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Home My WebLink AboutMiscellaneous - 57 STAGE COACH ROAD 4/30/2018 57 STAGE COACH ROAD 210106=0000-0 ', � , _ �_ Date. r. ?0* O TOWN OF NORTH DOVER • PERMIT FOR 4ASINSTALLATION �,SSACMUSES .r r' This certifies that jS'-��. e . . . . . . . . . . . . . . . . . . . has permission for gas installationr<' ". . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . at . .',. . . . L. . . . . , North. Andover, Mass. Fee.S.0 . . . . Lic. No?.-33.3. . . . . . GAS INSPECTOR �r ti Check# ( x: (Print MASSACHUSETTS UNIFORM APPLICATION FOR'PERMIT TO DO GASFITTING or rJL ype) Mass. Date 20 Per it If'qj C Building ocatl n wners � Type of Occupancy New C) Renovation❑ Replacementp/ Plans Submitted: Yes❑ No❑ 1 W O m G to (D ~ } Z Z O LU W Ln Lu SUB-BSMT BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Ins tailing Company Name be W,f604 kRo-_ 0 PQ/ jo�_ Check one: Certificate Address 7) Yuy ❑ Corporation Business Telephone ❑ Partnership Name of Licensed Plumber ort;as Fitter b e, A,YUY, lrnvt o. INSURANCE COVERAGE: I have a current ll billty Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No p If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE 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 onti7i s permit application waives this requirement Check one: Signature o Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and Information 1 have submitted for entered)In above application are true and accurate to the best of my knovNedge and that all plumbing work and Installations performed under the perm) ed for this 2PPlCron will be in co pliance with all pertinent provisions of the Massachusetts state Cas Code and Chapter 142 of the coerg L Type of License By C)Plumber g re o- s l L Ce umber or Cas Fitter Title ❑Casfitter City/Town px5s ter License Number APPROVED(OFFICE USE ONLY) ❑Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 26 i (Print or,TTyyp/e) �l�`✓ lel �U , Mass. Date, i��_ � 19 Permit Building Location c ��.R-- L" iowner's Name ,/� �? �A016 tt�, ZRO Type of Occupancy--R E51 i ) N 7-1 tQ New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes❑ No ❑ N N W N Y z s U; NN VCC N Q (n 0: O to = W J N W 0 C1 m t Z p W 4 ¢ C 0 ZO C }' W Q m N 1,- iJ W O a c rf F W 6 16- (.) (A ft ull tly. W N m < O N S W W tlf J < S G Q tl Q W W V tl }• 2 J f- Z 1. }, N ® Z O Z W O N = Z Q W W Z < ¢ Q Q O O W Q O W - O tl 2 W G tl c� Y a a H O SUB-8SMT. BASEMENT 1 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name (iAe jZ T T �!*)(n Ma T yr)t 0 Check one: Certificate Address 3 0 LID A t H i�A A f�-) 4-f j. ❑ Corporation M E T-H U E tj III is • o l k ❑ Partnership Business Telephone fd L —9 (7-71 2- Firm/Co. Name of licensed Plumber or Gas Fitter '�?q m P T A- '5 A M m 6 i A A?c> INSURANCE COVERAGE: I have a current f bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes V No ❑ If you have checked ves, please Indicate the type coverage by checking the appropriate box A liability insurance policy 0 , Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 El 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 the pe ' i sued for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. ByT of License: Plumber n ure of cen Plu or Gas Ftter Title sfitter ter License Number V a3) City/Town Journeyman APPROVED OF IC 0 L BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE____19 GASINSPECTOR l . -r 26Date.,/. /�/4 G. HaRTM TOWN OF NORTH ANDOVER prop PERMIT FOR GAS INSTALLATION: . CU � °+..fo^^•'`,fig - +� 9SSACHUSEt w a C This certifies that . . /q�!�rfa?t has permission for gas installation . HJA-- . . . in the buildings of ., 1,.v .s. . . . . . . 3 . . . . . . . . . . . . at 7 . . �.=? .4.North Andover, Mass: r. Fee.,2a :.. . . Lic. . GAS INSPECTOR y WHITE:Applicant CANARY:.Building Dept. PINK:Treasurer GOLD:File