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G-13-1070 d' a 42 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =:ate= =N1- CITY LS. ar+.+e.. 4 --�yy�_ m� MA DATED<� 5... F�PERMIT# 9 '7 7O JOBSITEADDRESS 77//c/744. Thi (-" -1 OWNER'S NAME /`/' .7/ , _ J GOWNER ADDRESSC satn...O� __ 1TELIraP. 3141• ,saj�FAXL J TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL❑ RESIDENTIAL[ ' PRINT • CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:a PLANS SUBMITTED: YES 0 NOB - APPLIANCES 7 FLOORS- . BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ SII II_--I _1--C'I-.�:IC'Il;I_ C` _ T _. El_._ `IT BOOSTER I,I I 11.�i IJ I..-J I-_1' ,.._,I _F{____I-___;I_� ICI I___)l_� CONVERSION BURNER II-.-_.11 i l 1i! I. I I__i j ;Ii I _ _'I - II -i COOK STOVE I �i i _I I. ' 'I_..- i.� 1 _''1_ - DIRECT VENT HEATER 11-11�._ . . ..t1.Thi--_ _I _.. ( !I_ _llI il_.. :i ;I_ ELS-,_I__< DRYER =___IIefh_ lhl III _ II h11 ili E 11 bl-. FIREPLACE __i1__ I_._I_,._: -_ __ _ 1_ __:I_ __ _1-._i__ FRYOLATOR I I . ll .....Ir-j11 _. I i. __I_ I' . 1 _ 1 39 FURNACE II.Y iI_ _. i1 I__ -'I I I.._c _ ._ I__ . I _ I- .1 1_.__., GENERATOR i __ __- --_.-F---t�_ _ _ 1 _ I GRILLE II II ,.._-II I s1 ..... I LI . INFRARED ... ` _. _ I_..._.. I INFRARED HEATER I 1--, , I_ _t___27. ' LABORATORY COCKS • II_ _II_, 1 __. !....... .__... _, i i _1_ . . _�_ ;1 _._' MAKEUP AIR UNIT ._ I.` 1 ___II_-' --_;'i._I i- _I I _ I�_I__ I _I_.....-I I__ i OVEN i__ . _IL ._J1- h_a 1 _ - `r---,--- =1 = '- `l = POOL HEATER . I I , , ROOM/SPACE HEATERi.......211.___11.__11_21_, [ I I_- 1 11 r I '1 z I I /1 ROOF TOP UNIT - - TEST UNIT HEATER _ -— UNVENTEDROOMHEATER !____.1 _11__J1__ _II-__i i__._L__ ry ' _. '__ I I_ ._ :'_ _. WATER -EATER OTHER 1 'I 17.I'1 .'L. 1 irift� I ��MI -=:1 _. I L„ r 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 LIABILITY INSURANCE POLICY ED OTHER TYPE INDEMNITY ❑ . BOND ❑ . 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and rate t t best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliant with 'I rtpi'ovof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Ventresca (LICENSE# 15742 SIGNATURE MP❑+ MGF 0 JP❑ JGF❑ LPGI❑ CORPORATION 011 3255 J PA RSHIP❑#) ]LLC❑# —J COMPANY NAME: South Shore Heating and Cooling�r _I ADDRESS[57 Whites Path i CITY South Yarmouth - ' STATE MA ZIP[02664 (TEL L508 398 6901 ---_�_!T FAX 508-760-268T1 CELLI 508-360-5277 EMAIL joe@southshoreheafngcooling.com • IP 1i7 _II U IS JI 1 T___,,;_rn jr JI''I 6 'ctJliLi Lie* ( KIM • cut ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ El FEE $ PERMIT# PLAN REVIEW NOTES