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HomeMy WebLinkAboutMiscellaneous - 12 MILLPOND 4/30/2018 12 MILLPOND 210/095.A-0012-0000.0 2994 Date. J.. ,�!,f��• •�• ca ,LORTN TOWN OF NORTH ANDOVER a 3=0y4,,.o t PERMIT FOR GAS INSTALLATIONS . o ,SSACMUSES t!] This certifies that . . /.�.. .� . • • • • • • • • L•,•,. • 4�• has permission for gas installation .:-��?� :.-.��,. • �� in the buildings of . . � /��.!... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ;/. . �? �l'�::. �. . . . . . . . . . . . . .. North Andover, Mass. Fee. .? Lic. No.. ?ttc�U. . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Y. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print of Type) NO . ANDOVER , MA Mass. Date 1g03�1 Permit �� a Building Location MILLPOND _ Owner's Name_ N0 . ANDOVER , MA Type of Occupancy RES New ® Renovation ❑ Replacement ❑ Plans Submitted: YesEj No O I zl I i! N h a I T K o 7- N W w O U F- n C7 'J 'n W _ W F r _ O a © n F < - 0 C O o F u t 6 w W CL C .� n _v _ 01 Q W U W — Vi W W < Q U 2 W 1 F C J F F W w O ! Q > Li F' J W 1 <UJ W > rt W = < ( C O W G O F- O C� = LL O O O. J U I C > O CL }" O SUB—HSMT. I I BASEMENT 1ST FLOOR 2N0 FLOOR I L I I SRO FLOOR 4TH FLOOR 57H FLOOR I I I I I I I I I I I I I 6TH FLOOR 7TH FLOOR 87H FLOOR I I I I I I I I I ( I j Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate 7 Address 91 BELIVIONT STREET C3 Cerperatlon NO .ANDOVER , MA . 01845 _ ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter JOSEPH KEVIN C:'-.LLAHAN INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equtvale^t which meets the requirements of MGL Ch. 142- Yes 42Yes ? No O It you have checked Les, please Indicate the type coverage by checking the appropriate box. A_Oablltty Insurance policy ED Other type of Indemnity D Bond D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Ct:!�ter 142 or the Mass. General Laws, and that my signature cn ;ais permit application waives this requirement. Check one: OwnerD Agent ❑ Signature of Owner or Owner s Agent I hereby oertlfy that all of the details and information I have submitted (or enle,ed) in ove appficallon are true and a=urate to the best of my knowledge and that all plumbing work and InstallaUcns performed under the er r.:t ( sued for lhl3 ayc��ab,,,In pflnnu with all pertinent provisions of the Massachusetts Slate Gas Cade and Gtiapter 142 of the l neral LaBy Trpi of Ucense: I tuber g•atur o c nse ,umoe or Gas Ftter l Titleasriller r Mastcr Ucerse Number M— 3 4 4 0 jC;ly/Town Jouineyman