HomeMy WebLinkAboutMiscellaneous - 35 MABLIN AVENUE 4/30/2018O
Date... /�! 2 3 j0 !�..... .
HORTM
TOWN OF NORTH ANDOVER
' PERMIT FOR., GAS INSTALLATION
S`SACHUSE _
6. , %'i `` t
This certifies that ... ......................... .
has permission for gas installation ...... �f .
in the buildings of .. kh^� -X ,!� ........................... .
'3)— ?� at .. .... .............. . , North Andover, Mass.
Fee. 30
. Lic. No.. ......
L'�I NSPECTOR
Check # C C
6666
I
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
/rt�N/C.
Owner's Name
New 0 Renovation 0 Replacement
Date ZZ —0,9
Permit #
Amount
L
Plans Submitted
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6TH.
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7TH.
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(Print or
Name of Licensed Plumber'or Gas Fitter �i r ✓�
Check one: Certificate Installing Company
ElCorp.
Partner.
Firm/Co.
INSURANCE COVERAGE
1 have a current liability Insurance'policy or it's substantial equivalent. Check one:
If you have checked es please indicate the a cove Yes
type rage by checking the appropriate box.
Liability insurance polic
No13
Y D Other type of Indemnity D Bond
Owner's Insurance Waiver: lam aware that the licensee does_ not the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this ermit application waives this requirement.
Signature of Owner or Owner's Agent Check one:
Owner 1 YA oA:; J9 i
9 hereby certify that all of the details and Apr
best of my knowledge and that all plumbing w,
compliance with all pertinent provisions of the
By:
Title
PPROVED (OFFICE USE ONLY)
1 have
vvvetion are true and accurate to the
nde e I d for this application will be in
and pt 2 of the General Laws.
.Signater
a of Lic�ed Plumber Or Gas Fitter
Plum 1030 /
Gas Fitter License Nuffi7er
Master
Journeyman