HomeMy WebLinkAboutMiscellaneous - 232 Pleasant Street �T
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NORTH
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PERMIT FOR GAS INSTALLATION
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This certifies that . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . .
in the buildings of
"at. ^? !��_y!., , North Andover, Mass.
Fee.5.2,�.. Lic. No.�;Y,6. �. . ?�'.J�. .Aw
GAS INSPECTOR ~
Check#
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5 ,12- 6
MASSACHUSEI*IS UNIFORM APPLIC N FOR PERK Ur TO DO GAS FITTING
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(Type or print)
Date
NORTH ANDOVER,MASSACH77,
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Building Locations 3 c) G 6`4 S Permit#
Amount$ `ja
O Owner's Name
New Renovation ❑ Rep a ment ❑ Plans Submitted ❑
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65r'� A C�.7 a U ROS � A a0. F O
SUB -BASEM ENT
BASEM ENT '" -1 e16
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
STH . FLOOR
(Print or type) ` Chec one: Certificate Installing Company
Name �e9�✓//�G �L v^A Corp.
Address /06 /l e> �1ev/v ❑ Partner.
Business Telephone d ffFirm/Co.
Name of Licensed Plumber or Gas Fitter �.9�✓/LC�, �d���L��/
INSURANCE COVERAGE Check one•
I have a current liability Insurance policy or it's substantial equivalent. Yes Er No❑
If you have checked yes,please indicate the type coverage by checking the appropriate box. ❑
Liability insurance policy ElOthertype of indemnity 13Bond
•
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 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 St as Code Pd Chapter 142 the General Laws.
By:
ignature of Licensed Plumber Or as Fitter
y
Title Plumber
City/Town _ as Fitter License Number
Master
4APPROVED(OFFICE Use ONLY) ❑ Journeyman
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