HomeMy WebLinkAboutMiscellaneous - 68 CRICKET LANE 4/30/2018 (2) 68 CRICKET LANE
210/107.A-0216-0000.0
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Date./;.. /.). G..? ....
2
MORT1y
of TOWN OF NORTH ANDOVER
- PERMIT FOR GAS INSTALLATION
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SACHUSEtA
This certifies that . 11 . A5�: .... . . . . . . . . . . . . . .
has permission for gas installation .14, .s: f 4-�. . . . . . . . . . . . . .
in the buildings of . .I-3r1.�.�9 G . �. . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . . .. North Andover, Mass.
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Fee.j&.' . .v. Lic. No.. I 4-!�-c ,.----- - - - - - .
GAS INSPECTOR
Check# 2J
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4244
MASSACHUSETTS UNIFORM APPLICATON FOR PERMPI'TO DO GAS Ff.rr] TG
(Type or print) Date �v2�_ W --
NORTH ANDOVER,MASSACHUSETTS — z
Building Locations lay i/ Permit# �i�
Amount$
Owner's Name
New Renovation ❑ Replacement ❑ Plans Submitted ❑
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m
O A C9 U GL' A a O
SUB
-BA SEM ENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH . FLOOR
8TH. FLOOR
(Print or type) - e: Certificate Installing Company
Name /�/d�bd. ' //�1Bi'/�Rf�f mla�� Corp.
Address ❑ Partner.
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Business Telephone d _ ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one-
I have a current liability Insurance policy or it's substantial equivalent. Yes ff No❑
If you have checked yes please indicate the type coverage by checking the appropriate box.
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 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 perfoimed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State GjVCode and Chapter 142 of the General Laws.
gnature of ' ensed Plumber Or Gas Fitter
Title
BY [Plumber
City/Town gas Fitter License Number
LJ Master
APPROVED(OFFICE USE ONLY) ❑ Journeyman