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HomeMy WebLinkAboutMiscellaneous - 412 MAIN STREET 4/30/2018 (3) / -- - - �-_ J � � T MASSACHUSETTS UNIFORM APPLICATION FOIJ PERMIT TO DO GASFITT1N ( rint or Type) NORTH ANDOVER Mass. Date U s f ti lhuilding Location �/�� �y s < 46,33-ermit # �C7,0 �J ���J✓F 2 Owners Name New '-1 Renovation Replacement n Plans Submitted Cn N N p� x x tz p F- `_ d QO] of N 4 0: p O D a x H a N p y ut 4 o L" x vt- in 0. a W 4 JLJ W w O7 a d x a C a W ~ W ~ x c� cr z 4 W - te a F" H 0 a U.0 t- W .t 0 W a 'x v � Y u. z cc ca m o z z o N z ¢ o o w .1 U a y Q o� f-- O SUR—RVAT. _ BASEMENT 1 ST FLOOR 2ND FLOOR 3110 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name Corp. Addressy i3DPartner. E,,!9 A,:5-,w a/// [ i irm/Co. Business Telephone: C-c),3 Ply/> Name of Licensed Plumber or Gas Fitter /�s-•�/,p Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ©Other type of indemnity [—] 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 u Agent I hereby certify that al] 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 aU plumbing work and Installations perfomud under f etmit imed to: this application wW be In compliance vith all pestlnent provisions of tho MUmchusetts Slate Gas Cade and Chapter 141 of tho Genual Laws. By T E LICENSE: lumber Title Gasfitter Signature of icensed City/Town• aster Plumber or Gasfitter Journeyman �_2 �� .APPROVED (OFFICE USE ONLY) License Iiumber i a . 1 � j NORTH rs TOWN OF NORTH ANDOVER 3? yt PERMIT FOR GAS INSTALLATION t JUL � x.990 SSACHUSE� This certifies that . . r r has permission for gas installation :'. . . . '.+.! . . . . . . . . i l jo in the buildings of . .r. . c::1. I 1 at � .�. . . .��!� . . .•1.,j.•. . . . . ., North Andover, Mass. (,,,-J,GAS INSPECTOR I WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) r-. C NORTH ANDOVER Mass. Date O building Location L�\& CnQ� S� Permit # c��21 -: ti 0V Owners Name�n-`� New 77 Renovation Replacement Plans Submitted Ck y FI XTUPES xz U) m aI v a F- y Q N CC .O N a o m r x N o m CC a o a x w w w o a a w 4 a- to > w z Uj v W z a� w a Q Q tL t- r z W W o .t Q x a CC d X w w u el Cr C7 < x }' 2 F f' }w. N 0 Z 0 2 W O N = su > W z Q cC 4 ¢ O o w a W t- a z o 0 x u. n � a o .1 c rr > Q c. t- o Sua—BSMT. \ BASEMENT IST FLOOR cr 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6THFLOOR TTK FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Namel;�4L`-74G�s S S��"S �� • � Corp. qP1( _ Address Partner. Firm/Co. Business Telephon6scfFl Name of Licensed Plumber or Gas Fitter Insurance Coverage: Ind'cate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Insurer ce Waiver: I , the undersigned, have been made aware that the licensee of this plication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner F-] Agent El 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 performed under'Permit isseed for this application will-be_-in eompHance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General LAWS. .. B TYPE LICENSE By Plumber Title Gasfitter Signa ure of Licensed Master Plumber or Gasfitter City/Town: Journeyman 3-)`35 APPROVED (OFFICE USE ONLY) License Number y��. `";�s.:,-. ':-r:."'�F,.al"r„d"..�.,w--•. _.,'.^S.,a-srt3`r+'`"�A.7i,l�µ-siF�'R�wE�?"��,i-'r.� "'.�y's"^'++.:�a,�` 2219 Date. . .. . l k? j NORTH ,, TOWN OF NORTH ANDOVER 0 � PERMIT FOR GAS INSTALLATION. O ,. m Ire �A . _ SS4CHU$ - F" This certifies that ? has permission for gas installa io . ./.� . (. :. . in the buildings o . . . ,�,!jiZ,.`, at 44 !Z . ,. , North Andover, Mass. Fee. .Is ... Lic. No.3... .a. . . . . . . . . . . . . . . . . . . . . . . . . . . . j 7 1 r1 GAS INSPECTOR 1 15.00 WHITE:App ----GARARY: Building DIRp PINK:Treasurer GOLD:File