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HomeMy WebLinkAboutBLDG-19-001147 • •-t'I i, I --,•-•---a.-•11-...-...--1'2WAGEACERISErrs UNWORIN APPLICATION FORRAP ITTO PERFOrad' as PITTING WORK sem, - CRT LS", }%,,, 7-4 (. fa DATE t i�a v lA> i, pea ris/rpG-n-ao/I`/7 JOBSITEADDRESS L '' P/,45.40` di- j OWNER'S NAME I f.ir w /licm- 4nietc f ow1NER=FESs ( Skir ?EMT OCCUPANOYTYPE cOMMERGIALQ EDUCATIONAL❑ ftEESIOEfit7TALril---- CLEAULTX NEM 0 RENOVATION:0 RWLACE s''IT: Lel': • RANG SUBMITTED:VE30 NOjo- MXUTRES T. FLOOR— I ge m 1 `I 2 3 I. 4 5 5 . T 8 9 10 11 12 13 14 BOILER I • COO TEF[ 111111 CdiYE?6fONI3URNER r • I - OOKSTOV6 - • DIRECi VENT HEATER - - LIRYER I I FInEFIREPLACE • I FRYO!1 TOP,' PURiAc I 1 I Q' lEPATOR I I I GRILLE I - LABOPA i'ORY 0001(8 I I irLAJC:UUP AIR UNIT I Ot;ch 1 _ POOL HEATER I I I I (�, ROONt I SPACE H TuTs 1 r Vi Se UNIT - { �' I UNIT f 14 1 UNIT HEATER L___1 I Q UHVGb hQ ROOM HEATER I - WATER HEATER • k i�� i7 1 I - By: - i �� di r. 1 1 I I , I have currentBabllhv MSURANCECOVERAGE Instrencapslfcg oils equielietwhich maga he,eyeLszimatsOHM_Ck-142 YE; L NO Q 'l tryouhave char3tedy�-oi asaindtejMaLyamofeoveragsbychecrangt eapprop-riateboxSow. (/ LIASILOYMSUPANCEPOLICY IW OTHER TYPE INDEMNITY 0 9Orim 0 - • OWNER'S INSUP.AtfJCEWAIVER:Iamaearedrat rhe Mamma days want;the/u mcnvera_gaLBgniredbyChapter?Eafthe MassachusetbCenral Ise,and t-haenlysignatureonWspaint apMcarlant:�aivslhisregoio: ma SIGNATUREOFOWNEROP.AGENT • _ GHECICONE ONLY: s Q, Q AGENTQ herebyceriir that all arta Mails and inhotmafanIhave submmed oranbts ICtatvledgaand IhatetplumbingwwQand Insisllailansperformed ondarlhepapamR�eforteappltman AUbsIndcalatpar atrnnallPte in lbe ertinent provIdon of Statø Plumbing Coda and Clhapler142erthe General La ciXtryreet PLUMBCRICAS1911 brH MAK n17 tIfividgeti tItLicens ,�`3`, SG nim r --i 'ee• coMPPhlvn le 5 CJ ape"?4idus. , - #/ae `-Jtra IAOnr,E5s:)/Rfrnn r . A'7`-. - 1 CIN: l + .rvi w7` (STATE WM ZIP: aa..-_ - Mie fiel &) 4* Ta S_Illrim-- jCEU-:Js s6a70E91 sWAIL: q It djlv0r.n��` MASIERLUI 1OURNEYP:ANQ LP INUTAL4ER Q CQRPORAfON•] (3g9QQ.,1PARINERSWP00 ILLCL]C5 "" U v 407-(9 7- 7//gee