HomeMy WebLinkAboutBLDG-16-002047 ` - NLASSAa7US C i TS U NJPO
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EN 17 JOSSITE ADDRESS: // 0A/4 E .1) "Ls C Ln OWNER'S NAME: �,�,Y�4T
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L tl� G OVJ,NEP.ADDRESS: TEL: PA-:
TYPE,OR
OCCUPANCY TYPE COIJIJE?CLA.0 EDUCATIONAL 0 RESIDENTIAL.O'
ppair
CLEARLY leg:0 P,ENOVA1OIt 0 REPLACE/ENT:[' PLANS SUBMITTED: YES 0 NO 0
APPLLANCES2 BOOR. Ssnt 1 1 2 3 1 4 1 5 1 6 1 7 8 1 9 1 10 11 112 1 13 1 1.4
BOILER, 1 j I I I I I I I I
• 1 BOOSTER 1 I I I I 1 I I
1 CONVERSION BURNER I I I ( I 1 I I
COOK STOVE r I I I 1 I I
1 DIRECT VENT HEATER I I I I II
DRYER ! I 1 1 1
FIREPLACE I I 11
1 11
FRYOLATOR I
1 FURNACE '
GENERATOR
I GRILLE
INFRARED HEATER
1 LABORATORY COCK
I M?JCEUP AIR UNIT
OVEN I
1 POOL HEATER I I
1 ROOM/SPACE HEATER I II
I ROOF TOP UNIT I I I
TEST f I I I 1
UNIT HEATER. I I I
I UNVENTED ROOM HEATER I
WATER HEA I=rt I I I I
L
•
I i I I II
INSURANCE COVERAGE
I have a currant riablIN insurance poly or its substhrfial egtiNaiantwhich mea the re uiemerts of MGL Ch.142 YE Lalio ❑
If you have ehecl a_d YES.please indicat=t e type of coverage eckfr g the approprial box below.
LIAB➢JIYINSURANCEPOUCY . OTHERTYPENDEWNTTY 0 BOND 0
OWNER'S INSURANCE WAIVER:I am aware that the Ear see does not have the insurance coverage required by Chapter 142 of the
Wiassachusetts Genaral Laws,and that my signature on this pa tappUcon waives this requirement
CHECK ONE ONLY: OWNER❑ AGENT 0
SIGNATURE OF OWNER OR AGENT l
hereby certify that al of the details and ulformafion1have subrrndad(or entered)regardingi1 sappkcationaretrueandaccuratatothebestofmy 1
Knowledge and hat all plumbing work and instillations periormed underlre permit issued for this applicavon will be in compliance wilt]all Pertinent
provision of She Massachusetts State Plumbing Coda and Chapter 142 ri the General Laws. _
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PLUIJiBERIGAS:I I I tKNAME fL l i ,,r Se. LICENSE# 306 Ili SIGNATURE
COMPANY NAME:TO ,c si'-><r• f k 5.:/-S ADDRESS J O -Z Lt r, ,r� .J Sr
CITY• yc_n.,„L.. / /riSTATE /fl', P: 6 26, 7 S FAX:
TEL: CELLSO8- 9z z- Uo of
CEIV
t INSTAL
ER.JOURNEYMAN - 1NST^ 0 CORPORA7101 — ' ❑_ 1-IG
OCT 092015
BUILDING EPARTMENT d4 al (..-te•1
By:
it7.
TWIN l'AUS1r01UC1 I'NCI'O1l USN ONLY FIYi1L INSI'P,CI'ION NO'1')s'S
- - &f CASTIV�1'V 1• ► ► C1! Yes No
(� m/1� t /!l ( S 1PPLIC- ON SERV S ASTIIE PLI1 ❑ ❑ r`S� C�
PERMITfl / ,� J /�--
J'LANJ.UiYJtW1NUMB —
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