HomeMy WebLinkAboutBLDG-15-004996 /0- /0lla
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
r a_ _ !4S \\
cliff CITY /n� MA DATES PERMIT# �/u�6p �/ /
JOBSITE ADDRESS[J. of f. -✓-- a IL.LCL.t'vm_�1W_L..G, J OWNER'S NAM/11 0 14
GOWNER ADDRESS 'MP...... AX
TYPE OR OCCUPAN Y TYPE COMMERCIALLI EDUCATIONAL] RESIDENTIAL
PRINT
CLEARLY NEW: 1 RENOVATION:❑ REPLACEMENT:Cl PLANS SUBMITTED: YES❑ NO0
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER �' �! _,� _ I M _i —' ____l _—; �I l
- BOOSTER i _I i � _I _ __ �I _ _� �I
CONVERSION BURNER _! _I
COOK STOVE 1 .! .I f ,.J _rI I _ i
DIRECT VENT HEATER _—_ I ! i_I ! ! _., ____! : t
DRYER I ----3 .--.1_.,_.� I'�t ..! _._.J ..._.,._t ___i i�_ __. ._.-.._.4
FIREPLACE � �, _ ) _ ! _ 1 _-. l ! I� �i
FRYOLATOR I t _ I I I
FURNACE _.! 1 __.-1 _I _ i Tt _ _ ! i ! + 1 i
GENERATOR ! �I - _ —' I
GRILLE .! —_i ! ' i I
INFRARED HEATER I I i !
LABORATORY COCKS ._ 7 l 1 1 _I I ! ! i � _ I
MAKEUP AIR UNIT • 1 ! ! 1
POOL HEATER awma .i .piammoompaft.
ROOM/SPACE HEATER mos in®CMN®�
O . man "At-5 -ra-v0 1 WINWRISIMISMI MI
TEST STANK _ iMIS�OOS -MIS
UNIT .... •: ■ IllaiRra ` i�M�SI���
IIINLi siti��.�'..SItct31iT3r�=7ill`•NWPM 14/L�j1NI�. �—IR
�R EAT;7fF/F 'I r, ..rr/' is= o���st�tsal
ory: J _A'RI.i_21 _ _ _MESA t MIRSIPMESINNEMPII.111
.�,... _
_BUILD!N.��y ',.TMEN :I I I ._—.-I ..__I ..�.I I i i !: : t I
BY. ..,-.�: I. ' I t--_.�.._) _...r.. i —,T...1�.�...�._t .,..,_..._ _..�._I .—•—! -.-.,t
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES El NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY L,L7.1 OTHER TYPE INDEMNITY ❑ BOND L
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- jER ❑ AGENT
SIGNATURE OF OWNER OR AGENT r/►/
I hereby certify that all of the details and Information I have submitted or entered regarding this application are true a • ,• • : e to the best of my knowledge
and that all plumbing work and installations performed under the permit Issued for this application will be In complia •. Cyt n rtinent • • - on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ///
if
PLUMBER-GASFITTER NAME I Phillip Durfee P LICENSE#113774 /, 'ITTATURE
MP[] MGF 0 JP 0 JGF Li LPG!C] CORPORATION 0# I PARTNERS ;0#1 —1 LLC[l#1t3152
COMPANY NAME:I Durfee Plumbing,&Heating LLC I ADDRESS 2A Huntington Ave.
CITY SouthYarnouth 1-1 STATE MA (ZIP L02664 (TEL 508-619-3078 I
FAX 508-258-0592 f CELLI0B-801-8004 'EMAILhil@durfe pplumbing.com
•
.
•
CU
��''Z'��� l9 -1 0)()/