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Home My WebLink AboutMiscellaneous - 42 FULLER ROAD 4/30/2018 42 FULLER ROAD 210/065.0-0087-0000.0 �,�v V UL(��rJ �� --� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print ff or Type) Z� >�I6 6k) e,� , Mass. Date * 1 J� �J Permit # Building LocationOvvne►'s Nam f' r / Type of Occupancy I T)[ N Ti r� New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes❑ No ❑ N N ¢ N ¢ N C O N = W W N ¢ O Z < ¢ O0 ¢ O 0 W < _ = 1, H 0. C , < W 2 N W R LL,¢ O O W m 2 0 Z W¢ C N W < W > C W 2, < ¢ < u x ¢ 'x O n x u. c .d v e > n a Fes- o SUB-BSMT, BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name_mit iAE(Z T Q . �+ (n MA TA�C'' Check one: Certificate Address30 0()4CH/hP ry i, f ❑ Corporation �1 r= T H U e tJ r�1 r1 U l y ❑ Partnership Business Telephone /LL— 7 cJ-7 ( 2--firm/Co. Name of Licensed Plumber or Gas Fitter t?(A E le T A J A m m lq 74 A?n INSURANCE COVERAGE: I have a current II. bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes G�' No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box A liability insurance policy 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner'sAgent Owner❑ Agent [I 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 the pe ' i ed for this application i be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. T License: ;OT.er lumber n ure of cen u or fitter Title tter Ucense NumberCity/TownICE L/TONm oueyman i Date. Z. .... . . Of`"OATH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,�. �,SS^C MUSES This certifies that . . .5 � �l=r.l�.�!�.... . . . . . . . . . . . . . -has permission for gas installation . . ;�'�,�! �'. .s....`. . . . . . . . . . . in the buildings of . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . ., North Andover, Mass. Fee/.G. . . . Lic. No.. . . ?.: 3. . . . . . . . . . . .. . . . . ..I. . . . . . . . . . . GAS INSPECTOR Check# 350' 1 iv1AJJAl.1'1ult,i It; uivir%imm ArrU'.,At11UN t-Uh t-=HMIf IU UU UASFITTING (Print or Type) 1t AW d , Mass. Date /Y Permit # J Building Location ?� u��' 9d-Owner`s m .Type of Occupanty New ❑ Renovation ❑ Replac4 (� Plans Submitted: Yesp No ❑ N ¢ A W N Y Z ¢ • ¢N N N N¢ O V y S f- W W ¢ O V m = 73 d J ¢ ~ < rz z O } W ¢ z z mo � d c .s W < 7. 1- N > us 4 N ¢ W Z U W N W < ¢ t- O F- S W W of < S ¢ ¢ ¢ W W H ¢ J W d > U. F- V -1 z < W < ¢ F- F' yW. N m z O 2 O N S < W > ¢ W Z. < ¢ _< < O O W O ly H SUB—BSMT. BASEMENT 1ST FLOOR 2NDFLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6THFLOOR 7TH FLOOR STH FLOOR Installing Company Name r',Ae fe T `A(n Al A T A X20 Check one: Certificate Address 30 Oo4 C H ih a rj i-K1, ❑ Corporation �1 r T H U E iJ 01 rl U (kPartnership Business Telephone "7 1 2--'Firm/Co. Name of Licensed Plumber or Gas Fitter o A E P.T A• 5 A M m f1i A en INSURANCE COVERAGE: I have a current I' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C�' No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy 0"" 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 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 p 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 the pe ' r ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. By T License: C� ;0' er lumber n ure of Licensedu or itter True tter License NumberCity/Town ourneyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO 00 41ASFITTINO I NAME A TYPE OF BUILDING LOCATION OF BUILDING f ' PLUMBER OR GASFITTER LIC. NO, PERMIT GRANTED GATE�..,�..�...19 GAS INSPECTOR