HomeMy WebLinkAboutMiscellaneous - 4 GIBSON COURT 4/30/2018[a
11133
D ate ..........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that...,. -A-( ................................... ................
...........
has ermission to perfonn ........ ��f ..............
p ..........
v2,
plumb:ln in the buildings of... ............... . 0
..4 r ............................ ...............................
at.... ;; ........ .... ....... .... . ..... .................................. North Andover, Mass.
Fee'..�, . . ....... Lic. No. t
..... K . .................................................................................
PLUMBING INSPECTOR
Check It
P
ME OR
PRINT
CLEARLY
MASSACHUSETTS UNIFORM APPLICATION FOR A
CITY lo T
JOBSITE ADDRESS
"R
TO PERFORM PLUMBING WORK
—
I
OWNER'S
PERMIT #
OWNERADDRESS�I�_iJQ 19 G�r, TEL FAX -
OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑
NEW: ❑ RENOVATION: ❑ REPLACEMENT:
FIXTURES Z FLOOR -BSM 1 2 3
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OILISAND SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR ONTFF
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/ MOP SINK
TOILET
URINAL
WASHING MACHINE t
WATER HEATER ALL
W&TER PIPING
RESIDENTIAL a --
PLANS SUBMITTED: YES ❑ NO 9-
9 1 10 1 11 j 12 1 13 14
I have a current MWmsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ❑ NO ❑
IF YOU CHECK YES, PLEASE INDICATE THE TYPE OF COVERAGE By CHECKING THE APPROPRIATE BOX BEI -OW
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
Massachusetts General Lauds, and that my signature on this permit application waives this requirement .
OF
II
CHECK ONE ONLY: OWNER ❑ AGENT ❑
I hereby certify that all of the details and information i have submitted or entered regarding this application are true and accurate to best of my knowl
and that all plumbing work and installations performed under the permit issued for this application will be in rcance with all Pe on of the
Massachusetts State plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME A84kQ , VJCJ ffr—.5 LICENSE #j j — SIGNATURE
Mpg JP y CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ #
COMPANY NAME ADDRESS F
CITY, C 1 STATEMA— c�'- TEL 2___
"�ak_
FAX CELL '�iC?v `r EMAIL
Date..�etl )� 1 -3
.................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
Th�is certifies that
has permission for gas installation, A...
in the buildings of ......... W tr
.......................................
........ 0 . . . .................................. . North Andover, Mass.
Fee!W .......... Lic. No. .. ....................................................................
GASINSPECTOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY MA DATE i±RMIT #
y
+'
JOBSITEAD
L�tbOWNER`� NAME
�-;;_DRESS r l
t Jr
t
OWNER ADDRESS -
A ��G� ..r,
TE -
_ _ FAX
-
tN
EARLY
OCCUPANCY7YPE
COMMERCIAL[] EDUCATIONAL
RESIDENTIAL
NEW: 0 RENOVATION:rj REPLACEMENT:
PLANS SUBMITTED: YES 13 NO[
APPLIANCES1
-,FLOORS-*
BSM 1 1 2 3 4 5 6 7 8
9 10 11 12 13 14
BOILER
BOOSTER
_ _ .....i . _ TM _. _ •_ .__.
!
CONVERSION BURNER
COOK STOVE
- --
DIRECT VENT HEATER
r_
DRYER
-
FIREPLACE
_
! i C"-1r'r f
t .�
�a ._
r - - r -- �-=- r--- r --
(COCKS
UNIT
HEATER
E 1 SPACE
0
I have a current Ila_ bility insurance policy or Its substantial equlvatent which meets the requirements of MGL. Ch, 142 YES (3 NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAG Y Ci1EGKtNG THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTIIBR TYPE INDEMNITY BOND - ...
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application wai es this requirement.
OF OWNER
CHECK ONE ONLY: OWNER 0 AGENT [:-]
r -" «1y u rat +aa u, utu- ueiens anu iniormauon i nave submitted Or entered regarding this application are true a accurate to the best,
and that all ;plumbing %vork and installations performed under the permit issued for this applicarion wip be In cornplia h all Pertinent pro'
Massachusetts State Plumbing Code and Chapter 142 of the general Laws.
_--°,� LICENSE #
PLUMBER-GASFITTER NAME -r { _ F Y �- M SIGNATURE
MP NO MGF EV JP GF LPGI CORPORATION (3# PARTNERSHIPLL
C
COMPANY NAME: j � ------- _I ADDRESS�
CITY/ STATE�IPJ_njC "MTEL[a—
FAX���I
Ll
Thy
A)IA`K C HOLM-ES
6 RUTH' C I`RCLE
HAVE Rei I h;.1 :;<:.<::::.. >°.
IE FOLLOW IC. 110ENS
A JOURNEYM/AJl�N(}-, L�B
A9 Date. . X
0or
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
Xhis certifies that ... ........
. ...... ........................
has permission for gas installation, ....... ........
irt' the buildings of .
.....................
at 1�� NorthAndover, Mass.
Fee7�-.S.'—'. Lic. No���-J... ..... . .............
Check# J z,/ GAS IN. TOR
5 161
A
.4
MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT TO DO GAS FcI�'�'TING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations `' 4 � � �� �� _ _ Permit #
Amount $ 2j ----
Owner's Name�p�,% 1�cs
New ❑ Renovation Replacement Plans Submitted
(Printor t , ) Check one: Certificate Installing Company
Name /, -G- _-1.44
Corp.
Add re s z s El
Partner.
Business Te ep one Firm/Co.
