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HomeMy WebLinkAboutMiscellaneous - 478 WAVERLY ROAD 4/30/2018N V. r L Q w LL O OC Q CG s Y y '6 O O LL E °i i (n ++ O. N (n 0 w o, Z z m C ° ro Ctw 7 O LL 7 O = N E t U N C LL 0 U a Z Z C i a 0D O O K — m C LL 0 V a Z U W w w 7 O K N 41 N m C LL 0 a N Q w 3 O w — r C LL z uj °c Q w uj 6L C i m o z O N N N O E N O O cv p •� L Q a) � Q O, �• N V E Q 0 S o = o V L y-' N C 4 � J i/ CD > c O O i O --ov O N O C N CD 41 E%- 0 CD z Q 0 p O 0 N .� 3 Q O• d 0 0 •N v0i = 0 Q L L cc CL y0+ N d 2 m N W Ov +- O O LL 0 4) N C •� t O W E C.) Q 0-0 N a' .> ' c 2 m .O O C O F 0 CL 0 0 as CL N N C cn �a m 0 O N O O z O Q J O Fa CO 2 z O m coz NW w a W H W 0- • ss 2 E CDz D N i 4W O CDv CL .CL c U _ U) O O H ca � o CL CL CF) Q _ J � O d z CLN _ Federal ID p 05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielsch Engineering CT Contractor Registration No 620120 60 Shawmut, Canton, MA 02021 CONTRACT �. 339-502-5197 FAX 339-502-6345 R1 S E'i Page 1 PROGRAM ENCINtEERING THM CMA-HES ar+Gn1meRl cmCT �BETWEEN s ArmTOMiRFoFOR DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTO WORK ORDER Benjamin Campbell (978)621-7936 07/31/2015 419692 00002 SERVICE STREET BILLING STREET Road Waverly 478 Waverly 478 Road SERVICE CITY. STATE. ZIP BILLING CITY, STATE, ZIP I - North Andover, MA 01845 North Andover, MA 01845 1 2 2015 ; 1 JOB DESCRIPTION i PHASE ONE - Proposal for this calendar year. $0.00 AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks, foams and other products, Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) This will require (8) working hours. A reduction in cubic feet per minute (cfm) of air infiltration will occur, but the actual number of cfin is not guaranteed. At the completion of the weather nation work, and at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING ADDER: (4) working hours. $340.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unf iced fiberglass balls to (202) square feet for damming purposes. $414.10 ATTIC FLAT: Provide labor and materials to install a 13" layer of R-45 Class 1 Cellulose added to(1059) square feet of open attic space. $1,724.54 ATTIC ACCESS: Provide labor and materials to insulate the back of (1) attic hatch with 2" rigid Thermax board. Weatherstrip the perimeter. $60.00 VENTILATION: Provide labor and materials to install (1) insulated exhaust hose to existing bathroom fan(s). $50.00 VENTILATION: Provide labor and materials to install ventilation chutes in (80) rafter bays to maintain air flow. $160.00 BASEMENT CEILING: Provide labor and materials to install (125) linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $218.75 BASEMENT DOOR: Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2" rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and scans with FSK tape. $7222 RISE Engineering will apply all applicable, eligible incentives to this contract You will only be billed the Net amount Currently, for eligible measures, Columbia Gas offers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 1000/6 for the Air Sealing measures up to the first $680 and an additional $340 if savings are justified by the auditor. For the safety and health of your home's indoor air quality, we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun, and after the weatherization work is complete. We will also conduct a full assessment of the combustion safety of your heating system and water heater. This has a value of $90 and is at no cost to you. Total allowable weatherization incentive is $3,110. $90.00 a Federal ID # 05.0405629 RISE Engineering RI Contractor Registration No 6186 MA Contractor Registration No 120979 A division of Thieisch Engineering CT Contractor Registration No 