HomeMy WebLinkAboutMiscellaneous - 164 MASSACHUSETTS AVENUE 4/30/2018 (2) 1
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TOWN OF NORTH ANDOVER
° p PERMIT FOR PLUMBING
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This certifies that ^'
...... ... ..
hhas permission to perform.............. ........................................
plumbing in the buildings of.......
at.... ` .. 5....... a........................:........... North Andover, Mass.
Fee.0 U0......Lic. No. ...............................................................
PLUMBING INSPECTOR
Check# ��
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- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT T
-- O PERFORM PLUMBING WORK
J` CITY
MA DATE i PERMIT# )
JOBSITE ADDRESSii,t ��
POWNER ADDRESS J OWNER'S NAM
TYPE OR OCCUPANCY TYPE TEL °"` `'"' FAX
COMMERCIAL .
PRINT ® EDUCATIONAL
CLEARLY NEW: RENOVATION: , RESIDENTIAL
REPLACEMENT:
FIXTURES 1 FLOOR PLANS SUBMITTED: YES
BATHTUB BSM 1 2 3 4 ® N0 .
5 6
CROSS CONNECTION DEVICE 8 9 10
11 12 13 14
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OI /SAND SYSTEM
DEDICATEDGREASE SYSTEM
DEDICATED GRAY WATER SYSTEM _
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
_ ... .
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK rv{
LAVATORY
,
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
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TOILET .... ... .
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES ~ ~
WATER PIPING
-
OTHER
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I have a current liability insurance policy or its substantial equiva ent which ch meetsG a re
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING
requirements of MGL Ch. 142. YES
NO
LIABILITY INSURANCE POLICY � THE APPROPRIATE BOX BELOW
OWNER'S INSURANCE WAIVER:I am are thatOTHER TYPE OF INDEMNITY� BOND
Massachusetts General Laws,and that my signature on this permit
the licensee does the insurance coverage required by Chapter 142 of the
application waives this requirement.
SIG
I hereby certify t at allo the deOF OWNER oORt oGEhave submitted or
CHECK ONE ONLY: OWNER
and that all plumbing work and installations pertormed under the permit issued for this ap licati AGENT
Massachusetts State Plumbing Code and Chapter ed of the General it issued
regarding this application are true
ws.
P on will be in compli n e ur to to the est of my knowledge
PLUMBER'S NAME JEFF HUTNICK II P - ent provision of the
MPD JPLICENSE#[15212
CORPORATION , SI ATURE
COMPANY NAME CALLAHAN AC AND HTG ®# 3532 PARTNERSHIP
# LLC C]#
CITY NORTH ANADDRESS 91 BELMONT ST
DOVER
STATE _.- MA ZIP 01845 -'
FAX CELL TEL 978-689-9233
978-423-6305 EMAIL PLUMBING CALLAHANAC.COM �
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Date...IiA�I..�.. ..................
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NORTh
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TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION
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This certifies that -t�-�—`T�N ���- l�t� I4 Y1r4,(v... �-
.................................................................... .................................
has permission for gas installation ...b .'.. a)
in the buildings f......... 4..r.. ..................................................... ..
........................
at............. .................................�... ........................... Andover, ass.
North er M
Fee.....��.-.. Lic. No. I h d.+dZ....... .. ...............................................
GASINSPECTOR
Check#
� MASSACHUSETTS UNIFORM APPLICATION FOR A PERM
_ IT TO PERFORM GAS FITTING WORK
s CITY
vL�
JOBSITE ADDRESS MA DATE ,�/ PERMIT# �-� l5
G OWNER'S NAME C L�
-01 OWNER ADDRESS
✓ 4 TYPE OR TE
PRINT OCCUPANCY TYPECOMMERCIAL FAX
CLEARLY EDUCATIONAL Ej
NEW: RENOVATION: REPLACEMENT: RESIDENTIAL
APPLIANCE 1 FLOORS-+ BSM PLANS SUBMITTED: YES NO
BOILER � 2 3 4 5
BOOSTER 6 $ 9 10 11 12 A3
N BURNER . `..
CONVERSIO ........,.
COOK STOVE
DIRECT VENT HEATER - �µ
DRYER
FIREPLACE
FRYOLATOR
FURNACE ` .
INFRARED HEATER _
LABORATORY COCKS ( '
MAKEUP AIR UNIT £L
ENO HEATEROM/SPA CE HEATEROF TOP UNIT � IwST i
UNIT HEATER
UNVENTED
ROOM HEATER
WATER HEATER
OTHER
,
INSU ,
have a current Iiaility_binsurance policy or its substantial equivalent wt OVmeets the requirements � � I
1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE App PRATEBOof MGL.Ch. 142 YES NO
APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Lj OTHER TYPE INDEMNITY 0 BOND
OWNER'S INSURANCE WAIVER:I am aware that the licensee does the insurance coverage required
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
9 q ed by Chapter 142 of the
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac El AGENT
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al
Massachusetts state Plumbing Code and Chapter 142 of the General Laws. curate to the best of my knowledge
PLUMBER-GASFITTER NAME JEFF HUTNICK I Pertinent provision of the
MPO MGF LICENSE# 15212
JP JGF LPGI CORPORATION 0#13532 1 PARTNERSHIP SIGNATURE
COMPANY NAME: CALLAHAN AC AND HTG �# LLC #
ADDRESS 91 BELMONT ST ~----- -
CITY NORTH ANDOVER
STATEMA ZIP 01845
FAX CELL 423-6305 TEL 978-689-9233
978
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