HomeMy WebLinkAboutMiscellaneous - 109 MILLPOND 4/30/2018 y -
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING e~'
(Print or Type)
Mass. DateO.ANDOVER ,MA
_2;6_ Permit #_ O
Building Location1W M-ILLPOND Owner's Name
NO.ANDOVER,MA Type of Occupancy " RES
New ® Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑
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BASEMENT 1
1sT FLOOR
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ORO FLOOR
4TH FLOOR ( I
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6TH FLOOR I I 1
7TH FLOOR
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Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certmcate u
Address 91 BELMONT STRFFT 13 Corporation
NO.ANDOVER, MA. 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142
Yes R] No O
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A Ilab(lity Insurance policy Z) Other type of Indemnity I] 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❑ Agent ElSignature of Owner or Owner's Agent
I hereby eartlfy that all of the details and information I have submitted (or entered) In ove appGcatlon are true and accurate to the best of my
knowledge and that all plumbing work and lnstallaUons performed under the permit sued for this appllcaU will b In pflance with all
perUnent provrsions of the Massachusetts Slate Gas Code and Chapter 142 of the neral Law
ey T e of Ucense:
Pt bet gnatur o c nse um a or Gas diet
' rile stoat
aster Ucense Number M-3440
Ci ty/Town Jo ur n eym an
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Ns s23 2094 Date./wf �r. :. . ....
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NpRT1, TOWN OF NORTH ANDOVER - -.
0 PERMIT FOR GAS INSTALLATION
S+ACMUSE�t
This certifies that . . . . . . .. . . .
has permission for gas installation . . . . . . . . . . .
in the buildings of ..,19C . . . . . . . . . . . . . . . . . . . . . . . . . '
ti
at . . ... . . . . ., No h Andover, Mas
Fee. a.y: r . . Lic. No. . . . . .
aAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File