620120 60 Shawmut, Canton, MA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 R I S E Page 2 PROGRAM ENGINEERING THS CONTRACT S ENTERED INTO BETWEEN RISE CMA-ETES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE OATE CUENTA WORK OROER BenjantinCampbell (978)621-7936 07/31/2015 419692 00002 SERVICE STREET BIWNG STREET 478 Waverly Road 478 Waverly Road SERVICE CRY. STATE, IIP SILUNG CITY, STATE, ZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION Total: $3,809.61 Program Incentive: $3,109.99 Customer Total: $699.62 WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE VM ABOVE SPECIFICATIONS. FOR THE SUM OF ***Six Hundred Ninety-Nine & 621100 Dollars $699.62 UPON FINAL INSPE ON UPON BALANCE ]0 APPROVAL BY RISE ENGINEFJUNG. COST REES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1% WILL BE CHARGED MONTHLY ON ANY YS. SEE REVERSE FOR IMPORT ORMATIO N GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION, NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHOR2ED-SIGMA --- E 9 C-TO ACCEPTANCE Q NOTE: THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 30 DAYS. ACCEPTANCE OF CONTRACT. THE OVE PRICES, SPECIRCATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED, You ARE AUTHOR®TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTUNED ABOVE 10S L 2 or. i t Sol an& OWNER AUTHORIZATION FORM Benjamin Campbell J, (Owner's Name) owner of the property located at 478 Waverly Road, North Andover, MA 01845 (Property Address) 478 Waverly Road, North Andover, MA 01845 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owrpfs Signature Dat The Commonwealth of Alinvat chuseas Department of Industrial Accirteau Office of Invesfigations I Congress ess Street, Siule a 00 Roston, 2V 02114-2017 Workers' Compensation Insurance Affidavit: Builders# ontrattorslEl tricians/ lumbers Applicant itafgt titm Ve_me Ott L&Cibly F Naim #°c rtititaailnditaia3ttzti;i; C of °Stag° . 16 Phone. . Are ;tyro an �ayex°. Citecic theppruapreate box:_ Typt Of prom (required): I . 1 am a employer with 4. [] I assn a gertmi contractor and 1 havc Hired the " New construction ovloye (fill,an€ilorpn-timo,* sub -contractors 2.[3 1 am a style proprietor or partna. listed on the attached Wit. 7. Remodeling drip and have no c mptoym-, These sorb contest tori hate S. ® i3t^rwlition *wking for me in any capacity. employees and have wworkt r �' 9, ttildin addititzn INo woaliet°s' ci miti Branco p comp. insurance., ruquired.] 3.0 We are a ixttlaoration and its 14_ ;j Electrical :repairs or additions, 3. rj I alit a home-owmer doing all work officers have exerciwd their I I _iti s tiltstnbing repairs sir additiow, myself t'hlo workm' cornp- 611 0P etrtpticzaz Per Mil.. i� � Roof repairsinsurance required.] e. 152, �s1(4), and we have. new 1,1.[) Other_ rmloyecs, (No Workers -_ i,ttmp. insurance reouired, l "Any atnlicam tat mks $ a *'I mace ahaa fill ansae txiet i g shear ek , t4irzaatt�aD t ic° inftwmat vn. t tl cs Who soul this at ada,it indir frog rhe} ars doiag all * k and tbcn him wtAide eantmL top.: arae submit a ne°.e ffidavit Indic at zsg suctz_ a�":cnittaastmt5 that clia�k tkaa� txax muss szzrichez3' ars �Id€iir�taat ai+esuaza Ilse at«'txct� ciz at�r tick-cenaatr�emss ?tat scats sulxethc:' c� r�xai ;hK en4ets� �aas<r rntp3uy tt'kraal `tmtm amhavc cm tag thcY must pac Nldc *heir crcr ' c10 mp. p0licy nmubet: t arae sap rpda er chat pa�rrulClia a�nrif xiattr ra far arp eft ►ttri B % tkePOMY an tab Batt artfarmtatittax. _... Inliumnce Company Naxw., .... 'CkLl.a Policy# carSclfns, Lic. �� � i i .�_ ,_ i U i� �", ct ..�. -0 i�,�pirttitatt L7ate: Wa tibSitc Addt�: ` V�qL f�(y. Attach a copy of the Worker' eor ensation pulley declaration pare Ohowirt, the policy natter and expiration date). Failure to soon covcrage as ria aired and r Sion 2.5A of MGL c,. 