HomeMy WebLinkAboutG-14-395 :/
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
111 CITY ..1'4JD_l _ ___I MA DATE /7-?�L? 1PERMIT# /Pig- gs
OWNER ADDRESS ' O.5'../74/1/41e77/71-1,7ITE
JOBSITE ADDRESS• 2 c /i I f'i flI bWNER'S NAME r �_�17 ax
9 ,t7
TYPENTOR OCCUPANCY TYPE COMMERCIAL,J' EDUCATIONAL ''^J RESIDENTIAL
PRI
CLEARLY y N X
NEW:ryI RENOVATION: J REPLACEMENT:_, PLANS SUBMITTED: YES�
APPLIANCES Z FLOORS BSM I 2 3 4 5 6 7 8 9 10 11 12
13 14
NBOOSTER -- J J
BOILER J J
CONVERSION BURNER J J J _ r _-_ -...J
• ^ COOK STOVE _ i. 1 J J _. J __1
N DIRECT VENT HEATER _J_-• _ I_ _J 1 ,e '- _J _ _ J __J . 1_ __.1
DRYER _J__ J 1 ___J -__ . , t f
FIREPLACE ___JT
_ 1 ._J' ,1® -.--_2 1
_ !
FRYOLATOR .,—. '
FURNACE __J-...--1 , MAI 1
GENERATOR
GRILLENOIXIMMISIMINIMISIMISION111110.1111.111111111111.11111.111111111
INFRARED HEATER M9 0101111111a11011IpoE11_ 1__ 1.1111_1
al
LABORATORY COCKS OM I 1
IRINII
MAKEUP AIR UNIT ...1
OVEN 1 J flIS
POOL
ROOM
TRE0s0TF TOP UNIT 111 _
UNIT HEATER
�
UN ,_:..,:_:.:.:.,p•jp1j u i aS . _._a 1I___
OT ER b8 J __ 1
93- �0 1 _,_J J 1
OCT232013 J -._J ___J J I i
1 ®® —_ 1 - J _ ....J . J
BUILDING D- 1• MENT INSURANCE COVERAGE
I ha • ' .....i.1- . -. cy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 'LINO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY IJ OTHER TYPE INDEMNITY ...J 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 0, • OW :R _J A tl _i
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are - -- d acc ate to e best• nowledge
and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance ttr all Pe nent pro • of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. '
PLUMBER-GASFITTER NAME STEPHEN A WINSLOW I LICENSE# 12298 SIGNATURE
MP .SJ MGF _J JP JGF _j LPGI __, CORPORATION !# 3281 __, _ i PARTNERSHIP _J#_- _,J.LLC __I# _- '
COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING CGA ADDRESS 8 REARDON.CIRCLE ._ _ : . _ _ _ '
CITY SOUTH YARMOUTH t ' STATE MA ;ZIP 02664 ._. TEL . ! -111Q.± ._.______....
FAX 508.39478256 _I CELL_ , _,_-. _„__ J EMAIL ACCOUNTSPAYABLEIEFWINSLOW.COM
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
•
y`
•