HomeMy WebLinkAboutMiscellaneous - Exception (711)Date..L�!"..a! .� l.......
„ORTy
of 11
o� TOWN OF NORTH ANDOVER
' PERMIT FOR GAS INSTALLATION
9 -
,SS^C'MUSEt
This certifies that
has permission for gas installation . .... ......
in the buildings of ..........
at . ����.... �P�-��' . , Noah Andover, Mass.
FeeLic. No.dy .� ..........
%.GAS I,�SPTOR
Check # �,.��' % (/
4721
MASSACHUSETTS UNIFORM
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
77 Gj �4 �--� j�y� G�—L��—�-Y�. Owner's
New ❑ Renovation Replacement
TO DO GAS FITT ATG
i
Plans Submitted
Date 4,771—e59
Permit # �!T k
Amount $ moi'F; _
or type)
�%� / Check one: Certificate Installin Company
Name /L�/ �v%sem Corp. �%
Addfess �'Partner.
Business Telephone �� 7 Firm/Co.
0.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes q No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy IM 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 13 Agent 1-3
I hereby certify that all of the details and information I have submitted (or entered) in above application
a true and accurate to the
best of my knowledge and that all plumbing work and installation performed under Permit Issued is application will be in
compliance with all pertinent provisions of the Massachusett�e�ipas Co andCh pter 14 the General Laws.
(Title
City/Town
APPROVED (OFFICE USE ONLY)
SignatuM—of Licensed Plumber Or Gas Fitter
El Plumber �L
® Gas Fitter LicenseNumber
Master
Journeyman
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SUB-BASEM ENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. F L O O R
4 T H. F L O O R
Iffif
5TH. FLOOR
6TH. FLOOR
7TH. F L O O R
8TH. FLOOR
or type)
�%� / Check one: Certificate Installin Company
Name /L�/ �v%sem Corp. �%
Addfess �'Partner.
Business Telephone �� 7 Firm/Co.
0.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes q No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy IM 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 13 Agent 1-3
I hereby certify that all of the details and information I have submitted (or entered) in above application
a true and accurate to the
best of my knowledge and that all plumbing work and installation performed under Permit Issued is application will be in
compliance with all pertinent provisions of the Massachusett�e�ipas Co andCh pter 14 the General Laws.
(Title
City/Town
APPROVED (OFFICE USE ONLY)
SignatuM—of Licensed Plumber Or Gas Fitter
El Plumber �L
® Gas Fitter LicenseNumber
Master
Journeyman
HOR7M
� 9
Date./:,,JJc?'..nO ..
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
'ISACMUS�
This certifies that ..............�.` `l ..:.. .... .
has permission to perform '.... .` .
................
plumbing int a buildings of *.... ... ......
at . ...�.... , North Andover, Mass.
Fee- 5...... Lic. No,�f%.7�5 ... .. .:.:.... � ...........
�PLUMBINGINSPECTOR
Check # 7
5;91
MASSACHUSETTS UNIFORM
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
of
CATION FOR PERMIT TO DO PLUMBIN
✓DateDY'
/.�w/Xz/ Permit # l J/
Amount 12p=—
(Print
2p i
New Renovation Replacement Plans Submitted Yes No
FIXTURES
(Print or type) '�/d �K �sPf �G �rL�� Ch -Co Certificate
Installing Company Name � "�— �. � ��
Partner.
Busirss Te ep one S— 7:77 7D Firm/Co.
Name of Licensed Plumber: �/�G �C7�%� �✓//y-_ !/,l//, �//v `t°�
Insurance Coverage: Indicate the pe o urance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
ignature Owner ❑ Agent
I 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 my knowledge and that all plumbing work and install i ns performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massacht ts Plumb" de ha l42 of th ws.
By:
SignaTure 01 LIQgi-Me(Ium
Type Jof Plumbing—=License
Title '� –7
City/Town LicenSe NUMer Master ❑ Journeyman
APPROVED (OFFICE USE ONLY