HomeMy WebLinkAboutMiscellaneous - 1939 Turnpike Street (3) Date. . .
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0 TOWN OF NORTANDOVER
' PERMIT FOR GAS INSTALLATION
SACHUSEI
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . .
has permission for gas installation .. . . . . . . . . . .
in the buildings of . . .': ��:`.. . . . ..: ' �''<� .?,-"L.. .. .. . . . .
~' at . nn�5/ �'e-e. : . . . ., North Andover, Mass.
Fee-e-10. . .. . Lic. No.j.'�A . . . . . :;.:;�;. . . �• . . . . . . . . . . . .
GASINSPECTOR
Check# ���'� V
� � � 6
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
u�
NORTH ANDOVER 09/05/07
_ , Mass. Date
City, Town
Permit#
�4 a Building Owner's
AT: Location 305 MIDDLETON ROAD Name HAROLD PARKER STATE
Type of Occupancy:
New Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6THFLOOR
7TH FLOOR
STH FLOOR
(Print or Type) Check One: Certificate
E. Osterman Propane Inc. 2553302
nc.
g Installing Company Name ❑ Corp.
' Address 22 Legate Hill Road ❑ Partnership
Sterling,MA 01564 ❑ Firm/Company
Business Telephone 978-422-0204 Name of Li nsed Plumber or G sfitter
Li
4 S dcly'I'SA
I 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 performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Si Wum of 0wnu/Agent.
I have a current liability insurance policy to include completed operations coverage. ❑ -
' By TYPE LICENS .
Plumber Signature of Licensed
Title PIumber or Gasfitter
City/Town Gasfitter
❑ ���
APPROVED (OFFICE USE ONLY) Master License Number
0 Journeyman