HomeMy WebLinkAboutMiscellaneous - 44 KARA DRIVE 4/30/2018 44 KARA DRIVE
210/098.A-0102-0000.0
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o� TOWN OF NORTH ANDOVER
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• PERMIT FOR GAS INSTALLATION
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This certifies that . f. .mss/�' !.! �1� / . . . ... .. . . . . r. . . . . . .
has permission for gas installation
in the buildings of
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at . .r._. '��. ���-- �. . , North ver, Mass.
�Fee. .. .J ... Lic. No.�r!.� . . . . . . . . . . . . . . . .
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
_ - (Print or Type) a-- oy b, t I 1 Mass. DateA 3 lei Lv- ermit#
Building Location LH O ner's Name Tom o rcmVlr°11
Xype of occupancy RI j I U eri 7Z2 1
New 0 Renovation pi Replacementr0 Plans Submitted: Yap No G-1,
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SUB—BSMT. r 1
BASEMENT ++
IST FLOOR i
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR I
7TH FLOOR I
8TH FLOOR
Installing Company Name YANKEE GAS Check one: Certificate
Address 140 SOUTH MAIN STREET tK Corporation 103C
MIDDLETON, MA 01949 [. Partnership
Business Telephone 978-774-' 2760 L, Firm/Co.
Name of Licensed Plumber or.Gas Fitter WILLIAM R, HAR R T S
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent w%ie. mee+s the requirements of MGL Ch. 142.
s Yes M No O
If you have checked Yes, please Indicate the type coverage by checking the appropriate box
A liability Insurance policy Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does nct 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:
owne{ Agent p
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information 1 have submitted br entered)in above appic6cn are trued accurate to the bes o1 my
knowledge and that all plumbing work and installations performed under the permit" to this do I be' pli all
pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of the Ge Lauri
By T of License:
Plumber gnature mbar ar Finer
Title Gasfitter
Master license Number 3785
Cipe/Town Plumber
APPP04ED(OFFICE USE ONLY)