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HomeMy WebLinkAboutMiscellaneous - 88 PLEASANT STREET 4/30/2018Date .,l��Z ......... Oit.toe^YO TOWN OF NORTH ANDOVER D PERMIT FOR ,GAS INSTALLATION �C This certifies that�?.....i..... ! .... has permission for gas installation in the buildings of ... /0.1� �/, ! A'os ....................... . 8 �J�4.sti.sr Z�� L at ..... tY .` ... 9 ............ A,, North Andover,F ass. Fee :$ ? : vcv Lic. No. A ?A .. ,�<clm�/ ............ GAS INSPECTOR Check # �l� S 11 NLASSAGWSEITS 0MRXI APPLICATON FOR PERIN-Hr TO DO GAS FI' ING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New ❑ Renovation ❑ Replacement Plans Submitted ❑ Permit # Amount $ Name of Licensed Plumber or Gas Fitter Chec one: Certificate( tal 'ng Company Corp. ❑ Partner.. ❑ Firm/Co: INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes r7lNo If you have checked yes, please indica e the type coverage by checking the appropriate. box. Liability insurance policy Una 13 type of indemnity ❑ Bond Owner's Insurance Waiver: Tam aware that the licensee does not have the Insurance coverage required by Chapter 142 of (tie ;Mass. General Laws.. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ AgentEl I hereby certify that all of the details and information 1 have submitted (or entereu) in above application are true anu accurare ro rne- bcst of my knowledge and that all plumbing work and installations performod under Permit Issued for this application will be if] compliance with all pertinent provisions of the MasSr�;huNtts Stata)Gas Code ancigpter 142 of the General Laws. By: Title CityrTown APPROVED (OFFICE U.SE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumbers ❑ Gas Fitter UcOnse Aum er Master Journeyman rn U y C. H o z z O Ei W " a ,�, a r w0 w w Cn a 0 w E rc��4l H �I O W A ce 14 U 9 y A 24 H O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR . 4T I1. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR t 8TH. FLOOR Name of Licensed Plumber or Gas Fitter Chec one: Certificate( tal 'ng Company Corp. ❑ Partner.. ❑ Firm/Co: INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes r7lNo If you have checked yes, please indica e the type coverage by checking the appropriate. box. Liability insurance policy Una 13 type of indemnity ❑ Bond Owner's Insurance Waiver: Tam aware that the licensee does not have the Insurance coverage required by Chapter 142 of (tie ;Mass. General Laws.. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ AgentEl I hereby certify that all of the details and information 1 have submitted (or entereu) in above application are true anu accurare ro rne- bcst of my knowledge and that all plumbing work and installations performod under Permit Issued for this application will be if] compliance with all pertinent provisions of the MasSr�;huNtts Stata)Gas Code ancigpter 142 of the General Laws. By: Title CityrTown APPROVED (OFFICE U.SE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumbers ❑ Gas Fitter UcOnse Aum er Master Journeyman 9291 Date. �' ��•° :'� TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING f , This certifies that . ,/117.I.?glo.'!. ./�ir!C'©�! .... ..... . has permission to performhC��ai�yr� ,�; ...... �, . . plumbing in the buildings of ../ lQl/'/.! 4!-? .................. . at .R 6 a.'7.. . , North Ando% -MA.SSACRUSETTS U1 gORM APPLICATXON FOR PERNM TO 7D O PLUMBWG (Type or print) NOF,THANDOVER, Building s pate -Z,�- )�� Permit Amount - New RenovationReplacementPlans Submitted Yes No n � Ch2§ one: C 1�tificate (Print -or type) Corp. Installing Company Nam 4�4 El Partner. Address Firm/Co. Business Telephone Name of.Licensed Plumber: Insurance Coverage Indicate a of insurance coverage by checking the appzopnate box:Bond Liability insurance policy Other type of indemnity ;Insurance Waiver: I, the dersigned, have been made aware that the licensee of this application does not have any one o£the above tBreeinsurance ` Signature Owner E] Agent . � � .. . I hereby certify that all of the details and information I have submitted (or entered) in above application are.true and accurate to the best of mylmowledge and that all plumbing wWicensed tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the lumbing C d Chapter 142 of the General Laws. By: er Type ofPlumbingLicense Title/,0,; City/Town icense um er Master Journeyman APPROVED iOMP13 USE ONLY - The Com"zonwea rlth oflllassachusefts DCPaitmenf o f £radush ial Accidents Office ofbives�bations 600 Wasizington Street 13osiarz, .1f� O�XIX . �tl►�lv_mr�s�go�Idia 'workers' Compew;aii.on Insurance -Affidavit: Builders/Contractors/Electricians/Plumbers 'kTI Hcant•Information ' Please Print Legcqbb Namo (Business/Ora nization/lndividual): Address: City/state/Zip; Phone #: -Axe you an employer? Check the appropriate box: I. I aTn a employer with 4. [] I am a a • beneral contractor and I Type of protect (required): employees (full and/or part time) * have hired •the sub -cont =tors 6 Near construction 2.0-I am a sole proprietor arpartner- •listed on the attached sheet, # 7. 