HomeMy WebLinkAboutMiscellaneous - 84 MILLPOND 4/30/2018I�
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING L �, i
(Print or Type)
G
Town of k- Date l .3 19 9p6 Permit
Building Location Owner's Name
Type of Occupancy,
New Z,-' Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑
Installing Company
Business T
7 Oo
Name of Licensed Plumber or Gas Fitter
C,
Check one:
rporation
❑ Partnership
❑ Firm/Co.
Certificate
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
If you have checked Ye, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 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 entered) in above 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 with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of theGener Laws-
BY T of License:
Plumber Signature of Licensed Plumber or gas Fitter
Title fitter
aster License Number � G7 �%
City/Town Joumeyman
APPRONM OFFICE US _ ONL
BTU Date .....................
2037
% A �
,ORTH
pf
TOWN OF NORTH ANDOVER
t„eo ,e'��.0
? e° •e p
PERMIT FOR GAS INSTALLATION C.
Fi
�9SSAC14USES
_j
This certifies that ..-4-��..�� ...... ....
has permission for gas installation
in the buildings of .. f' , ......... . ... . .. . .. . . . .
at , ... , , _ , . , North Andover, Mass..'
Fee.?? 3'_% ... Lic. No.l.4?.7. ?J .. ...... r
GAS INSPECTOR
WHITE:- Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File..
ld.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG
(Print or Type)
NO .ANDOVER , MA ,Mass. Date :.19 permit/#�Di%`�,� .. - •. = -
Building Location ay MILLPOND Owner's Name
NO . ANDOVER , MA Type of Occupancy - RES
New ® Renovation ❑ Replacement ❑ • Plans Submitted: Yesp ' No ❑
Installing Company Name CALLAHAN AIR CONDITIONING
Address 91 BR •MONT STREET
NO.ANDOVER,MA. 01845
Check one:
C3 Corporation
❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN
Certificate 7
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes R3 No ❑ '
If you have checked Les, please Indicate the type coverage by checking the appropriate box.
A llablilty insurance policy Zl 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 [1
I hereby certify that all of the details and information I have submitted (or entered) in ove appricatlon are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the permit sued for this appllcauU will b In pflance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law
BY T e of Ucense:
tuber gnatur o c nse um a or Gas titer
Tills asGller
Master License Number M-3440
�Y Journeyman
rTZK77Yr-.DO .
N
N
W
N
N
N
Y
U
tZ
vi
`�
in
5
N
W
W
N
W
O
U
01
}
S
7f
O
u
C3
V3
LU
0
O
O
O
¢
W
Z
V
N
W
<
it
W
'�
+�
W
W
O
a
O
i
u.
LLA
t-
V
J
W
IN
<
W
>
Q
W
O
{
r
S
H
<
m
.(
_
O
O
O
_.
W
W
�'
O
O
►i
-
1,-
'=
0
O
Ci
S
W
7
O
C
J
U
C
>
G
d.
F-
O
SUB_aSMT.
BASEMENT
ISTFLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
57H FLOOR
I
6TH FLOOR
B
7TH FLOOR
8TH FLOOR
Installing Company Name CALLAHAN AIR CONDITIONING
Address 91 BR •MONT STREET
NO.ANDOVER,MA. 01845
Check one:
C3 Corporation
❑ Partnership
Business Telephone 508-689-9233 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN
Certificate 7
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes R3 No ❑ '
If you have checked Les, please Indicate the type coverage by checking the appropriate box.
A llablilty insurance policy Zl 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 [1
I hereby certify that all of the details and information I have submitted (or entered) in ove appricatlon are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the permit sued for this appllcauU will b In pflance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law
BY T e of Ucense:
tuber gnatur o c nse um a or Gas titer
Tills asGller
Master License Number M-3440
�Y Journeyman
rTZK77Yr-.DO .
46
2078 Date .. .. k
HpRTM TOWN OF NORTH ANDOVER
Of t�,.ao e
,,4•p
o� yq p� PERMIT FOR GAS INSTALLATIONa
�9SSACHUSE�
>n
3
This certifies that .71l9..........
• ,
has permission for gas installation ..'!�!'/.�? .,Y .......... n
in the buildings of A� 19 X .&I. !? .......................
at .......... North Andover, Mis.
.T
Lic. No... k.S�.G>. .
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File