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HomeMy WebLinkAboutMiscellaneous - 69 HERRICK ROAD 4/30/2018 69 HERRICK ROAD 210/015.0-0060-0000.0 Date... .1.�. '.I1. .................. O�r10RT11,� \ TOWN OF NORTH ANDOVER . PERMIT FOR GAS INSTALLATION s`SACHU This certifies that ....!"'..................................... has permission for gas tinstallation .....��- �► in the buildir}gs of............................................................ ....................................................... at..�0 ..`` ...... .2'.0 .... ...................... North Andover, Mass. Fee v ........ Lic. Nol.)..�...5....... .......................................... ........................... GASINSPECTOR Check# t " �� L UPJ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I uarW A r4olhln MA DATE 07 I 12015 PERMIT# (� JOBSITE ADDRESS ` OWNER'S NAME Z 0�i2 tJ OWNER ADDRESS I Same TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ® RESIDENTIAL❑ PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ Q� APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 1 DRYER J FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER . ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER 1_ UNVENTED ROOM HEATER WATER HEATER OTHERIx Re lace I LZ3 and Associated Pi in INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'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 co pliance with all Pe 'n nt vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASF ITTER NAME I Robert Josey LICENSE# 9185 SIGN URE MP 0 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# 3788C PARTN RSHIP❑#® LLC❑#� COMPANY NAME: RH White Construction Co ADDRESS 41 Central St 'CITY I Auburn STATE MA ZIP 01501 TEL 508 832-3295 . FAX 508-926-4347 CELL 508-245-7431 EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES c _l 'Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ....................................................................................................................................................................................................................................................... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency LICENSEE More... Name: ROBERT A. JOSEY REFERENCES& E DOUGLAS,MA RELATED INFO NEW SEARCH Disclaimer Regarding **This Licensee has additional Licenses,click here to view them.** Website License Searches Glossary of License Status Codes Licensing Board: PLUMBERS Et GASFITTERS License Type: MASTER PLUMBER More... License Number: 9185 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Wednesday,July 15,2015 at 3:20:42 PM. i ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board_code=PL&type class=_M&li... 7/15/2015 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: James & Karen Robertson Property Address: 69 Herrick Road Policy Number: HP3047196 Date/Cause of Loss: 9/6/2014, Windstorm/Tree File or Claim Number: 30182-M Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Mike Peterson r n On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class IMai P C - 17 Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053