HomeMy WebLinkAboutMiscellaneous - 38 MILLPOND 4/30/2018MASSACHUSETTS UNIFORM APPLICATIO�� FOR PERMIT TO DO GASFITTING
(Print or Type)
N10.ANDOVER,MA Mass. Date ��� 1g_ Permit
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Building Lcca(ion �3�5 MTLI,POND Owner's Name
N0. ANDOVER MA Type of Occupancy RES
New ® Renovation ❑ Replacement ❑ . Plans Submitted: Yes❑ No ❑
Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate Ir
Address_ 97 BELMONT STREET C3 Corporation
NO . ANDOVER , MA . 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Flrm/Co.
Name of I lcenseci PlumhPr nr ras Fitter JOSEPH KEVIN CALLAHAN
INSURANCE COVERAGE:
I have a current Ilabiltty Insurance policy or tts substantial e utvalent which meets the requirements of MGL Ch. 142
Yes IBJ No ❑
If you have checked Les, please Indicate the type coverage by checking the appropriate box
A Ilablltty Insurance policy JD Other type of Indemntty ❑ 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 application waives this requirement.
Check one:
owner -7 Agent ❑
Signature of Owner or Owners Agent
I hereby certify that all of the delals and information I have submitted (cr entered):,��ne'ral
ove apD5-atlon are lrue and ar~urate to the best of my
knowledge and Lhat all plumbing wcrk and !nstallaUons performed under the perp'.ed for this eppllcaU will b In pflance with all
pertJnenl provisions of the Massachusetts Stale Gas Cana and Chapter 142 of the Law
T�pi of Ucense:
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aster Ucense Number M– 3 4 4CAy/Town uineyman
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Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate Ir
Address_ 97 BELMONT STREET C3 Corporation
NO . ANDOVER , MA . 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Flrm/Co.
Name of I lcenseci PlumhPr nr ras Fitter JOSEPH KEVIN CALLAHAN
INSURANCE COVERAGE:
I have a current Ilabiltty Insurance policy or tts substantial e utvalent which meets the requirements of MGL Ch. 142
Yes IBJ No ❑
If you have checked Les, please Indicate the type coverage by checking the appropriate box
A Ilablltty Insurance policy JD Other type of Indemntty ❑ 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 application waives this requirement.
Check one:
owner -7 Agent ❑
Signature of Owner or Owners Agent
I hereby certify that all of the delals and information I have submitted (cr entered):,��ne'ral
ove apD5-atlon are lrue and ar~urate to the best of my
knowledge and Lhat all plumbing wcrk and !nstallaUons performed under the perp'.ed for this eppllcaU will b In pflance with all
pertJnenl provisions of the Massachusetts Stale Gas Cana and Chapter 142 of the Law
T�pi of Ucense:
[-� F_'lumber S alur o c nse umbe or Gas tier
i,lle (Prf S+�srt I a r
r r�yi
aster Ucense Number M– 3 4 4CAy/Town uineyman
!J' nf1CT/f. Vii;` C i
J r
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211 �l Date . %' .. ;
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N0RTN TOWN OF NORTH ANDOVER :
pF �,.ao ,e gtip q
f0 '� p� PERMIT FOR GAS INSTALLATION
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This certifies that. �'� �?.....�,/�........�.
has permission for gas installation. ....
in the buildings of .,1/�1��! ................ r
at ............ , North Andover, Md%.
Fee r,.s .... Lic. No..3.S!%U .. .... .
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File