Loading...
HomeMy WebLinkAboutMiscellaneous - 5 IRVING ROAD 4/30/2018 5 IRVING ROAD ' 210/052.0-0062_0000.0 -� f - -- - -- -_ -- - - -__ Date..` TH Of.NOR1ti o? 6 0 TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION O• _"ti "•`sy SACMUSEt This certifies that . . . .:J.•. . 1-�.� .{ . . . . . . . . . . . . . . . . . . has permission for gas installation . . . -... . . . . . . . . . . . . . . in the buildings of . . .AJ.o(i.cctr 0. y.t . . . . . . . . . . . . . . . . . . . . . . . . at . ..5.� . . ./. .R. .�4 }. . . .�.C . . . . . . . , No�h Andover, Mass. Fee.144--. . . Lic. No.. .L . .. . . . . . . .. . . . . . . GAS INSPECTOR Check# 4955 MASSACHUSETIS UNIFORM IICATONFORPERIVIITTODO GASFfrfING (Type or print) Date NORTH ANDOVER,MASSpACHUS TS r Building Locations S� — �' "� Permit# J 3 Amount$ A/C,Owner's Name (` ,✓� ��� ��c� New El Renovation EIReplacement �-- Plans Submitted El U vi U W a" G O C4 F z 2 O F W a O d Q O O F C7 U G4 w O o o z a o 3 a 0 a 5 a ate. H 0 SUB B ASEM ENT BASEMENT 1ST. FLOOR 4 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type) Cff one: .Certificate Installing Company �� J �2L J-- C'f Corp. Name �� $ Address ,5 (3 U K /' U 21 � ❑ Partner. ,� Firm/Co. Business Telep one 7 Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑. 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 pemut application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I tion I have submitted or entered)in above application are true and accurate to the t 'hereb certify y he details and informs that all of plumbing work and installations performed under Permit Issued for this application will be in and that all 1 best of my knowledgep g etts a Gas e f era compliance with all pertinent provisions of the Massachus odand Ca pter 142 oGenLaws. Signature of Licensed umber Or Gas Fitter By: ©'plumber S-6`3 Title City/Town ❑ Gas Fitter (cense um er [3—Master Journeyman APPROVED(OFFICE USE ONLY) ❑ Date... .^.......: cF,N0 oT e,tip TOWN OF NORTH ANDOVER ? ya e G M PERMIT FOR GAS INSTALLATION' SSACHU`�ES d f � � f. . This certifies that . . . ..l .f` ... . . . . . . . . . . . has permission for gas instal al tion/.9,,,_-!lf; in the build' gs of . . . . . . . . . . . . . . . . . . . . . `. . . . r at . . . . . . . . !. . . . . . .. North Andover, Mass. Fee. Lic. No. : 1.0)!. GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING � (Print or Type) l NORTH ANDOVER Mass. ` Date ' l uilding Location Y►ii ST Permit Owners Name ? New '7 rrr Renovation D Replacement Plans Submitted FIX7"�I1:1rc to d! tt1 0 � S F G us 07 C O tOj n t0- S N _ .. O W < O = O Z r Z m N {✓ W W O CL W F- to Cr 4 m w z Q w trr �, 4 o o W o: t- 1W- z H z �., W w c7 0 U. IW. w cti c Z d W G tt f' >- N m O O N 2 _ Q y C W O d G Q d O O W S O LL, k� t= : O 0 U. a to .,t 0 � > Q a F- o f I Sua—ssmT. SASEMEMT 1 ST FLOOR 2ND FLOOR G1 3RD FLOOR I 4TH FLOOR 5TH FLOOR 6TH FLOOR TTK FLOOR 6TH FLOOR (Print or Type)� � Check one: Certificate InstallingCompany Name—goyj Corp. Address •$2jp6� Partner. �7 "-Firm/Co. Business Telep ne: 0j/7 A2,�L� Name of Licensed Plumber or Gas Fitter P046nQzij LSO Insurance Coverage: Indicate the type of insurance Covera e by checking the appropriate box: Liability insurance policy U�f Other type of indemnity D Bond Insurance Waiver: I , the undersigned, 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 17 Agent 11 1 hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing Work and Installations perforated under Ptrmit issued for this applintion wit!-Ix in eompHance with all petttncnt provisions of tho Massachusetts Slate Cas Code and ChApter 14:of the Genetat Laws. By TYPE LICENSE: ck Plumber Title Gasfitter ignature of Licensed City/Town: Master Plumber or Gasfitter Journeyman 7.: APPROVED (OFFICE use ONLY) License Number