HomeMy WebLinkAboutMiscellaneous - 95 MOODY STREET 4/30/2018Date. ,1.,/ l? —. < . ` ...
TOWN OF NORTH ANIPbVI
9
• PERMIT FOR PAS INVALLA
This certifies that ...P.. J....�'A L :, K .................
has permission for gas installation ... J). ?.Y ?:l . : ..............
in the buildings of ....1. Q j ...............................
at A v... ............ North Andover, Mass.
Fee. Lic. No. SY,. ... ....ISINSPECTOR
Check # ] ? 1 cl
1
V
NIASSACHUSETTS UNIFORM APPUCATON FOR PERNU TO DO GAS FITTING
(Type or print) Date L `A Q
NORTH ANDOVER, MASSACHUSETTS
Building Locations L) 5 -74,Gl Permit # ✓ r/
Amount $ 5 0
Owner's Name D -V1
New Renovation Replacement 0-- Plans Submitted ❑
(Print or type)�Q j Check one: Certificate Installing Company
Name _ {tiJ 5 */L��%til l�liL '� trL'`-7� ❑ Corp.
Address `f J K 6)2 �
Partner.
�t U G�-v d ✓ �� -7-t.-i 1 L/ -
Business Te ep one -� jt fo /� D R" -Z-0 Firm/Co.
Name of Licensed Plumber or Gas Fitter 13d b ,�j�¢-/`off 14-e . t
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ED— No 13
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 13- 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:
Signature of Owner or Owner's Agent Owner 0 Agent C]
L _
- Y --y L -L - U, L„U „L;tu„3 uLjj HI 1111uiwu I uuvc suolumea kor emerea) in above application are true and accurate to the
hest 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,s StoWGas Code 4jud ChapterA42 of the General Laws.
LS y:
Title
City/Town
(APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber � 3
Gas Fitter License um er
aster
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SUB-BASEM ENT
B A S E M ENT
1ST. FLOOR
2 N D. F L O O R
3RD. FLOOR
4TH. FLOOR
5 T H. F L O O R
6 T H. F L O O R
7 T H. F L O O R
8TH. FLOOR
(Print or type)�Q j Check one: Certificate Installing Company
Name _ {tiJ 5 */L��%til l�liL '� trL'`-7� ❑ Corp.
Address `f J K 6)2 �
Partner.
�t U G�-v d ✓ �� -7-t.-i 1 L/ -
Business Te ep one -� jt fo /� D R" -Z-0 Firm/Co.
Name of Licensed Plumber or Gas Fitter 13d b ,�j�¢-/`off 14-e . t
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ED— No 13
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 13- 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:
Signature of Owner or Owner's Agent Owner 0 Agent C]
L _
- Y --y L -L - U, L„U „L;tu„3 uLjj HI 1111uiwu I uuvc suolumea kor emerea) in above application are true and accurate to the
hest 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,s StoWGas Code 4jud ChapterA42 of the General Laws.
LS y:
Title
City/Town
(APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber � 3
Gas Fitter License um er
aster
L---T—
Journeyman