HomeMy WebLinkAboutMiscellaneous - 41 MARBLEHEAD STREET 4/30/2018 41MARBLEHEAD STREET
210/008.0-0021-0000.0
7560 Date.)t.�.�A�.......
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TOWN OF NORTH ANDOVER
O 1 P
PERMIT FOR GAS INS LLATION
} �,SSAC NUSEt•(
This certifies that .!`'. .. �. .5 ! '�.'P. . . . .�� . . . . . .
has permission for gas installation . . ��f b. . .G4! P-t- . .
in the buildings of .� ''�1"�� t'.. . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . .��North Andover, Mass.
Fee. . Lic. No..I2 3. �.�-'`�< �1. . . .
knit�SPECTOR /
Check# 1 Q (s
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: `7�L, A-„tAdc�-----�A.
Date:--4 /2 Z/1 Permit#
Building Location: ! YL�^G AP Owners Name: /-A (V'VA
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential ❑
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: 0-' Plans Submitted: Yes❑ No❑
FIXTURES
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BASEMENT 1
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2 Nu FLOOR
3 FLOOR
4 TH FLOOR
5 FLOOR
6 FLOOR
—f'FLOOR
8 FLOOR
Company j J 4-/��a-7 Check One Only Certificate#
InstallingCom an Name: `t
�1 ❑Corporation
Address:�� 3oXr'�J City/Town — f,r !7 vJca�'�ate: '
^D �� El Partnership
Business Tel: !i 7�� a Fax:
❑Finn/Company
Name of Licensed Plumber/Gas Fitter:
INSURANCE COVERAGE: �/
I have a current liabilityE
insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 'No❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Dl"- Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 El Agent E]Si nature of Owner or Owner's Agent
By checking this box❑;I 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 pe 't issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plum Code nd Chapter 142 of the Q&neral Laws.
Type f License:
By lumber
Title ❑Gas Fitter Signature of Licen Plumber/Gas Fitter
[Iaster
City/Town ❑Journeyman License Number:
APPROVED OFFICE USE ONLY ❑LP Installer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITT04G
(Print or Type)
f NORTH ANDOVER Mass Date
,-;..
kuilding Location Permit # 33
Owners Name
New '—I Renovation �] R placement Plans Submitted D
FIXTUP.=S
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SUA-6S7.1T.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name Q Corp.
Address Partner.
Firm/CO.
Business Telephone:
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of i isurance coverage by checking the
appropriate box:
Liability insurance policy E5 Other type of indemnity Q Bond
Insurance Waiver: I , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 17 Agent F7
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 perfomied under Permit issued for this application will-be in compliance with all pertinent
provisions of tho Massachusetts State Cas Code and Chapter 142 of the Genual Laws.
TYPE LICENSE:
By
Plumber
Title G fitter ignature of Licensed
City/Town: Master Plumber or Gasfitter
Journeyman
APPROVED (OFFICE USE ONLY) Lice sNumber
Date.. . .. . .. . . ... .. . . ....
7 ic3 ?
HORTM TOWN OF NORTH ANDOVER
pf ��ao ,a,b0
'0 PERMIT PERMIT FOR GAS INSTALLATION
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�9SS/1CeMU5ES -
This certifies that . . . .`. . . . . . . . . .!°:' G... . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . .
in the buildings of . . . . t. . . . . . !.". !:.1. !.�.lr. . .�. . ...... . . . . . . . .
at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee/. . . .—: . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOR
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