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HomeMy WebLinkAboutG-13-542 it "1J' ,tlCyi'frrYll Y.r9G • OUT1 Wl�mk L1..442•RJ Min AI, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK W. DATE PERmirp b_._..�� I cmc L��' � I t,ipBSTrEASORESS _ ,►f_ g J n OWNER'S NAME Yelanal IG ova ,l'(1‘• ' cSocm2- Tec all "CI �� 0 O I TYPEOCCUPANCY TYPE c y� PLANS aleMrfrF��0 No D MINT CLEARLY NEW:❑ RtE ATION:0 REPLACEMENT;Id II 9 10 laninlie OILER ES T. FLOOR— eon Q© 3 6 B _M_ 1111111 Mal BOOST ER Millanlialilliniallalieln sbN SUMER �rIIral area llingi DROKSIOVE r_ _���'_allinillal IS pIRECTVENTHFATHl ��_ DRYERMan FRYOLATOR RE.1� IM)rl♦—MISIginlial.���_ lll♦ alni FURNACE l♦lr(�1♦ CialATOR ==t—A illi _r LABORATORY EUPMcoacs 0 I llaillnallallii • MAKEUPMOOi S__ _. '� OVEN IIIIII MI POOL HEATER ROOM I SPACEAWATER ��'a�'—N_S_ m— ROOFTOP UNIT __ UNIT HEATER la MS �'_v I WS MI wATER EO=OA HEATER )):� �---� WATERHEATER 1 I - I I_ 1 MOS • I i 111111/111nallS 11111111.1.11111. INSURANCE COVERAGE I have a raeterd6z�7T'"L'"sura"ce poky ori.Ysobabntalequiva(ardvA --aeoflAlr'L.Ch.142 Yej 0Q It you have checked M..plane intricate the type of covers checklistthe appropriate banSowe LIABNTYINSURANCE POLICY 1Q OTHER TYPEII1DUSM Y 0 BOND 0 OWNER' the insurance coverage required by Chapter 1Q of the • I Masnds se is ene alE .and that my cunt re on thisss wai Das requirement. Maesadrmetls General Laws. ttr� ds�e onPrxr�aPP»On--- CkECKONEONLY: OWNER 0 AGENT 0 ISIGNATURE OF OWNER OR AGENT • I hereby ger y Metalofthe d s aid information Mae Soiled(or entered)sregadog this ere Ina and=tato fie bed of my uirtand6LKafsgosp iserueP� fa Vs nil heit�lyoalce+ldhaAPertinent �tlsiane theMasthat adlus tis CcdeaidQar her142 citeGener-SL c. prwisanddlaMas551� . COMPANY NAME;thx WNW( (Uml , y F/kin I ADDRESS it< , th3 t.t2as4,L1 CITY: 1 I) L1 iCfn ISTAT`e 5111 ER WS-6 PP: s d �J . TEL-I�OS' �i3j 1 N-P-c( ken MA$Tr bl ❑ CPINSTAI[$i© CORPOR�`•TfON[] _ IP •it 111111111111 - Pi[�€JLLC0R (Ao(c p Pr t a., Bulowell uI L P.02 BY...------------:_