15:2 can lard to the itn . iti�iit of c mi at penalties trf a lirite lap to S1,500.00 an for one-year imprisonment, as us ll as civil penalties in the form of a STOP WORK ORDER and a fine of lap to S250.00 a day against the violator, lk advig d €stat a copy of this :statenwnt may be forwarded to the Office of Investigations of the f)iA ff9r insurance coverage cenfscaticm, I do hereby cenify am r clic pa and pe Ofl rl 1*9t the i4orMation pro viar d ta&vr is true aad corned. I _«s m Official use only. Do atm° white in 1aar,area jo be rompirled by cdv orrowtt official - City or Towns m PerrttWLkeaee p Issuing Authority ((itrrle one) 1. Board of health 2. Building Department 3• Cityafown Clerk 4. Electrical Inspwtor �. Plumbing inspector &. Ater Contm i"€ssott•. Phone ACORO0 ACCO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 7/7/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Martin J Clayton Insurance Agency, Inc. 1649 Northampton Street P. 0. BOX 989 Holyoke MA 01041-0989 CONTACT Nancy Usher NAME: Y HONE Ext: (413)536-0804 �°� No): (413)534-7874 ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA:Nationwide Mutual -Harleysville NATIO INSURED Gauthier Insulation 44 ESSEX ROAD IPSWICH MA 01938 INSURERB:Allied World Natl Assurance Co INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLDICYOLICEFF PM/DDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED PREM SES(Ea occur ence) $ 50,000 MED EXP (Any one person) $ 5,000 X GL43487F 7/6/2015 7/6/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000 , 000 X POLICY D PRO- JECTF-1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 11000 ,O00 B EXCESS LIAB CLAIMS -MADE AGGREGATE $ 119 , 000 DED I I RETENTION -CLO $ SE020792125-194985 10/18/2014 10/18/2015 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N �ER OTH- STATUTE ER E.L. EACH ACCIDENT _ _ $ ANY PROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSUREDS) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION 01 ti1111A 1J"_11 -11-1 a i1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 FRANCIS AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MP"drd9tLad with pdfFactory trial version www.pdffactory.com .LJIa.> ,"tiA 1Z/10/2014 1:21:37 PM PAGE 2/002 Fax Server ` CERTIFICATE OF LIABILITY INSURANCE 1 211 012 0 1 4 THIS CERTIFICATE IS ISStIFO AS A MATTEtt OF INFORMATION 011LY AND CONFERS 110 RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES 1107 AFFIRMATIVELY Oil NEGATIVELY AMEND, EXTEND Oli ALTER THE COVERAGEAFFORDED 13Y THE POLICIES BELOW. THIS CERTIrICATE OF INSURANCE DOES NOT COIISTITUTE A CONTR.AC"T BETWEEN THE 1SS1.111IG INSUREI'.(S), AUTHORIZED REPRESENTATIVE OR 141ODUCER, AND THP CEILTIFICATE HOLDER. IMPORTANT: If Lhe certlfic'ate holder Is an ADDITIONAL INSURED, the pallcy(les) mu sl: be endorred, If SLIBROGATIOt'1 IS WAIVED, suhjeri. to the LerTnn and condillons of Lhe pollcY, certain policies may require an endomemenL. A I:Lal-emeM on this certificate does not: ronler rights Lo the cen'.ilicate holder in lieu Of such endorsement(s). Clayton Martin J Ins Agency Inc *k nerxleY Assigned Risk Service_ 1649 Northampton St „rr . E.+) 800 63444589 PO Box 989 ntx;:.F s. Policy5ervicesCherkleyrisk,a')m Gauthier Insulation Inc!NsuzrR E. ---._.._.-------.---._."._....-.._ PO Box 344 _..- - --- ..-_.......... _._.._ ;NSXCRL Ipswich, MA 01938 INS UR ERn I N$1Ai ER E .....,�......