HomeMy WebLinkAboutG-12-729 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
'z.70:1--'s CITY l (�/JMO �-1 MA DATES rJ �-/7-/,]PERMIT#G-a- 425 -
JOBSITEADDRESS C/BC? eit- -6,4 1OWNER'SNAME t//DO h)/LJ -I
G /CO-•/n ltlti- pe)( ) �SDY3b It// 1FAXI
OWNER I 1 n V✓Ylc�
TYPE OR OCCUPANCY TYPE AL[] EDUCATIONAL[ ] RESIDENTIAL Ia
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CLEARLY NEW:[•] 'RENOVATION:❑ REPLACEMENT:[ PLANS SUBMITTED: YES❑ NO
APPLIANCES 1 FLOORS-. BSM 1 �a a2ai�tay�3 0 5 6 ry,�7 7 8 9 10 0.1. 13 14
BOILER S.5ly��yr_1S1f I 5SiSi5 a 5 5151
BOOSTER —'1 ; moi l l: i l01. 1;a is IN illigaii/�' �
CONVERSION BURNER l ISala., , SIl�l.'z 11t1T.T� r r _*1��111 ._.
N COOK STOVE Mg ra SSlI111111.1111I 1S11111i11111'ma■1+r1 11111 1J4i111111j
DIRECT VENT HEATER ,S a u.IuI11MISS IIs INN Sal SI 11111
#�:fM�11J' 15;'imi iasis i'os Jos Birt° 1Wlll
09 FRYOLATOR illai11�1U1r1J JI'�1rl masoci�'fiII W S 55 pmrl
1 DRYER �' 'r � �
FIREPLACE —01111111.1111.011111111$11111.111.111.0111=
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FURNACE • � _____ _
LABORATORY HEATER 11111t'1�0SS
GENERATOR ��
5 MI SI 51
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GRILLE � I I ���%�'
—ip■11:fp111'11■1)•Iu1�SINIK 11 Sri55IS
INFRARED i �'��'
MAKEUP AIR UNIT SI�lSS&ice MilMI51i�11 S, I I
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POOL HEATER 5,fjS, ll5SI—ISI Isii�la5SISl
ROOM/SPACE HEATER 5i5II55I5 S S'Si ISIS 5':51 151
ROOF TOP UNIT i l51I) , 5,S S Sill it Ilai ifSS1 I
TEST SSSSfll—•111115s,ial_i ss _ti l
UNIT HEATER ' 0.111i'SII SI iss(oslas la.is,l ,m=OS Sial
UNVENTED ROOM HEATER 5'1111111!f1i11111 011111 SI 5 Sal 1110,5 5155 55
WATER H ER --- ---- S_ISIi,_�''_asalitSian�1�OJ 1
oTHE3�,:._ �.__ ISi;r ill111111 11 ■ t 111111,11105,511111115.55111111101111.MIS SEIS SS,nil s
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lissigiusissusis jams sa 1fi_Ir1111Ji1®11i111 11111 isime
INSURANCE COVERAGE
I have a currentJlability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ILI NO _}
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ILI OTHER TYPE INDEMNITY 2 BOND 0
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not havq 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 r NLY:. OWNER _J 'GENT '
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and Information I have submitted or entered regarding this appllcaUon are true and : • = the b of my 'ge
and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with = -:rtnent -ro'cion of
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A
PLUMBER-GASFITTER NAME I STEPHEN A.WINSLOW I LICENSE#1 12298 SIGNAT RE
MP r:_] MGF V JP IJ JGF LPGI Li CORPORATION IJ#r281C 1 PARTNERSHIP....J# 1 LLC Dili _ I
I
COMPANY NAME:i E.F.WINSLOW PLUMING d HEATING I ADDRESS re REARDON CIRCLE
CITY SOUTH YARMOUTH 1 STATE rirA IZIP 02664-- 1TELI508.394-7778 I
FAX 508.3948256 CELLI N/A EMAIL ACC OUNTSPAYABLE@EFWINSLOW.COM 1
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY
FINAL INSPECTION NOTES
Yes No
•
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT 8
ELAN REVIEW NOTES •