HomeMy WebLinkAboutMiscellaneous - 58 SAUNDERS STREET 4/30/2018 58 SAUNDERS STREET
210/029.0-0010-0000.0
1
r
' Date.. �-�. .�!'. . . ...... ..
.g ,f
HORTM
TOWN OF NORTH ANDOVER
• . PERMIT FOR GAS INSTALLATION
� 9 °'..�o✓^t4h
SSACHUSE
2 This certifies that . t -'. . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . .
f in the buildings of . . .F ... .... .... . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . . . ,. , North Andover, Mass.
�1
Fee �. Lic. No... .�?t?; . . - / ! . . . . . . . .
J GAS IN
,,PEGTOR
Check#231, 7
573 IV
..�.'u`s�'b� �..,��awr'�r �.,h-���_,�;,;��..��:s';,a.�s �:a3�.,m,• yG-�s�x„c '»..�.��.:��`+d�r�,;�.tiy. �+"-�c
MASSACHUSE M UNIFORM APPLICATON FOR PERAOr TO DO GAS FI'rHNG
(Type or print) Date �p
NORTH ANDOVER,MASSACHUSETTS
Building Locations Ja .� t�T Permit#
Amount$
Owner's Name )qr ��
New Renovation Replacement Plans Submitted
01
a
NU
aa
U v� F+ `� O A
izG z W z W W O O 0 0 O z V O
. 0
- 0
SUB-BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
ATR . FLOOR
5TH. FLOOR
6TH. FLOOR
7TH . FLOOR
8TH. FLOOR
(Print or type) Chec o e: Certificate Installing Company
Name /y d� 111-6, ��U L Corp.
Address , �,��' Ill!❑ Partner.
Business a ep one Rrm/Co.
Name of Licensed Plumber or Gas Fitter
• INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
. If you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 1:3 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
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 ad nera]Laws.
By: ignature of k1censed Plumber Or Gas Fitter
Title [E] Plumber
City/Town ® Gas litter License Number
Iaster
APPROVED(OSCE USE ONLY) ® Journeyman