T A . `AM MA T A U Check one: Certificate
Address30 0-QA C H m A►y 4-KI ❑ Corporation
n1 F- TH UE I\j r11 rl 0 f kq ❑ Partnership
Business Telephone ./,*9 —q 9"7 1 17i rm/Co.
Name of Licensed Plumber or Gas Fitter '*R Qj3 E P'T A• SAMAtq74leo --
INSURANCE COVERAGE:
I have a current I bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142..
Yes No ❑
If you have checked yes, 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
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 the pe • i ed for this application be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ofrn
AnerLaws.
BY T of Ucense: LLQ
Plumber cerise
u or fitter
Title tter
er Ucense Number 9333
City/Town O IC Journeyman
i
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
I
NAME S TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR OASFITTER
LIC. NO.
PERMIT GRANTED
DATE 19
OAS INSPECTOR