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HomeMy WebLinkAboutMiscellaneous - 70 BUCKINGHAM ROAD 4/30/2018 (2) 70 BUCKINGHAM ROAD J/ 210/02Q= .0 r { Date........... ..............................� i r 140 7 TOWN OF NORTH ANDOVER PERMIT FOR-GAS INSTALLATION �, =.'.•� s�cMus� This certifies that .. '.....�`...:`................'.....e'.... Q..... .........................e has permission for gas in tallatio ................ }T...�..... in the buildings of...................�..` !q' i .................................................................................... at . � " °�' , North Andover, Mass. LPA^' ...:...:...:..:..Lic. No. .Fee:...:. .. 1. ...... ..................................................................... GASINSPECTOR Check# of 05 6M - .° 1. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATEPERMIT# 071 2 I66 015 JOBSITE ADDRESS LgQy OWNER'S NAME, (pi --� GOWNER ADDRESS Same TEL - FAX PPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIALED CLEARLY NEW:E1 RENOVATION:El REPLACEMENT:® PLANS SUBMITTED: YES® N0LD APPLIANCES Z FLOORS- BSM 1 1 2 3 1 4 5 6 7 8 1 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR 3 FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHERI x Re lace Gas Meters x and Associated Pining INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO 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 Pert* en provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1051 PLUMBER-GASFITTER NAME Robert Jose LICENSE# 9185 SI RE MP Ej MGF® JP® JGF® LPGI® CORPORATION[J# 3788C PARTNERSHIP®#�7 LLC®# COMPANY NAME:j RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE MA ZIPI 01501 TEL I_(52L832 3295 FAX 508 926-4347 CELL 508-245-7431 EMAIL I i �0. 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 I I r Division of Professional Licensure: License Search Page 1 of 1 01 .. TIS 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£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 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://license.reg.state.ma.us/public/PubLicenseQ.asp?board_code=PL&type class=_M&li... 7/15/2015 R. H. White Construction Co., Inc. Town of North Andover REFERENCE DESCRIPTION AMOUNT Permits 60.00 Permits 60.00 Permits 60.00 Permits j 60.00 Permits 60.00 Permits 60.00 Permits 60.00 Permits 60.00 Permits 60.00 Permits 60.00 i CHECK DATE 07/13/15 CHECK NUMBER 407 TOTAL ALL INVOICES 600.00 aSARGUARD.„ LaHousni usu crsos»aL ' Date. l.:.`.�.". .... .. ,4ORTH Of ,'t' o� ° TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION zy 9SSACHUSEt O This certifies that . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . in the buildings of . . . .V.1� . . . . . . . . . . . . . . . . . . . . . . . . . at . .�?.o. . (3� r.! r r . �/� . . . . . . . . . . .,!North Andover, Mass. Fee.d.J.. :. . . Lic. No.. 3 3.3 . . .�l._✓..-�� . . . . . . GABS INSPECTOR Check# ? G ) 7 4186 E MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING `�7 ' (Print or Type ,96 �, A Imo' , Mass. Date i4 2cx>__- Permit Building Location �Anil 2520wnees Nam r' r ti Type P�of Occu I ill' 7 cY New ❑ Renovation ❑ Replacement 2e"' Plans Submitted: Yes❑ No❑ N ( '` N W N Y Z S .'` iAN VCC N rt H C O N S H W W W F V _ C Z O W F- < Z O r W. r Q m W 6: Y W H d C < M CC V W = N Z < CC O c W W W d1 J = < = Q ce d Q W ~ W V = H Q Y < W < C ~ f �- m 2 O 2 W O N = CC W Z. < _ = <d J V E > G d FO SUB—aSMT. BASEMENT - 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR Z 6TH FLOOR' 7TH FLOOR 8TH FLOOR Installing Company Name �t i r^AE(Z T A . :1r-1m m A T b Q Check one: Certificate Address__ 3 0 00,4 C H iy1 A ry tom(. ❑ Corporation OILTHUE0 ❑ Partnership Business Telephone /�92 —917"7 f 9--Firm/Co. Name of Licensed Plumber or Gas Fitter -! OAE eT k 5AMr1')yqTr4 C� INSURANCE COVERAGE: I have a current f}abiiity insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9' No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy ' Other type of indemnity❑ Bond Cl 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 [3 I hereby certify that all of the details and information I have submitted(or entered)in above application aretrue and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe i ed for this application . be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. BY Tj of License: Plumber ',WhIture of Uc6nsed­ u _. or Gas Fitter Title tter er License Number 9.333 City/Town O C N Journeyman f P BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE Hoe APPLICATION FOR PERMIT TO DO GASFITTING i NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19- OAS INSPECTOR a