HomeMy WebLinkAboutMiscellaneous - 78 MILLPOND 4/30/2018, J6
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFiTTIN' G t
(Print or Type)
NORTH ANDOVER Mass. Date
Building Location /��l,'/` ✓�� �/ �j�, ' j
Owners
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New '^ Renovation II Replacement L] Plai
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Permit
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Name /J? L�,�,,� /��,
s Submitted ] / X,�
(Print or Type)
Installing Company Name
Address
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Check one: Certificate
Q Corp.
Partner.
1"A /J�i'r� J., �% ���_ ? Firm/Co.
Business Telephone:
Name of Licensed Plumber or Cas Fitter r �- ,i� �? 1�r✓ a �%
Insurance Coverage: Indica .e ;yPe of i^suran.ce coverage by checking the
appropriate box:
Liability insurance policy C Ct;:er type of indemnity 0 ..Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owneriagent of property Owner = Agent Q
I hereby ccztify that all of the dcuils and information I have submitted (er entered) in &Fore appiiealion are true and accurate to the best of my
knowledge and that all plumbin; woric and lnstaL'acioos ;cforxacd under fteratic iuued fo: this sppiication will be in colaptianae w{tla all pertlacat
provisions of the Massachusetts State cas Gide and :apses :s: ei a-.* Gcic i Laws.
I Plc�rt;,er
Title I GasLitter Signature of License
;easter PlumberorGasfitter
C'�y/Tcwn: Journeyman � 7,1 /�
APPROVED (OFFICE USE ONLY) Lice'n_te Number .
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(Print or Type)
Installing Company Name
Address
/' J7- -
Check one: Certificate
Q Corp.
Partner.
1"A /J�i'r� J., �% ���_ ? Firm/Co.
Business Telephone:
Name of Licensed Plumber or Cas Fitter r �- ,i� �? 1�r✓ a �%
Insurance Coverage: Indica .e ;yPe of i^suran.ce coverage by checking the
appropriate box:
Liability insurance policy C Ct;:er type of indemnity 0 ..Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owneriagent of property Owner = Agent Q
I hereby ccztify that all of the dcuils and information I have submitted (er entered) in &Fore appiiealion are true and accurate to the best of my
knowledge and that all plumbin; woric and lnstaL'acioos ;cforxacd under fteratic iuued fo: this sppiication will be in colaptianae w{tla all pertlacat
provisions of the Massachusetts State cas Gide and :apses :s: ei a-.* Gcic i Laws.
I Plc�rt;,er
Title I GasLitter Signature of License
;easter PlumberorGasfitter
C'�y/Tcwn: Journeyman � 7,1 /�
APPROVED (OFFICE USE ONLY) Lice'n_te Number .
A
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Dept.
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG u/
(Print or Type)
NO . ANDOVER , MA , Mass. Date ted- : 10Y_ permit CQ09,7
Building LocationY MILLPOND Owner's Name
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NO . ANDOVER , MA Type of Occupancy RES
Im
New ® Renovation ❑ Replacement ❑ • Plans Submitted: Yes❑ • No ❑
Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate u
Address 91 B .MONT STREET ❑ Corporation
NO . ANDOVER , MA . 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142-
Yes
42Yes Q No ❑ '
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A ilabllity insurance policy 91 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 taws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ 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 applcatlon are true and accurate to the best of my
knowledge and that all plumbing work and InstallaUcns performed under the permit sued for this applicaU will b In p(lance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral law
BY T e of Ucense: �'
Plumber gnalur o c nse um a or Gas atter
Title Gasritter
Master License Number M-3440
ArY Journeyman
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SUB—aSMT.
BASEMENT
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1ST FLOOR
2N0 FLOOR
ORO FLOOR
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4TH FLOOR
STH FLOOR
I
6TH FLOOR
I
7TH FLOOR
STH FLOOR
Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate u
Address 91 B .MONT STREET ❑ Corporation
NO . ANDOVER , MA . 01845 ❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142-
Yes
42Yes Q No ❑ '
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A ilabllity insurance policy 91 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 taws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ 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 applcatlon are true and accurate to the best of my
knowledge and that all plumbing work and InstallaUcns performed under the permit sued for this applicaU will b In p(lance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral law
BY T e of Ucense: �'
Plumber gnalur o c nse um a or Gas atter
Title Gasritter
Master License Number M-3440
ArY Journeyman
0 .
ATS 27 Date... �.. .�?.
_.
F NORTH , TOWN OF NORTH ANDOVER.
O i •e, 't'p - .J
p PERMIT FOR GAS INSTALLATION
This certifies thatdam--
...............
has permission for gas installation . .... ....
in the buildiRgs of °' a+ ..........................
at ...74 f ,� 771,11 . ... . . . . . . . . . . , North Andover, Mass.
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Fee. f`1p4� Lic. No. Md
S3 25, 00 PAID GAS INSPECTOR
WHITE: Apple ant CANARY: Building Dept. PINK: Treasurer GOLD: File