HomeMy WebLinkAboutG-13-935 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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JOBSITE ADDRESS /tfnC/45, Jj/N lx.y /S L �
� OWNERS NAME EI�omrnrp G6 r124 le2�
G OWNER i/G( Cl2 7fl7 cS C.l�t1P . ._....__ e r_� ? _
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TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL EDUCATIONAL Li RESIDENTIAL�I
PRINT
CLEARLY
NEW:__„1 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES E,( N01(
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER � _ 4I I_ i 1J
BOOSTER :. __..__I .___i._ I
CONVERSION BURNER ..__. I
COOK STOVE , i J _ __' .___ ! _ J,...__ __ ( I 1
DIRECT VENT HEATER J ,_ 1' l . __) _ i- _J
DRYER
FIREPLACE
FRYOLATOR I _ —! I ' 7 _
FURNACE i ! _—
GENERATOR
0o GRILLE
INFRARED HEATER
LABORATORY COCKS ...' _I I I
r'n MAKEUP AIR UNIT I _i ...I
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST I ' � _._ I
UNIT HEATER
UNVENTED ROOM HEATER ; m ! ! . i yI
WATER HEATER StfarJt.-Fnn4C- I
OTHER ;--___ ! �..._' i I 1 I —I
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES Ld NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ± OTHER TYPE INDEMNITY ,, BOND (,,,,.I
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 ON Y: NER ` AGENT '.
SIGNATURE OF OWNER OR AGENT
and thaall plumbingwork and Installations performed under the for this apg application
willapplication are true a urate the bt fin kof ge
Massachuses StatPlumbingCode and Chapter 142 of the General Laws.
ed this application will In compliance wi all inept Ision oP
I herebycertifythat all of the etails and information I have submitted or entered r
PLUMBER-GASFITTER NAME STEPHEN A.WINSLOW !LICENSE# 12298 SIGNATURE
MP's MGF LI JP _I JGF i.;_j LPGI[,J CORPORATION i+,t#!3281C i PARTNERSHIP LJ# J LLC
COMPANY NAME: EF Winslow Plumbing&Heating Co Inc. I ADDRESS{13-Reardon Circle
CITY South Yarmouth I STATE I MA JZIP`02664 TEL 150: tg 7778 ,1" +- r
FAX4508-394.8256) CELL N/A IEMAIL)accountstarble@efvnnslow.com It i r
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ 0
FEE: $ PERMIT#
PLAN REVIEW NOTES