HomeMy WebLinkAboutMiscellaneous - 45 VILLAGE GREEN DRIVE 4/30/2018at
Date./.�.-.. �....:. ` ... .
TOWN OF NORTH ANDOVER
' PERMIT FOR GAS INSTALLATION
s ' s
This certifies that 41
.� F �. '... T ......% .. .
has permission for gas installation ...............
in the buildings of ... �..f.. .'. �. �. `.........................
at ... North Andover, Mass,
Fee. ::.. Lic. No.. l .......
1
GAS INSPECTOR
Check # 1� 6 / 3
364
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(.Print or Type)
NORTH ANDOVER Mass. Date
4jffi.,t uilding Location 45 Permit # b
Owners
Y
Name MoLjree>n rormi ,C
• New -7 Renovation �J Replacement M Plans Submitted D
.� -r lDCG
(Print or Type) Check one: Certificate
Installing Company Name 1And00er. plba. E NtG. (6.4 =rlC. • Corp. 2Z
Address 20 fteo^ '[fir. 0"7"t :2WI.0 Partner.
trio-ek ULF,Y%_. t�i0.. ®19:(-I4 Firm/Co.
Business Telephone: (-dl7A) 685--8SRZ
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 = 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 17 Agent 1!
1 hereby certify that alj 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 aU plumbing wont and insatiations perfornrcd under Permit iuued for this apptication will -be in eompUsnoe with CU Pertinent
provisions of tho Massachusetts Slate Cas Code and thaptes 14: of the General Laws. • -.
YPE LICENSE:
Plumber
asfitter- Sign tune of Licensed
Master Plumber or Gasfitter
Journeyman W9{b3
License Number
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1
BASEMENT
I
IST FLOOR
2ND FLOOR
3RQ FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name 1And00er. plba. E NtG. (6.4 =rlC. • Corp. 2Z
Address 20 fteo^ '[fir. 0"7"t :2WI.0 Partner.
trio-ek ULF,Y%_. t�i0.. ®19:(-I4 Firm/Co.
Business Telephone: (-dl7A) 685--8SRZ
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 = 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 17 Agent 1!
1 hereby certify that alj 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 aU plumbing wont and insatiations perfornrcd under Permit iuued for this apptication will -be in eompUsnoe with CU Pertinent
provisions of tho Massachusetts Slate Cas Code and thaptes 14: of the General Laws. • -.
YPE LICENSE:
Plumber
asfitter- Sign tune of Licensed
Master Plumber or Gasfitter
Journeyman W9{b3
License Number