HomeMy WebLinkAboutMiscellaneous - 75 MIFFLIN DRIVE 4/30/2018 (3)I
Date ..,/ .. �A ........
p• ..o rySNI TOWN OF NORTH ANDOVER
• PERMIT FOR GAS 11ASTALW71ON
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This certifies that ?l..... %� jY. 5-1, t .................... .
has permission for gas installation .... 61. tr.:.......
in the buildings of ..............................
at ... i ......... North Andover, Mass.
Fee. .7 ?..-.. Lic. No........... _.....•............
l GAS INSPECTOR
Check #
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MASSACHUSETTS UNIFORN( PLICATION R PERMIT TO DO GASFITTING
(Prl>n or'tYx> _
,Mass. Date �7 d�a 7 Permit #
Building Location Owner's Name ko 8 i/�l4N&--f'
Owner Tel# 6 86 — iQ S� Type of Occupancy
New ❑ Renovation q/leplacemetn ❑ Plan Submitted: Yes ❑ No 2
FIXTURES
Installing Company Name -M7 �1 Sa CO, Check one: Certificate
Address y 0 So (7-N l)lAl N S%- ❑ Corporation
M)9- 0 1 q 4 � ❑ Partnership
Business Telephone 9 78 aa3 — X30' , `Firm/Co.
Name of Licensed Plumber or Gas FitterN L rQ R S O >13
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MICHAEL BRYSON
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Address y 0 So (7-N l)lAl N S%- ❑ Corporation
M)9- 0 1 q 4 � ❑ Partnership
Business Telephone 9 78 aa3 — X30' , `Firm/Co.
Name of Licensed Plumber or Gas FitterN L rQ R S O >13
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EUGENE A. HARRIS
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Date .�./". . 7...... .
TOWN OF NORTH ANDOVER
o ; PERMIT FOR GAS INSTALLATION
This certifies that A/
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has permission for gas installation .. �i'/...1 !L.s_ rid (', , .... , , .
in the buildings of ... �.1:. : {.:,�...........................
at fl /' .......... North -Andover, Mass.
Fee. Lic. No... ... ......
GAS INSPECTOR
Check # a/
G
M a :�# 4��, -_ n 90
MASSACHUSETTS UNIFOR4PPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
�OcJ ,Mass. Date IN d S/ a 7 Permit n S � a rC)
Building Location %�'%1 % / FF23 DIOwner's Name ko 8r21 NCr-i'
Owner TeLlr�7� > 6 ge� I9 S� Type of Occupancy
Plan Submitted: Yes ❑ No 2
New ❑ Renovation q,,"Replacement ❑
FIXTURES
Installing Company Name My r CO Check one: Certificate
Address l / oy0 o-rH #7r7/ N ST ❑ Corporation
���aLETaN MR - oi94L ❑ Partnership
Business Telephone ) oZa3 — I30 `(Firm/Co.
Name of Licensed Plumber or Gas Fitter I � / % C � � � � Q 2 y S D
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 have dtec ked M, 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.
Chedc one:
Owner ❑ Agent ❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and Information I have submitted (or enters
knowledge and that all plumbing work and installations performed under the per
rtlnent provisions of the Massachusetts State Gas Code and Chapter 142 of tl
By Type of Ucense: _
Plumber
Tittle -Gas Atter
-Master
City/Town • qoumeyman
APPROVED (OFFICE USE ONLY)
In above application aro and accurate to the best of my
Issued for this applippoh will be tg"ance with all
Slgne)dre of Licensed Plumb4j&f6e9'Fitter
Ucense Number Q d 1.
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���aLETaN MR - oi94L ❑ Partnership
Business Telephone ) oZa3 — I30 `(Firm/Co.
Name of Licensed Plumber or Gas Fitter I � / % C � � � � Q 2 y S D
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 have dtec ked M, 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.
Chedc one:
Owner ❑ Agent ❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and Information I have submitted (or enters
knowledge and that all plumbing work and installations performed under the per
rtlnent provisions of the Massachusetts State Gas Code and Chapter 142 of tl
By Type of Ucense: _
Plumber
Tittle -Gas Atter
-Master
City/Town • qoumeyman
APPROVED (OFFICE USE ONLY)
In above application aro and accurate to the best of my
Issued for this applippoh will be tg"ance with all
Slgne)dre of Licensed Plumb4j&f6e9'Fitter
Ucense Number Q d 1.
Date..Cj! �."�. �:.r...... .
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HORTM
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3? �` TOWN OF NORTH ANDOVER
^off PERMIT FOR GAS INSTALLATION
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This certifies that ... r.,1.:.Ir .'./. r1 ......................
has permission for gas installation .. t. .. ... ............ .
in the buildings of .. ; �',�.. 1...x...1..... / .......... • • • • •
at .. , ..'.. ,c;,� .�./. .'r' ::............. . North Andover, Mass.
Fee.. �.t..:.. Lic. No. 1........ r ...�:.. -, , _-. .......
GAS INSPECTOR
Check # i
Inspection of Gasfitting
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
10
U11.Massa Date LS.+ Permit #---------------
Building LocationZ.57— Owner's Name,
tel` �
Yp o ccupancy t ! /"
New ❑ Renovation ❑ Replacementx Plans Submitted: Yes[j No O
Installing Company Name—Uuoc( S � � ��
Address_�
Check one: Certificate
_ �LI�.( � p 0 Qnf.
corporation - 22 sac, _
a`� � �
Business Telephone_�� - FSS 1 - x,53(0 Partnership
Firm/Co.
Name of Licensed Plumber or Gas FitterQV-i 1-1
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes R No O
If you have checked yam, Please Indicate the tYpe'covera e by checking the appropriate box.
A liability Insurance policy f Other type of indemnity O
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 Cavner or Owner's Agent Owner O Agent ❑
I hereby certify thatall of the details and information I have submitted for entered) in above 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
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Te of license.
Title Plumber ignature o icenseum er or as fitter
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A liability Insurance policy f Other type of indemnity O
Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
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Check one:
Signature of Cavner or Owner's Agent Owner O Agent ❑
I hereby certify thatall of the details and information I have submitted for entered) in above 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
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
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Sewer Connection Fee $
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