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HomeMy WebLinkAboutMiscellaneous - 41 FARRWOOD AVENUE 4/30/2018 41 FARRWOOD AVENUE U-10 2101467.3-0041-0010.0 \ Date..... .`.. ... . �... . . t NORTH OF 6 0TOWN OF NORTH ANDOVER O 9 r . PERMIT FOR GAS INSTALLATION SACNUSEtS This certifies that . . . .Y,r. . . . . . . . . . . . ... . . . . . . . . . . . . . . . has permission for gas installation . .j`." -�v. . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . at . . . . . . . ., North Andover, Mass. Fee.,.%�'. . . Lic. No.. ... . .! . . :. . ""Y�./-. . . . . . . . . . . . . GAS IP&5 CTOR Check# � JJI �� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING _ CitylTown: OV MA. Date: a Z o �\ Permit# Building Location ��\�r VJJa@ Owners Name O.`C�\A�P Q P-e.Y1 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional❑ Residential New: ❑ Alteration: ❑ Renovation: ® Replacement: © Plans Submitted: Yes❑ No Q �n2, FIXTURES F- (n w = � Z w Y N W 0 D i 0 UJ � O (n ~ rn Cn p w Z17- UJ Z O Z U) W Q ca0 I" a tW- p 0 W X N > W N O W y 0 W 1W- p = LL 2 UJ F- > O W Z CD J F- F- O Z J O 11- FF- W I.- W W Z W N J Q Q m W 0 Z 0 y ~ > Z Q F- o o LL 0 0 = i g 0 °a °�Fw- > > > 0 SUB BSMT. BASEMENT -TsT FLOOR 2Nu FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 In FLOOR _ (7 Check One Only Certificate# Installing Company Name*-X�.: `� �'���t ''+R �Corporation .� Address: �'�'r'^ ` � City/Town 'E4s3aState:�l� _ �---- ❑ Partnership Business Tel:�-w colts L � -k% Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter:+r�� ..'�'tt.� INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No El If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 9 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 Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's Agent By checking this box ;1 hereby certify that all of the details and information I have submitted(or entered)regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ® Plumber ❑Gas Fitter Signature of Lid used Plumber/Gas Fitter Title [ Master City/Town []journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: S PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCII 1 I f PLUMBER.GASFITTER LP INSTALLER LICENSE NUMBER:'- PERMIT UMBER:"PERMIT GRANTED DATE: f GAS FITTING INSPECTIOR y i