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HomeMy WebLinkAboutMiscellaneous - 201 GREENE STREET 4/30/20181 1 1 - ", r-, - Date ... ....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING V,� -9�� � �v ,C- It -L C, � l (� V/�- This certifies that .............. . ............. ............... ...... has permission to �(C-Y-j ... ....... .... ... plumbing in the buildings of 1k at C2 b I (QNro ........................................................ : .................................... North Andover, Mass. Fee .��5 . ...... Lic. No. .. ..... ............................................. PLUMBING INSPECTOR Check # i L P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE /0 PERMIT # (W -7 I JOBSITE ADDRESS! %Z s r OWNER' NAME t-"J� OWNER ADDRESS TELE��FAXE OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL NEW: a— RENOVATION: ® REPLACEMENT: FIXTURES Z FLOOR BSM 1 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTIO WATER HEATER ALL TYPES WATER PIPING OTHER A,-, , r/ 'Ai t . i nit I��r 2 3 1 4 1 5 1 6 1 7 RESIDENTIAL [3—' - PLANS SUBMITTED: YES 8 1 9 1 10 I 11 1 12--F-1-3 14 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [D OTHER TYPE OF INDEMNITY [j BOND E] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNERE] AGENT E] I hereby certify that all of the details and information I have submitted or entered regarding this application are tru n u and that all plumbing work and installations performed under the permit issued for this application will be in com a th II�Pertinent pro s on of theest of my Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I JEFF HUTNICK -JLICENSE # = IGNATURE MP[� JP 1 CORPORATIONS # 3532 PARTNERSHIP[]# ' LLCD#[ COMPANY NAME I CALLAHAN AC AND HTG ADDRESS 91 BELMONT ST CITY I NORTH ANDOVERSTATE MA ZIP 01845 TEL (g7g—ggg_9233 �e _ __ FAX CELL 978 423-6305 EMAIL ,PLUMBING@CALLAHANAC.COM P Date .....�C�?� (.�. �. .................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that:... 7�-4 ....................................... ....................... . ................... ...... has permission for gas installation..v, 44rnt............. ........................ in the buildings of ..... at ...... 9-M..... PPj.e......��7� ...................... North Andover, Mass. Fee ...--...... Lic. No. �t21- ........ ..................................................................... GAS INSPECMR Check # a 11W s �J.� A 19 fw G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK NEW: RENOVATION: 0 REPLACEMENT: APPLIANCES Z FLOORS - BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATFR WATER HEATER BSM 1 1 1 2 1 3 1 4 1 5 PLANS SUBMITTED: YESEI NO 6 1 7 I 8 1 9 1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true an cc a the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian i P rti vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME DiFF HUTNICK LICENSE # 15212 SIG `URE MP Ej MGF 0 JP El JGF LPG] CORPORATION []# 3532 PARTNERSHIP # LLC # COMPANY NAME: CALLAHAN AC AND HTG ADDRESS 91 BELMONT ST CITY NORTH ANDOVER STATE ZIP MA 0184 TEL 978 689-9233_ _ _ a FAX CELL EMAILPLUMBING@C ALLAHANAC.COM