HomeMy WebLinkAboutMiscellaneous - 66 BONNY LANE 4/30/2018 � �� ��v�.y ���z�
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Of MORTM ,4'
o� TOWN OF NORTH ANDOVER
- PERMIT FOR GAS INSTALLATION
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This certifies that . . . . `.. . . . .. . . %�. . . . . . . . . . . . . . . . . .
has permission for gas installation .! . . . ': . . . . . . . . . . . . . .
in the buildings.of . . . . . . . . . . . . . . . . . . . . . . . . . . .
at ... . . . . . ., North Andover, Mass.
Fee. ). . . Lic. N-4 �'. . �. .� �. . . . .
GAS INSPECTOR/
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITnNG
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MA Date _V 2� _ -4 Receipt# Pemrit#
Building Location�6 Bt��� - Gi��v2 OwneesName'*AA 's- ��
Map; Lot Zone: TypeofOcr..tpancy
New Renovation ❑ Replacement❑ Plans Submitted: Yes❑ No ❑
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SUB-BSMT.
BASEMENT
IST FLOOR
ZND FLOOR
3RD FLOOR
4TH FLOOR ( v �• �`
'14
5TH FLOOR
6TH FLOOR
i 77H FLOOR
8TH FLOOR
Installing Ccmpany Name EASTERN PROPANE & OIL, INC. Checkone: Certificate
Address 131 WATER ST DANVERS NLA 01923 Corporation
Estimate Value of Work: ❑ Partnership
Business Telephone 800-322-6628 ❑ Firm/Co.
Name of Licensed Plumber orGas Fitter 'egf
INSURANCE COVERAGE:
I have a current Ii ''y insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked Les, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 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 applicationCwraiivvess this requirement.
Owner C3 Agent❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of
my knowledge and that all plumbing work and installations performed underthe permit issued for this application will be in compliance with
all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the eral Laws
By
Type of License:
Plumber Si ature of Licensed Plumber or Gas Fitter
Titre Gasfitter
Master license Number
City/Town Journeyman
APPROVED (OFFICE USE ONLY)
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111111 IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
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