HomeMy WebLinkAboutMiscellaneous - 426 FARNUM STREET 4/30/2018 (3) �a6 F.4�N�-�`i Sri�ei \
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINC 1
-i (Print or Type)
Ca,, NORTH ANDOVER Mass. Date
1huilding Location G/,2 6"� 11W1eP UPJ 09 ,S'f Permit # lip
J/2 AAID021,45-17 Owners Name
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New Renovation Replacement n Plans Submitted •Q
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IN I
SUl3l-6St.1T.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
EST
H FLOOR
H FLOOR
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(Print or Type) Check one: Certificate
Installing Company Name P�9 (_] Corp.
Address (�jR�� ,S' J Partner.
?9 (/L ks Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter 66'e/ 7
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box: _
Liability insurance policy Q 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.
I�
Signature of owner/agent of property Owner L� Agent
I hereby certify that all of the details and Information I have submitted (or entered)in above application are true and accurate to the hest of my
knowledge and that all plumbing work and lnstaUadons petfomtcd under fermi( issued to. this application will be In compliance with all rctunent
provisions of tho Massachusetts State Gas Code and Chapter lit of tho Ccnual Laws. .
13y TYPE LICENSE:
Plumber
Title Gas fitter4f Signature of LicEgsed
City/Town: Master Plumber or Gasfitter
6'orneyman
APPROVED (OFFICE USE ONLY) Livens I umber
Date.
RP 528
' I
NORTH TOWN OF NORTH ANDOVER
l
PERMIT FOR GAS INSTALLATION
9 .
,SSAC MUSEt � - .
This certifies that . . . . . . - :'n/.!'�.21. :: . . .
l` f 17.E � tl!tFC'
has permission for gas installatio
r in the buildings-af-c!�!. .'J` ✓L!'. .
at .` 01'5
�2/}l�zi. . !',. . . . . . North Andover,Mass.
Fee. Lic. No. D-?5 . . . . . . . . . . . . : . . . .. . . . . . . . . .
�0 C'1-e 4J Q611 GAS INSPECTOR
WHITE/Ap�Pli aaferj CANARY: Building Dept. PINK:Treasurer GOLD: File