HomeMy WebLinkAboutMiscellaneous - 108 MILLPOND 4/30/2018 108 MILLPOND
210/095.A-0108-000p_0
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y� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NO . ANDOVER , MA Mass. Date ��� ig Permit
LV Building Lccatlon LJiLLPOND Owner's Name L52 NO. ANDOVER , MA Type of Occupancy RES
New ® Renovation ❑ Replacement ❑ Plans Submftted: Yes❑ No O
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I I I I I I
BASEMENT I I I
1ST FLOOR I
2N0 FLOORI I
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5R0 FLOOR I_ I ( I I I J 1
ATH FLOOR I I I I I I I
STH FLOOR
6TH FLOOR I 1 I I I I I I
7TH FLOOR I I I I
i V I I I
8TH FLOOR
Installing Company Name CALL AHAN AIR CONDITIONINC Check one: Ceritflcate -71
Address 91 B L�^ONT STREF'I _ D Corporation
NO . ANDOVER , MA . 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN C:,LLAHAN
INSURANCE COVERAGE:
I have a current Ilabllfiy Insurance policy or fts substantial equivalent which meets the requirements of MGL Ch. 142
Yes RJ No ❑
iIf you have checked Les, please Indicate the type coverage by checking the appropriate box
A Itablllty Insurance policy Z3 Other type of Indemnity ❑ 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:
owner-0 Agent ❑
Signature of Cwner or Owners Agent
I hereby certity that all of the delais and information I have submitted (cr enterec'r in ove appGca(lcn are true and accurate to the best of my
kncsledge and that all plumbing wcrk and !nslallaUens pericrmed under the perm.:', �,dsued for this appflcaUqq wdil b In pflance with all
pertinent provisions of the Massachusetts Slate Gas Cade and G"-lapter 142 cl the neral Law
@y T e of Ucensei
( Ftumber ,S-,awr o c nse umoe or Gas ler
t Tiitle as(lt6r
' aster Lc,nse Number M— 3 9 9 0
co/7own Journeyman
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T23 Date. . . !>. `?. . ...
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HORTH TOWN OF NORTH ANDOVER
of „to ,e,tio
0` PERMIT FOR GAS INSTALLATION,:
�9SSAC14USEtty p St
This certifies that . `��` �.r�. . . . �. . . . . . . . . . . . . y
has permission for gas installation . . ./.".7- j< .6?(. .... . . . . . . . .. J`
in the buildings of
at . . . . . . . . , North Andover, Maw,
Fee.). Lic. No.3 . . . . . . . . . . . . . . . . . . . . . . . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File
Date. ..
HORTM
3=Oy�,.ao ,e1�yo�
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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. t�9SSACMUSES
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This certifies that t6?cIS„ . , h , , , , , , , , , , , , , , , , ,
has permission for gas installation . . . k)A*C
in the buildings of . . , sv l<< v Nti
at . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee. . . . . Lic. No. l to g�. . 'T.Dto221 I
A AA(C,,....--. . . . . . . . . . . . . .
C GASINSPECTOR
Check#
4229
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Building Locations AQ PO �I Zl�l Permit#
Amount$
`SU ( tl kq-YL,-" Owner's Name
New Renovation Replacement Plans Submitted
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U C va
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SUB-BASEMENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH . FLOOR
7TH. FLOOR
8TH . FLOOR
N�ate� type) Cone:
�C /S G(� ����j21� � � Co: Certificate Installing Company
,yy rp.
Address �Or 6� Partner.
Business Telephone E] Finn/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [3 NoO
If you have checked yies pleas4 indicate the type coverage by checking the appropriate box
Liability insurance policy ®" Other type of indemnity 13 Bond 0
Owner' ,Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass.(ieperal Laws,and that my signature on this permit application waives this requirement.
Check one:
Signaturedof Owner or Owner's Agent Owner 0 Agent a
hereby certify that all of the details and information I have submitted r entered)in above application are true and to to the
best of my knowledge and that all plumbing work and installations ormed and �m►it Issued for this applicati
compliance with all pertinent provisions of the Massachusetts S Code and Chapter 142 of a General
By: Signature of Licensed Plumber Or Gas Fitter
Title Plumber
City/Town Gas Fitter um er
0 Master
APPROVED(OFFICE USE ONLY) ❑ Journeyman