HomeMy WebLinkAboutMiscellaneous - 36 WOODBERRY LANE 4/30/2018 (2)Date ....... ........... .
TOWN OF NORTH ANDOVER
s PERMIT FOR GAS INSTALLATION
This certifies that .'`.` l? s *''.. .�`....................... .
has permission for gas installation .... f ..........:........ .
in the buildings of ..!C..7-?`. f. `..r .......................... .
at .3 C u c, c� r �� E� f r . , . . ., North Andover, Mass,
Fee.. ` Lic. No../.'.'. ..:.......
GASINSPECTOR
Check #
3633
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING Q —
__ (Print or Type)
Mass. Oate�^ L/— 200-- Permit # 3
r
Building Location :0 WODAIr�./ LN Owner's
NameLb" 11,(", Ilri
—�—
TYPOc. PancY
New Renovation ❑ Replaceent Plans Submitted: Yes[] No ❑
Installing Company Name TOWNSEND OIL COMPANY .
Address_ 75 WEST MAIN STREET
GEORGETOWN, MA 01833
Business Telephone 978-352-8711
Name of Licensed Plumber or Gas Fitter TIM BOBOLA
Check one: Certificate.
Corporation
❑
Partnership
❑
Firm/Co.
c
N
W
N
N
N
Y
U
Z
G
C
uj
0
(n
_
k.,
O
u
J
w
C
OUf-
a
�
~
d
<
eO
r
Z
O
Z
O
O
~
=
w
G
to
w
Fu
<
=
n
L
OF
C
F
d
N
C
W
Z
U
w
N
W
c7
d
C
C
W
0
W
W
_
w
U
Ul
d
0
Co
=
O
z
C'
O
Ll
=
¢
Z
O
v
S
LL
k 7.
3
C-
0
<.<
J
O
U
O
C
W
>
o.
0
a
%4
1-
F-
O
SUS—BSMT.
,
SASEN.NT
75T FLOOR
Ix
I
2ND FLOOR
3 R 0 FLOOR
I
I
4TH FLOOR
STH FLOOR
6TH FLOOR
7THFLOOR
STHFLOOR
�-H
Installing Company Name TOWNSEND OIL COMPANY .
Address_ 75 WEST MAIN STREET
GEORGETOWN, MA 01833
Business Telephone 978-352-8711
Name of Licensed Plumber or Gas Fitter TIM BOBOLA
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes X3 No ❑
If you have checked yes, paease Indicate the type coverage by checking the appropriate box
A liability insurance policy Kk 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 signatute 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 entered) in above application are true and accurate to the best of my "
knowledge and that all plumbing work and installations performed under the 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
8Y Tj of License:l
Plumber Signature of Licen r
True Gasfitter
Master License. Number
City/7own Joumeyman
APPFOVEff (OTTICE USE ONLY��
Check one: Certificate.
Corporation
❑
Partnership
❑
Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes X3 No ❑
If you have checked yes, paease Indicate the type coverage by checking the appropriate box
A liability insurance policy Kk 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 signatute 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 entered) in above application are true and accurate to the best of my "
knowledge and that all plumbing work and installations performed under the 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
8Y Tj of License:l
Plumber Signature of Licen r
True Gasfitter
Master License. Number
City/7own Joumeyman
APPFOVEff (OTTICE USE ONLY��