_� __ INS UREI;F IrT!a ry Iu ctIiCIFY THAT THE POLICIES OF -INS MANCE LISTED BELOW HAVE BEEN ISS LED IV THE USURED,NANIED ABOVE FOR THE PDLI(Y PERIOD : INDICATED, NOTWITHSTANDING ANY REDUIREBAEtdT, TERM OR CONDITION OF ANY CONTRACT t)R OTHER DOCUMENT WITH RESPECT TO WHK;H 'THIS CERTIFICATE hdAY @E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERA•IS. EXCLLtZ;IONSAND CONDITIONS OF SUC'HPOLIC'IES LIMITS SHOWN MAY HAVE BEEN REDUCED RY PA In r•1 A1141 TYI'F '7F Im1RANcF - Pr)I I r.Y NUMRF R Mass Save Program/Conservation Services Group, Inc 50 Washington Street West Borough, MA 01581 ACORD 25 (201010,) SNi)ULDANYOFTHE ABOVE DES ORISEDPOLIC7ES BE (:ANCELLED BEFOF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A(;C:ORDAl`K:E WITH THE POLIA.Y PROVISIONS. BRAC 3139 AUTOMOBILE LIAWLITY WORKERS COMPElb ATION AND EMPLOYERS' LIABILITY Y•'N( Y+('S`. AI U- uTH- ANYPROnRIcibR/PARINE TORY I.It!1';5 ER O!"fu;i:rNCMR rR I;XQ!.UI7 i. C) IVA (LLuIA rllnrY itr NILS El WC-20-20-OO18B1.OG 10130/2014 1110130/2015 EC � A CII;r c In EN1 $500,000 711 pw+, 4" l:1 e 111,Cer nr. gr,•R7P7 !�N ;)r L:IPERA110N56•;�cu. "MIP: ' $ 5{xl,lmi) .;:5"I I7!P TE)N C.fe1'%RA'.!ON5'1!, (: l; A11UN:';'S'I:.111 t: i. ., (At[.cl, k:; {)li [i '.Di. n.t1 <�I;c:, al R>,nr rG; Schatlok, '3 '.-4 -P^ ;1•.v' MIT $ 5(111),000 ! .nn. •. >p.;.n Ip r.r,,,ts �'. Coveragee Election Category Elect, Status Nag StatFa(s) All_EntitieS/Locations Officer Exdude Kurt Gauthier MA officer include BrittnieAiello Gauthier Insulation Inc 44 Essex Road Ipswich, MA 01938 Mass Save Program/Conservation Services Group, Inc 50 Washington Street West Borough, MA 01581 ACORD 25 (201010,) SNi)ULDANYOFTHE ABOVE DES ORISEDPOLIC7ES BE (:ANCELLED BEFOF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A(;C:ORDAl`K:E WITH THE POLIA.Y PROVISIONS. BRAC 3139 c c5 All a > €$ M r:"Z Q ; R A is n A L Go C a Q f1 r:"Z Q ; R A is n A L C a � a a N �;S N Q 5 � (TQ M.8� . 0, Xs CEO � a a N �;S N Samuel F. McCormack Co., Inc. Insurance Adjusters and Appraisers ADJUSTERS AND APPRAISERS May 7, 2015 Town of North Andover Building Inspector 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 RE ASSURED: Benjamin Campbell LOSS LOCATION: 478 Waverly Road, North Andover, MA 01845 POLICY NO: 1333826 TYPE OF LOSS: Ice dam DATE OF LOSS: 03/01/2015 OUR FILE NO: 15-05694 To Whom It May Concern: Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3113 is appropriate, please direct it to the attention of this writer and include a reference to the above - captioned insured, location, policy number, date of loss and claim or file number. Thank you for your anticipated cooperation. Very truly yours, Kim Shepherd Adjuster ks@mccormackadjuster.com cc: Board of Health 42 Holbrook Avenue, Braintree, MA 021841-800-972-5399 (781) 843-1222 Fax (781) 849-8191 One Jonathan Bourne Drive, Suite 7, Pocasset, MA 02559 (508) 403-2600 Fax (508) 403-2602 www.mcconnackadjuster.com Date. ....... TOWN OF NORTH ANDOVER 4 �15 PERMIT FOR GAS INSTALLATION c' ........ This ertifies that (� ..... .............. 11 IY r le - has perthission, for, gas installation in the buildings o ....... I Px5. ........................ at ......... ,,North Andover, Mass. tic. No..I.j ........ ....... ASINSPECTOR Check # '2 73'i 3 'v"A00At,HUSt 115 UNIFORM APPLICATION FOR PERM17 TO DO GAS FITTING City/Town:_/��---------, MA. Date: Building Location:_4-o-El 1)) L!��----- Type of Occupancy: Commercial ❑ Educational ❑ New: Alteration: ❑ Renovation: ❑ Owners Name: ----- Industrial ❑ Institutional ❑ Residential [�J Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES unecK Une Only Certificate //# INSURANCE COVERAGE: -1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Acent Owner ❑ Agent ❑ --- - .._ By checking this box in; I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License:----- _.. [�Plumber ------ -- Tine ❑ Gas Fitter ----- Master Signa, u 6 Licensed Plumber/Gas Fitter Cly/Tows, - ❑Journeyman -- APPROVCED(OFF-ICE USE ONLY ❑ LP Installer License Number: ___ �%�_•/