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HomeMy WebLinkAboutMiscellaneous - 39 BREWSTER STREET 4/30/2018 (2),4OF TH pf .ao ,ti0 L � P SSACMUSS Date. ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .../;x "q./.,4 .r ..... ! . �. e ............... has permission for gas installation ............................ in the buildings of.....?���!�.......................... at ... 3 ... 13. North Andover, Mass. Fee ....° .. Lic. No. ��' `� i... ..... GAS INSPECTOR Check # 4 5911 MASSACHUSETTS UNIFORM APPUCATON FOR PER NUr T, 'DOGAS FITTING (Type or print) Date a -13-U-7 NORTH ANDOVER, MASSACHUSETTS Building Locations 39 4? -e'', s / e✓Z S/ . Permit #�i 7 Amount S -36 Owner's Name q U i SM 4 R -T — New Renovation Replacement Plans Submitted (Print or type) Name m //f ®S i>> e /. f i C— Che k one: Certificate Installing Company Corp. Address /� Ca 11 h S s ✓ Partner. 0i9/yVe2-S /7'1/4 0/9J3 11 Business a ep one '2-7->- / o irm/Co. Name of Licensed Plumber or Gas Fitter :7—/;,, INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D�— Noo If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 111-- Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: 1 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 13 Agent 0 1 hereby certify that all of the details and infnrmAnn I have c„h—;ff.A r.,. ...... A.:- -L-.._ -F,Fru --- — uUc auU d"UISIC W HIC 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 Massachus�tate Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S re of Licensed Plumber Or Gas Fitter Plumber /D y/3 Gas Fitter License Number ©aster Journeyman � x Q L° z w w a w v w Q w w� o a a w N w� A F x w> z z H m z o o w x dz �e x D w x z d 3 a a 0, d a o u o x W a a F O SUB -BASEMENT > A BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) Name m //f ®S i>> e /. f i C— Che k one: Certificate Installing Company Corp. Address /� Ca 11 h S s ✓ Partner. 0i9/yVe2-S /7'1/4 0/9J3 11 Business a ep one '2-7->- / o irm/Co. Name of Licensed Plumber or Gas Fitter :7—/;,, INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D�— Noo If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 111-- Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: 1 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 13 Agent 0 1 hereby certify that all of the details and infnrmAnn I have c„h—;ff.A r.,. ...... A.:- -L-.._ -F,Fru --- — uUc auU d"UISIC W HIC 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 Massachus�tate Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S re of Licensed Plumber Or Gas Fitter Plumber /D y/3 Gas Fitter License Number ©aster Journeyman