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o� TOWNNO H ANDOVER
' PERMIT F AS INSTALLATION
SACMUSEt
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . :'%'..`. . . . . . . . . . . . . . . . . . .
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in the buildings of . �/--. . '` . . . . . . . . . . . . . . . . . . . .
at . .4�. . .P . . . . . . . , North Andover, Mass.
Feef :` . . . . . Lic. No.� ' . . . . . . . . . . .
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p GAS INSPECTOR
Check
5938
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS ffrMG
(Type or print) Date �113
NORTH ANDOVER,MASSACHUSETTS
Building Locations A Permit# <5 93 rg
unt$
Owner's Name
New❑ Renovation ❑ Replacement Plans Submitted ❑
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a o W a a o z o z w
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SUB-BASEMENT
BASEM ENT
1ST. FLOOR
2ND. FLOGR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
STH . FLOOR
(Print or type --ehe k one: Certificate Installing Company
Name _ \lQl'�YaW� i\'�oyencl,�e�2 1 alyl'���- elq 1 Corp.
n
Addr s ❑ Partner.
'
usiness lelepnone ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Q�,(�l�� ��evi(JA e--
INSURANCE COVERAGE Check o :
I have a current liability Insurance policy or it's substantial equivalent. Ye No
❑
If you have checked yes,ple i icate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ 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 ner ❑ Agent ❑
I hereby certify that all of the details and information 1 have sub ed(or ent ed)in above application are true and accurate to the
best of my knowledge and that all plumbing work and install ons perf r a Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachus��s
Stated Chapter 142 of the General Laws.
By: Signature of Licensed Plumber itt r
Title ❑ Plumber �!
City/Town ❑ Gas Fitter License NumSer
Master
APPROVED(OFFICE USE ONLY) JtJoumeyman (,ice
Date. . .V�1.,�k.. . . ... .
f HOFTH 1
0p TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
• o � i
�9SSAC HU5Et
This certifies that . . . �.l�e. .t . . . a/.� . . . . . . . . . . . . . . . .
has permission for gas installation . . . . �°�. .�.�.. . . . . . . . . . . .
in the buildings of . . P c� ` . . . . . . . . . . . . . . . . . . . . . .
at . . .� . � .4`i. . . ". . . . . . .. North Andover, Mass.
Fee.3.4 . . . . . Lic. No.A G c ). ?. . . . . . .. . t�- !`'y!`. . . . . . . .
GAS INSPECTOR
Check#
ES 716
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,N1k%ACRUSFM UNUORA/I APPUCATON FOR PERNIIT TO DO GAS FrrnNG
(Type or print) II
Date
NORTH ANDOVER,MASSACHUSETTS fI
Ccs
Building Locations [J f Permit#
Amount$ s L?i'
Owner's Name Q
New❑ Renovation ❑ Replacement ❑ Plans Submitted I
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O a p W E. I
Gw w V U C z F v� 0 C D � I
U F L F d W W w 0 W F
o a � � � a z a a
SUB -BASEiMENT
B A S E M ENT I
p 1ST. FLOOR I
2ND . FLOOR
I
-j-
3RD. F L O O R
4 4T II . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
STH . FLOOR
I
(Print or type) Ch c one: Certificate Installing Company
Name 14,tl
Corp.
Address Partner. 1
l >
isiness'telephone n �/CO j
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes "--Na❑
If you have checked , please indicate the Coverage by checking theapp appropriate box. I
Liability insurance policy �� Other type of indemnity Bond 1 I
I
I �
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the j
:Mass.General Laws. and that my signature on this permit application waives this requirement.
Check one: I
Signature of Owner or Owner's Agent Owner Agent I
I hereby certify that all of the details and information I have submitted('or entered)in a ove application are true and accurate to the
hest of my knowledge and that all plumbing work and installations pertorn .d nn rmit Issued For this appli on will be in
compliance with all pertinent provisions of the�lussachusctts State(.a x an ha ? th enc aws.
I
Bv; Signature of Licensed Plumber Or Gas Fitter
Title ^^ Plumber /
�J
I
Ci v25-� I
City/Town Gas Fitter tc,en e Number
Master
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\PPROVED(OFFICE USE ONLY) Jo eyman I
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