Loading...
HomeMy WebLinkAboutMiscellaneous - 25 Philips Courts N IWO Date. .a 7 pf " �? �' �p TOWN OF NORT,AN- OVER PERMIT FOR GAS INSTALLATION This certifies that...e- :%,!� � . ..... . has ,permission for gas installation .. A HA4 n S in the buildings of nA ,r- ! H .... ................... at . ......... , North Andover, Mass. Fee. -3 0 Lic. No... . 1�� y S, N SPECTOR !J Check # J . 6 • i _ f LF MASSACHUSETTS UNIFORM APPUCAT DN FOR PERNIlT TO DO GAS (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations P/t/// hS (f Permit # / J A (Print or type) G`� LL14 Name Address -r— / /� / Check one: Certificate Installing Company ( El Corp. C� A- t/ ❑Partner. ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter I 1 F— - INSURANCE COVERAGE Check one: I have a current liability insurance, policy or it's substantial equivalent. Yes 0— No❑ If you have checked Les, please indicate_ the type coverage by checking the appropriate box. 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 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 GA nd/Chpter 142 of the General Law-. By: Title City/Town, APPROVED (OFFICE USE ONLY) Signature of LiUnsed Plumber Or Gas Fitter p Plumber / S rs-,I 0 ❑ Gas Fitter License Number ❑ Master 0 Journeyman Owner's Name mount $ 3p 00 �) AL v� A New ❑ Renovation ❑ Replacement E Plans Submitted ❑ (Print or type) G`� LL14 Name Address -r— / /� / Check one: Certificate Installing Company ( El Corp. C� A- t/ ❑Partner. ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter I 1 F— - INSURANCE COVERAGE Check one: I have a current liability insurance, policy or it's substantial equivalent. Yes 0— No❑ If you have checked Les, please indicate_ the type coverage by checking the appropriate box. 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 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 GA nd/Chpter 142 of the General Law-. By: Title City/Town, APPROVED (OFFICE USE ONLY) Signature of LiUnsed Plumber Or Gas Fitter p Plumber / S rs-,I 0 ❑ Gas Fitter License Number ❑ Master 0 Journeyman w ��• �a O w w c o v, W x w W F '" o. cG > d w w Q x a o w F x a Z d W Q Z F F w U O > Gz F U a W W O x Fz Z d 3 C 0 C d O O W O W x o SUB-BASEM ENT .a v a > c C6 F B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T H: F L O G R 8TH. FLOOR (Print or type) G`� LL14 Name Address -r— / /� / Check one: Certificate Installing Company ( El Corp. C� A- t/ ❑Partner. ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter I 1 F— - INSURANCE COVERAGE Check one: I have a current liability insurance, policy or it's substantial equivalent. Yes 0— No❑ If you have checked Les, please indicate_ the type coverage by checking the appropriate box. 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 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 GA nd/Chpter 142 of the General Law-. By: Title City/Town, APPROVED (OFFICE USE ONLY) Signature of LiUnsed Plumber Or Gas Fitter p Plumber / S rs-,I 0 ❑ Gas Fitter License Number ❑ Master 0 Journeyman Date!/ANDOVER '"*©, if��.... HORT#i !i p � . TOWN OF NORT fk PERMIT FOR GAS INSTALLATION �9 S y9SSACMUSE�Sy - . This certifies that ... ....:....... . phas permission for gas -installation--,- ......... in the buildings o:. ��4...... ........ ........... . at (5. .. ...... ... , North Andover, Mass. 001. r" Fec� ,i .- . Lic. No%o �. � .......... �.. GAS INSP,OR Check # 5847 MASSACHUSETTS UNIFORM APPLICATON (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Permit # ' Amount $ i Owner's Name 1,0 0-,-L Q v pf -AJ New D Renovation D Replacement Plans Submitted D (Print or type) Name Address l� Business a ep one Check one: Certificate Installing Company D Corp. Partner. Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes O� No 13 If you have checked }_es, please indicate the type coverage by checking the appropriate box. Liability insurance policy �- Other type of indemnity0 13 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: Signature of Owner or Owner's Agent Owner D Agent �—j —111.7 -- -1 ucLanz� aur u1w1wMwn i nave suomir[ea (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and install ons performed under Permit IssuedAor this appli ti will be in compliance with all pertinent provisions of the Massacl iK State Ga//ode and Apter 142 o�,Yhe Gene�aws. By: Title City/Town APPROVED (OFFICE USE ONLY) Si nature of Licensed lumber Or Gas Fitter Plumber Gas Fitter License Numbero [3--14aster DJourneyman Gam. x w a o H x z F z z F x w z d z x w a w F x C5 F 7 F z z W C7 O > w U x z d d C E, > m z O F Z W O F W Z a z o w 3 a a o a > c a H o SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4T 11 FLOOR 5TH. FLOOR 6 T H. F L O O R 7 T H. F L O O R 8TH. FLOOR (Print or type) Name Address l� Business a ep one Check one: Certificate Installing Company D Corp. Partner. Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes O� No 13 If you have checked }_es, please indicate the type coverage by checking the appropriate box. Liability insurance policy �- Other type of indemnity0 13 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: Signature of Owner or Owner's Agent Owner D Agent �—j —111.7 -- -1 ucLanz� aur u1w1wMwn i nave suomir[ea (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and install ons performed under Permit IssuedAor this appli ti will be in compliance with all pertinent provisions of the Massacl iK State Ga//ode and Apter 142 o�,Yhe Gene�aws. By: Title City/Town APPROVED (OFFICE USE ONLY) Si nature of Licensed lumber Or Gas Fitter Plumber Gas Fitter License Numbero [3--14aster DJourneyman Gam.