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Home My WebLink AboutMiscellaneous - 34-36 Fernwoodm GJ Dat .. .... tkoRTPI Of 41 TOWN OF NOT ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................. t'-%. ................... has permission for gas installation in the buildings ofA do ........................ at................................. I North Andover, Mass. Feej..<�— ..... Lic. . .................... GAS INSPECTOR Check 6632 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /lf _A1u00ywL Mass. Date 20 dg Permit # Building Location 3 Y Few) w o o o Owner's Name Owner Tel# Type of Occupancy ,-c5' New ❑ Renovation ❑ Replacement ❑ flan Submitted: Yes ❑ No ❑ FIXTURES Installing Company Flame LtAW -, c f , r& Address136_,L0 til°C A-- l ,'q, - Business Telephone #`� Name of Licensed Plumber or Gas Fitter ---�� Check one: Certificate corporations ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch, 142. Yes 0 --No ❑ If you have checked yes, pl, -ase indicate the type coverage by checking the appropriate box. A liability insurance policy d 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 11 Agent 11Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above aoolication are true and accurate to tha hast of m, knowledge and that all plumbing work and installations performed under the permit issue ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge o is ap lication will be in compliance with all I s. _ BY T e of License: Title • lumbe m Sigh ur 'Licensed Plumber or Gas Fitter • -Gas fitter -as er-- License Number City/Town • -Journeyman APPROVED (OFFICE USE ONLY) NOON USE NOMEMENNUME so 111MUMEMEN NESS No MEN 0 ��INEEENEENENNN WE KNEW 0 mom ENEEMENNEEME WEENNEENEENNE MEMENNEEMENNEEMEN ON SEENNEMEN Installing Company Flame LtAW -, c f , r& Address136_,L0 til°C A-- l ,'q, - Business Telephone #`� Name of Licensed Plumber or Gas Fitter ---�� Check one: Certificate corporations ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch, 142. Yes 0 --No ❑ If you have checked yes, pl, -ase indicate the type coverage by checking the appropriate box. A liability insurance policy d 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 11 Agent 11Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above aoolication are true and accurate to tha hast of m, knowledge and that all plumbing work and installations performed under the permit issue ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge o is ap lication will be in compliance with all I s. _ BY T e of License: Title • lumbe m Sigh ur 'Licensed Plumber or Gas Fitter • -Gas fitter -as er-- License Number City/Town • -Journeyman APPROVED (OFFICE USE ONLY) Dat .. !.. . 0-ryO � oTOWN OF NORTH ANDOVER 40 PERMIT FOR GAS INSTALLATaOI�+ SSACHUSE� This certifies thateGl�,4. .............. has permission for gas installation in the buildings of . 34' ...j i .4P - ............ at ................... ......... , North Andover, Mass. Fee)S...... Lic. No. �J/ � . ...................... ..�5 GAS INSPECTOR Check # 6633 G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) %P-.-W1)� j')- ,Mass. Date 1,13/200(e Building Location :� 6 FeRIJ w0,1 -)b Owner's Name Owner Tel# New ❑ Renovation ❑ Permit # Type of Occupancy At: r1 2 Replacement ❑ Plan Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name <aAL�A/� A --C-.. L Address 13, L -%'7e) . S' Z Business Telephone # L SLgC-)-:3 Name of Licensed Plumber or Gas Fitter QEF/— UI Check one: Certificate ErCorporation 114 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current Iia "lity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checkedeyes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 'tj 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 13 Agent ❑ Signature of Owner or Owner's 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 ml rmowreage ana tnat all plumbing work and installations performed under the permit issu o is application will be in compliance with all City/Town APPROVED (OFFICE USE ONLY) State Gas Code and Chapter 142 of the Ge I s. T e of License: ! •• lumbe Sig Licensed Plumber or Gas Fitter • -Gas fitter j ] ICE• ase License Number • Journeyman