0 Remodeling slap and have no eraployees These sub--•couiractozs have $. [] Demolition working for me in any capacit3r [No workers' corap. insurance p workers' comp. insurance. �. 0 We are a corporation and its '9. 0 Building addition required.] o$%cers have exercised their 10.0 Electrical'repairs or additions 3. I am a homeowner doing all work right of exemption per MOL 11 ElPlumbing repairs or additions Myself [No workers' comp. iT,nu c. 152, §4), and we have no 17 0 Roof repairs mce required ] t employees. [No •workers' Pomp. M' Surancp, required-] 13.[l Other TJO._....,1 ^..]'_ SU llr. Cn• t:^.0 £e^-II� L`'CPJ v. ^...^..^.S T..O-^uI:C.S.S' COL^^`^'c��.^..,..i:.... £Tomeowxters who submittiiis affidavit indicating fhcy nnv de g all w ic asci = r " " P� ��..y_,.. � v =� , (Contractor Eb t eb�kLs t o : a, o uta ; �;an onai sheet showing }he `hen hueflutside ean*�cta s ifi t,t su uii a new amdavit indicating such. b namabf the sub -contractors and theirwerkers' comp. policy informatim f am an employer that is providing workers' corrzpensauon insurance for my empldyees: Beloit, is the police and job site. informafaon. , Insurance Company Name: Policy # or Self -ins. Lie. Expiration Date: Job Site Address: City/state/Zip: .A.ttach. a copy -of the workers' compensation policy declaratiou page (shawing the policy number -and expiration date). Failure to secure coverage as required under• Section 25A ofMGL c. 152 can lead to the imposition of c ' inal penalties of a nine up to $1.,500.00 and/or one-year irnprisonmenf, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to 5250;00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. _ I do here$y ceriifjs under the pains and penalties of perju'31 thrar the info provided above is true and correct; Sieuature: .. . • -- _ Date: -- - . Phone A Official use only. Do not write in this area, to be completed bj: city or torn official C431 or Town: ?erMW_r.;r-Pnc Jssuiva .A.uthorl y (circle one); I- Board of Health 2. Building, Department 3. City/Tawn CIerk 4. Electrical Inspector S. Plum biug Inspector 6. Other Contact Person: Phone'# Date. � �l! . /P ....... r NORTp TOWN OF NORTH ANDOVER/// 'X PERMIT FOR GAS INSTALLATION .,.r • o r s' �9S.. � � •met This certifies that 1.11 '......... has permission for gas installation .. ............... . in the buildings of .. �:L............ �f f ................. . at �-? Q. ?' . , North Andover, Mass. ov Fee. ...... Lic. No&.'?1f6...�..�P . .......... . GAS IN,�• .v�TOR Check # /7---) Ti 0 2 ,r V� MASSACHUSE IS UNUDRM APPUCATON FOR PERMIT TO DO GAS FTrfLNG (Type or print) Date 1-11-16 NORTH ANDOVER, MASSACHUSETTS Building Locations ff P' /�� ��r Permit # Amount $ �Q Owner's Name -JI47 New ❑ Renovation ❑ Replacements Plans Submitted ❑ (Print or type) Name Add** fss tgA),Vfi v 4-- %liPl 04-�e !4 .` Name of Licensed Plumber or Gas Fitter ///V% Check one: Certifica7ng Company Corp. GG��99 ❑ Partner. ❑ Firm/Co. rIhave SURANCE COVERAGE Check one: . a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ ou have checked yes, please i dicate the type coverage by checking the appropriate box. ❑ Liability insurance policy Caber 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and lnrormanon i nave suut,uucu dui el,lcicu) 1n aFjjj .— a1 .— -- —Ux— w u1c 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 Massachu�ptts State Ga* Co and Ch ter 142 of the General Laws. C__, by: Title City/Town IA,PPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 104 d ie ; Gas Fitter License Number t Master Journeyman x w U W W aO U F+ x H x W F F z O F W O W z z w o w x a ] w ., z z A a o a ko o U o x z w A o w a F o f SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOORfT 8TH. FLOOR (Print or type) Name Add** fss tgA),Vfi v 4-- %liPl 04-�e !4 .` Name of Licensed Plumber or Gas Fitter ///V% Check one: Certifica7ng Company Corp. GG��99 ❑ Partner. ❑ Firm/Co. rIhave SURANCE COVERAGE Check one: . a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ ou have checked yes, please i dicate the type coverage by checking the appropriate box. ❑ Liability insurance policy Caber 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and lnrormanon i nave suut,uucu dui el,lcicu) 1n aFjjj .— a1 .