HomeMy WebLinkAboutMiscellaneous - 161 Foxwood Lot 28 cl
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TC: r + 3(Print of Type) ulvli UHM APPLICATION FOR PERMIT TO DO GASFITTINQ
. NORTH ANDOVER -d2 a a
. Maas. Data tg . 6
Building Permit # 23 / o r
Location O -��� - C � '
Owner's
Name
New . Renovation ❑ AeplacemerA O Plans Submftted:. Yes ❑ Nop
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SA1111M$NT.
.1 IT FLOOR
IND FLOOR
311110 FLOOR
4TH FLOOR
STH FLOOR
4TH FLOOR
f
7TH FLOOR t
ITH FLOOR
n Check one: CertNicate
inztafling Company Name
P-I&arp,
Address_ �-� . �k � w!
1 d Partnership
IMA 3 / ❑ Firm/Co.
13usiness Telephone_
Name oI_Llcensed Plumber or Gas Fitter - S C V-9—
:INSURANCE
-2NSURANCE COVERAGE: Check on
•1 have a current liability Insurance poilcy of Its substantial equtvaient. Yes No ❑
'1f you have checked yes, please Indicate the type coverage by checking the appropriate box.
A;itat,glty Insurance Policy Other type of Indemnity ❑ Band ❑
OWNER'S INSURANCE WAIVER: 1 ern 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:
nature of Owner or Owners Agent Owner El Agent C1
'I hereby ceriliy that all of the details and lnformation I have submitted (or entered)in above application are true and accurate to the best of my
knowledge and that sit plumbing work and Inatellatlons performed under the permit Iss;eo
for this applicstion will be Incompliance with all
pertlnant provislons of the Massachusetts State Ons Code and Chapter 1112 of the T nse:
Titleumber ns un um er or as er
ter
Master Lkense Number I ^ ? ��
Ctty/Town. ❑joumeyman Z'v—•Tz—a--
:Ar't fXMD(OFFICE UST: ONLY)
1
TI2310 Date.�.�,fi`�/..yl.. .. ...
I.
' pORTN TOWN OF NORTH ANDOVER -'
3r "t PERMIT FOR GAS INSTALLATION
's 9 �•• fig♦ �; �+ yPAYMENT �
9SSACHUSES
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OCT
This certifies that .(f./?f.!!�.s k,4rpT{���RLtECTT . . . . . . . .
has permission for gas installation . ./11. p u. . C! `?.:t. . . . . . . .
in the buildings of . . ��. w. R. ?-. . . . . . . . . . . . . . . . . . . . . . . . . .
at . .M .�':�.". . . . . . . . . . . , N An8over, Mass.
Fee. .?!2 . . . Lic. No..l y . . .tG
•. . . . . . . . .
ASINSPECTOWHITE:Applicant CANARY:Building Dept. NK:Treasurer GOLD:File