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BLDG-15-005984 d-/2 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK till CITY 7am(pf f fh IMA DATE EQ2-../----1 PERMIT# Df7-15---420,W JOBSITE ADDRESS I /S I 'S,IY re Ie At (.KJ I OWNER'S NAME 5Y'tl. I GOWNER ADDRESS I 8 1 Cat 10i2 (.4 t.,1..( I TEL FAX TYPE R OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL. l CLEARLY NEW:EL RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOD APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i i , 1 i t' J BOOSTER - li ;- , - - I CONVERSION BURNER i -p; Ii �i_�-- ��_ 4i _"i' _i _.-. --il_"" I ;do - " ak 1 COOK STOVE q J DIRECT VENT HEATER -e- -L- a li -- I - , I- 41 I- -"sa. '-ii _I DRYER1 N I I FIREPLACE q ., c I d ' 1 FRYOLATOR - ,- -0_-- ,; Ii FURNACE I --- --�. - - a 1 GENERATOR 'Pi I .. I GRILLE - a - a i INFRARED HEATER '-t II -,; I LABORATORY COCKS N 4 r ? +.,� y -- MAKEUP AIR UNIT '-4'i ti d II 4d. a- OVEN POOL HEATER H i I ROOM/SPACE HEATER a- t 4 ii L '—11 - `I4t 1 ROOF TOP UNIT j�'r i 3 ,,. , _-_, Vl , � - i_ -. __.- -` i TEST - _- I t OT1ER ! r i n 1 UNIX/CEO ROOM HLJ FA -- — --_ WATER ' �Sn / d : t' I 1 I 0 {} -- I ----. 1 [> ------ I I -, INSURANCE COVERAGE 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 Q OTHER TYPE INDEMNITY 0 BOND 0 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 ON NE r III AGENT ❑ I hereby certify that all of the details and information I have submitted or entered regarding this application ar and :,:y., -mak:.•-- - and that all plumbing work and Installations performed under the permit Issued for this application will be i pl• -✓V' L.d rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME ISpencer Hallett I LICENSE# 16224 SIGNATURE MP[] MGF 0 JP❑ JGF❑ LPG'❑ CORPORATION❑#I I PARTNERSHIP 0#1 I LLC❑#I I COMPANY NAME:ISpencer Hallett Plumbing 8,Heating, Inc. I ADDRESS[381 Old Falmouth Rd Unit 36 I CITY IMarstons Mills I STATEI Ma IZIP 102648 ITEL[508-428-6080 I FAX I CELLI JEMAILIspencer©hallettplumbing.com I ,e(ok cimg ait 6/thr- . G o(8`7 il/y • . i •