— -- —Ux— w u1c 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 Massachu�ptts State Ga* Co and Ch ter 142 of the General Laws. C__, by: Title City/Town IA,PPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 104 d ie ; Gas Fitter License Number t Master Journeyman Date D. ....... NORTH V. TOWN O NORTH ANDOVER 41 PERMIT FOR GAS INSTALLATION This certifies that .... /-/;/a ..................... has permission for gas installation ............................ in the buildings of .......................................... at ....6U . North Andover, Mass. Fee...,. Lic. No........... ...�;-S- .- , . ..... INSPECTOR Check # 56U4 14 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS _ Date Building Location g15 -� `lO tot ?'q Sd{AJ I T Permit # Amount Owner -XAAle- $ /Vi 41J/QPIT if S New Renovation Replacement El Plans Submitted Yes No El FIXTURES i 1 11' �������������������������• (Print or type) Installing Company Name /7"4/41114----- 001(/41 /3«v Address PC) 136X S%.z L RJAA4 -e M,4 a 4Y V3 Business Telephone (o 2r S g 5-,o y Check one: ❑ Corp.. El Partner. UFirm/Co. Name of Licensed Plumber: 7�Wol 4 S #69� /f0-?-?--� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity D Bond D Certificate 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 Signature Owner 11 Agent 13 I hereby 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Plumbing Code and Chapter 142 of the General Laws. BY Signature OT Licenseaum er Title Type of Plumbing License a y/ �3� City/Town Ice�e�Pum er Master Journeyman a APPROVED (OFFICE USE ONLY ,vIASSACHL;SFM UNIFORM APPUCATON FOR PUMr TO DO GAS FM[ING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations ¢ IU P/ -r S7— Permit Amount S u -A rii-e S m-4 i/ RIM e S Owner's Name Newa Renovation a Replacement Plans Submitted 11 (Print or type)�J C e one: Certificate Installing Company Name //19b 0�''4� RZy"4 e/ n/ 0 Corp. Address p O 13oY 5-7 Z Partner. Z,4c.'/I'rA✓c e MA- O/Xi/ Z us►ness a ep one y 7 Y ev gr s 5 S d Firm/Co. Name of Licensed Plumber or Gas Fitter %�pw 4 s A/a¢f�l>/�A�tJ INSURANCE COVERAGE• Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes to No0-, If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy IK" 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 nne- Signature of Owner or Owner's Agent Owner V Agent t hereby certify that all 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 incl installations performed ander Permit Issued for this application will be in -- crnpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Ti tle CitwTcwn ,�PPRO'Y'ED -CFFICE I:9E c,',t.r; Signature of Licensed Plumber Or Gas Fitter I_^J Plumber d YYu Gas Fitter Lict�Cum er Master Jeumetiman 3449Date/)..%.G..6........ + NORTFI TOWN OF NORTH ANDOVER pF to e,ti0 of 'p� PERMIT FOR GAS INSTALLATION A This certifies that ../". 611114 /........................ . has permission for gas installation ...Y�..�-/ .................. in the buildings of .. l .' '.� �: r .............. . . . . . , North Andover, Mass. Fee.. 3 -? . Lic. No. 2 :! f ..... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS ffn]NG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations 8 8 / I-e95,gA,1T S7— 32O y/. ewe �'ly/f Owner's Name New ❑ Renovation ❑ Replacement ® ' Date io 20oo Permit # t Amount S G+ �s✓e //,`�� Plans Submitt ❑ (Print or type) Check one: Certificate Installing Company Name f%4��D�1✓�r/ �Cd.�/w Corp. Address �� �� ❑ Partner. os�yL- Business Telephone yJ,&' c/ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter/I�4/✓ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy L � 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby 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 pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and C -banter 142 of the General Laws. Bv: Title CityiTown APPR01,/'ED wFr•icr: usE ONi.y, Signature of Licensed Plumber Or Gas Fitter ❑ Plumber a LI.7-0 ❑ Gas Fitter License iNumoer Master Journeyman f: (Print or type) Check one: Certificate Installing Company Name f%4��D�1✓�r/ �Cd.�/w Corp. Address �� �� ❑ Partner. os�yL- Business Telephone yJ,&' c/ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter/I�4/✓ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy L � 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby 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 pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and C -banter 142 of the General Laws. Bv: Title CityiTown APPR01,/'ED wFr•icr: usE ONi.y, Signature of Licensed Plumber Or Gas Fitter ❑ Plumber a LI.7-0 ❑ Gas Fitter License iNumoer Master Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) t C NORTH ANDOVER ,Mass. Date , Ci" I C/ building Location Permit # p Y • New '7 M6CAV— Owners Name Renovation 0 Replacement 14 Plans Submitted (Print or Type) Installing Company Name Address /�_ O/U" _ WMM Check one: Certificate Corp. Partner. C,0710 • 6-v/0-- CIWI Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insuranc(- Coverage. Indicate