HomeMy WebLinkAboutMiscellaneous - 62 BREWSTER STREET 4/30/2018 62 BREWSTER STREET U-1
210!023.0-0078-0000.0
TO G 0 7 2 Date.yt�
`7.�.... ..
-, `
Of No 07"-1 TOWN OF NORTH ANDOVER LO
0 �s aA
� . s
PERMIT FOR GAS INSTALLATION
SS HU
T
N
This certifies that . .. .. . . . . . . . . . . . . . . .
8
has permission for gas installation .. .LA...-. . . . . . . . . . . . . . . . .. .
in the buildings of . . N . ... . . .. . .. . . . . . . . . . . . . . . . .
at . G ?. . . . . . . . . . . . . .5 . . . .. . . .. . .. North Andover, Mass.
Fee. 1?. . . . . . Lic. No../. . . . . . . . . . . . . .. . . . . . . . ... . . .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File
`t� r
J MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Mass. Date Permit # a v 7 Z,
` Building Location s — Owner's Name �Ack_Lrm5 n
Type of Occupancy Ow
New E] Renovation ❑ Replacemento. Plans Submitted: Yes❑ No ❑
N
N
W .n
Y z cc vi
N ¢ N ¢ OLU
cA =
(7 N W 00 U m ~ A
C: d ¢ Z z O w
d ¢ O O
C3 of F y W O a ¢ a H
W < F. u� d
fA ¢ W = V W = fA z W4 ¢ O D > W
W W W J Q + a¢ W W = h ¢
0 f. Z J r- Z r. W W O > LL !- W J I.. W
Z d W - Q ¢ .. f } N m Z O Z O N S
d W > ¢ w n Z d ¢ d a O O W 2i O W F-
¢ '= o c� s a a 3 c Q > ❑ a H o
SUB-BSMT.
BASEMENT
1 ST FLOOR
2ND FLOOR I
3RD FLOOR _ I
4TH FLOOR
STH FLOOR
6TH FLOOR 1#
7TH FLOOR
STH FLOOR
Installing Company Name Check one: Certificate
Address t 1� . n c� Corporation
oos�'p \A ❑ Partnership
Business Telephone SLn. )(nzll� Firm/Co.
Name of Licensed Plumber or Gas Fitter 1�
INSURANCE COVERAGE:
I have a curr9pA liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have check es, please indicate the type coverage by checking the appropriate box.
A liability insurance police 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 OwnerO Agent ❑
1 hereby certify that all of the details and information I have submitted(or entered)in above application are true an�accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application willlpe in o liance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of e-Peneral Laws.
By T e of License: i7
------
Plumber Signature of cense lumber of as Fi ed
Title aI ter
aster License N t er /Do
City/Town Journeyman
APPROVED(OFFICE USF ONLY)
,r
BELOW FOR OFFICE USE ONLY
Y
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE
�NO.
F
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 99
PLUMBING INSPECTOR