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BLDG-19-000342 • • 1 < MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' -• .-:-.4 --= cir yn rw oui4n • . • j MA DATE( 7-11-13 (PERMIT#ntilf1c4v 5' .��''tt JoBSI EADDREssI59 7 fards'�-. R d •. (OWNER'S N• AME I�j9i 'wJ-h "0 Pw ( �" OWNERADDRESS f ' • • • . (R78/5/37-19,7(FAX • PRINT OCCUPANCY TYPE •COMMFRCLAL� EDUCATIONAL Q RESIDENgIAI.Q ararY NEW:Q RENOVATION Q REPLACEM NTy . PLANS SJBM ITS% YESQ NOD . • APPLIANCES] FLOORS-, BSM fl®©fl©OQ f a 10 n©®m • BOILER MSlaISSa•r=l11111>Laaat, aaai lif*II . BOOSTER alfalfa,Men=Mit MN;e—=La aa=a CONVERSION BURNER laIM)lit_a,a _Wa�Ta a`a ia- • COOK STOVE Jt� ;i, � �"1.� ~.jam DIRECT VENT HEATER • ,1i —.a.1111tI ,1♦illikaaaa a._, DRYER S— .t— --a—. . FIREPLACE 1�■r=afa , aa,�a �ararll �arS.are • FRYOLATOR as ar 1111t ra .W.— —a'M; f: ! FURNACE • ai=a illi a s ar;a =_a a ar • GENERATOR wwua l `�nfla.naamnim" =.r�iiit: GRILLE ___alar—_ •—=1— .a aassa INFRARED HEATER --11i > .111 ,fl — at W.MSS ME LABORATORY COCKS MINIM araa Mita taJ a a;a aSaIC011/ at • MAKEUP AIR UNIT aaa a a.11 a a`11M11111111 14_Sa ma OVEN a;ail aa_a�'f r.SIM =;all[ AIM INK ar a ' POOL HEATER a aa7 ps -sarnumtatnara =ate • ROOM!SPACE HEATER ' 111111110=41.11•111.111nClanallit a a aim ROOF TOP UNIT • Mk't_.a jot asSana a-SAIL Min S t --____ TEST ... -..- . • 1.atfl —a�-a—Mla Nat a • ' UNIT HEATER • leMita ara armor " asditr ---lilt Ulaarrnan:ca;.t,alhylny:.affin-a_a tan.._aN.Waal MtM WATER r • MK a at",a a s aara _■w a a`a<_at : • O0- _-- -- -- OISMC,l aa, INOWINra llaniafa=:ar a_aa,a+ aar aa.at,al fa fa airy-- IlianNIMINIMINNIIMatalaaaaaaaaaa a a a�aa a.aEa a inura watt am • • INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Cit 142 YES Q IIFYOUCFHECK DYES,PLEASE INDICATE THE TYPE OF COVERAGE BY CtlQNGTIEAPPROPRIATEBOXMow ' • • UABILITYINSURANCE POLICY,12( OTHER TYPEINDEMNLTY❑ • BOND [ . OWNER'S INSURANCE WAIVER:L am aware that the licensee does not have the insurance coverage required by Chapter 142 of the ' Massachusetts General Laws,and that mysignatreonthis permit application waivesthisr eer:let • • • • CHECK ONE ONLY: OWNERQ AGFN'Q SIGNATURE OF OWNER OR AGENT •' • I hereby certify that all oftha details and Information I have submitted orerteued regatta;this applcalon are true and accurate to the best of my knowledge and that all Writing work end Humans performed under the Permit Issued forth aPPliGath adgbob pRance with all on of fla Massachusetts Stale Plumbing iiiii•••and Chaptri142 of. , _, laws. 1 PLUMBER-GASFI ERNA.Mfi r I '&R -LCEN.SE 7 S �1cL:J MP0 MIGFO JPQ JGFI LPGIQ/ . CORPORATIONQ#• PARTNERS IPQlL�-1U.C[ . ( COMPANY NAME ")Y e9y rCrerfo✓ (ADDRESS( lie1 p4r6e ' r4 CITY I' 01-95+ brlrn0s1,obie • .( STAW�(BFI OO6( d (1E4 77t/ A'34 76se I FAX • • I clad %• (FNAs) jy C?9 cast lerb.� y L 9 :I CGm. ( . / j210 #- Fera-c — �/�3 cmc