HomeMy WebLinkAboutMiscellaneous - 14 Webster Woods Lane /jl GJj�Si�i� 6"eol-)5
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NpR*N TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION
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This certifies that . . . .(!. r ? .F.' . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . MK . .- ` . . . . . .
in the buildings of . . . : .V.! . . . . . . . . . . . . . . . . .
at .?. 3 1:1.1.J. . . . . ., Nort_ h Andover, Mass.
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Fee. . .? . . Lic. No../!. 7?.f . �
GAS INSPECTOR r
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
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MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FmING
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NORTH ANDOVER, MASSACHUSETTS
Building Locations j I Permit# S�
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=tea New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑
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(Print or type) Check one: Certificate Installing Company
Name Gerry Keefe Plumbing Pi �A^^? R� ❑ Corp
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Address Towksburv. 01876 Parmer.
1013
Business Telephone ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter 7 era t-G e--e tit°•�f
INSURANCE COVERAGE + Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
A If you have checked ves•please indicate the type coverage by checking the appropriate box.
Liability insurance policy ® Other type of indemnity ❑ Bond
Owners 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
( 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 installations per tormed under Permit Issued For this application will be in
compliance with all pertinent provisions of the Massachusetts State s Code and C to 142 oft e General Laws.
Bv. Signature of Licensed Plumber Or Gas Fitter
Tide ❑ Plumber ta-7 7e
City/Town ❑ Gas Fittert�ivumoer
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APPROVED(oFi--u-usE om.Y) ❑ Journeyman