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HomeMy WebLinkAboutMiscellaneous - 58 MILLPOND 4/30/2018 58 MILLPOND �n 210/095.A-0058-0000.0 ______� �1 3322 ,ap R7h TOWN OF NORTH ANDOVER 13rObat�.ao ,+1tipL PERMIT FOR GAS INSTALLATION • a j ,SSACHUSEt This certifies that . %?. .: :.<: !e. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . �..:1. . . .: . . . . . . . . . . . . . . . in the buildings of . . . . . . ` J.:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .S . �. . . ,�:;?,.• r:�. . .,!. . . . . . :. . . . . .. North Andover, Mass. Fee. Lic. No.. y. .`! . . . . . . . . . . . . . .... ....�.. . . . . ,GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR -WRMIT TO DO GASFITTiNG (Print r Typ Wiz . !a , Maasss.. Dattee /� :.19 l� Permit # 3 a. Building Location Owner's Name Type of OccupancyL�S New 2— Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ y y W y Q Y y y V y y C y CC O y S }. W W C }-� y O V m = !r O J C F- I; >- = 'C' .O F- O W C C O O 113 O C y H C ur t = �... V7 W W ¢ C. J = 1 C x C V ►. _ ,� F' }. W WUs 0 O ? iL t- < W ? C w = Cr < O O W O ►y M' C = O v S U. O O d J V ¢ > O C SUB—aSMT. BASEMENT Y 1ST FLOOR 2ND FLOOR 3RD FLOOR I I 4TH FLOOR STH FLOOR aTHFLOOR I 7TH FLOOR aTH FLOOR Installing..9ampany Name CALLAHAN AIR CONDITIONING & HEATING Check one: Certificate # Address 91 BELMONT STREET Corporation Nn ANnQVFR-MA Q1RL5 ❑ Partnership Business Telephone 978=689=9233 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter JOSEPH K.CALLAHAN INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes IS No ❑ If you have checked Yes. please indicate the type coverage by checking the appropriate box A liability insurance policy Mr 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 application waives this requirement. Check one: Signature of Owner or Owner s Agent Owner❑ Agent C1 I hereby certify that all of the details and information I have submitted(or ent�rerdllln ove apptictton are true a accurate to the best of my knowledge and that all plumbing work and installations performed under the emsuedfor this applicaWon11 with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 othe neral L17, aws. Tie of Ucense; Title Plumber gnatu o ce a um Gasfilter M=3440 Master License Number City/Town Journeyman Ar'fM1(T/t / �pf NOgT ' e O o ' "ate• ` hahTshe p'sbere,e tfl,hfCglNoeshs �� M' o USE7ts Not � qH0� 4 jF�OA !n 'hat. . at for r�O� C4Th /ySLT ,q gas ofi17stlF /l i -IC U pan, �G ' (y // ,Orth' .,. •�r' . N's � er ..A ar pFOToq:`- h?ass. A TieasUre, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print at Type) 1f0� A • Mass. Oate �_19 Permit Building Location z_ l'el� ';9"W4l Owns Name e of Occupancy New Renovation O Replace"/0 Plans Submitted: Yes❑ No O N N {fC • W YI N N V us a: N R O (n S F- W W0 W O C7 m f• S 'J1 cc O d C N d v W =2 < O C > W J 4.W > !� v W F- }. w o Us 0 _ w _ < W > W O 2. < s < < O O W E O tai l'- U. U. 7 3 0 O J U C > C SUB—aSMT. 1 BASEMENT 1ST FLOOR 2140 FLOOR 3RD FLOOR I I 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installin .a ©m CAL g.Cr pany Name LAIIAN AIR CONDITIONING & HEATING Check one: Certificate rr Address _ 1 BELMONT STREET O Corporation -- Nn ANDQVFR-MA n 1 R1L s O Partnership Business Telephone 978=689=9'233 O Firm/Co. Name of Ucensed-Plumber or Gas Fitter JOSEPH K.CALLAHAN INSURANCE COVERAGE: 1 have a current liability insurance policy or As substantial equivalent which meets the requirements of MGL Ch. 142 Yes ®• No O If you have checked yes, please indicate the type coverage by checking the appropriate box A liability Insurance policy V Other type of Indemnity O Bond [3 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: signature of Owner or OwnersAgent Owner[] Agent E3 I hereby cerUy that all of the details and information I have submitted(or entered)In abov applicallon are true and accurate to the best of my knorNedge and that all plumbing work and Installations performed under the permit Iss d for this application will in compliance 1 Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge al Laws. T e of Ucense: By [City/Tawn itle Plumber atur cense um er or ,iter GasGtter M=3440 Muter cense Number,� Journeyman