HomeMy WebLinkAboutMiscellaneous - 940 FOREST STREET 4/30/20181" = 138 ft
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Horizontal Datum: MA Slateplane Coordinate System, Datum NAD83,
Meters Data Sources: The data for this map was produced by Merrimack
�►ORTIy Valley Planning Commission (MVPC) using data provided by the Town of
North Andover. Additional data provided by the Executive Office of
Environmental Affairs/MassGIS. The information depicted on this map is
for planning purposes only. It may not be adequate for legal boundary
F p definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
♦ _ >} THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY
OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
• ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
INSPEGTIONS SERVICES LOG
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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has permission for gas installation ..' ...�-:. . . .............
in the buildings 9f...... z . �:: z.•� .r.- ........................ .
at .. ? ?t 7..� �" �! . :'�.......... , North Andover, Mass.
Fee- � a . Lic. No.... �? .. /�_ '_- ....... .
GAS INSF46T4A
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MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date �Z \Z c i,
NORTH ANDOVER, MASSACHUSETTS
Building Locations �� \ U Permit #
'' ll Amount
N �JL�L�%� Owner's Name C-
New 151 Renovation Replacement 1:1 Plans Submitted
(Print or type)Check one: Certificate Installing Company
Name M J \ � �\ � t Corp.
Address ` )v JU .7,I` 1 `�''` C�w C, rl Partner.
Business Telephone -) ( —� t ( ',40-)l Firm/Co.
Name of Licensed Plumber or Gas Fitter W\\ �'� A
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INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Noo
If you have checked ,yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy �. Other type of indemnity 13 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 U A
I hereby certity that all of the details and information l 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 Status Code and Chapter 142 of the General Laws.
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber t Z k2 L j
Gas Fitter License Numoer
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SUB-BASEM ENT
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IST. FLOOR
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3RD. FLOOR
4 T H. F L O O R
5TH. FLOOR
6 T H. F L O O R
7T H. F L O O R
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(Print or type)Check one: Certificate Installing Company
Name M J \ � �\ � t Corp.
Address ` )v JU .7,I` 1 `�''` C�w C, rl Partner.
Business Telephone -) ( —� t ( ',40-)l Firm/Co.
Name of Licensed Plumber or Gas Fitter W\\ �'� A
e
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Noo
If you have checked ,yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy �. Other type of indemnity 13 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 U A
I hereby certity that all of the details and information l 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 Status Code and Chapter 142 of the General Laws.
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber t Z k2 L j
Gas Fitter License Numoer
® Master
Journeyman