HomeMy WebLinkAboutMiscellaneous -Lot 5 Cricket Lanei
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Date... ... ...`..'..... .
°•° TOWN OF NORTH ANDOVER
77"
PERMIT FOR GAS INSTALLATION
9
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This certifies that .. ...:�:.'............. ............ .
has permission for gas installation ... , �:........ r . t.. .
in the buildings of ... t.' �`: �.�; .....{ �� : ��
at ...l. I .....,.. ...... North Andover, Mass.
Fee.. 7 ci,. ' Lic. No.. 1........ ..................... 7V....
GAS INSPECTOR
Check #
35 0
E-9
9
MASSACHUSETTS UNIlORM APPUCATON FOR PERNUT TO DO GAS FITTING
or print)
Building Locations
MASSACHUSETTS
S-- CF)'fx
Owner's Name
New El Renovation ❑ Replacement ❑
Date -9 6-
! Permit # 3 ���
c (� Amount $
Plans Submitted ❑
(Print or type) Check one: Certificate Installing Company
Name Galinskv Plumbing & Heating Inc. ® Corp. 1906
P.O.Box 1701 Haverhill, MA 01831
Address ❑Partner.
Business Telephone 978-374-1743 ❑ Finn/Co.
Name of Licensed Plumber or Gas Fitter Stephen C Galinskv
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 ® 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 ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true anct accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit sued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Cjps Code 94,9Kap 2 of the General Laws.
(OFFICE USE ONLY)
Signatt(re N4.icensed Plumber OrCoaoFitter
® Plumber
❑ Gas Fitter License Number
er
❑ Master
❑ Journeyman
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1ST. FLOOR
1
1
2ND. FLOOR
3110. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7T 11. FLOOR
RT 11. FLOOR
(Print or type) Check one: Certificate Installing Company
Name Galinskv Plumbing & Heating Inc. ® Corp. 1906
P.O.Box 1701 Haverhill, MA 01831
Address ❑Partner.
Business Telephone 978-374-1743 ❑ Finn/Co.
Name of Licensed Plumber or Gas Fitter Stephen C Galinskv
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 ® 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 ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true anct accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit sued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Cjps Code 94,9Kap 2 of the General Laws.
(OFFICE USE ONLY)
Signatt(re N4.icensed Plumber OrCoaoFitter
® Plumber
❑ Gas Fitter License Number
er
❑ Master
❑ Journeyman