HomeMy WebLinkAboutG-13-699 .S: , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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JOBSITE ADDRESS
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Q _�yL -.1 � � MA DATE:/ Z,�/c�f��PERMIT# !�/�J-�a/�
,�C,� '17 P�{/G�L�/ISt Xi) `OWNER'SNAME p ri/�L/C//1 J2-�/�CcL
1 G OWNER ADDRESS 3,9,41 _ ,__.
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TYPE OR _- - ^—• __. .
PRINT OCCUPANCY TYPE COMMERCIAL__ EDUCATIONAL RESIDENTIAL ?
sO CLEARLY •
NEW:: RENOVATION: REPLACEMENT:. /
MMPLANS SUBMITTED: YES.�..,? NO .._;
APPLIANCES 7 FLOORS BSM 1 2 3 • 4 5 6 7 8 9 10 11 12 13 _ 14
BOILER -r.
BOOSTER ;- _ `� =v
CONVERSION BURNER - 4 — _ f- =-, — —
COOK STOVE - •
— — --.---__t- -
DIRECT VENT HEATER — — •
DRYER
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FIREPLACE _
FRYOLATOR • __ __ -
FURNACE '
GENERATOR __- — -
GRILLE ,i i—Tr— , , = • ;
INFRARED HEATER c r-' —� - .-
LABORATORY COCKS
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MAKEUP AIR UNIT = _
OVEN
POOL HEATER IArrtiP
ROOM I SPACE HEATER _— _ _ -
ROOFTOPUNIT .. u-- - ` L� � pT a--_.
TEST -
I: %'i -
UNIT HEATER T
UNVENTED ROOM HEATER - , -a, ^ --_ -__c_., _. .,
WATER HEATER .:. '- _ --
,OTHER.
INSURANCE COVERAGE — "
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES L `NO _,
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY j OTHER TYPE INDEMNITY BOND 1 '
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 . , WNER 7 n GENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true an rate o the .-- of my • edge
and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with II eminent•rovisio . e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Stephen A.Winslow I LICENSE#' 12298
_._..__ .. SIGNATURE
MP MGF ,j JP____J JGF ; LPGI__. CORPORATION +!# 3281C : PARTNERSHIP•_.;# ; LLC #
— ____ ter'
COMPANY NAME;E.F.Winslow Plumbin &Heating-Co.,Inc. ADDRESS:8 Reardon Circle _.
CITY .South Yarmouth _
STATE: MA ZIP 02664 ____TEL 508-3947778 T/78 z_-
FAX;-508-9-94-8-256 I CELL WA EMAIL accountspayable@efw nslow.com
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