HomeMy WebLinkAboutMiscellaneous - 88 AUTRAN AVENUE 4/30/2018Date ..(<" �X
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TOWN OF IJO ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..X.
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has permission for gas installation ... . // ................
in the buildings of ..0. -'. / /? !!� .` ........................ .
at `. ..,� -. .I... ........ , North Andover, Mass.
Fee..3 U.... Lic. No. I....`. `.... !, ... P.. .........
i GAS INSPECTOR
Check # Gj y t
6022
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
VMass. Date 6W.
Building Locati
Owner's Tel #
New ❑
i
2007 Permit # 6 0-L -L--
Owner's
Owner's Name s,
Type of Occupency
Plan Submitted: Yes
❑ No ❑
Installing Company Name Addario's Plumbing & Heating LLC. Check one: Certificate
Address 20 Cooper Street X Corporation 2720
Lynn, MA. 01905 Partnership
Business Telephone 339-440-8100 Firm/Co.
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Insurance Coverage
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑x No ❑
If you have checked fes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑x 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:
Owner ❑ Agent
Signature of Owner or Owner's Agent
I hearby certify that all of the details and 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 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 Type of License:
Title X Plumber
City/Town Gasfitter Signature of Licensed
Approved (OFFICE USE ONLY) X Master
'1�
Journeyman License Number 13106 XX
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