HomeMy WebLinkAboutMiscellaneous - 65 Foxwood Lot 16 61-15'
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1 ,J UfAli-UHtvt APPLICATION FOR PERMITTO DO GASF
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Print of Type)
NORTH ANDOVER Maas. Date
Building
Permit #
,,cPV' Location
1a rPOwner's,
- _ / Name-
New C Renovation C1 Replaicemen# C] Plan' Submitted:.. Yes ❑ No
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SASIMEHT
14T.FLOOR
2110..FLOOR.,
SRO FLOOR
47H FLOOR
j STH FLOOR -77
J 4TH FLOOR I
7TH FLOOR t
0TH FLOOR
` Check one: CertNicate
lnstafting Company Name 1.r. S Q• f�n c
Address �•O . k v. °rP. _L.._�i 6
1 [j .Partnership
1;d �'�.-L l/ lA t�. S 3 / Firm/Co.
`Business Telephone -
.Name of Ucensed Plumber or Gas Fitter ) c
` HSURANCE COVERAGE: Check on
t have a current liability insurance policy or Its substantlal equtvaient.: Yea f No p
If you have checked es,
y_ please Indicate.the type.coverage.by checking the„appropriate t�ox.,
IA liability Insurance poilcy L7 piper type o! kx�emnity ❑ Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by .
Chapter 142 of the Maes: general Lawn, arra,that my signature on this perrntt appl1catlon waives this requirement.
Check one:
� nature o Owner or Owner's ant Owner ❑ Agent ❑
lI he&eby certify that aq of the details and'lr formation I have submitted ((r entered)In above application are true and accurate to the b
est of Yknowledge and that all plumbing work and Installations performed under the perrrid Issued for this rippikatlon wilfbe In compilanee with all
my
pertinent provisions of the Massachusetts State.Gas Upde and Chapter 142 of the al La
BY T nse:
umber
Title ter na urs o nae um er or as er
ICttylTown Master !}cense Number> �
�Journeyman �
AF'MOVED:(OFFICE USE ONLY)
1
1� Date.2316
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A
NORTH TOWN OF NORTH- ANDOVER
p PERMIT FOR GAS INSTALLATION
.. S4CHU5 43
This certifies that . .e.4ell�.sft�. . . . :?t . . . . . . . . .
has permission for gas installation A):?
in the buildings of . . . . . . . . . . . . . . • . .
r at : .6.�?. . .�n�,u--U �d. . . . . . . . . . . , N Andover, Masi
s
Fee. . . Lic. No./
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:FI{b