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HomeMy WebLinkAboutMiscellaneous - 69 LYMAN ROAD 4/30/2018 691 YMAN ROAD 210/021.0-0043-0000.0 Date.......... ...................................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION s�CHU This certifies that ....................................e`�b ��,�0 .............................................. has permission for gas inset llation V1A„a:... ' -.... ..... ..� .............. T inthe buildings of..................... �' ................................................................................. at..: ..:..: ..!!n '!.... . ....:.:.......................North Andover, Mass. Fee:( ? .. :...... Lic. No0J...1.kit)......... r'y GAS INSPECTOR Check# ! 1 .0004 cs MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY Vx dort.,— MA DATE 071 12015 PERMIT# JOBSITE ADDRESS G OWNER'S NAME GOWNER ADDRESS I Same TE FAX TYPE OR OCCUPANCYTYPE COMMERCIAL® EDUCATIONAL [j RESIDENTIALE] PRINT CLEARLY NEW:® RENOVATION:EZI REPLACEMENT:® PLANS SUBMITTED: YES[j N0[j APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 .13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE LJ 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 6NVENTED ROOM HEATER WATER HEATER .) THER x _ 1– e lace P Gas Meters x Tl 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 E]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 pl* nce w0 all Perti ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Robert JoseyLICENSE# 9185 S GNATU MP Q MGF❑ JPEI JGF® LPGI® CORPORATION[j# 3788C PARTNERSHIP®# LLC®#� COMPANY NAME:j 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 e,y 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 ella 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 More... LICENSEE Name: ROBERT A. JOSEY REFERENCES& E DOUGLAS,MA RELATED INFO NEW SEARCH I Disclaimer Regarding "This Licensee has additional Licenses,click here to view them."" Website License Searches Glossary of License Status Codes Licensing Board: PLUMBERS ft 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. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://Iicense.reg.state.ma.us/public/pubLicenseQ.asp?board_code=PL&type_Class=_M&li... 7/15/2015 L Date .�. ...................... NORTH - o?' °�, TOWN OF NORTH ANDOVER 1- 9 PERMIT FOR GAS INSTALLATION ,gSACHUS�S This certifies that .. ....................... /Q ��........ � ..,�/ ....... has permission for gas installation . °. .......�.... � .. . r`�......... in the buildings of..... . ...........'A .. ......... ....................... North Andover, Mass. ��.55 Fee....................... Lic. No. .......................... .............................................................:....... GASINSPECTOR Check# 461 lb 0,62 n. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .r CITY A16C} n ✓e MA DATE 07 I 12015 PERMIT# W JOBSITE ADDRESS O L OWNER'S NAME GOWNER ADDRESS I Same TEL — IFAX TYPE OR OCCUPANCYTYPE COMMERCIAL[] EDUCATIONAL ® RESIDENTIAL❑ PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:® PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER q\ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 3 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT ,Z OVEN V POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER x Replace I Gas Meters x and Associated Piping INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑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 compliance with all Pe inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Robert Josey LICENSE# 9185 SIG ' TU MP 0 MGF® JP® JGF® LPGI® CORPORATION❑# 3788C PARTNERSHIP❑#® LLC®#0 COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE=ZIP 101501 TEL508 832-3295 FAX 508-926-4347 j CELL 508-245-7431 JEMAILI 'Ry 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 4 y y n 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 More... LICENSEE Name: ROBERT A. JOSEY REFERENCES& E DOUGLAS,MA RELATED INFO NEW SEARCH I Disclaimer Regarding **This Licensee has additional Licenses, click here to view them.** Website License Searches Glossary of License Status Codes Licensing Board: PLUMBERS£t 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 disciplinaryi n in play actions s dat g 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. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://Iicense.reg.state.ma.us/public/PubLicenseQ.asp?board_code=PL&type_class=_M&li... 7/15/2015