HomeMy WebLinkAboutMiscellaneous - 67 PLEASANT STREET 4/30/2018 (2) 67 PLEASANT STREET
2101055.0-0045-0000.0
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Date.. �. .. .. ..
o= o TOWN OF NORTH AN® VER
PERMIT FOR GAS IN ALLATION
y9SSACHUSE�t
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This certifies that . . . . .n1!. !� 1� l. .f��. � . . . . ..l �. . . . . . . . . .
has permission for gas installation
in the buildings of . . . :�'- .�. . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . IK ! /. � . . .IS
North Andover, Mass.
Fee. Lic. No.. �2Y!:. . . . . . . . .NSPECTOR~
Check#
6780
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
KJOILH A00626L . Mass. Date 23 GAO Permit # GjG
Building Location667 YO',L.EASAM-T 7— Owner's Name ALA O DC&)t//eST
W kTN A 0,0DUFk, OA Type of OccupancyL-
New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] Nocc
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SUB—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR _
1 `
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR 1 -71
Installing Company Name BAY STATE .GAS COMPANY Check one: Certificate #
Address 55 MARSTON STREET X7 Corporation 1862
LAWRENCE, MA 01841 - 2312 ❑ Partnership
Business Telephone 71B-6 8,7-110 5 Err *306 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No ❑
If you have checked Vis, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy X( 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 application waives this requirement.
Check one:
Signature of Owner or Owner's Agent , Owner[3 Agent ❑
I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accrue to the best of my
knowledge and that all plumbing work and installations performed under the permit iss f r this application wll n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene (j
TI
of Ucense:
Plumber Signature of cense Plumber or Gas
Title Gasfitter
Cit /Town Master License Number 374-5
Journeyman
APPPOWff
O IC S-ON
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE
NO.
APPLICATION FOR PERMIT TO ADO GASFITTING
NAME il< TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFITTER_
LIC. NO.
PERMIT GRANTED
DATE .19
GAS INSPECTOR
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