HomeMy WebLinkAboutMiscellaneous - 40 MILTON STREET 4/30/2018 qy,
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3? TOWN OF NORTH ANDOVER
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• - PERMIT FOR GAS INSTALLATION
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SACNUSE�A
This certifies that . . . . .0 ra L t'� . . . v' S. . . . . . . . . . . .
has permission for gas installation . . ."2� f
in the buildings of . .T.6&.4. . . . .N . . . . . . . . . . . . . .
at . . . . <.df�7 . . . . . ., North Andover, Mass.
.Fee.50— (,J. . Lic. No..27)66s. . . .
GAS INSPECTOR
Check# 7
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFMING
(Print or Type)
Mass. Date 08 �01ZDII Permit #
Building Location 40 N i m7 ST. Owner's Name 7'A IJ N 611 YK ki
�61QYN atJD6l1rR. ,NA Type of Occupancy 2 FAN►L`/
New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑
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SUB-BSMT.
BASEMENT 2
1ST FLOOR
2ND FLOOR I
3RD FLOOR
�) 4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Q..
Installing Company Name COLUMBIA SAS GF MASSACHUSETTS Check one: Certificate #
AddrCss 55 MARSTON STREET )0 Corporation 1862
LAWRENCE, MA 01841 - 2312- ❑ Partnership
Business Telephone 9 7 8-691- 640 6 ElFirm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked res, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy D< 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 signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner-E] Agent ❑
I hereby certify that all of the details and information I have submitted(or entered)in aboup pplication are true and accu�gte to the best of my
knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/
T e of License:
Plumber Signature of Licensed Plumber or Gas
Title Gasfitter
City/Town Master License Number 3745
APPROOVED FICE SE Y ONLJourneyman
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
N0.
APPLICATION FOR PERMIT TO PO GASFITTING
NAME & TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE _19
GASINSPECTOR