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HomeMy WebLinkAboutMiscellaneous - 9 COMMONWEALTH AVENUE 4/30/2018a Date./.,/. . . ......... F? �p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLA.,ION • .,_ .._ LIZ 9SSACMUSEt �{ / This certifies that . ` , c. l� �. r ...... ................. has permission for gas installation (f .......... . in the buildings of .....%14c ......................... at ... ` ..Cc!��k �N k ,-w c !G , North Andover, Mass. Fee. ?. a -w" Lic. No. / ) /` ?v .. ... 1 ....... . GASINSPECTOR Check # L 6209 MASSACHUSETTS UNIFORM APPLICATON FOR PER Ur TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations —' Renovation 4J�1"\ t� Owner's Name Replacement Plans Submitted Date Permit # 4!4 Amount $ (Print or type).-� % Check one: Certificate Installing Company Name Irv: �+--� 0 Corp. Address <2c\ saS`� , /Y\C,)SS 0 Partner. Business I a ep one �� �— ��IlkSl 1 L...1 Firm/Co. Name of Licensed Plumber�or Gas Fitter (A , INSURANCE COVERAGE C% one: I have a current liability Insurance, policy or it's substantial equivalent. Yes NoO If you have checkedrtes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 0 Bond 13 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 13 Agent I 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 compliance with all pertinent provisions of the Massachus to has Code and Chapter 142 of the General Laws. By: Title City/Town. 'APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber , 5 ! '� H AA Gas Fitter License INUMDer Master Journeyman � a w � w w rA o a$ z H G14 �' z U W v, Z E C O °' > W tw7 H z F Q x w a w w �" °w x a z w a s > CM zz o z w o x s o o a > o F o SUB-BASEM ENT o°. B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOG R 7TH. FLOOR STH. FLOOR (Print or type).-� % Check one: Certificate Installing Company Name Irv: �+--� 0 Corp. Address <2c\ saS`� , /Y\C,)SS 0 Partner. Business I a ep one �� �— ��IlkSl 1 L...1 Firm/Co. Name of Licensed Plumber�or Gas Fitter (A , INSURANCE COVERAGE C% one: I have a current liability Insurance, policy or it's substantial equivalent. Yes NoO If you have checkedrtes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 0 Bond 13 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 13 Agent I 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 compliance with all pertinent provisions of the Massachus to has Code and Chapter 142 of the General Laws. By: Title City/Town. 'APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber , 5 ! '� H AA Gas Fitter License INUMDer Master Journeyman Date. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .� ...... P,� .................. has permission for gas installation• -7,.- .......... in the buiIdings of ........... at .4�—North Andover- Mass. Fe; ... Lic. GAS INSPECTOR Check 0633 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date 6J-2-2'�� 20 Permit #(J3dS Building Location9 CCOKFnt-)(St)c-,a � PruOwner's Name C-imzusco N - 1� %J ZoQ LKl- Type of Occupancy New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑, No ❑ Installing Company Name �� . Check one: Certificate # Address lor-:;o coy l� �Ci © 3H 3 ❑ Corporation ❑ Partnership Business Telephone 3�s�t�� ❑"rirm Co. Name of Licensed. Plumber or Gas Fitter l/v INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1 Yes L� No ❑ If you have checked Yes, 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. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's 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 installation 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: ❑ Plumber Title ❑ Gasfitter City/Town ❑ Master APPROVED (OFFICE USE ONLY) 3 urnsyman Signature of Licensed Plumber or Gas Fitter License Number 2 -SOI co U Z ir (1) U for (%)cr (p^} >- m Q W 4W ZO M O Z W m (n W 4 W = Z O > W W W z J LU Z Q W W (7 d:W LL W U J to cc , W Q W > �, W j Z Q Q m ZO W O ft 2 O 0 2 LL >i 0 C7 U ¢ > 0 d F- O SUB-BSMT. BASEMENT r 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name �� . Check one: Certificate # Address lor-:;o coy l� �Ci © 3H 3 ❑ Corporation ❑ Partnership Business Telephone 3�s�t�� ❑"rirm Co. Name of Licensed. Plumber or Gas Fitter l/v INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1 Yes L� No ❑ If you have checked Yes, 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. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's 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 installation 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: ❑ Plumber Title ❑ Gasfitter City/Town ❑ Master APPROVED (OFFICE USE ONLY) 3 urnsyman Signature of Licensed Plumber or Gas Fitter License Number 2 -SOI