HomeMy WebLinkAboutMiscellaneous - 8 Martin AvenueCb
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Date......... ........... I
TOWN OF NOWH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ... ...........
has permission for gas installation 'A� ..............
in the buildings of .... ...........................
at ...... r).., North Andover, Mass.
Fee -2-6-.'.. Lic. No. ��'.-3 ...............
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Check
6355
MASSACHII-S
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(Print or ype)
1 1�
Building Looncatiort
New❑ Renovation o
UNIFORM APPLICATION FOR -PERMIT TO DO GASFITTiNG 475�
Rate r 69 2QO Permit ZY
Owned' am Q N,^,il
Ua—Type of occupancy
Replacementy, flans Submitted: Yes p No 0
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-installing Company riam('2
Business Telephone jP() .< X %.".I) --
Name of Licensed Plumber or Gas fritter
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Check ane: Certificate
❑ corporation
❑ Partnership
INSURANCE COVERAGE:
I have a current} billty insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes No Q
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity 0 Bond p
OWNER'S INSURNACE WAIVER. l 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 thls permit application viralves this requirement
Check one:
signature of Owner or owner's Kg—en! Owner ❑ Agent 0
I hereby certify that all of the details and Information I have submitted for entered) to above application are true and accurate to the best of
my knovKedge and that all plumbing work and Installatibris performed under the per /4s ued for this applicatio�u tIt be in compliance with
all pertinent provisions of the Massachusetts 5 tate Gas Code and Chapter 142 of the G ne Laws. I ii I
Type of W'J U,, .C.�
BY ❑ Plumber ,a re of Licensed Piitiber or Gas Fater
Ticic i ❑ G gist
APPROVED
t r License number �L-3 03
APPROVED (OFFICE USE O1vLl) 0 Journeyman
Date .. / . - /- UG..... .
ee�` TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
�a
This certifies that ... .....
has permission for gas -,,installation ..' . .........
in the buildings of.1.'"�........................... .
at.... :, . , North Andover, Mass.
i' .Z/
Fee ?...... Lic. No�A4?...
C G S INS GT R
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Check #
A69
N ASSACHUSErIM UNIFORM APPUCATON FOR PERMiT TO DO GAS F FLING
(Type or print) Date 7AIle G
NORTH ANDOVER, MASSACHUSETTS
Building Locations �` a I'✓ `-�''a, Permit #
Amount $ �5
Owner's Name (2f C
New ❑ Renovation El Replacement a Plans Submitted 11
(Print or type)
Name .I-7-1
Address ad
7T v 7
4eA-Z 60f -e AL
rJ n -. 5Lfi
U
Check one: Certificate Installing Company
E] Corp.
11 Partner.
[3-Firm/Co.
Name of Licensed Plumber or Gas Fitter J3 D i� 51�
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [3---r No
If you have checked}_es, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 11— Other type of indemnity 1:1 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:
Signature of Owner or Owner's Agent Owner Agent 13
11�1cy Lc1 Lily u1a1 all v1 u1n uMaus auu imormanon i nave suomittea (or enterect) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachyqe s Sto Gas Code 4d ChapterA2 of the�General Laws.
(Title
City/Town
OVBD (OFFICE USE ONLY)
Signature of
r7rPlumber
0 Gas Fitter
13 --Master
Journeyman
'sed Plumber Or Gas Fitter
tcense N um er
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SUB-BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type)
Name .I-7-1
Address ad
7T v 7
4eA-Z 60f -e AL
rJ n -. 5Lfi
U
Check one: Certificate Installing Company
E] Corp.
11 Partner.
[3-Firm/Co.
Name of Licensed Plumber or Gas Fitter J3 D i� 51�
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [3---r No
If you have checked}_es, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 11— Other type of indemnity 1:1 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:
Signature of Owner or Owner's Agent Owner Agent 13
11�1cy Lc1 Lily u1a1 all v1 u1n uMaus auu imormanon i nave suomittea (or enterect) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachyqe s Sto Gas Code 4d ChapterA2 of the�General Laws.
(Title
City/Town
OVBD (OFFICE USE ONLY)
Signature of
r7rPlumber
0 Gas Fitter
13 --Master
Journeyman
'sed Plumber Or Gas Fitter
tcense N um er