HomeMy WebLinkAboutMiscellaneous - 48 MILLPOND 4/30/2018 48 MILLPOND '
210/095.)048-0000.0
. X31
MASSACHUSETTS UNIFORM. APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) t
NORTH ANDOVER Mass. Date �.J
Building Location ,`hayl) Permit
//Z/., 4'�J� Owners Name
New
X. Renovation II Replacement II Plans Submitted D
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(Print or Type) / C. one: Certificate
Installing Company Name ?P- 0 �I e-A , �/1{� [�Corp.
Address �- k os Partner.
d Awbe ilre,' Mq. Firm/Co.
Business Telephone: ejf g76aV
Name of Licensed Plumber or Gas Fitter %j�pyL 1'1ryQ�'
Insurance Coverage: lndica:e the type of insurance coverage by checking the
appropriate box:
Liability insurance policy = Other type of indemnity = Bond Ej
Insurance Waiver: f, the ur.dersicned, 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 ❑ Agent Q
I hcreby certify, that all of the deuils and information 1:are submitted (or cntered)in above app(ieation are true and aotsrate to the best of my
&nowtedse and that atl ptutnbin; wort and lnstatiatiotts —�cfarae d unrSC P-_rmit iuuzd fo. this appuation will be In eompHimcis with all perdstcnt
provisions of the Massachusetts State Cas Qde and 06a7tcr ts:et'rho C#e.=.t Laws.
By TYPE LICENSE-
i Plumber
Title G a s f i t t e r Signature of Licensed
er Plumbe-- or Gasfitter
City/Town: ,�r.journeyman
25411 -
APPROVED (OFFMS USE ONLY1 License Number
f
-- -- -- BELOW FOR OFFICE USE-ONL.
FINAL INSPECTION SKETCHES NO• PROGRESS INSPECTIONS
MERCURY TEST
FEE
FINAL INSPECTION
APPLICATION FOR PERMIT TO DO GASFITTING'
NAME & TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE - 19
-
GAS INSPECTOR
292 / <
Date. ......
„ORTN TOWN OF NORTH ANDOVER
3? '� PERMIT FOR GAS INSTALLATION
t •
+,.ao I� ty CpS
SACHUSEt 1`+j
J
This certifies that . . . . . . . . . . . . . . . .
has permission for gas installation
a
in the buildings of . .�'. : .1. .�f !. ... . . . . . . . . . . . . . . . . . . . . . . . .
G/.?t' yr .� l / �, ��
at . . . . . . . . . . . . . . ., North Andover, M>3s.
Fee. . (,.- . . Lic. No.� . y.l. . . .... . . . . . . .
GASINSPECT
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer