HomeMy WebLinkAboutMiscellaneous - 48 PATRIOT STREET 4/30/2018 48 PATRIOT STREET
210/013.0-0021-0000.0
l
6 6 Date.....
G HORTM
of „ao ,'�'°
32 �` TOWN OF NORTH ANDOVER
• - PERMIT FOR GAS INSTALLATION
�9SSACHUSE�
This certifies that . . .... . .t . . . . . ... . . . . . . . ..�. . . .`. . . .. .
has permission for gas installation . . . . . . . .,5�??
in the buildings of . . . .y. .lq.zx-:' .. . . . . . . . . . . . .
at . . .1 ,��,, .�. . . . . . . . . . . . . . . . . . . . . . . North Andovd, Mass.
Feer5�:S�J Lic. No
GASINSPECTOR
Check#. i
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: V AN0641412 —, MA. Date: ~/U Permit#
Building Location: Y/f��-AoT s Owners Name: P1 L
Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New: Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑
FIXTURES
Y� ~ fn U) U
m 2 0O W W U fn F- 0F = W W
Z Z p W W W IY O F-
O z
W F'- N U W W Z 0 to 0 W LLI (L H 0 = LL
W W Z (7 J F- F- O Z J U' LL Fes. = W F W LU
v o I=i tag CW7 = _ O a. > > > O
SUB BSMT.
BASEMENT
1 FLOOR
2 FLOOR
3RL)FLOOR
4 THFLOOR
5 FLOOR
6 FLOOR
7 -FLOOR
8 FLOOR
` Check One Only Certificate#
Installing Company Name:--�J�/�- /�-c..fi (}�
2'Eorporation
Address:� &5Llt CVVT 'T City/Town: /V l nik�r� State:
❑
(i Partnership
Business Tel:,?) 1'-6 c( `l)--l3 Fax:
o ❑Firm/Company
Name of Licensed Plumber/Gas Fitter:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yeses nio❑
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 ❑ Bond ❑
OWNER'S INSURANCE WAIVER:1 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 Agent Owner 1:1 Agent
By checking this box❑;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 d d Chapter 142 of the General Laws.
Type of License:
By - Plumber
Title ❑Gas Fitter Sign re ens d Plumber/Gas Fitter
['Master
City/Town ❑Journeyman
License Number:
APPROVED OFFICE USE ONLY ❑LP Installer (J