HomeMy WebLinkAboutMiscellaneous - 44 Jerad Place \L
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No TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION
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r This certifies that .? . !: :�. . . . : . . .�� r
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has permission for gas installation .....I. / . . . . . . . . . . . . . . . . . . . .
in the buildings of . .f. . . .'. . . . . . . . . .'::�.L . . . .'. . . . . . . . . . . . . . . . .
at ! .'.!. 'l !. . . . . . ., North Andover, Mass.
Fee— ;f,jk. ,Lic- No. %� ? . . . . . . . . . . . . • . . .
1819 -
� GAS INSPECTOR
WHITE:Applicant CANARY: Building Ddpt. PINK:Treasurer GOLD:File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
t NORTH ANDOVER Mass. Date OC.
Building Location�y >6gggb elg c'e Permit # 3 �/
.� Owners Name ` j 'M(geof(pNlj C off !((
• New r'I Renovation D Replacement Plans Submitted D
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SUIT-8SMT,
BASEMENT � l'
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
STHFLOOR
(Print or Type) Check one: Certificate
Installing Company Name tA')18/0,1 Corp.
Address-110Pamf&,,/ I�is Partner.
Firm/Co.
Business Telephone: T(b"'
Name of Licensed Plumber or Gas Fitter
Insurance Coverage_: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy 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 l] Agent 17
1 hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my
knowledge and that sU plumbing work and installations performed under'Permit iuced to: this application will-be in compliance with aL pertluent
provisions of tho Massachusetts State Cas Code and Chapter 142 of the Genual Laws.
By TYPE LICENSE:
Plumber
Title Gasfitter Signature of Licensed
City/Town: Master Plumber or fitter
Journeyman �Ud LG
APPROVED (OFFICE USE ONLY) LiC:er se -Nur6ber