HomeMy WebLinkAboutMiscellaneous - 50 PARKER STREET 4/30/2018 (2) 50 PARKER STREET
J/ 210/044.0-0023-0000.0 - - - ---- -
l
Date. aG. Q.�. . . ......
NORTH
°F
3� y` TOWN OF O DOVER
PERMIT FOR GAS INSTALLATION
9
AcMUSE�S
This certifies that . ?w '/' R.-r.r :c. . . .... . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . A 5.-. .����l Z. . . . . .
in the buildings of l � . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . .,,�. ? .!�. . . . . . . . tj North Andover, Mass.
Fee. G. . . Lic. No..h .`/ .? . . . . . . . . . . . . . . . . . . .
/GAS INSPECTOR
Check#
0
5664
i
MASSACHUSEIIS UNIFORM APPUCATON FOR PERM TO DO GAS F rrDNG j
(Type or print) Date
NORTH ANDOVER,MASSACHUSETTS y
Building Locations __ 5'O 1 ,4 �.�/`� 5' T Permit#
y/— 64 c/C E4 Owner's Name Amount$
New❑ Renovation ❑ Replacement ® Plans Submitted
a o W
a W o �) x a
C4 F
Pa NF a p O U p W F
CW7N Z 4 C T W a W 9 W A E x
W U
.14 o U °a A a o
SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND . FLOOR
j
3RD. F L O O R
y 4TH . FLOOR
5 T H . F L O O R
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) Check one: Certificate Installing Company
Name �Ll� v�=TTF �L 1'J` 11 Corp.
Address 'V 1 C H !Vo
El Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter e41,4-7-?'F-
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No❑
If you have checked Yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy � Other type of indemnity13
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 1!3 Agent
i 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 Gas Code and Chapter 142 of the eneral Laws.
e�"
B Signature of Licensed Plumber Or Gas Fitter
Title By:
Plumber /
City/Town Gas Fitter License Numoer
Master
APPROVED(OFFICE USE ONLY) �Tourneyman