HomeMy WebLinkAboutMiscellaneous - 58 HEWITT AVENUE 4/30/2018 / 58 HEWITT AVENUE
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210/060.C-0038-0000.0
(Print or Type) —ova ~rrL'VAIIUN FOFI pEAMITTO DO OASFITTINQ
NORTH ANDOVERMass. Date
Bundling '�*P-- 19
Locations .r- PermR # 52-6 L5—�
Owner's
Name � � /d s
New � Renovation O Replacement +
v'' Plans Submitted:, Yes 1) No Q
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4TH FLOOR i s
7TH FLOOR
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aTH FLOOR
Installing Company Name �vrCheck one: certificate
Address `l -�-� -- Q Corp.
d Partnership
Business Telephone O _ O Flrm/Co.
Name of Ucensed Plumber or Gas Fitter
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent. Yes la'
one
If You have checked yes, please Indicate the type coverage by checking the appropriate boIf
A liability Insurance policy I Other type of Indemnity ❑
Botx! D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required b
Chapter 142 of the Mass. General Laws, and that my signature on this Y
Permit aPPllcatlon waives this requirement.
% Check one:
nature o towner or DYVnet's en Owner O Agent
11
1 hereby certlfy that an of the details and Information I have submitted(or entered)in above application are true and accurate to
pertinent
P and that an plumbing work end Instellatlons performed under the rmit Issued for this appllcatlon will be M compliance with all
prMlnent provisions of l e Massachusefl9 Stale Gas Coda and chapter t,2 pe the best of my
aP of the(lWWW lacus.
Tof tcense:
Title Plumber v4R z
Gasfitler a o Tisa um er of as et
fflmaster
CItyRovm 1.10umeyman (cense Number -At--
AITTI0NEn(OFFICE USE ONLY)
Date. '.'/.. �?. . ....... .
NORTH TOWN OF NORTH ANDOVER
cr PERMIT FOR GAS INSTALLATION
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SgACHUgE n
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This certifies that .�, . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . .
in the hy9dings of . f c, k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . .f1� ., . . . . . . . North Andover, Maf.
. . . Lic. No.:?. .�. .`. . . . . . . s�ayt. : . . . . . .�.
ASINSPECTO a
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer