HomeMy WebLinkAboutG-14-250 combo t 8O --
'* MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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VOW...,/ CITY MA DATE I� PERMIT# 6�9- 2co
JOBSITE ADDRESS _ 7—l /l Ail �� , OWNER L U,�Q,W 1 S I
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OWNERADDRESS C _. . . __ ( p7_ /�FAXC
TYPE OR OCCUPANCY TYPE COMMERCIALLI EDUCATIONAL[ RESIDENTIAL
PRINT
CLEARLY NEW:r] RENOVATION:[ REPLACEMENT: PLANS SUBMITTED: YES[l NOD
APPLIANCES 7 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
4" -, —
BOOSTER
CONVERSION BURNER 11 I i,-- i
COOK STOVE -`
DIRECT VENT HEATER ,Th -- -- -
DRYER - - -' -_
FIREPLACE
FRYOLATORFURNACE - - 1 1 11 --- -- -- ,, ,
GENERATOR
GRILLE
INFRARED HEATER - -- --5 --- --- - — -_ —LABORATORY COCKS
MAKEUP AIR UNIT
OVEN I
POOL HEATER - - -- --
ROOM ISPACE HEATER __ _ '-..._.._-
ROOFTOPUNIT -._ :_. :..,I
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER r
IEC1uED - 1
.. INSURANCE- -- - -
SE18. 2013 _ - -
Y COVERAGE `
I a::T- ; •.ipt,,_iJ' :titmice/we policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES [±j NO [ �i,-.
I I 16 -- ---."r'LCAof INMATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [17,1 OTHER TYPE INDEMNITY [I BOND [ ,1
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 0 AGENT Li
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 t.t _ best of my knowledge
and that all plumbing work and installations performed under the permit Issued for this application will be in complianc,with . 'St- •y;;_of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME[Joseph Ventresca v ��-�LICENSE# 15742 SIGNATURE
MP[+] MGF[TI JP Li JGF nLPGI[1 CORPORATION[!f#13255 IPA' , RSHIP[_ii#E___ _ -?_ LLC[ #[ _.1
COMPANY NAME: South Shore Heating and Cooling -I
1 ADDRESS[Al Whites Path ��
CITY [ outhYarmouth --- I STATE LVAJZIP[02664 "[TEL 128-..?.93-S901 1
FAX ._.1 CELL[508-360.5277 y g
FIEMAIL[joe@southshoreheatingcooling.com