HomeMy WebLinkAboutMiscellaneous - 35 Allen StreetW
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Date.
NORTH
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F� ` °p TOWN OF N0Af H ANDOVER
' - PERMIT FOR GAS INSTALLATION
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SS^C MUSEt h
This certifies that ..../�G .�. �.......'..
has permission for gas/installation .. kA. .13 /Y ...................
in the buildings of ..............................
at ...?: i..114 Yn'...� ............. North Andover, Mass.
Fee. 6..... Lic. No. ./.Q F ' . ........
GAS INSPECTOR
Check #
5325
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
&W r hn -_&C (W , Mass. Date 1Lk 0�
City, Town ^
Permit # J J ��
BuildingOwner's
AT: Location ,35- 0j Len Gt_ Name 0 �
Type of Occ upancy:Ak
New Renovation ® Replacement 11
Plans Submitted Yes ❑ NoDQ
(Print or Type) I / i Check One: Certificate
Installing Company Name A) I d P n n � nC 0 Corp. -C2? "1
Address q`�(.In (� i'1 P {'1'�P—�
PPartnership
Q ❑ Firm/Company
Business Telephone 9 +18 —513 1 q 94 Name of Licensed Plumber or Gasfitter
I hereby certify that all of the details and information 1 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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of Owner/ Agent
I have a current liability insurance policy to include completed operations coverage. ❑
By TYPE LICENSE:
Title ❑ Plumber Signature of Licensed
Plumber or Gasfitter
City/ Town ❑Gasfitter ,s' _
APPROVED (OFFICE USE ONLY) El Master lj 4 �1 9 5 c5 1f
❑ Journeyman License Number
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(Print or Type) I / i Check One: Certificate
Installing Company Name A) I d P n n � nC 0 Corp. -C2? "1
Address q`�(.In (� i'1 P {'1'�P—�
PPartnership
Q ❑ Firm/Company
Business Telephone 9 +18 —513 1 q 94 Name of Licensed Plumber or Gasfitter
I hereby certify that all of the details and information 1 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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of Owner/ Agent
I have a current liability insurance policy to include completed operations coverage. ❑
By TYPE LICENSE:
Title ❑ Plumber Signature of Licensed
Plumber or Gasfitter
City/ Town ❑Gasfitter ,s' _
APPROVED (OFFICE USE ONLY) El Master lj 4 �1 9 5 c5 1f
❑ Journeyman License Number
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