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210/095.A-0002-0000.0
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NO.ANDOVER ,MA Mass. Date : 1g Permit #-ja o?6 = .
a Building Location -ILLPOND Owner's Name
NO.ANDOVER,MA Type of Occupancy ' RES
New ® Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑
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71 SUB—BSMT.
BASEMENT
1ST FLOOR
ZN0 FLOOR I ( I I . I v
3RD FLOOR I_ I ( 1 I I r✓I
4TH FLOOR
STH FLOOR I
6TH FLOOR' i
7TH FLOOR
8TH FLOOR
I' Installing Company Name CALLAHAN AIR CONDITIONING Check one: Ceri lcate 7
Address 91 BELMONT STREET ❑ Corporation
NO.ANDOVER,MA. 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Ucensed 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 Q No ❑
If you have checked Yes, please Indicate the type coverage by checking the appropriate box.
A liability Insurance polity Z) 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 appllcatlon waives this requirement.
Check one:
Owner(:] Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the decals and information I have submitted (or entered) In ove appricatlon are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the permit sued l0r this appilcatl will b In p(Iance with all
peNnent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the qneral Law
t3y T e of Ucense:
0m,
lumber gnatur o c nse um a or Gas tier
Title asritter
Cily/Town aster Ucense Number M-3440
AP P110 TF.I CMZ` p . Journeyman
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o �} Date... . .... ... .
.pORTH TOWN,.OF NORTH-:ANDOVER - ;
32 PERMIT:FOR GAS INSTALLATION
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SSACMUSEtty -
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. This;certifies-that . . ec'.�-�.',�
,has permission for gas installation .
in. the buildings of
. . .
at I�lorth Andover Mass:
L1
Fee
25.00 PA1. GAS'1NSPECT0R
WHITE:Applicant CANARY:Building Dept PINK:Treasurer GOLD File: