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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
.Mass. Date 19 Permit # c216
a` Building Location 'Owner's Name//%/�S
A 1",Ae Type of Occupancy
G
New &a' Renovation ❑ Replacement ❑ . Plans Submitted:' Yes❑ ' No M-.
Installing Company Name
f
Business Telephone/ /Z/&
Name of Licensed Plumber or Gas Fitter
Check one:
Corporation
❑ Partnership
O 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 O No O '
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy O Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: 1 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 OwnerO Agent ❑
1 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 installatlons 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 the Ge eeZal Laws.
BY Tie of Ucense: C�
Plumber Signature of Ucensed Plumber of Gas itter
Title Gasfilter
Master Ucense Number
APrnPnC7
own
MVF(S(-OTi'iC . Journeyman • O
IN
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No
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ME
Now
ME
MEN
NONE
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Installing Company Name
f
Business Telephone/ /Z/&
Name of Licensed Plumber or Gas Fitter
Check one:
Corporation
❑ Partnership
O 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 O No O '
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy O Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: 1 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 OwnerO Agent ❑
1 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 installatlons 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 the Ge eeZal Laws.
BY Tie of Ucense: C�
Plumber Signature of Ucensed Plumber of Gas itter
Title Gasfilter
Master Ucense Number
APrnPnC7
own
MVF(S(-OTi'iC . Journeyman • O
^s
~r Date ...
I .: !� .....
p:
NORTry TOWN OF NORTH .ANDOVER
0 `p PERMIT FOR GAS INSTALLATION
9
�9SSACNUSEtt -
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This certifies that .... 1.--�-�?. �T ../:. / •lrc .VV.YY. j. ... .
has permission for gas i stallation 1.-w��.C°.FC-.
in the buildings of 1 ................
at North Andover, Mass.
Fee 0 . � . Lic. No.3 ").. x
04/Q 25,00 RAID GAS INSPECTOR
WHITE: Applidant(—CWARY. BuildIn'g Dept. PINK: Treasurer GOLD: File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NO . ANDOVER , MAMass. Date %V _19 Permit
Building Lccatlon 7& MIMILT,POND Owner's Name
NO.ANDOVER,MA
New ® Renovation ❑
Type of Occupancy.
RES
Replacement ❑ Plans Submitted: Yes❑ No ❑
Installing Company Name CALLAHAN AIR CONDITION INC:_
Address 91 BEL MONT STREPT _
NO.ANDOVER,MA. 01845
Business Telephone 508-689-9233
Name of Licensed Plumber or Gas Fitter _
Check one
I3 Corporation
❑ Partnership
❑ Firm/Co.
JOSEPH KEVIN CALLAHAN
Certmcate A
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142
Yes RD No ❑
If you have checked Vis, please Indicate the type coverage by checking the appropriate box
A Ilablllty Insurance polity J] Other type of Indemnity ❑ Bond O
OWNER'S INSURANCE WAIVER: I am aware that the Ilcensee 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 C.vner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or enterec'r ;n ove appUcatlon are Lrue and accurate to the best of my
knowledge and that aJl plumbing work and InstaJlaUons performed under Lhe permit Vsued for thls appllcaU will b In pflanee with all
pertJnen( provisions of the MassaenuselLs Stale Gas C1de and G)3pler 142 of the (;�AneraJ lbw
I By Tililil-u"11r,
f Ucense
ber Snalur oc nse umbe or Gas iterTiiitle fillerterUc nse Number M— 3 4 4 0
City/Tcwn neyman
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Installing Company Name CALLAHAN AIR CONDITION INC:_
Address 91 BEL MONT STREPT _
NO.ANDOVER,MA. 01845
Business Telephone 508-689-9233
Name of Licensed Plumber or Gas Fitter _
Check one
I3 Corporation
❑ Partnership
❑ Firm/Co.
JOSEPH KEVIN CALLAHAN
Certmcate A
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142
Yes RD No ❑
If you have checked Vis, please Indicate the type coverage by checking the appropriate box
A Ilablllty Insurance polity J] Other type of Indemnity ❑ Bond O
OWNER'S INSURANCE WAIVER: I am aware that the Ilcensee 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 C.vner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or enterec'r ;n ove appUcatlon are Lrue and accurate to the best of my
knowledge and that aJl plumbing work and InstaJlaUons performed under Lhe permit Vsued for thls appllcaU will b In pflanee with all
pertJnen( provisions of the MassaenuselLs Stale Gas C1de and G)3pler 142 of the (;�AneraJ lbw
I By Tililil-u"11r,
f Ucense
ber Snalur oc nse umbe or Gas iterTiiitle fillerterUc nse Number M— 3 4 4 0
City/Tcwn neyman
AP f nC-;" 07= 0
V
1,Date. . K ......
2115 j.
,ORTPI TOWN OF -NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SACH
This certifies that � 11C 4?q 4� ....%4 Cr . . . . . . . . % . . . . . . .
has permission for gas installation 1. e.h, A C
...................
in the buildings of. Z 4'� ..........................
at ....... North Andover,
MaI4.
Fee. Lic. No. ......
- -
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK' Treasurer GOLD: File