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HomeMy WebLinkAboutMiscellaneous - 344 WAVERLY ROAD 4/30/2018 (2)N O J D �o "' m o � O D o v 74 �, 6 Date../ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . g. . -T� . �� ��? :'� ... 6.—. & ..... * * ' has permission for gas installation in the buildings of .............................. L at .... J. y .... <orth Andover, Mass. Fee. Lic. No.. /TO 3. OR -4� eAi IN�PiC�d Check# 0 I NAASSAa SEMUNUDRIVIAPPLICATONFORPERINHrTODOGASFfrr]NG (Type or print) NORTH ANDOVER, -MASSACHUSETTS Building Locations New ❑ Renovation Owner's Name'a% Replacement' Plans Submitted Date /d//f`/4) Permit # Amount $ ('Print or type) Name 4- lame of Licensed Plumber or Gas Fitter 1-3 0 �Y� /_ Check one: Certificate Installing Company In Corp. ElPartner.. ®' Firm/Co: INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0- No If you have checked yes, please indicate the type coverage by checking the appropriate. box. 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: Signature of Owner or Owner's Agent Owner ❑ Agent I hereby certify that all of the details and information I have submitted (or entere(l)1n above appllcatlon are true nnu accurate ro me• best of mti knowledge and that all plumbing- work and installations Vurforniod under t Po-.rn t Issued for this application will be in compliance with all pertinent provisions of the Massa lscStaeAti Codd �1ncl Chap 12he General Laws. ®ate By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of lumber ED Gas Fitter 0 Master r 1 Journeyman aCd Plumber Or Gas Fitter tcc� ,nse (Num er (� U vi x 0 z H r 0 z o H w w N z popi� a p H rxW� F x7 O $ A U` a U x H IS SUB -BASEMENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR . 4T I1. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR ('Print or type) Name 4- lame of Licensed Plumber or Gas Fitter 1-3 0 �Y� /_ Check one: Certificate Installing Company In Corp. ElPartner.. ®' Firm/Co: INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0- No If you have checked yes, please indicate the type coverage by checking the appropriate. box. 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: Signature of Owner or Owner's Agent Owner ❑ Agent I hereby certify that all of the details and information I have submitted (or entere(l)1n above appllcatlon are true nnu accurate ro me• best of mti knowledge and that all plumbing- work and installations Vurforniod under t Po-.rn t Issued for this application will be in compliance with all pertinent provisions of the Massa lscStaeAti Codd �1ncl Chap 12he General Laws. ®ate By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of lumber ED Gas Fitter 0 Master r 1 Journeyman aCd Plumber Or Gas Fitter tcc� ,nse (Num er (� Date.5//�/.—.�. � ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... r .......... has permission for gas installation ...... in the buildings of. ................................. at 1A /-,/ .......... North Andover, Mass. Fee.5-.q.'.. Lic. No..3?. �GA*S INSPECfOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO UO GA,SFiTTING (Print or Type) NO 2T H I QL06(Z Mass. Date --�P 1-�AQQJ Permit #�� Building Location 3 �i — 3y�O CJAVC-94E y Owner's Name .C66CkT l-EVV Uol?�TH A QD0V6 nA Type of Occupancy f ES/DEEi 7119L- -.2 FA411G / 1-1 C-1 New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET XJ Corporation 1862 LAWRENCE, MA 018 4 1 - 2312 ❑ Partnership Business Telephone (j' 71B- 6 8 7 -110 5 exr *30 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy 19( 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: Signature of Owner or Owner's Agent Owner❑ Agent El I hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accury�te to the best of my knowledge and that all plumbing work and installations performed under the permit issuf r this application will b>;in,compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. d FBy T e of License: PlumberSignature of Licensed Plumber or Gas Gasfitter0 Master License Number 274-5 Journeyman FICE USF ONLY) •• ■����������������� ■■Omnison Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET XJ Corporation 1862 LAWRENCE, MA 018 4 1 - 2312 ❑ Partnership Business Telephone (j' 71B- 6 8 7 -110 5 exr *30 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy 19( 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: Signature of Owner or Owner's Agent Owner❑ Agent El I hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accury�te to the best of my knowledge and that all plumbing work and installations performed under the permit issuf r this application will b>;in,compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. d FBy T e of License: PlumberSignature of Licensed Plumber or Gas Gasfitter0 Master License Number 274-5 Journeyman FICE USF ONLY) CI z LL N J C7 2 O N O a ~ W ~ U � LL a 0 v LL z O Z J Z O O F LL LL ❑ tl J_ LL Q GZO LL O m r} W t. a w LL Q m a O O U_ } J F ZO w w °- .+s O a w o ? cS a LL Z J a J J I a� W F - Z Q W cc I— C) a F.. o i Q W a Locatiog No. Date 970S CI TOWN OF NORTH ANDOVEO Certificate of Occupancy $ Building/Frame Permit Fee $ Ile �,— �C) Foundation Permit Fee $ Other Permit Fee $ Z5 Sewer Connection Fee $ Water Connection Fee $ 5: 9 - TOTAL $ Building Inspector Div. 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