HomeMy WebLinkAboutG-14-466 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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=41_s CITY ; &6.,071-1,. .( ,..WL`50 1 MA DAkE7 PERMIT# /V��i�S , i
' JOBSITE ADDRESS
�i 1/ lu��rJG�E(�jf)S OWNER'SNEME�.I��7UZlrP�FAXi�,
GOWNER ADDRESS „ '7*"
TYPE OROCCUPANCY TYPE COMMERCIAL', EDUCATIONAL .3 RESIDENTIALt
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CLEARLY NEW:Q RENOVATION:0 REPLACEMENT:2PLANS SUBMITTED: YES'. I NOD
APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14
BOILER
BOOSTER ;
CONVERSION BURNER
COOK STOVE _ I w 1: ._. ,._._._.. __ _ ._.I ._i .. J : I__.....:
DIRECT VENT HEATER ! _. ___.I —J _. _I'I .,___...,_.'. JAI — I .
DRYER
FIREPLACE
FRYOLATOR ` J ' ! �.
FURNACE
GENERATOR — — --- _____ _ —.T. _ ____ ---I ---I--
•
GRILLE
INFRARED HEATER .._..J -� ___._i . ____ _-:__, ___J_.___ _.__.I_.___ - ...-- J--_,.-
LABORATORY COCKS ___.._.., _.......J ,_...._. .._.___ _-... . ...T_. __._.J.__..J .___,_; ..__l ,-•—i -_.-
MAKEUP AIR UNIT _ I .._- I ._ . . _ ._
OVEN
POOL HEATER l l __
ROOM 1 SPACE HEATER — ` _J — _— I --! __J —i — .`J ___._
ROOF TOP UNIT 1 _.-_._. _ _._J __._,_ _ I ____ . . J .. I..,,,,„_,,,,1 _
TEST __.J _ _J
UNIT HEATER . . . ___ I I CCS, _.._I _.._.J
UNVENTED ROOM HEATERI — - -1 — ., — __I —"
WATER HEATER — _.— ' -J_J —:---I®- - .1___
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.14. RYE I' I'j9 1-V E 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1x1.1L6q(0337
LIABILITY INSURANCE POLICY ' ) OTHER TYPE INDEMNITY '„I BON r ENOV 13 2O1
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Cha ter42of 11w
Massachusetts General Laws,and that my signature on this permit application waives this requirement. BUILDING D E HT.
CHECK 0 INNER ,.J AGENT i
SIGNATURE OF OWNER OR AGENT E
I hereby certify that all of the details and Information I have submitted or entered regarding this application are true an curet to the b- of my kno
and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance wit al agent r *vision oft -
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -
PLUMBER-GASFITTER NAME STEPHENA.WINSLOW LICENSE# 12298 SIGNATURE
MP +! MGFLI JP 7 JGF:,-"I LPGIC CORPORATION E1# 3281C PARTNERSHIPL'# T I LLC ._'#I J
COMPANY NAME: E.F.Winslow Plumbing&Heating Co.,Inc. I ADDRESS'8 REARDON CIRCLE
CITY •SOUTH YARMOUTH I STATE I MA I ZIP:0-26,84___i TEL 508.394-7778 __ ______ R.
FAX 508494-8256 m,.I CELL NIA [EMAIL' accountspayableefwinslow.com
/3. 7/6
ROUGIi GAS INSPECTION NOTES TFIIS PAGE FOR INSPECTOR USE ONLY
FINAL INSPECTION NYes No
OTES
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ = PERMIT#
aAN REVIEW NOTES
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