HomeMy WebLinkAboutBLDG-16-000564 Il..' ' _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CiritI ,G CITY rri 1 mO- t MA DATE 7 PERMIT# B/Ob /G" 5W
JOBSITEADDRESS I '/ O/ A:411 10WNER' ,,:� r—/�G . I
GOWNER ADDRESS /ELL L37 e"/":4FAX 1
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL RESIDENTIAL j.V
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CLEARLY NEW:LI RENOVATION:U REPLACEMENT: PLANS SUBMITTED: YES❑ N0
APPLIANCES 7 FLOORS-+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER ! i 1 i
BOOSTER I I ! f i i
CONVERSION BURNER J ! i !
COOK STOVE
DIRECT VENT HEATER I .__...!
DRYER
FIREPLACE ! I i i ! I 1 r
FRYOLATOR 1 I I
FURNACE '
' GENERATOR ! wl __f I i
GRILLE i I 1
INFRARED HEATER I � _ _i —! I __ p
LABORATORY COCKS z 1.._. ..._-. " _--_-1 __ .-•" _.---.._! -.__ _„_ 1
MAKEUP AIR UNIT I l
OVEN 1 ) ' --_.) f I : I
POOL HEATER - 1J
ROOM/SPACE HEATERT! I
ROOF TOP UNIT , t I
TEST i I I
UNIT H • . R —I _- I l _i --' i
UNVEN ED'Rc Mc44EFER J E D t — I I
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OTHER b y t ' —Tt
— JUL-282015- -
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABIUTY INSURANCE POLICY Cj OTHER TYPE INDEMNITY D BOND 0
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: OW r AGENT ❑
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 : - .est of my knowledge
and that all plumbing work and installations performed under the permit Issued for this application will be in complian :, :. provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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PLUMBER-GASFITTER NAME Phillip Durfee LICENSE#113774 SIGNATURE
MP LJ MGF CI JP u JGF U LPG'[J CORPORATION❑#I I PARTNERSHI•,_J# 1 LLC[:3#j 3152 I
COMPANY NAME:I Durfee Plumbing&Heating LLC I ADDRESS 2A Huntington Ave. I
CITY South Yarmouth I STATE MA IZIP!02664 ITEL 508-619-3078
FAX(508-258-0592 I CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;joy@durfeeplumbing.com