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HomeMy WebLinkAboutG-18-5739 I. � > CITY L..✓ lna444 I MA DATE[y/[! l 7571 PERMIT#/°�-D61r-o6 6737 JOBSITEADDRESS L fly /i>tL-- . ,. , OWNER'S NAME L re- GOWNER ADDRESS L.., �5'R /K � j TEL . �Qst-_05--5 AX L L T TYPPEvOR OCCUPANCY TYPE COMMERCIALE] EDUCATIONAL RESIDENTIALPRI tx CLEARLY NEW:[ , RENOVATION:pi,- REPLACEMENT: PLANS SUBMITTED: YESE NOj APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT R E C E 9 V n OVEN POOL HEATER ROOM/SPACE HEATER ApR 12 118 +t ROOF TOP UNIT I TEST I BU o r har r UNIT HEATER 'I . UNVENTED ROOM HEATER WATER HEATER OTHER f t INSURANCE COVERAGE _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L✓NO C I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY RJ OTHER TYPE INDEMNITY f BOND ri 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. CHECK ONE ONLY: OWNER El AGENT El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my kno dge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Penin provision Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Eric T.Kinch LICENSE# 16257 SIGNATURE MP[✓j MGFi3 JP _ JGFI S LPG'IT CORPORATION✓# 4030-PLC PARTNERSHIPS# 'LLC y, COMPANY NAME:Eric T.Kinch Plumbing&Heating Inc ADDRESS 14 Hanover St#10 CITY Hanover STATE Ma ZIP 02339 TEL 781-829-6666 FAX 781-829-6667 CELL 781-351-1190 EMAIL kinchplumbing©gmail.com Ge Az (7416/A(