Name of Licensed Plumber or Gas Fitter 1l l q L X u/1 C
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [3 No
If you have checked yes, please indicate the type coverage by checking the appropriate box. ❑
Liability in policy 1—_3 Other type of indemnity 13 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 mtormation i nave suDrmttea kor entereu) in auuvc appnt�auvu d- tiuc anu a'--uiaLc w u,c
best of my knowledge and that all plumbing work and installat' s pe ormed under Permit d for this application will be in
compliance with all pertinent provisions of the Massachuse State asrr'�v{de an Chapter of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber �� 3/ 3
Gas Fitter License NumBer
El Master
^! Journeyman
AST. FLOOR
5TH. FLOOR
,7T FLOOR
-H.
(Printor t , ) Check one: Certificate Installing Company
Name /, -G- _-1.44
Corp.
Add re s z s El
Partner.
Business Te ep one Firm/Co.
Name of Licensed Plumber or Gas Fitter 1l l q L X u/1 C
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [3 No
If you have checked yes, please indicate the type coverage by checking the appropriate box. ❑
Liability in policy 1—_3 Other type of indemnity 13 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 mtormation i nave suDrmttea kor entereu) in auuvc appnt�auvu d- tiuc anu a'--uiaLc w u,c
best of my knowledge and that all plumbing work and installat' s pe ormed under Permit d for this application will be in
compliance with all pertinent provisions of the Massachuse State asrr'�v{de an Chapter of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber �� 3/ 3
Gas Fitter License NumBer
El Master
^! Journeyman
MASSACHUSETTS,,UNIFORM APPLICATION FOR PERMIT TO DO
(Print or Type):.f
4i90RTH _AN1) V -SR Mass.
buildin Location,
~ ^ _ Owners Name,
N
fill,
h
(i
r
GASFIT` IOG
Date
Permit
ewe "�1 Renovation U Replacement j] Plans Submitted E]
-,,
FIX, UR=c
I Print` `or;,?`ype).a Check
lns lling kCompany Name ANDOVER PLBG. & HTG. CO. , INCM
Addrress _+5731 SO. ' UNION STREET
it ft .1
l LAUR^ENC1= . 1r1A.... 0184.3
_r2 696
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
�
(
This certifies that . � �.�. F: : ; � 1 � • • • •� • • �, • • , • • „ • • • . •
has permission for gas installation�.... • • • • • . • • . .
in the buildings of .C! !�.�J���.c�•�;•/ �••.•.•.••..••••.••.
at .. l.... .r. h. sG ter... .......... North Andover, Mass.
Fee. 2p; 00 • • PAID ..................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
one: Certificate
Corp.*; 1 2 1
X2122
Partner. _
Firm/Co.
41,
rya (' :.. J 7 1 39
Cr L A R O S F_- -. ..,,,,..,
s' i r. •, ,ti 'iiN � i e.'
�rrant:e toverege by �i�e+�leir�g� l:h� ",���
lindemnity' [ Bond;; I,,
ieen made aware that the A censee`'of
labove three insurance coverages:"'
�Owner 17 Agent „lr
tered) In above application are true and NCO -0010 to tba best *(MY
Iced [or this application will -be In cotnplutLos Vtit to ptranent
LICEN
-�-__
nber4.. �..
Fitter Si nature off;;►ie)ysed
:er - Plumber bir` l GaLKL�.tt ear
rneyman 9831 '" t
License. Nulrttbterf_f�
O
to
d
a
a
tll
u
in
O
v
a
O
o
'4Ir
0
CC
,
<
m
N
UA
F'
W
W
O
IL
O
W
tu
!—
to
Ic
Yt
0!
J
Y
•V(
S
a
Q0.'
a
W
~
W
W
UJOW
07
O
It
O
N
S
I
t
ce
x
o
t�
:C
w
n
(5
:�
v
e:
to
y
Q
o.
f-
o
SUR—asmT,
BASEMENT
17T7 FLOOR
2NO FLOOR
3R0 FLOOR
4TH FLOOR
•t.
5TH FLOOR
GTH FLOOR
F
1
1
1
1i
1TH FLOOR
STH FLOOR,
-
t
+;
•`:
;;
I Print` `or;,?`ype).a Check
lns lling kCompany Name ANDOVER PLBG. & HTG. CO. , INCM
Addrress _+5731 SO. ' UNION STREET
it ft .1
l LAUR^ENC1= . 1r1A.... 0184.3
_r2 696
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
�
(
This certifies that . � �.�. F: : ; � 1 � • • • •� • • �, • • , • • „ • • • . •
has permission for gas installation�.... • • • • • . • • . .
in the buildings of .C! !�.�J���.c�•�;•/ �••.•.•.••..••••.••.
at .. l.... .r. h. sG ter... .......... North Andover, Mass.
Fee. 2p; 00 • • PAID ..................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
one: Certificate
Corp.*; 1 2 1
X2122
Partner. _
Firm/Co.
41,
rya (' :.. J 7 1 39
Cr L A R O S F_- -. ..,,,,..,
s' i r. •, ,ti 'iiN � i e.'
�rrant:e toverege by �i�e+�leir�g� l:h� ",���
lindemnity' [ Bond;; I,,
ieen made aware that the A censee`'of
labove three insurance coverages:"'
�Owner 17 Agent „lr
tered) In above application are true and NCO -0010 to tba best *(MY
Iced [or this application will -be In cotnplutLos Vtit to ptranent
LICEN
-�-__
nber4.. �..
Fitter Si nature off;;►ie)ysed
:er - Plumber bir` l GaLKL�.tt ear
rneyman 9831 '" t
License. Nulrttbterf_f