HomeMy WebLinkAboutMiscellaneous - 60 CAMPBELL ROAD 4/30/2018 (2) 60 CAMPBELL ROAD
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BuAding
Locallo- -1I ��i-_ Permit atr 7
Owner's
/ Name _ 7_*-
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rNew ❑ Renovation p' Replacement ❑
Pians Submitted: Yes, No ,
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4TH FL00rt
o aTH FLOOR
71
OTH FLOOR
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i I _.tsllng Company Name�
RP�� Check one:
Certificate
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Corp.
Address a �L,./<e v(r� ley-C �
d Partnership
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Name Of Ucensed Plumber or Gas Fitter S
IN>I<'URANCE COVERAGE:
1 hav® a Current liability Insurance policy or its substantial equtvalend. , Yesck❑/e
I@ you have checked yes, please indicate the type coverage by checking the appropriate bo
A liability Insurance policy Ile
Other type YP indemnity .p Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not ha
Ye the insurance coverage required by
C hgAer 142 of the Mass. General Laws, and that my signature on This
Permit application waives this requirement.
Check one:
i
•o Owner or Owner's ent Owner ❑ Agent ❑
1 Mraby WIRY[hat all of the details and InlormaUon I have submItled ((f enlemd)in above application ars true and accurate to lila bast of
Ikrlowfedpe and that aA plumbing work and inelallallons psrlormed under the rmtt issued for this application>MA be fn nw
PWWIent proVisbna of the Massachusetts Slalo Das Gbd®an®Chapter
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Gasniler m of of of
p�/Tv aster Ucense Number Id��
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AP PnO D(Of FICE USE ONLY
2774 Date. /....... .. ........
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NpRTM TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION'
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This certifies that . . . .!
has permission for gas installations . ..F. .... . . .
in the buildings of . . .. ... -. . . . . . . . . . . . . . . . . .
at . .. . . . . . . ., North Andover, Mass.
Fee: :. . . Lic. No:�3�i:-�. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer