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HomeMy WebLinkAboutMiscellaneous - 337 Sharpners Pond RoadAP Dater'....... `......... . °� TOWN OF NOR "NDOVER PERMIT FOR GAS INSTALLATION This certifies that ...' . ?... ...... .:='c has permission for gas installation +�.- -1 �:.......... . in the buildings of ... at -,r' .................. North Andover, Mass. Fee.Lic. No.N[I2A 7., .......... / GAS INSPECTOR Check # 2,74 9 L; i P G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) N ANDOVER Mass. Date 10/16 Building Location 337 SHARPNERS POND RD Owner Tel# 781-233-1633 New ❑ Renovations 2009 Permit # Owner's Name JOSEPH COPPOLA Type of Occupancy RESIDENTIAL Replacement ❑ Plan Submitted: Ye[] No[] FIXTURES Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter WAYNE FORSYTH M3874 Check one: Certificate Corporation ❑Partnership ❑Firm/Co. INSURANCE COVERAGE: I have a cuOcecked liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesNo r -1f you have yLs, 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 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 m, Knowieage ana mat all piumDmg worK ana installations pertormed under the permit issued for this a plication will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General L By Type of License: 2-1 1 • -Plumber Signature of Licensed Plumber or Gas Fitter Title City/Town APPROVED (OFFICE USE ONLY) • Gas fitter M3874 • -Master License Number • -Journeyman MEN Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter WAYNE FORSYTH M3874 Check one: Certificate Corporation ❑Partnership ❑Firm/Co. INSURANCE COVERAGE: I have a cuOcecked liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesNo r -1f you have yLs, 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 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 m, Knowieage ana mat all piumDmg worK ana installations pertormed under the permit issued for this a plication will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General L By Type of License: 2-1 1 • -Plumber Signature of Licensed Plumber or Gas Fitter Title City/Town APPROVED (OFFICE USE ONLY) • Gas fitter M3874 • -Master License Number • -Journeyman