HomeMy WebLinkAboutMiscellaneous - 731 JOHNSON STREET 4/30/2018 (2)r
OO w
O
C
OD Q O
p Z
c
O Z
c
O O A
o m
o m
Date .. *��7k ........
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .•`!. .. �� '���'�' ` .'"....t,- / ..........
has permission for gas installation ... 47. 7.-1). (J -e ...............
in the buildings of'g� `'''' .......................... .
at..7.3. .. a.�. `" ?"'''...... % , North Andover, Mass.
� L
Fee.2.4.:¢. Lic. No..A. !?. if G*4-A ..............
GASINSPECTOR
Check # j J
7901
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO. DO GAS FITTING
City/Town:► t-0. MA. Date: It / 1 r
Permit#
Building Location: - 'JA--,,..� Owners Name: s (J
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential j-
New: ❑ Alteration: ❑ Renovation: ❑ Replacement:9❑ - Plans Submitted: Yes ❑ No ❑
FIXTURES
Z W PU)L) F--
m= O WO= CO CO
O Z Z O ►1J Ix W O F- M
N W CO W g m 0 ~ W O W X
> co v z U) 0~ w a WQ~Q wW
> V W Z O J W Z 9 W= W O (n = Z W
V 0 0 t=i. Ua' 0 W W �> O Z 0 W Z Z W 1--
I=—
o a
SUB BSMT.
BASEMENT
1 FLOOR 1
2 FLOOR
3 FLOOR
4 1H FLOOR
6 FLOOR
6 FLOOR
7 FLOOR
8 FLOOR
Installing Company Name: a—bom�,'d qo AL Check One only Certificate #
Address: orporation
City/Town• / I �L�(�� _State: /�' �e
Business Tel: ��� Fax _ ❑ Partnership
❑Firm/Company
Name of Licensed Plumber/Gas Fitter:f
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes E? No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ET'�'- 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Si nature of Owner or Owner's A ent Owner ❑ Agent ❑
By checking this box ❑; I hereby ce"ify that all of the details and information I have submitted (or entered) regarding this application are true and
accurate c the best a my Knowled 0 of that all plumbing work and installations pertormed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plurng Code and Chapter 142 of the General Laws.
ByyNc v� L-715
[dumber
Title ❑Gas Fitter
G -Master
City/Town ]Journeyman
APPROVED (OFFICE USE 0NLY) 0 LP Installer
'signature of Lic�9ised Plumber/Gas Fitter
License Number:
t
Never Contacted for Inspection
If
11
333}
C
Date ... ...•••••
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
n
This certifies that ... tll-
has permission for gas installation _.A-. .— .-ua-... ........... .
in the buildings,of ... ....................
at, f ...����%.�- �. ..... , North Andover, Mass.
Fee :'�:.... Aic. No`. '. ,3:;. .. ...........
/ GASINSPEG,OR
i
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
ype or print) D 19
NORTH ANDOVER, MASSACHUSETTS
Building Locations 731 J_d4sbw CS;-, Permit #
Amount S
Owner's Name
New17Renovation 1:1 121*" 121*"- t]
Plans Submitted
(Print or type)
Name__
Address
Check one: Certificate Installing Company
❑ Corp.
❑ Partner.
Business Telephone azS'Firm/Co.
Natlhe of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
Ifyou have checked yes, please indicate the type coverage by checking the appropriate box.
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.
Sienature of Owner or Owner's
Check one:
Owner ❑ Agent ❑
I nereov certtty that all of the details ana Information 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts,�r�s C6ie and Chapter 142 of the General Laws.
By:
Title
City/Town
I PRO`'ED (OFI--ICF. USE ONLY)
gnature of Licensed Plumber Or Gas Fitter
Plumber 10200
❑ Gas Fitter License Number
er
❑—Niaste:
r7 Journeyman
I
I
ILMMIF
(Print or type)
Name__
Address
Check one: Certificate Installing Company
❑ Corp.
❑ Partner.
Business Telephone azS'Firm/Co.
Natlhe of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
Ifyou have checked yes, please indicate the type coverage by checking the appropriate box.
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.
Sienature of Owner or Owner's
Check one:
Owner ❑ Agent ❑
I nereov certtty that all of the details ana Information 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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts,�r�s C6ie and Chapter 142 of the General Laws.
By:
Title
City/Town
I PRO`'ED (OFI--ICF. USE ONLY)
gnature of Licensed Plumber Or Gas Fitter
Plumber 10200
❑ Gas Fitter License Number
er
❑—Niaste:
r7 Journeyman