HomeMy WebLinkAboutMiscellaneous - 7 Fernview Avenue U-12 7 FERNVIEW AVENUE U-12
210/452.8-0007-0012.0 `
Date. . .. . . . . .. . . .. ..
kQRTH
OF .�io ,ti0
o� TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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This certifies that,.,- - . .-. : ---- %` ... . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . . . .
in the buildings of-.--.-,. . . . . .. . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at !I. -� �� * �!!.���� . . fes" , North Andover, Mass.
Fee.(. .`.. . . . Lic. No.. .3. . . . . ,l•. � ,� .. . . . . . . . . . .
GASfNSPECTOR
Check#
365 ,
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASF1Tf1NG
tPrint or Type 15
Mass. Date G6° J �d� Permit # dGQ"Z-'
Building Location / �e V�W Alt, 0'`/o-Z Owner's Name
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i�L�( ype of Occupancy_ 7i i�
New ❑ Renovation ❑ Replacement Plans'Submitted: Yes❑ No ❑
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SUB—BSMT.
BASEMENT
1 ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name Ali('A (Z T A • `AI-A Al A T A X20 Check one: Certificate
Address, 0-0A C H in H� i-Kf,, ED Corporation
' T H U e fJ 01 rl D t k y ❑ Partnership
Businest Telephone_ �z, �?Z -9 9-7 f 2--'Firm/Co.
Name of Licensed Plumber or Gas Fitter �R()A E P-T A- 5 A mi"e T-r4 Po
INSURANCE COVERAGE:
I have a current I' bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked Les, please indicate the type coverage by checking the appropriate box
A 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 ❑
1 hereby certify that all of the details and inforrnation 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 the pe ed for this application be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner laws.
BY Tof License: L Z�
Plumber 1-§4nAture of cen u or itter
Title tter
er License Number 9333
City/TownJourneyman