HomeMy WebLinkAboutMiscellaneous - 44 Kingston Street 44 KINGSTON STREET
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Printor Typ )
Mass. Date ' 1g 97 Permit #
Building Location �j//1�(l�,S� Owner's Name v�
�j; � .
/ / Type of Occupancy
New p Renovation ❑ Replacement p� Plans Submitted: Yesp ' No ❑
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SUB—BSMT.
BASEMENT
1STFLOOR
I
2ND FLOOR
3RD FLOOR I
4TH FLOOR
STH FLOOR
6THFLOOR
7THFLOOR
STH FLOOR
Installing Company Name -d.gmea•, P. 6g f/tInc / Check'one: Certificate
Address_ P,0, 3 vx 88 ® Corporation 2/4 4C
--- M e h u en, Ma ❑ Partnership
Business Telephone—LuuO ) 68?-9755 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter_ lion
INSURANCE COVERAGE:
I have a,curren Ifablifty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes M No ❑
If you have checked yes. please Indicate the type coverage by checking the appropriate,box.
A Itablifty insurance policy Other type of indemnity❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the1icens e
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:
Owner❑ Agent ❑
Signature of Owner or-Owner s 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 best of my
knowledge and that all plumbing work and Installations performed under the permit issued for this ap on will be in compliance with all
Pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of neral Law
T epe of Ucense: �, e .t
Title Plumber ignature o cen um er or Gas titer
astiitter
Master License Number_ 44,2
City/Town Journeyman
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*'1 2 519 Date ,�0/ . .. . ... ..
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tiTOWN OF NORTH ANDOVER
pF t�.ao ,^10
0 � op PERMIT FOR GAS INSTALLATION .
�9SSACHUSES
This certifies that . . L . . . . . . . . . . . . . . . . . . .
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has permission for gas installation . . . . . . . . . . In.
in the buildings of . . . OX. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . North Andover Massa
Fee.,.?.D..:. . Lic. No..?.K` . .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File