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HomeMy WebLinkAboutMiscellaneous - 667 SOUTH BRADFORD STREET 4/30/2018 i' 667 SO BRADFORD STREET 210/104.D-0149-0000.0 1. Date 4. .. . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION (N Lam' This certifies that . . . . v!'?�. . . . . . .t. . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .(?-C� �. . . . . . . . . . . . . . . . in the buildings of. . . . (�1 �,//1. . . . . .Gir!!. . . . . . . . . . . . . . . . . . . . . at . . . 46.7. . . c . . . . . . S.1 . . . . . . . North Andover, Mass. Fee . S� . Lic. No.'Z-f �.7. . . . . . . . . :!`�401 -. . . . . . GASINSPECTOR Check# 2 36 2- 8419 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ! MA J -U.V C�1.m.:.......,. MA DATE 1, �,t.� I �)2PERMIT# ........... JOBSITE ADDRESS: ( .. rod, OI��a. ...,,.., ;OWNER'S NAME .1�� I,p...MQ..r(�.�Q. OWNER ADDRESS _ U! . . IQ�.T..V1,< ..m.�l. . , _. TEL .Q l�'UQ,a. GI,V.1FAX' ... ,.._. .._ I TYPE OR OCCUPANCY TYPE COMMERCIAL ,� EDUCATIONAL -, RESIDENTIAL PRINT CLF,ARLY NEW: ,..' RENOVATION REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 :3 10 11 12 13 14 BOILER BOOSTER _ CONVERSION BURNER _ ._._. .. _.__ COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR . FURNACE _ GENERATOR = GRILLE INFRARED HEATER . . LABORATORY COCKS MAKEUP AIR UNIT OVEN ._ POOL HEATER - ~' ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _ _ ....... OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES �_/, N'O I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY , OTHER TYPE INDEMNITY BOND j ,: OWN ER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this,permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws PLUMBER GASFITTER NAME S ee-zei LICENSE#8y3 7, SIGNAT RE" MP 4/ MCF,..,.,t JP JGF LPGI CORPORATIONtr' jv 13 3 PARTNERSHIP' # LLC COMPANY NAME:'4`Aiko.Asn/ awd(coli(/ 'ADDRESS CITY f3 A� Ta�.7..: . ..,, w. STATE/. O-/f',ZIP of b; 47- 'TEL FAX qj 0 2`t�`. ( LL ..... EMAIL .,r k I V C UI'd ) ,I.,C�-IQ `C6 H. __.. � � � � �� --� �N r a r l Fold,Then Deiach Along All Perforations f w i•'r S u n e t 4 a tI r,n5 N A C, ¢P P,i Fl N ,.. ... 'F..o.:,•.�Ga1C8d7 . ti. a t.�.-��._a d d' 9.ke".,,,,.";.�, .0.�.a..dl;..y,., IMPORTANT NC TIC.E BOARD PLUMB .RS ANr) GASFITTERS PL LICENSED ,15 A �.r'.ASTER PLUMBER` PERMITS FOR PUIru1BI (;- .1JJD I 'TTING ISSUES HE ABOVE LICEPdSL TO': ;- INSTALLATIONS ON 5T, 1`c G'ir �Uu OI USED FACILITIES MUST BE FILE;I A;'NE OFFICE OF THE STATE BOARD. TYPE THOMAS E IIrEKS N -t1 PO Bb:x 85 1]+ : MERRIMAC MA 01860'-00.85r 164560 8437 05/01/1.4 164560 .F ^�\.'•, I..u.lr,_. L Fold,Then Detach Along All Perforations Fold,Then Deiarh Along All Perforations `r,).;t6M0' .3 itEf�5..' 7 OF ,d.e v.S .r.ib x:-f sllx,..ia. .S:T.Wa t � aw f� BOARD 'LUMBER.S AND GASFITTERS IMPORTANT NOTICE F PL REGISTERED AS A PLUMBING CORP r�t, PERrv'1 T', FOR PLUOBING AND GAS FITTING ISSUE==S THE ABOVE LICENSE TO:'. INSTAa L 9TIONS ON STATE OWNED OR USED FACIU Ik:S MUST BL' FILED AT THE OFFICE G•'=THE STATE BOARD. TYPE THOMAS WEEKS bsPEFI A DIPIETRO HEATING COCIh' -C P`0 BOX 85 5U) NERRIMAC MA 01860-0085( t 164559 3083 05/01/14 164:55:9 j 41t i( ila rvrt 1TSIy� f �r(r r k 7� fi 1 �l� ase y. e? L�.s4�,.,&�,i4o'y�.,n i Fold,Then Detach Along All Perforations Folcl,Tien Detach Along All Perorations ✓I�,Sltfi'�..'1 t "+o ,� e r OF IMPORTANT NOTICE BOARD PLUMBERS AND GAS'' ITERS PL LICENSED AS A JOURNEY NI.ANI. PL. UMBER . Nsri��S FOR ONPLUMS ON BING AND OWNED FI Ut ISSUES THE ABOVE LICENSE TO:' FACILITIES MUST BE FILED AT THE V OFFICE OF THE STATE BOARD. TYPE THOMAS : E WEEKS N cn _J PO BOX 85 c. .. MA 0186.0--108.5 MERRIMAC � -.6456114711 05/01/14 . 164561 ` • 3407 Date..//. `... . . . NOR7�y TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACHUSES This certifies that . . . . . . . . . . . . . :�. . `:.`. . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . r�7i � Fly. .<. C . . . . . . . . . at . . . North Andover, Mass. Fee. .rl . . Lic. No.. SC. . . . . . . . . . . . . . . . . . . ... . . . . . GAS INSPECTOR I WHITE:Applicant CANARY:Building Dept. PINK:Treasurer � MAP - W PARCEL � d MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT GAS FITTING 0 4, S a y(Type or print) Date 11l/'-6 19 00 NORTH ANDOVER,MASSACHUSETTS Building Locations � SU ��✓ Permit# 3 4� D 7 Amount$ JA (� Owner's Name New❑ Renovation ❑ Replacement ©/ Plans Submitted ❑ x w � a �. c U M � x c Q H a z j o Z > d x w v w x w o x GW7 F Z .a Q x W w > w y Z O Z O rj W x O V x w 3 A C7 U a > SUB-BA SEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) y 42�k one: Certificate Installing Company NaTe —_ r �1 r / litiL 1Ati--�° /�a`` L�JI Corp. Address S-Dl-7v k J 5 ❑ Partner. Business Telephone �F- (; U �j Zy [3-Firm/Co. Name of Licensed Plumber or Gas Fitter a i) INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑— No[:] If you have checked yo,please indicate the type coverage by checking the appropriate box. Liability insurance policy ED-- Other type of indemnity ElBond ❑ 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 Owner ❑ 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 under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse t Gas Cond Cha pte�4 42 of the eral Law By: ignature of Licensed Ph-Ker Or Gas Fitter Title ❑Plumber City/Town ❑ Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ❑ Journeyman