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HomeMy WebLinkAboutMiscellaneous - 99 MILLPOND 4/30/2018_Cj /Y//1 1'/� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING-- (Print or Typ ) Mass. Date ,% _19_!EZ Permit # �� Building Location Owner's Name Type of Occupancy —•S' New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ • No ❑ Installing pony Com Name41, Addressl/ Business Telephone _ od Name of Licensed Plumber or Gas Fitter Check one: M"—Corporation ❑ Partnership Certificate tr INSURANCE COVERAGE: 1 have a current Il;tipfty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 99-- No ❑ It you have checked yes, please Indicate the type coverage by checking the appropriate box A flabilfty Insurance policy 19"--, 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 Owner❑ Agent ❑ Agent 1 hereby carUty that alt ()(the details and Information I have submitted (or entered) in-11bove application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for Vs application I be ;In compll ce with all pertinent provisions of the I.tassachusatts Stale Gas Code and Chapter 142 of the eneral Laywd .0 T e of Ucense: Title rbef ign re o censq um er or Gas Ater City/Tcwn aster License Number a' Ar,f'TiC:VF Journeyman N N ¢ W N y N ¢ N H R U O = N �" ¢ r J N W O U 6] F- 1f O u ¢ ¢ O _ W ¢ m N w F- 4 y W O f. yr aF- o > -C US¢ W - U W= N yr ,: ¢ p LLA W C >- H m U. O O ¢ S O c7 S k > a d. F- O SUB—BSMT. BASEMENT I 1STFLOOR , I 2NO FLOOR I I I + I I 3RD FLOOR 4TH FLOOR ( I I I I I I 5TH FLOOR I I I I I ETH FLOOR I I 7TH FLOOR I I I STH FLOOR I Installing pony Com Name41, Addressl/ Business Telephone _ od Name of Licensed Plumber or Gas Fitter Check one: M"—Corporation ❑ Partnership Certificate tr INSURANCE COVERAGE: 1 have a current Il;tipfty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 99-- No ❑ It you have checked yes, please Indicate the type coverage by checking the appropriate box A flabilfty Insurance policy 19"--, 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 Owner❑ Agent ❑ Agent 1 hereby carUty that alt ()(the details and Information I have submitted (or entered) in-11bove application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for Vs application I be ;In compll ce with all pertinent provisions of the I.tassachusatts Stale Gas Code and Chapter 142 of the eneral Laywd .0 T e of Ucense: Title rbef ign re o censq um er or Gas Ater City/Tcwn aster License Number a' Ar,f'TiC:VF Journeyman 2-584 Date. ........ o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 1. .................. C. has permission for gas installationr) .. in the buildings of !. /0. 5.k <- ........................ . at .. `�cl../ ?.�. �. t/ -PAk,, 54........... , North Andover, Mass. Fee.3.,?.' .. Lic. .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 2 rji ISO . ANDOVER , MA Mass. Date permit #/o`t 09 a Building Lccatlon.1�y_-HI,LLPOND Owner's Name NO . ANDOVER, MA Type of Occupancy RES [ru New ® Renovation ❑ Replacement ❑ . Plans Submitted: Yes❑ ' No p Installing Company Name CALLAHAN AIR CONDITIONING Check one: Cer-Kcate i Address 91 BELMONT STRFFT C3 Corporation NO. ANDOVER, MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Ucensed 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 X3 No O If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability Insurance policy fI Other type of Indemnity C Bond D 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 cn this permft application waives this requirement. Check one: Owner❑ Agent D Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in cve appfieatlon are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this aY=77 ance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the neral law 8y T e of Ucense: umber gnalur o c nse um a or Gas ltei` r Title s(lter ester License Number M-3440 City/Town Jouineyman APFl-KAT- F FIC Q . N N N N UCC W N ) ` N 2 N R O O N W W NUJ < o © N u F'- y LC W O a d a C z~ b R Q N V w < W = 2 F- N C O o > W W C W S W W > 1"" U.. W j- C.7 S J H C W < H of -- W � •` O tl S L- S o o J U C > a a F- O SUB—BSMT. BASEMENT 1STFLOOR ZNO FLOOR I i 3RD FLOOR I_ 4TH FLOOR STH FLOOR 6TH FLOOR 1 7TH FLOOR 8TH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING Check one: Cer-Kcate i Address 91 BELMONT STRFFT C3 Corporation NO. ANDOVER, MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Ucensed 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 X3 No O If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability Insurance policy fI Other type of Indemnity C Bond D 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 cn this permft application waives this requirement. Check one: Owner❑ Agent D Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in cve appfieatlon are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this aY=77 ance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the neral law 8y T e of Ucense: umber gnalur o c nse um a or Gas ltei` r Title s(lter ester License Number M-3440 City/Town Jouineyman APFl-KAT- F FIC Q . TOWN OF NORTH ANDOVER Of .ao 'q.yo . 02 ' PERMIT FOR GAS INSTALLATION s 9 �9SSNC'HUSE- This certifies that.. ���? �.� ,�, •l%C, .. , , • • . • , has permission for gas installation j .............. :: cu in the buildings of . - � I J� . S ........... ......... .. at . . , , , North Andover, Maw. N 4 Fee. ?' :.:.. Lic. No. 6).... .... ........... ..... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File .46 NO 2098 Date, C . . TOWN OF NORTH ANDOVER Of .ao 'q.yo . 02 ' PERMIT FOR GAS INSTALLATION s 9 �9SSNC'HUSE- This certifies that.. ���? �.� ,�, •l%C, .. , , • • . • , has permission for gas installation j .............. :: cu in the buildings of . - � I J� . S ........... ......... .. at . . , , , North Andover, Maw. N 4 Fee. ?' :.:.. Lic. No. 6).... .... ........... ..... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File