HomeMy WebLinkAboutBLDG-15-005747 - I MASSACHUStTTS UN1rOKM ArrLILAI IVIN rump,rarum I i.+ I �.. v•v. . ..•- • •• ••••_ ..........
r- -- 67 o/�6 PERMIT# DADA-11-00571/7
�,, .' �_� CITY: yG�.•^Ow-rtr MA. DATE '"
JDESIIEADDRESS: 'Sin / Ir/t..# .Tc�A,J Rd OWNER'S NAME f•r•n. / 5 c - Q4/-
G OWNERADDRESS: Ta: Fick
OR
OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL cr-
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:2— PLANS SUBIvI Iri ED: YES 0 ND 0
I APPLIANCES-1 FLOOR I Bsrt 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 10 111 12 I 13 114
I BOILER I I I I I I I I I I
I BOOST I I I I I I I I I
I CONVERSION BURNER I I I I I I I
COOK STOVE I 1- I I I I I I
1 DIRECT VENT HEATERDRYER i
I I I I I I
FIREPLACE
FRYOLATOR I I I I I I
I FURNACE I I I . 1 ' 1 I
GENERATOR I I I
I GRILLE I I I
INFRARED HEATER I I I I I I
1 LABORATORY COCK I I I I I I 1
I MNCEUP AIR UNIT I I I I 1
IDS I I I I
I POOL HEATER I I I• • I I 1 1
I ROOM/SPACE HEATER I I I I I I I 1_
I ROOF TOP UNIT I I I 1..----+------i
1
TEST I I I I I I I 1
UNIT HEAT? 11111
Uh'VE41=D ROOM HEATER I 1 I I I 11111
WATER HEATER I I I I I I I ' 1 1 I 1
I - I I I 111111 1
!
INSURANCE COVERAGE
I have a current liability insurance policy or i6 substa trial equivalent which ma the regememans of MGL Ch.142 YES YA NO 0
if you have checked YE,please Vhcaietha type of coveracheckbg the appropri box Flour. .
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND 0
OWNER'S INSURANCE WANIR I am aware that the li nsee does not havethe insurance coverage required by Chapter 1t2 of the
M,assachusets General Laws,and that my signature on this permit appUca ion waives this requirement
CHECK ONE ONLY: OWNER❑ AGENT 0
SIGNATURE OF OWNER OR AGENT
hereby oeriiiy teat all of the details and information I have subrridied(or errtered)regarding fits appGcaiion statue and accurate to the be of my
Knowbdge and that al!plumbing work and msallations performed undertle permul issued for this appIceo ,I .a In comprancewtl Blip=inert
provision of The Massadwsetls State Plumbing Code and Chapter 142 of the General Laws. ``,r /
PLUMBERIGASLIittt.NAME. 6,-. ' ,gti/4{ LICENSE i30ln Sr NATURE
COMPANY NAME:/do-4cehie ft. 6,Cs ADDRESS: /03Crn/cln 6r
CITY: `J'cr..,aK ft, Pork BTATEmq 71P:07.67C FAX
TElz ca S3Z o
Jaz-4 d ( EMAIL RECEIVED
MASTER 0 JOURNEYhtAN'VLP INSTALLER❑ CORPORATION❑t RARRRIO ff1 LLC 0#
BUIL__DQ(ING /c 1w � 'LK Het
B �7i
OUGC FRC. r► ► 1 . TMLL51'�#GUFO1l•IN 'LCfOIIUSLONLY 1rINALl.NSI'ECI'1ONNOTES
.
Yos No
TIIIS APPLICATION SERVES AS THE PERMIT 0
--------------
FEE: $ PERMIT U
a'LAN TIMMY Nous ..
_ — —
_ — --- — --