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HomeMy WebLinkAboutBLDG-19-003065 1/50 MA.p: PARCEL.' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ti Y f �e ,� r���u H I CITY T MA DATE SJ1R J PERMIT f{/61PG 19 Ct 3�� - JOBSITEADDRESS I aIOWNER'S NAME 1Kisg , g•.-e_�, ,Wj G OWNER ADDRESS II TEII 607- i/-/f¢7 IFAXI - TYPE OR OCCUPANCY TYPE COMMERCIALD EDUCATIONAL 0 RESIDENTIAL ii PRINT ' CLEARLY NEW:® RENOVATION:❑ REPLACEMENT:Lr PLANS SUBMITTED: YESD NOEI APPLIANCES 7 FLOORS-4 aSM 1 2 3. 4 6 6 7 6 9 10 11 12 13 14 BOILER ii , J . . 1 . _ 1 1 i I _ 1; if BOOSTER .011.010.1.1.1011101.1010300011.0,111001101111.11, CONVERSION BURNER 11M11M101. 11111 11111iM 11M1MIM11101 iM I i1MMMIlilUMlrM1M 1001lA 10.1IMJUI11.11.1.119111 1110111 COOK STOVE $10.1.1.011100310*On lfj 00.0011100011.0101101.01001000011001 f G 1 MI 111A110,110 _'f : IIAM IU DIRECT VENT HEATER �;f�IMM�41�'fl111i1A)�MI�IMU DRYER 1 1Illglull!Mr111,1111011Oa.MICIP1111MI 1SES1i11M)IM11I11lialMI FIREPLACE SSC 55555511101...ipl1Um1;[1>lMint1111NM111 UPOILLIntill.1.11.1.1111.1110041.1.1.1111.0.311.11.11.1011111. 311.11P M GENERATOR ! )i ' i;I Ji S SISI S I RILLRED HEATER Ilia 1wL�rM11111r"""illi "°1 111.1 111�wM�1i1MMMM1Ma� 1011_1>)]IMM�1�1Ill MIIMM�111lIM111111!1' FURNA E 11111011111.1110.111.110 01.00.000.1101.11111.01.00110.111111.0101.11011..111.1 .10111001 LABORATORY 5S S_ISSF MAKEUP AIRUNT COCKS ilIlT � I Sl5I ISI II OVEN SOONIlISSIh0 I 0.N10 11M1M i is POOL HEATER )01111,10.1011.110.0411.11 � )I 5S ROOM/ CE HEATER 5$ . M M Monrsa. ROOF TOP T i 'SI TEST • '1I MJ1a010011 51f10lf11Mi i1il1i100 1 f(b 1N 41 UNIT HEATER 1 M )s " .SIM ..I* II 1111111.10.11011 UNVENTED ROOM HEATER $ . S ].A11111Aid Mi1101101!1)011 IMIMLMl,1.1 . . LI�Ii lingf M11M1S1 WATER �I JS _IJI$1100100111001.10010.01130,101.00010110 � , 1M111MI11111JA111.111.1.1.111M.i1 11 i1 sIrla Oh �.--�-,�.,�,,,,, ... � I Imo) � j I� 1110011 a— 41100SISMOIS51 M111aN .00011M1NA510011,Ip 1 ,IN INSURANCE COVERAGE I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES (21-NO-EI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE INDEMNITY 1 J 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: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT el I hereby certify that e0 of the details and Information I have submitted or entered regarding this application are fru ((nd aceetlylo the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in v9'01110106 wi alt ertinent provision of the Massachusetts State Plumbing Coda and Chapter 142 of the General Laws. 1 l/ f'�'."'�•• J / PLUMBER-GASFITTER NAME 1 ,4 I Gaff 411 n 'LICENSE'''."J'i f 6 SIGNATURE MP I Mar® JP 0 JGF 0 LPGI© CORPORATION j f,�PARTNERSHIP 014 . j L10 •Ill—--1 COMPANY NAME n.9 v i. al ADDRESS " im -t—,7. CITY Imo- goo ^:, ,, . I. STATELt/t9_1ZIPI Pat 44 f lf• IT 0l-39N2 FAXICkitt7iCELLI Qs•9511'403 EMAICI, f: C a/a a G ci 14,4 444ir cede .G 9 A-1----------.-2 cbi4 /(1 C 1C ail, t