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HomeMy WebLinkAboutMiscellaneous - 49 MILLPOND 4/30/2018 49 MILLPOND 210/095.A-0049-0000.0 �O � � J t. Date.. . / NpRTM =0* TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION . 9 SACMUSESt This certifies that S CO has permission for gas installation . .f'U!N . . . . .. . .GA:S, �U. . . in the buildings of . YA pro N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . �� . . .f .�VN©. , North Andover, Mass. Fee. Q�.� Lic. No..(.. �?��. . : l�r.u.2.?'. .µ!l<c �a'. . . . . . . . i QC f GAS INSP t k Check# 3 v 4476 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FTITIlVG (Type or print) , Date O c`✓ �(.) �D NORTH ANDOVER,MASSACHUSETTS\ Building Locations , L b0 Permit# Amount$ Owner's NaIV 42/ New Renovation Replacement n Plans Submitted r� C7 3 F O p > cb G HC a ao 1 W H off SUB-BASEM ENT BASEMENT 1ST. FLOOR 2N D. FLOOR 3 RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR or type) � - / /( ^� /r � CD one:Corp.Certificate Installing Company Name Address �'t Partner. Business telephone - Finn/Co. Name of Licensed Plumber or Gas Fitter cS-'�i�'I .L 25' J 5;2 J )d Q INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [M N,0 Ifyou have checked yes,please indicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity ® Bond Q r 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 D Agent i hereby certify that all of the details and information I have sub i ed(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installati and it Issued for thislication will be in compliance with all pertinent provisions of the Massachuse Code and Chapter 1,4 2 ofthe Ge r Icityrrown y Signature of Licensed Plumber Or Gas Fitter itle Plumber A M Gas Fitter License Number 0 Master APPROVED(OFFICE USE ONLY) 1;7,,l Journeyman