HomeMy WebLinkAboutG-13-1109 /0) , ()to__ Combo #8b --
. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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Aft�t CITY C5 -:r- - 1'l t( _... 1 MA DATE _ _ i
���� _.o IPERMIT# 6V3-��og
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a�I OWNER'S NAME C ra CJw _ W_ w VY J,
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OWNERADDRESS C_ ...-.. .,.„-..-_�TE 0_ ---:.._/ /�Q"IJFACIy.,.__1_I
TYPE OR OCCUPANCY TYPE COMMERCIALD ,EDU/CATIONAL[I RESIDENTIAL[
CLEARLY NEW:[,,.,,[ RENOVATION:[+ REPLACEMENT:`-{y PLANS SUBMITTED: YES[TJ NOE[
APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER -- I " - 1
BOOSTER - I - ; - '
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER I i i” . — -
DRYER
FIREPLACE 1 . ` -
FRYOLATOR r
FURNACE -- r. . H -
GENERATOR
GRILLE ,
INFRARED HEATER I_ I_ .. .
- I—
LABORATORY COCKS ,
MAKEUP AIR UNIT
OVEN
POOL HEATER - ' - . -,
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER -- 'I '
UNVENTED ROOM HEATER
WATER HEAIER_______ _:
_OTHER — - -
I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO [.1
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [ii OTHER TYPE INDEMNITY 0 BOND Li
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 [-3 AGENT Ei
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 ccurate ttt� best of my knowledge
and that all plumbing work and installations performed under the permit Issued for this application will be In compliant with Isi of the
Massachusetts State Plumbing Code end Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME I JosephVentresca )LICENSE 415742 itrgiij SIGNATURE
MP a MGF J_. JP[J JGF Q LPG]0CORPORATION 9# 3255 - 1 PA RSHIP C]#`...._ _ 1 LLC o#r
COMPANY NAME: South Shore Heating � � —
�yvyy and Cooling �- ADDRESS 57 Whites Path
CITY ISouthYarmouth _I STATErMA ZIPL02664 ITEL508 iv C.u_V.ED
FAXI508-760-2681 1 CELL[508-360-5277 „EMAILjoe@southshoreheatin9cooling.comm
JUN 2 4 2013 )
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BUILDING DER,q$TMENT
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