HomeMy WebLinkAboutMiscellaneous - 70 Kingston Street J70 KINGSTON STREET J
210/023._Q0006-0070.T
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MORTM TOWN OF NORTH ANDOVER
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0 .. � `p PERMIT. FOR GAS INSTALLATION
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This certifies that . ..... . . . . . . . . . . . . . . .
has permission for gas tallation'-. . . . . . . . . . . . . . . . . . .
. in the buildings,of .iZ ,. �?-� ? �( . . . . . . . . . . . . . . . . . . . . . . . .
at !. . . . r `��z�!�'�.( �. r) ., North Andover, Mass.
Fee ,�. ."� Lic.cNo.. . . . . . . . . . ��. . . . . . . . . . . . . .
GAS INS�CT�gFi
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WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) 1
NORTH ANDOVER Mass. Date - ��`d r
a �uilding Location 7D K.na �tc��, 5�,-met✓ P rmit # ! y
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.� Owners Name L%Ae-,se-n go
New '-7 Renovation II Replacement Plans S mitted D
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SUQ—BS t.1T. �
BASEMENT
Z ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
TTH FLOOR
STH FLOOR
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(Print or Type) Check one: Certificate
Installing Company NameAndover Pblg. & Htg. Co., Inc. d Corp. 2122
w Address 20 Agpan Dr_ llnit-10 Partner.
Methuen, Ma. 01844 Firm/Co.
Business Telephone: (978) 685-8383
Name of Licensed Plumber or Gas Fitter George LaRose
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy F71 Other type of indemnity Q Bond
Insurance Waiver: I , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 0 Agent
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I hereby certify that all of the details and information I have submitted (or entcred)in above application are true and accurate to the best of my
knowledge and that ati plumbing work and Instillations pctformed under'Permit issced to: this appt"ication wdl-be In compliance with all pertinent
provisions of tho Massachusetts State Cas Code and t7upter 14.of the Gencrat Ltws.
B YPE LICENSE:
By
Plumber
Title asfitter- Sig ature of Licensed
City/Town: Master Plumber or Gasfitter
Journeyman 9983
APPROVED (OFFICE USE ONLY) License Number