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Home My WebLink AboutG-14-431 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • to CITY: LJ ' Y N R i^'- MA DATE: /1- V- P, PERMIT# /J/9.. 0/ JOSSITE ADDRESS. 4 `r cTvi et /yam G ;c. OWNER'S NAME ret At w Co Al Ad 0 /r GOWNER ADDRESS: TEL' FAX• TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL❑ PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 APPLIANCES1 FLOOR I Ssmt 1 1 1 2 1 3 4 5 1 6 7 8 1 9 1 10 111 1 12 I 13 1 14 BOILER I I I 1 I I I BOOSTER I 1 CONVERSION BURNER I 1 I I 1 I I —_ COOK STOVE I I I I I DIRECT VENT HEATER I _ DRYER FIREPLACE I I _ I FRYOLATOR I I I FURNACE I 1 I I I I I I I GENERATOR INFRAREDGRILLE HEATER � I I I LABORATORY COCK I I MAKEUP AIR UNIT I I I OVEN I I . POOL HEATER I I • ROOM/SPACE HEATER I 1 I I I ROOF TOP UNIT I I TEST I I I I UNIT HEATER" - . . ,._ I I I I UNVENTED ROOM HEA " 1 I I WATriitliwi nthL UI'+LJ a g' f✓. .'. i [t INSURANCE COVERAGE �/ ave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES a NO 0 If you have checked LEI please indicate the type of coverage y checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 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 ray signature on this permit application waives this requirement /114—Pt 1 CHECK ONE ONLY: OWNER AGENT 0 SIGNATURE F OWNER OR AGENT hereby certify that all of the details and information I have submibed(or entered)regarding this application are the and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compile ce with a erlinent provision of tie Massachusetls State Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASFITTERNAME: / c V-crt T. C0woc icENSE#, / 3 37/ SIGNATURE COMPANY NAME: 0 u a rill Na#t in. ADDRESS: / y 3 .G K e H T Peck le! CIN: Loa .4-e-kcvr,... STATE *^ 4qq ZIP: o2 CI ' FAX: $03 Z 1/6"/ 7a. TEL: Co P 2P/ G/ 72, cEn 7743SC86"EMF,tL: — / MASTER JOURNEYMAN 0 LP INSTALLER 0 CORPORATION 0 s PARTNERSHIP 0 r LC'�€ LIP OU II G 5 N.VE _ f ► - r TILTS PAGE FOR INSPECTOR USE ONLY FINAL INS L'EcriON NOTES Yos No THIS APPLICATION SERVES AS TME PERMIT 0 0 FEE: $ PERMITS )'LAN REVIEW NOTES COMMONWEALTH OF MASSACHUSETTS - DIVISION OF PROFESSIONAL LICENSURE-BOARD OF LIPLUMBERS A MASTER PL MBER ISSUES THE ABOVE LICENSE TO: PETER J SAVARY ' 143 GREAT NECK ROAD N. WAREHAM MA 02571-2426. . - tea.._, • 13371 • 05/01/14 146539 COMMONWEALTH OF MASSACHUSETTSLICENSE NO. .. EXPIRATION DATE SERIAL NO.- DIVISION OF PROFESSIONAL LICENSURE-BOARD OF SHEET METAL WORKERS ' AS A MASTER-UNRESTRICTED ' ISSUES THE ABOVE LICENSE TO: PETER J SAVARY m 143 GREAT NECK RD r ' ' WARENAM , MA 02571-2426 1 ' ` 4557 09/28/14 240878 '. ' LICENSE NO.' c.EXPIRATION DATEa SERIAL NO..? ?: COMMONWEALTH OF MASSACHUSETTS DIVISION a. PROFESSIONAL LICENSURE-BOARD OF i.' PLUMBERS AND GASFITTERS LICENSED AS A JOURNEYMAN PLUMBER I ISSUES THE ABOVE LICENSE TO: PETER J SAVARY i! • 143 GREAT NECK ROAD iy i ' • WAREHAM MA 02571-2426 25840 05/01/14 146541 LICENSE NO rki.! EXPIRATION DATE •"SERIAL NO. • � , • • CONTROL# H 3 5 4 6 91 9 IMPORTANT If this license is lost or destroyed, notify your Board at the: i i Division of Professional Licensure,1000 Washington St., Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws !. as amended.It is a personal privilege,and must not be loaned I. or assigned to any other person. Keep this license on your • j' person or posted as required by law. i e_ • - - . CONTROL# H450902 • - _ --- - - • IMPORTANT • • If this license is lost or destroyed, notify your Board at the: • Division of Professional Licensure, 1000 Washington SL, I I Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to Insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws • • ' I as amended.It is a personal privilege,and must not be loaned II or assigned to any other person. Keep this license on your kperson or posted as required by law. • CONTROL# H354693 IMPORTANT i I If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100. If your name or address shown is changed, notify your board 1 of correct name or address to insure proper mailing of next .I Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended.It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. i I .