HomeMy WebLinkAboutMiscellaneous - 50 FARNUM STREET 4/30/2018 (2) 50 FARNUM STREET
210/107.A-0087-0000.0
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3r °` 6 TOWN OF NORTH ANDOVER
G O P
PERMIT FOR GAS INSTALLATION
SAC HUSES
This certifies that c r U
has permission for gas installation . . . . . . . . . . . . . . . .
in the buildings of . . e'. .� F<. �>
at . . �- A -1. IA6. . . . . . . . . . . ., North Andover, Mass.
Fee. : ?. . Lic. No.. . . . . . . . . . .7. . r. .t. . . . . . .
,GAS INSPECTOR
Check#
4475
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MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FTITING
(Type or print) Date .2e2 D3
NORTH ANDOVER,MASSACHUSETTS
Building Locations 50 Farnum Street Permit# `{ 7>
Amount$ a -
Owner's Name Jackie Coleman
New❑ Renovation ❑ Replacement Plans Submitted ❑
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SUB-BASEMENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type) one: Certifica Installing Company
Name Andover Pl bg. & Htg. Co. , Inc. Corp. 21 Y2
Address 20 Aegean Dr. Unit 110
❑ Partner.
M6thimn Ma nj51AA
Business Telephone (97R) FRS—R-AR-A ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter George Larose
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes No[:]
If you have checked M please' irate 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 permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State GWCode and Chapter 142 of the General Laws.
By:
ignature of icensed Plumber Or Gas Fitter
Title I J Plumes
City/Town ❑ as Fitter License Number
❑ as
APPROVED(OFFICE USE ONLY) ❑ Journeyman