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HomeMy WebLinkAboutG-13-269 -/, N` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '-TM, ?TOL Iv CITY W y4/nia4'1 I MA DATE /0-P-0/,-. I PERMIT# &i -co 49' JOBSITE ADDRESS 5-03 2nrde U ItN7 m g OWNER'S NAME /.entre ,9. 'Thorsen sen 1 GOWNER ADDRESS 2,/-2 Whin Sf� YYa/ivna / /N/f a/8a/_u/�TEL FAI TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL PRINT CLEARLY NEW:D RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOD APPLIANCES t FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ft -1 _. II_ Il,_._ ..dl„ it _� i( _ I n I BOOSTER II I�k . , }�-f��JiII �I II ,1 V kl: i=---,2 \CONV-.::--CONVERSION ERSION BURNER �� 1 . , dnSI Cil l 1-='-i"--III-if,„- i I 11 Il c"QOOKSTOVE CennfrAci .�' is/..IIS 1i I _ :1 Ir 11 tl, . . 1 ; II .. @ 1' U DIRECT VENT HEATER ILII IL. . ,k�I(� I II 1 i _„-...51.-'1" 11.1-ki - DRYER 11-11 1 I 1„... 1 _,,,,,y II ,y I . 'I ff k.w, II I-, !REPLACE , I y Si„._ it „f,,� ' I_„ ,I I, a i( gj .,,, i1 �,P t'r\ FRYOLATOR I . ..fly_ -r i.,z,. IIS) I II wfi�'I �...... Il k; ilr ,_ tl .n I RNACE • E- t( _ If_ ill . II Lk(�I__.—1-1' I 'IIII. Ir .I Ise' GENERATORL„.._ ., GRILLE I "f- 1( - 1 ' i I it I 1 _ � ti_ li ,.. ,..I • • , - _ o 7,71_ I1.„_,, Pf�B ,..„_11.._)17.71„.„.„, II tl .,.,„11,, ,.„., MAKEUP AIR UNIT I - 1` I , IS S LABORATORY COCKS '_' l , I l I 1f it, (( -11 I .� , u o 1 I T----11—II 4j id—�If�i n iri rry , a mn• . > r OVEN I - ---s n5i.� ...Lc'�—Ily ii v.fl I, 1j 4 POOLHEATER L —°' I 1 1r I d ROOM/SPACE HEATER ( 7.7.-'. 17_ 1721.1 1_,J _....,,..1 (m it .,1 I ROOF TOP UNIT f ___ l _ >�41�fl „ 11 I I IT ,,,ii _,& , w. . .. TEST � ..��.. I wiles � UNIT HEATER ILII_ .,d ;41a 1 .�. II .J1 ' ,1 nT.. ,, .., i ...., ,.I UNVENTEDROOMHEATER I . ii .,,_ IIS I 17�,W i1 I1�, ..a.,�,114 ,__ 1�,.,,4 WATER HEATERL_ 4 41 I 1 OTHER [ Ik i ! ft —4 —ISI I. 1-4--.. Is_ 4 C1 I Ii . I-1 4� I l I , t I -1i. f- 1 ,.. ; ._II 41. f r, 1 _ 4 ITM ' ti.�l __ 1'114n__ -_ (moi 4 .I-- EI -il `I I INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ©NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 4g OTHER TYPE INDEMNITY ❑ BOND ❑ 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 ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I"' I hereby certify that all of the details and Information I have submitted Or entered regarding this application are true 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 compliance with all Pertin�eentt provision of the -; Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - G�G�'`�'' FnK W PLUM@ LICENSE#1779Y SIGNATURE _ MP❑ .MGF❑ -JP❑:JGF❑ LPGI❑ CORPORATION Q# 1761-G PARTNERSHIP ED 1LLC❑# _ COMPANY NAME: RutTl/s he. I ADDRESS fl2 Mrd-TccL Dyne- ‘-n.... CITY v W. yOlvtri .y1. ?=: -r - r-. I STATE E MA JZIP 02473 TEL Sba-Dr /303 FAX 508-'n/-9310 I CELL EMAIL