HomeMy WebLinkAboutMiscellaneous - 63 MILLPOND 4/30/2018 63 MILLPOND
210/095.A-0063-0000.0
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3� �` TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION
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This certifies that . . ' �.!M!� :�. . PS r �-✓. . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . .
in the buildings of . . .(, . . I� ��!+ . . . . . . . . . . . . . . . .
` at . . . . . . . . . . . . . . . . .. .�.!�. . . . . . . Y . . . ., North An over, Mass.
Fee. 3p Lic. No.. .l:Q
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GAS INSPECTO
Check#
4446
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Klass. Date �� � ermit #
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Building Location
g � Owner's Name
/GIS/�Pi1���—C�
Tyge of Occupancy
New r Renovation ❑ Replacement J// Plans Submitted: Yes ❑ No ❑
FIXTURES
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SUB-BSMT.
BASEMENT
1st FLOOR
2nd FLOOR
3rd FLOOR
4th FLOOR
Sth FLOOR
6th FLOOR
7th FLOOR
8th FLOOR
CLIMATE DESIGN HEATING and AIR CONDITIONING,LLC
Installing 5 South Summer Street Check one: Certificate
Address Bradford,MA 01835 Corporation 21/q 76
978-372-9999(phone)
978-372-0882(fax) - Partnership
Business Telephone i.ic. plumber:
Oki t; :�. ��b � = Firm/Co.
1+Jame of Licensed Plumber or Gas Fitter d
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of,IAGL Ch. 142.
Yes ! No C:
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity C Bond C;
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Mass.
General Laws, and that my signature on this permit application walves this requirement.
Check one:
Owner '_ Agent
Signature of Owner or Owner's agent
I hereby cenint that all of the details and information I have submitted for entered)in the above application are true and accurate to the best of my knowledge and that all plumbing work
and installations penormed under the permit issued for this application will be in compliance with all pertinent provisions of the massachuserts State Gas Code and Chapter 142 of the General Laws.
Type of License:
By Plumber
Gasfitter
Tide �7Aaster na re of Liceny�
Girter
Journeyman b9Cit!Town License Number
.APPROVED(OFFICE USE ONLY) -
3
FINAL INSPECTIONS SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME is TYPE OF BUILDING .....,.... ._ - __._.._-.._.._._..__ _..-..
LOCATION OF BUILDING __._.._.._...... __ .___—._.....___—__.._.
PLUMBER OR GASFITT'ER
LIC. NO.
PERMIT GRANTED
.P
Date _—.._--- --- – 19 — --
Gas Merc. ------- ----- --- t
Final Insp.----------- -------------
Gas Inspector