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HomeMy WebLinkAboutMiscellaneous - 45 MABLIN AVENUE 4/30/2018 45 MARLIN AVENUE 210/011.0-0020-0000.0 ZZ C1 Date.9V ...... .. .. NORTH 0f �..o 0 TOWN OF NORT ANDOVE " PERMIT FOR GAS 1 STAL ION SACNUSE�ty This certifies that I'VA. . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .�. r.t" . . . . . . . . . . . . . . . in the buildings of . . . �`�. .! . . . . . . . . . . . . . . . . . . . . . . . . . . . . at 4?x . .` . . . . . . . ., North-Andover, Mass. > > LI/Fee. .�� . . . . Lic. No..,:.;.?. . . . . . . . . . . . . .. . . . . . . . . . G�S INSPECTOR- Check# ,// V MASSACHU-SETT S UNIFORM APPLICATION FOR'PERMIT TO DO GASFITTING (P nt or Type) ' 4 Mass; Date Zp L Building L ationwnera1- a-i . Type of Occupancy New❑ Renovation j 0 Replacement Pians Submitted: Yes 0 No o t a2 `� 7a' �n w «., G cn U '` �—" >- Z z c� 0 0 w z _ �. O o j `n ¢ _ w Qq „� H _ Z u� > z ¢ m z .� w O O ; SUB-BSMTuj 0• ' BASEMENT i< 1ST FLOOR 2ND FLOOR 3RD FLOOR. t 4TH FLOOR STH FLOORf' 6TH FLOOR 7TH FLOOR 8TH FLOOR -Installing Company Nano-' Check one: certificate Add s ❑ Corporation Business Telephone 9 �� ❑ Partnership Name of Licensed Plumber or Gas Fitter rm/co. INSURANCE COVERAGE: 1 have a currentjjablllty Insurance policy or its s bstantial equivalent; which meets the requirements of MCL Ch 142. Yes No ❑ If you have checked yes, please indicate tfie typo of coverage by checking the appropriate box. A liability Insurance policy Other type o�Indemnity 0 Bond ❑ 'OWNER'S INSURNACE WAIVER: I am aware that th icensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws, and that my signor re on ffils perm application vraives this requirement Signature o Owner or Owners Agent Check one Owner ❑ Agent ❑ I hereby certify that all of the details and information I ha te submitted for enteredl in above application are true and accurate to the best of my knovNedge and that ali plumbing work and installation performed under the per s ued for this appiicatlo It be In compiia ce with all pertinent provisions of the Massachusetts s tate Gas Code and Chapter 142 of the t? ne 1 Type of L cense:. Ttlo p Piumbe' a re of tensed 1 ber or Cas Fitter ❑ ciryrIovm Ca'6+►aster License Number_ 3 L APPROVED(OFFICE USE ONLY) ❑Journey an Date. . . . . .. . . . . NORTH o� y` TOWN OF NORTH ANDOVER � ..._. A - ' PERMIT FOR GAS INSTALLATION SS HUS This certifies that . . . . . �.�.�: /w'.: . . .1 �. . : . . . . . . . has permission for,gas installation . .�A. .f"l. . . . . . . . . . . . . . . . . . . . in the buildings of . . f i1-!f... . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . �{ ��1��'�,1�.`�. . '�. . . , North Andover, Mass, Fee.2C. 7777 Lic. No. L . . . . . . . . GAS INSPECT©R Check# 0 7266 R PERMrr TO DO GAS FITTING MA,SSACHUSETTS UNIFORM APPLICATON FOR (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations Y`- 14,#n 1;6A1 I/d: Permit# Amount$ Owner's Name New Renovation ❑ Replacement © Plans Submitted ❑ U z ° 0 0 O zo F x 3 a v a a F 0 [BASEMENT UB-BASEM ENT ST. FLOOR ND. FLOOR 3RD. FLOOR -[4TH. FLOOR TH. FLOOR TH. FLOOR TH. FLOOR TH. FLOOR (Print or CjMk one: Certificate Installing company Q NameT L.:O r/-q �' Corp• Address d d�C 5 7 aZ ❑ Partner. L4w4 e.,v<e m * a/,? �L Business Telephone 971 6 h'5- 9 50 Y ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 7 Vc)e 4s A 4//v eAq el INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifyou have checked yes,please indicate the type coverage by checking the appropriate box Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I 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 i hereby certify that all ofthe 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 Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts State Gas Code and Chapter 142 ofthe General Laws. -- 3- _;4 By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber a Y 1 33 City/Town ❑ Gas Fitter License Iqumber ❑ Master APPROVED(OFFICE USE ONLY) Journeyman Date!�A IP TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING 1P CHUS This' ,eertifies that . . . . • • • • . . ... . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . Ilesem. .. ... . . . . . . . . . . . . . . . . at . . . North Andover, Mass. l. . .Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING Check ff I�NS, CTOR 8333 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location Vs— llleli V Owners Name � i S�L� `a Date f'� it# _ Amount TypeofOccupancy blual-iliG=' New 0 Renovation 0 Replacement ` Plans Submitted Yes No FIXTURES a Summ lvW ?J`DIFIOCR 3MELOM MKOR SME OM 6mmfm 'TM)HIOM 8M R011t 4+1 (Print or type) /� Check one: Certificate Installing Company Nam U&I LORA !" �JN El Corp, Address PO ! Qa x 5 i _.- p Partner.* Business Telephone4-,V60 — s'e 1-3 Firm/Co. Name of Licensed Plumber. 7o-ly 11OZZ47 I Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® 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 Signature Owner 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 Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts State Plumbing and Chapter 142 ofthe General Laws. By: Signinum of Mccristenaum er Type of Plumbing License Title City/Town License 114umoer Master E] Journeyman II� APPROVED(OFFICE USE ONLY