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' TOW NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .A.�c '�f�,� 'f .........................
has permission for gas installation ...................
in the buildings of ..... R..t ..........................
at .....! North Andover, Mass.
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Fee .. CD
.. Lic. No........... ---t ..... .
4 c ( M G . R
AS INSPECT
Check # .0 PI r
5332
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Name of .Plumber Of.r Fltter:.u�en 3 Acid
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INSURANCE:CpyERA
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Y liabilltY policy flc its wt*:h -meets. MW -requiremer�ts..d-
K you have; MGL -<Ch: =142-
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9e�y the Appropriate. box,
A tiabilty insura . ncoponcy - - - -_
OWNER'S INSURANCE:yy�R 1 artrawara
Chapter- 1.42 -ot.':G=
-theticazsee. dpes>not=have - _the InUffanceXOvera
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wabies -this requirement.
8i9nature otA Check one:
of flwi�eers Agent , . OwnerO Agent 0
hereby Y that ap of the Viand iMwmation l have submitted
9e ari." a�.pi��p tU �_ under V* p in abo�ee appf true and aoauate.to the best.o-
a°�'"°"t Provisions of the Massachusetts Stat, Gas.Code aad t�rmrt -suod far _
Chapter 142 of the General will be in oompGance w*:'
rrtte T Of Umase- .
Gasfifter natr re ofV er atter
City/Town Mash UO&M Number
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