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Home My WebLink AboutMiscellaneous - 649 Appleton Street i" 3 J 38 Date/7. l'`.. ........ ,ORTPI TOWN OF NORTH ANDOVER Of .... .... 3= ' o PERMIT FOR GAS INSTALLATION ' f P ,SSAOHUSES This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gasinstallation . . . . . . . . . . . . . in the buildings of . . j-. . . . . . . . . . . . . . . . . . . . . . . . . . at .`�.�. . . - . . . . . , North Andover, Mass. Fee% . . . l.ic. No.1`''.y.,r`r . . . 1. ..., �.�!. . . . . . . . %`- 1©/7 `,7 GAS-INS PLECj,,0R WHITE:Applicant CANARY: Building Dept. PINK:Treasurer yZ� MASSACmsr=TTS UNIFORM APPt:,iCATION FOR PERMIT TO 00 GASFITTINQ fttrfnl at Type) �� ✓�� Mass. bale NS ov(J 1� Permit rs r Building Location ✓/ Ownetra Nartte i M ��✓et A0 TYPa of Occupancy New p nenavation 13 Reptae ent Q Plans Submitted: Yelp No 0 N } = R \ V N V 1.. O _ ill i 4C M _ at .e low a zoil r �V O ea N ft r v tY M a et IQ+ O > p Y i W F }. tw M O y V.10 X � J N W a e z o u s 1� Z1 o c� tOj a s o ` o sus—asMT. e�►altil2llT 1sT FLOOn 2110 FLOOR 3ROFLOOn 4 T11 FLOOR STtl FLOOn sT11 FLOOA 7T11 FLoon •Til FLOOn lalling Company Name 5,f- X 1-2-11—� Check one: Certificate # ire:s z 5 O Corpotation mesa Tclephone_2 7 Z -;3-7 /— 73Sg Q Firm/Co. ie of Licensed Plumber or Gas Fitter unANCE COVEnAGiE: io a current IIabUlly Insurance porky or Its substantial equty I t which meets the tequtroments of MGL Ch. 112. Yes O No ❑ . U hav6checked res, Please Indicate the type coverage by eking Ihta appropriate box. tinny f urance poticy a Other type of tnd&MHy C Bond O IEA'3 INSUnANCE WAIVE11: I am aware that the licensee does not have the Insurance coverage required by 'ter 112 of the Mass. General Caws, and that my signature on (fits permit appikatlon waives this requirement. Check one. vie of Ownel of (Jwnar a Agent OwnerQ Agent 0 Y CVf1fFy that all of the deta{la and Infolmalion I have submtiled fw anise"In abate epofleallon ste bue and soevrata to the batt of my dila and thatas fubtng work and Insfalfallonf pedatmed undar the Qermil 12211"/a I11112 epptfcallon twirl be tit compAance with It nt v►evttbnt ar IhamMesaachutette Slate Gaa Code and Qtaptar 112 of the amend laws. T of ibex : WhIt I'fUntbQr n luta of UcInsedtimber al aU t� - O.irhllar /1 M-11l01 (.ltsnae Number Z/ .b w n e yin an SKETCIIES BELOW FOR OFFICE USE ONLY PROGRISS IN! FEE f NO. APPLICATION FOR PERMIT TO 00 GASFITTING •4 NAME 6 TYPE Of BUILDING LOCATION Of OUIlO1NG PLUMBER OR GASFITTER LIC. NO. 1 N 1 PERMIT GRANTED Date Gas Marc.