HomeMy WebLinkAboutMiscellaneous - 505 PLEASANT STREET 4/30/2018 505 PLEASANT STREET
210/037.C-0033-0000-0
Date.�. .:. . .. . ..G.Z. ...
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3r �` TOWN OF NORTH ANDOVER
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• - PERMIT FOR GAS INSTALLATION
�9SSACHUSEt
This certifies that . .
has permission for gas installation . . . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at North Andover, Mass.
Fee. Lic. No. s . . . . r. �: ` . ... . . . . . . .
GAS INSPECTOR
Check# !. C
4209
MASSACHUSETTS UNIFORM APPLICATONFOR PERNIlT TO DO GAS FITTING
(Type or print) Date --
NORTH ANDOVER,MASSACHUSETTS
Building Locations go <=?�-SA AT- .0? Permit# YLd 9
Amount$ p, /
_Owner's Name ni/f, /3/1 GC=
New o Renovation Replacement Plans Submitted E
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SUB-BASEMENT
BASEMENT
1'ST. FLUOR
ND. FLOOR
3RD. FLOOR
riTH. FLOOR
3T H. FLOOR
6TH. FLOUR
7TH. FLOOR
STH. FLOOR
(Print ortype)6 I?rGlf%Z12 . 1�t , one: Certificate Installing Company
Name Corp.
Address 2 3 �� `{'�'c19 `s a Partner.
SPS
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Business Telephone r9 13-Firm/Co. .
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes JE[ Noo
If you have checked yM please indicate the type coverage by checking the appropriate box.
Liability insurance policy 19— Other type of indemnity 0 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 Q Agent [:I
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 MassachusettsSta�Code and Chapter 142 of the General Laws.
By: Signature ofLicensed Plumber Or Gas Fitter
Title 0— 7-02--0 2 3 S
City/Town [:] Gas Fitter License Number
Master
APPROVED(OFFICE USE ONLY) journeyman