the type of i-isurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 Bond Insurance Waiver: 1, 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 U Agent M I hereby certify that all of the de(AUs and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that sU plumbing work and installations performed under Permit issced for this application .wdl-be in compliance with all pertinent provisions of tho Massachusetts State Gas Code and Mapter 142 of tho General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE:9�n�_ Plumber " Gasfitter. Signa ure of Licensed Master Plt;mi�,or Gasfi.tter Journeyman/((��y� License -Number lA � W N a o CC N N CC o V m_-C re = H La m� x to to N t- W W O O= O W tu t^ N cc cc N O w U Q W z to '- t• d N cc a o ct a y 4 W w W ; z .= x is W � OW a w t- w F- U z t.12 cc z d W K4 a.• W �- a> m z k o r z W .� o H us W x d ,u > ' d d d O O W a a z o 0 u. to O ..t 0 y Q n. t- o p tf SUR— iE S I.t T. 1 BASEMENT ISTFLOOR 2MD FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7Tt{ FLOOR 8TH FLOOR (Print or Type) Installing Company Name Address /�_ O/U" _ WMM Check one: Certificate Corp. Partner. C,0710 • 6-v/0-- CIWI Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insuranc(- Coverage. Indicate the type of i-isurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 Bond Insurance Waiver: 1, 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 U Agent M I hereby certify that all of the de(AUs and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that sU plumbing work and installations performed under Permit issced for this application .wdl-be in compliance with all pertinent provisions of tho Massachusetts State Gas Code and Mapter 142 of tho General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE:9�n�_ Plumber " Gasfitter. Signa ure of Licensed Master Plt;mi�,or Gasfi.tter Journeyman/((��y� License -Number Date.,/.-.// ' f ! .... . 17 pORT#1 TOWN OF NORTH ANDOVER 1 p f '6. tip FO? y` c L9 PERMIT FOR GAS INSTALLATION. M 9q SSACHUSE� h r This certifies that .. .............. ... 1 t..,<,�.. . has permission for gas installation ; ......... ........ in the buildings of , ..... , , , , , , at .. ��,� t . , , S, ?'�.. , • . , , . , North Andover, Mass. Fee. 4 :... Lic. No........................... 10/11/94 09;09 (GAS IINnnSPECTOR WHITE: Applicant CANARY: Building Dept. 15'0$INK:^F►Basurer GOLD: File 4.,; ., MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIH��"� (Print or Type) h NORTH ANDOVER ,Mass. Date kuilding Location �/r' Permit # Owners Name • New "t Renovation D Replacement Plans Submitted D F T ► =c (Print or Type) Check ne: Certificate Installing Company Name /�/,/,p�/�,� i�/��,U� f�7 - , orp. Address ,� 3� El Partner. Firm/Co. Business Telephone:- Name of Licensed Plumber or Gas Fitter,f' Insurance Coverage: Indicate th. type of insurance coverage by checking the appropriate box: Ot Liability insurance policy her type of indemnity F --j Bond Ej 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 Q 1 hereby certify that all of the details and information 1 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 mpliance with all pertinent provisions of the Massachusetts State Cas Code and Q►apter 142 of the General Laws. By TYPE LICENSE:— Plumber Title sfitter Signa ure of Licensed Master Plumb O Gasfitter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Number a Y • • • J SEEN MEN NEENEWE ENSIS .. ■■mmommonsmosommommARESERS■ .. ■ENSEENn OEM INS EMENEE ESSISE (Print or Type) Check ne: Certificate Installing Company Name /�/,/,p�/�,� i�/��,U� f�7 - , orp. Address ,� 3� El Partner. Firm/Co. Business Telephone:- Name of Licensed Plumber or Gas Fitter,f' Insurance Coverage: Indicate th. type of insurance coverage by checking the appropriate box: Ot Liability insurance policy her type of indemnity F --j Bond Ej 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 Q 1 hereby certify that all of the details and information 1 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 mpliance with all pertinent provisions of the Massachusetts State Cas Code and Q►apter 142 of the General Laws. By TYPE LICENSE:— Plumber Title sfitter Signa ure of Licensed Master Plumb O Gasfitter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Number [IC N a 1737 Date. ! :.............. .b gra HpRTH Q.TOWN OF NORTH ANDOVER pFt,eo ,s'� 3? ° PERMIT FOR GAS INSTALLATION2 ♦ s C SACH This .•r O This certifies that . z". ............................. . has permission for gas installation .. ................. in the buildings of ......... ............................... at ........ .....�......... "........... , North Andover, Mass. Fee.......... Lic. No........... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File