HomeMy WebLinkAboutMiscellaneous - 17 Jared Place �`
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NORTH TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION
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DAAi SSACHUSEt
This certifies that .l. . . . . . . .
has permission for gas installation . ✓.t! .= �f�;�,:�. '! ! . . .
in the buildings of . . _..' ; ... . . . . . . . . . r'. . . . . . . . . . . . . . . . . . . . . . .
at .. . . . . North Andover, Mass.
Fee. :,1 .�/Lic. No.1.11.1.�._,
r ; GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File
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55AUUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER , Mass. Date
Building _� PermitUV
Location_ c� //►►,,��ilu
Owner's
' Ur""_
New U/ Renovation ❑ Replacement ❑ Plans SubmRted: Yes ❑ No C7
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• •AIEMENT
1OT FLOOR
IND.FLOOR I
$RD FLOOR
ITH FLOOR
STH FLOOR i
GTH FLOOR
TTHFLOOR
fates FLOOR
Check one: Certificate
Installing Company Name ---r— I�T)fxCorp.`
Address qQ j J)n lin 9�_ b . l' P S��� 11 Partnership
0-firm/Co.
Business Telephone
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE: Check one
I have a current IlabIIRy Insurance policy or its substantial equivalent. Yea ❑ No ❑
If you have checked"s, please Indicate the type coverage by checking the appropriate box.
A 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:
% ❑
nature o Owner or Owner's ant Owner Agent 11
I hereby certify that all of the details and Information I have submitted (or entered)in nbove application are true and accurate to the best of my
knowledge and that ail plumbing work and installations performed under the permit issued for this appllcatlon will be n compliance with all
pertinent provisions-of the Massachusetts State Gas Code and Chapter 142 of the Genet Laws.
By_ T f License:
umber Signature o nae Plumber or as Fitter
TitlefGaasfitler �!
Ctty/Tovm �Jouster meyman Ucense Number 63 6
MPr10VED(OFFICE USE ONLY)
BELOW FOR OFFICE USE ONLY
PROGRESS INSPECTION
FINAL INSPECTION SKETCHES
FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME S TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER OR GASFTTTER
LIG NO. .. . . .. - ._.. _ ._.
PERMIT GRANTED
DATE 19
GASINSPECTOR