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HomeMy WebLinkAboutMiscellaneous - Exception (537)z�� `r t Date ..! TOWN OF NORTH ANDOVER O � F • - PERMIT FOR GAS INSTALLATION . 9 �9SSACHU5EtS This certifies that .. . has permission for gas installation ... . in the buildings of - G� ..��''`�jC ............... North Andover Mass. Fee. Lic. No. ......................... . J GASINSPECTOH Check # ©�G� 4697 MASSACHUSFTTS UNHURM APPUCATON FOR ffI pe or print) Building Locations NWA AoA4vVc—:A_ MASSACHUSETTS Owner's l New o Renovation Replacement 0 TTODOGASFMnNG Date -? -2—Y-6 y Permit # 149-7 Amount. $ J Plans Submitted 0 ° z --g� a� o a [B-BASEM ENT 1111 ISEMENT 1sT. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR @TH. FLOOR or type) / G hi / "7� % one: Cern to �s llin Name -- `ie, yr S `�-i g ComPY ..Ld Corp. Address Q o "Z: 17o Partner. Z- 3 Business Telephone - -7 Firm/Co. Name of Licensed Plumber or Gas Fitter /1. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substa,al equivalent. Yes wiNo13 If you have checked M, please indicate the type coverat M by checking the appropriate box. Liability insurance policy Q• Other ty )e of indemnity 1:1 Bond Owner's Insurance Waiver: I am aware that the licenser 41oes not have the Insurance coverage required by Chapter 142 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: ❑ g E3 Signature of Owner or Owner's Agent Owner Agent t hereby certify that all of the details and information I have submitted (or entered) in above application are true and arcuate to the best of my knowledge and that all plumbing work and installations paformed under Pemu'pls ed for this application will be in compliance with all pertinent provisions of the Massachusetts State s V Chp jg; gof the General Laws. APPROVED (OFFICE USE ONLY) V -?fg-hature of Licensed Plumber Gas Fitter Plumber G. )rFitter MIZ.Me N17M er Journeyman Date ..../ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ACHUS�tS This certifies that .'T<%t,i has permission to perform ..l �!Il ....... .. ............ . plumbing i -n the buildings of � 1. .,. , , , , , , at . , �W1 L/�. .. "?.�/.../............ . North Andover, Mass. Fee . ✓ Gv . Lic. No..�/U� � No..//U'��p ........ . PLUMBING INSPECTOR Check #� l 5;59 Y v� I MASSACHUSETTS UNIFORM or print) Building Luce V10(17-14 New Renovation d Replacement ATION FOR PERMIT TO DO PLUMBING Date Permit # Amount D s Name FIXTURES Plans Submitted n (Print or type) Check one: Certificate Installing Company Name G a l i n s k v P 1 u M b i n e & Heating X� Corp. 1 9 fah Address P. 0. B o s 1701 pier. `Na VPrhi 11 M, f11 911 R"ni!ss Telenhone I A 7 R— 3 7 4 —1 743 It Name of Licensed Plumber: I Stephen C. G r l i n s k y InsUrance Cove e: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity 11Bond IInsurarm Waiver: 4 the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance vignature, Owner 11 I hereby certify that all of the details and information i have submitted (or ente best of my knowledge and that all plumbing work and installation tm ' , compliance with all pertinent provisions of the Massachusetts to m g A By: T1W.ffFe7L7censea TYpe of Plumbing License Agent 11 above application are true and accurate to the Permit Issued for this application will be in 9d Ohanter 142 of the General Laws. Title 11-144 City/Town er Master a Journeyman 13 APPROVED (OFFICE USE ONLY