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CITY OF EVERE'YT <br /> GAS PIPING TEST AFFIDAVIT <br /> Homeowner � G % <<� . �fPf��s <br /> Address ��13 0 e� `'� � <br /> Permit No. �U�D� -n�"L' <br /> The gas piping system was tested at �_�_PS� for a total of 1 � minutes. <br /> � /' ��� �aa- � <br /> WITNESSED BY ��-'z- L '�"`�� <br /> (signature of o upant requestiny yas service) (date <br /> INSTALLED BY �4 ���'�`y " ." � ��'"� � <br /> (signature of mstalling gas fitter) (date <br /> Piease arrange for someone to be present on the date of requested inspection to provide <br /> access tor the inspector. <br /> Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />