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210/095.A-0023-0000.0
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NO.ANDOVER ,MA Mass. Date 19 Permit
R Building Location ?,® MILLPOND Owner's Name 6�11119APJzo>;y
NO.ANDOVER,MA Type of Occupancy " RES
New ® Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ ' No 0
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SUB—BSMT.
BASEMENT J
1ST FLOOR
2ND FLOOR I I I
3RD FLOOR
4TH FLOOR I I
STH FLOOR
6TH FLOOR I 1 I
7TH FLOOR I I
8TH FLOOR I I
Installing Company Name CALLAHAN AIR CONDITIONING Check one: Ceri lcate u
Address 91 BELMnNT STRF T C3 Corporation
NO.ANDOVER,MA. 01845 ❑ Partnership
Business Telephone 508-689-9233 0 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
42Yes R1 No O
If you have checked Les, please Indicate the type coverage by checking the appropriate box
A liability Insurance polity V Other type of Indemnity 0 Bond 0
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:
OWnefO Agent 0
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) In ove apprication are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the permit sued or this appl,c will b In glance with all
peNnent provisions of the Massachusetts Slate Gas Code and Chapter 142 of the neral law
t eY T e of License: �'
PPIber gnatur o c nse um a or Gas titer
Tititer License Number M-3440
Cily/Town neyman
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v;2 813 Date.. 1.�,�1. .......
NpRTIy TOWN OF NORTH ANDOVER
p?pae4,�eo ,e 1tip�
p PERMIT FOR GAS INSTALLATION
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This certifies that . . :.�:..��! � , L;:'. .; : /l. . . . . . . . . . . . . . . . . .
has permission for gas installation . �:. . d. . . . . . . . . . . . . . . . . . .m. .
in the buildings of . . . . . . . . . . . . . . . . . . . .�. .
at . . . . . . . . . . . .. North Andover, Mugs.
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Fee. . . Lic. . . . . . . . . . . . . . . . . . . . . . . .. .
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer