HomeMy WebLinkAboutMiscellaneous - 46 ELM STREET 4/30/2018 (2) 46 ELM STREET `
2101042.0-0016-0000.0
Date.. . .. ... ... ..
NORTH
TOWN OF NORTH ANDOVER
0igsailam
F
• PERMIT FOR GAS INSTALLATION
�1S SAC HUSEt
This certifies that . . . . . . . . . . . . .` . . .
'
has permission for gas installation . . . r. . ��'//Zfcf{y7 . . .
in the buildings of . . . . . ...
vPris
. . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . .1/ ��?. . . . . . . . . ,, North Andover, /Mass.
Fee. !-7Y,�*?. Lic.
GAS INSPECTOR
Check#
i I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
1VOR1N AI`1DNE12, , Mass. Date 05 Z Permit #
Building Location 4-6o 81..I''t S Owner's NameWaT gf—VIENS
W RIH Q U DV Ems, MA Type of Occupancy-5I RAMI LT_
New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑
N
N W N
NN U
CCh
to rt N O N = h
C7 J N W Oh U ¢
Z ° W ~ Q m Z O �` r
4 a O O
d m N h W w O a G Ito
to a N O V W N Z a a O. O > w
WW N W Z Q S W W h W
C7 H Z J h Zr. W W O > W J {. W
Q W Q r" >• N ® S. O O fA MW
4 W > a W M Z. < m 6 < O O W W O h
O t9 S U. a G d ..i a > a a F- O
SUB—BSMT.
BASEMENT f
7STFLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STN FLOOR r
i.
Installing Company Name COLUMBIA (;aS GF MASSACHUSETTS Check one: Certificate #
Address 55 MARSTON STREET X7 Corporation 1862
LAWRENCE, MA 01841 - 231Z ❑ Partnership
Business Telephone q 7 8-691- 640 6 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked res, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy 1K 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 El
I hereby certify that all of the details and information I have submitted(or entered)in abo pplication are true and accurate to the best of my
knowiedge and that all plumbing work and installations performed under the permit iss f r this application will n Ompliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S.
[103y T e of license:
Plumber Signatureof Licensed Plumber or Gas attoritle GasfitterMaster License Number 37q-5ity/Town Journeyman /00PPROVED TOFFICE U—SF ONLY
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME & TYPE OF BUILDING
S `
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC: NO.
PERMIT GRANTED
DATE _19
r
-� GASINSPECTOR