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HomeMy WebLinkAboutMiscellaneous - 62 COTUIT STREET 4/30/2018 62 COTUIT STREET U-2 210/023.0-00700000.0 Date. .�:�...�. ..!. .. .. HORT01 02 TOWN OF NORTH ANDOVER ' Okr7 PERMIT FOR GAS INSTALLATION s a th 9 �,SSAC NUSEt This certifies that . .J. . . . . . . . . . . 'T . t .` . . ./may has permission for gas installationSf P. . . . . . . . . . . . . . in the buildings of S�` l� . . . !. .`! if.�. . . . . . . . . . . . . at . . .Z. . . 0.�V %.... . . . . . . . . , North Andover, Mass. Fee. 2 U< ° Lic. No..P 3.?. . . .I?.,.- . . GAS INSPECTOR Check#/ V 7 9 66 MASSACHUSEM UNHURM A,PPUCATON FOR PERMIT TO DO GAS ffrrJNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Lmations Z. C G 1/ 1 r Permit# Owner's Name /{mount$ New Renovation D Replacement Plans Submitted ❑ U rA W rJ' .a tri C O U O aa W W p O G z C U W � f- C d W Z to Z > V F Z F d x C W O 14 z t z z ° z W O ro :� ° �° o d F o SUB -BASEMENT > BASEMENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR ENE 5TH . FLOOR 6TH . FLOOR 7TH . .FLOOR. 8TH . FLOOR (Print or type) Name_ '� / /y� /w, �/��- Check one: Certificate Installing Company Corp. Address d . __71 U. Partner. usmess 'e ep one ^. 13'-Firm/Ce. _ Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE I have a current liability Insurance•policy or it's substantial equivalent Check one: If have checked Les,please indicate the a coverage Yes D' NoO typ erage by checking the appropriate box. Liability insurance policy �- Other type of indemnity D Bond 0 Owner's Insurance Waiver. I,am aware that the licensee does not have the Insurance coverage required by Chapter]the Mass. General Laws,and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: I Owner Agent i hereby certify that all of the details and information 1 have submitted(or entered)in above pplicationD a and accurate best of my knowledge and that all plumbing work and installations p rformed under Permit I sued for this application will in the compliance with all pertinent provisions of the Massach Stat as Cod d Chapter 42 of the neral Laws. By: Signature of Licensed Plumber Or Gas Fr� Title Q" .Plumber ✓;{ City/Town, icense u ber Gas Fitter ©.—Master APPROVED(OFFICE USE ONLY) Journeyman