HomeMy WebLinkAboutMiscellaneous - 50 Lincoln Street SD /-Inic01-N S7-1;�E-Er
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO D
(Print or Type) O GASFII`i'ING
NORTH ANDOVER , Mass. Date 8/16/ 1g91
Permit # f
Building Location 50 Lincoln Street Owner's Name Bruno Szelest
for 1st floor
Type of Occupancy I Ie
New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑
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SUB—BSMT.
BASEMENT 1
1STFLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOREffl
Installing Company Namer
Check one: Certificate
Address 55 M A RS i pQ
.® Corporation
LAW EQCF
Business Telephone 50 R - C�R 7. n 5 ❑ Partnership
Name of Licensed Plumber or Gas Fitter ❑ Firm/Co.
INSURANCE COVERAGE:
have a current Ilabiltty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes �f No ❑
It you have checked res, please indicate the ' . i
type coverage by checking the appropriate box. r
A liability insurance policy1 Other
type of Indemnity❑ Bond ❑ ►�rl
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance c
overage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requireme'rit; . .
Check one:
Signature of Owner or Qwner's Agent Owner[] 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
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all y
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene UY ws•
T e of license: �P ���
Title Plumber Signature of Licensed lumber or Gas Ftter
Gasfitter
City/Town Master License Number
APPROVED 0 IC ONL Journeyman
BELOW FOR OFFICE USE ONLY
FINAL INSPECTION SKETCHES PROGRESS INSPECTION
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FEE
N0.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME & TYPE OF BUILDING
f . .
LOCATION OF BUILDING
PLUMBER OR GASFITTER
LIC. NO.
PERMIT GRANTED
DATE —19 ;
GA3. INSPECTOR
t�;a
Date. .. .. / /// . .. . . .
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NORTH f 1 LT6WN OF NORTH ANDOVER
N�Oryz"EO OZ.
PERMIT FO.R.GAS INSTALLATION
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- �9SSACHU'-'
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This certifies that .�7.� � .� .ti ��.,... . . . . . .
has permission for gas installation .... . . .
in the buildings of . .:, . . +`Z!-:>:1,.! . . > ..zr. f.,, . . . . . . . . . . . . .
at . . �. �!._ ::'. . .'`?:r. y. . .1 r. t . . . . . . .. North Andover, Mass.
Fee. 'fes.` Lic. No.. k.` . . . . . .... ..I . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applcant t CANARY: Building Dept. PINK:Treasurer GOLD: File