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HomeMy WebLinkAboutG-14-094 nae-cc mum awarroree r.nd iw -ac-ant aa•� . '� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORKNM i41 CITY (� 1. MA. DATE II� � PERMIT€ L5'7—°91/ �& ygr CAVNEKSNAME' tf1SGcS 1 '� �� "ADDRESS �1�•7�i��_..n�jit� otsi G^I TEL- - FA>C� J 6 TYPE OR OCCUPANCY TYPE C CIAL 0. EDUCA1xx AL 0 Allta PRINTPLANS SUBMITTED: YES❑ NO ElC(EARLY NEW:0 RENOVATION:❑ E T: FIXUTRES 1 FLOOR- Bust o© 3 an 6 7 B 9 10 Ina �� IWN BOILER _ ■ BOOSTER F MI-�111111111,�__-_IIIIIIIII`_ COOKsT ION -R gall. '_�'__ ��__�r_ DIRE STOVE �___—a� IIIIIII DIRECTVENTIJ1TT1t )i)� �)r���r � DRYER I I I I r FIREPLACE I I FRYOLATOR I FURNACEI GDIERATOR , I I Gialt.E I I LABORATORY COCKS I • MAKEUP AIR UNIT I I I i I OVEN I t POOL HEATER I ` I I J ROOM,SPACE WATER I I I I lI ROOF TOP UNIT TEST UNIT HEATER I I II UNVENTEO ROOM HEATER I I jl WATER HEATER ` I • rrpin�c I I I i V I I I I 4 I • i I I !'� ~ I I INSURANCECOWFRAGE . w which meats the requirements of MGL Ch.142 YES 0 NO ❑ t av a toured lane insurance rag oriis substantial equ rte" re F checked�please indicate the type of coverage �kn6 the sppropnate box below. UI BOND 0 WI O 0 • LuteL1TYINSURANCE MuCY OTHERTWEIND`MNITY 0 U `� 0 �? •v :r INSURANCE WAIVER:I am aware thanks license does not Mgt i coverage requited by Chapter 142 of the W ¢ ` - weds General Laws.and that my signature on this permit application cation waives this requirement. IX m m CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 1 bembYthat al of the dotal*and iiforawlion I have Smiled(or ordered)regent;this appl os• true and accurate to Me best of my Knoop end that el plumbing work and intaIl Eos paternal under the pemdhmd far this-.•i-'YFr`• will be in compliance silk all Pertinent prorisian of the Massadu>seUS State Plumbirg .C444 and Ouner 142 of Me Geral laws. . • - r0r and JuariSEI ( IQ( PtS1MBERIG/�it�NAMC I�0 f1 COMPANY NAME:t he k l Ponnli 'sinibt f 1-khrll+ -`1 115 IQ A Skizsi U1 Dr i CITY: nd�171 e� ESTATE: (M ZIP:+nas( a I FAX: I' SISINA1JJ • I TEL:50c6 33.J Loll. IC61; t UQcCOJO/KO CDivKJrpopioROf aft ead ItrssTERgV D .U'tNS7ALLER[] GF- IPARTNERS`tiP(]@I LLCaSI� ' ii /} TOTHL P.02