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Home My WebLink AboutMiscellaneous - 8 MILLPOND 4/30/2018i N_ O O N �D 0 0 g b j Date.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........... .......( .... / ............ ......... ......... . ..... ... has permission for gas ins jallation. . . . ............................ inthe buildings of ....... .r........:E.......................................................................... at ............?'...........2` North Andover, Mass. Fee%% -- — ------ Lic. No. 11"i-1(40 Check # 2,207 10381 ...................................... GASINSPECTOR K42 'sv MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK = CITY I MA DATE I PERMIT #�: 0 ( lT JOBSITE ADDRESS t OWNER'S NAME "UI - —" OWNER ADDRESS TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL& CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENTS PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES Z FLOORS- BSM 1 1 2 3 4 5 6 j T 1 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER C COOK STOVE SL DIRECT VENT HEATER 'y DRYER FIREPLACE FRYOLATOR I FURNACE v GENERATOR GRILLE INFRARED HEATER I LABORATORY COCKS MAKEUP AIR UNIT — OVEN POOL HEATER �-- ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER --_ WATER HEATER OTHER INSURANCE COVERAGE �S I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW .LIABILITY INSURANCE POLICY 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT ❑ I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance 'th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME/��/,�� j LICENSE # jar/�� SIGNATURE MPX MGF ❑ JP ❑ JGF ❑ LPGII CORPORATION [I# PARTNERSHIP ❑ # LLC ❑ # // COM PANYY�NAME cz-1t� t.A.� /k "-05-_ RI MA 'ADDRESS _ C -'Y 1-t- CITY STATE ZIP `? TEL _ FAX CELL EMAIL 'sv t ,. ,` -i-Ji — MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) .. ..- . . - -- - �20 7 NO.ANDOVER , MA Mass. Date 19 Permit a Building Location g MIMILLPOND Owner's Name L NO . ANDOVER , MA Type of Occupancy . RES New ® Renovation ❑ Replacement ❑ . Plans Submitted: Yes❑ No ❑ Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certmcate - Address 91 BELMONT STRFET 13 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: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 - Yes 42Yes? No ❑ If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability Insurance pellcy f] 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: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or ent�',eyr�m'!'tn ove appGcalion are true and accurate to the best of my knowledge and that all plumbing work and InstallaUons performed under the sued for this appllcaU will b In pllance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 otheral Law BY T e of License: tuber gnalur o c nse um a or Gas Fitter Title sfitlet aster License Number M-3440 City/Town Journeyman Ar MK -)VT- ff7= O N_ N x U _ ' toQ N rc O m N tt W W J N W t- 0 Uj 4 m N F-' J rt W O O = a a C o F- tz N V 1414 W _'- F- N O� > W W c7 ! C = J J � F- W ¢ W v O lL tu f- -. U w J N W 4, _ F � rn m z O a C i �t o x p w� 3 0 0 > a h- SUB—BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR I I ( I 3RD FLOOR 4TH FLOOR I I I STH FLOOR 6TH FLOOR I 7TH FLOOR I 1 8TH FLOOR I I Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certmcate - Address 91 BELMONT STRFET 13 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: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 - Yes 42Yes? No ❑ If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability Insurance pellcy f] 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: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or ent�',eyr�m'!'tn ove appGcalion are true and accurate to the best of my knowledge and that all plumbing work and InstallaUons performed under the sued for this appllcaU will b In pllance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 otheral Law BY T e of License: tuber gnalur o c nse um a or Gas Fitter Title sfitlet aster License Number M-3440 City/Town Journeyman Ar MK -)VT- ff7= O st�i3rr...t.:ii+"`-.i's'W�S'--"'_•�':'..'^�" `_":�."` ""'C' -.'v" `-,P•: �.q''•—y-.•,.'..'+"'^�""""' +d-a,r+i*'�" i aTO� Date../ t.c! t.:. 20(! i HORTry TOWN OF NORTH ANDOVER - pFt��ap ,0 '� op PERMIT FOR GAS INSTALLATION Oq ♦' SA US This certifies that ..CAA ..... .......... `= has permission for gas installation /P!,�P' ................ in the buildings of ....................... at , . ... North Andover, Massa'R, Fee.,) -.S,.'.. Lic. No....7.`(y f GASINSPECTOR ch WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: Filer o