HomeMy WebLinkAboutMiscellaneous - 42 Phillips Court U-A 42 PHILLIPS COURT U-A
210/095.0-0032-0OOO.A
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Date. . . /././.7 (f Z- ......
f WORTH , .s
TOWN OF NORTH ANDOVER
F 9
• - PERMIT FOR GAS INSTALLATION
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SSACHUSE -
This certifies that . ' E
has permission for gas installation
in the buildings of . . . . yt. . . . . . .
at . . . �jfZ: .����. rll1 . .� '!� , Northam ndover, Mass.
Fee. . 6. .,.f Lic. No. .
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GAS INSPECTOR
Check#
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASMITTING
(Print or Type)
MaINC12 Mass. Date I b12 Q 12 Permit #
'building Location 42` 4 PH ILLlPS Gr. Owner's Name Wll.l,l AM CA A!TY
" �•°•` t`t(�R'CN Aty0OVU-11 HA. Type of Occupancy 2 F NIL
New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑
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SUB—BSMT.
BASEMENT Z
ISTFLOOR
2ND FLOOR
3RD FLOOR _
N4TH FLOOR
STH FLOOR
O6TH FLOOR
(--oO 7TH FLOOR
STH FLOOR'
Installing Company Name_COL..UMBIA -GAS GF MASSACHUSETTS Check one: Certificate #
Addr6ss 55 MARSTON STREET X] Corporation 1862
LAWRENCE, MA 01841 - 2312- ❑ Partnership
Business Telephone 9 7 z-69.1- 640 6 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter Francis X. Corkery
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No
If you have checked yes, 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". /,
d accur,ote to the best of my
knowledge and that all plumbing work and installations performed under the permit n compliance with all
dinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GeS. j
T e of License:
Plumber Signature of Licensed Plumber or Gas
Title Gasfitter
Master License Number 3745
City/Town Journeyman
APPROVED OFFICE SE ONLY
_ i•
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
FEE ;
N O. ,
APPLICATION FOR PERMIT TO bO GASFITTING
NAME TYPE OF BUILDING
r LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE .19
GAS INSPECTOR