HomeMy WebLinkAboutG-16-1952 • I IYIASSAC:Hus=115 UN1rLt.MArrLILA 1 icily rvr...r L_r.nu, 1•-• . •-••• "•••••• — •- • -• •--- •--•-•
OCT e:21)/5i PERMir#ne7/lo W ?5
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JOESITE ADDRESS: C7 7 A/ti Efe4 / �n70WNEt�.`S NAIJia 011,661v vorC V`
OWNER ADDRESS: • TEL7 i 'witr( FAX
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TYPE OR OCCUPANCYTYPE COMMERCL I.D EDUCATIONAL 0 RESIDENT UtL KI
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Iv/ PR=
PLANS S SUBMI1 1�J YES 0 NO❑
CLEARLY NEW:V RENOVATION!:0 P.EPLACE :0
APPLLANCES7. FLOOR-. I Ssnt 1 I 2 I 3 I 4 5 5 7 8 9 1 10 11 12 1 13 1 14
I BOILER 1 I 1 1 I 1
• 80051rK I ! I I I I
CONVERSION BURNER 1 I I
COOK STOVE 1I I I I
DIRECT VENT HEATER I I I
DRYER I
FIREPLACE V I i 1
FRYOLATOR I �_ I
FURNACE 1 I
•
GRTOR I rel I
I GRILLE ILLE I
INFRARED HEATER I I
LABORATORY COCK I171
MAKEUP AIR UNIT I I
OVEN I \ I !
I POOL HEAT- I V. •
ROOM J SPACE HEATER I I •
I ROOF TOP UNIT I
TEST V I I I I
a
UKirH:ATI
I UNIVENTED ROOM NEATER I I I I
WATtZi hcli r( I I I I
I I I
I I I
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INSURANCE COVERAGE
I have a currant Natty'ssu ance policy or I's substntial egcuvalentwlvch m sthe nazi-eine=of MGL Cli 142 Yrs Doo 0
If you have checked Mr please indicate the type of coverage b checting the appropri box below.
LIABILITY INSURANCE POLICY OTHER T YPE ThIDEtrrii QTY 0 BOND 0
OWNER'S MSURANCE WAIVER I am aware that the ficnsee does not have the insurance coverage required by Chaptar142 of the
W csachusettsGenualLaws,andhatmysignabneonthispermitappEconwaivesthisrequirement
CHECK ONE ONLY: OWNER❑ AGENT ❑
• SIGNATURE OF OWNER OR AGENT
hereby certify that at of tie dells and mformauon I have subrrirsad(or entered)regarding this applcaton are rue and accurst to the be. of my l
Knowledge and tat all plumbing work and insalle:dons performed undertre permit issued for this appt aeon will be in comppanca with all Perfnant
provision of The Massathusets State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER/GASH LIbhxNAMES1PA/C Z POerer' LICENSE# SIGNATURE
COMPANY MME: ADDRESS:
Cf Y STATE 21P: FAX:
BAAL
MASTER 0 JOUP.NEYMAN2 LP INSTALLER 0 CORPORATION❑ Y"= •` _ up 0
OCT 05 2015 , I !��/
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Tim rim T aims!'EcrOAIUSLONLY FINAL11VS1'ECA'JQ NousW.W.IG S ii. ' r "i•iki9
(. 0--cueht 2// /5— Yos No TI115 APPLICA ION SERVES A5T11- PERMIT ❑ ❑ _
FEE: $ PERMITa — -_
FLAN EMMY NO'A'H S ..
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