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HomeMy WebLinkAboutG-12-311 J r— MASSACHUSETTS UNIFO ' PLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • r CRY I Yarmouth Shit'' MA DATE •- PERMR fieri 2- I) G JOBSITE ADDRESS I iR , A(/4' IOWNER'SNAMEI2 ,,n,cs rag a? I OWNER ADDRESS: I I Ta: I I FAX I TPP OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW 0 RENOVATION:0 REPLACEMENJ PLANS SUBMITTED: YES 0 NO 0 BOILER FIXUTRES 1 FLOOR-• fume 1 2 3 4 5 8 7 8 9 10 11 12 13 14 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATERDRYER (� 0 FIREPLACE I I l7 r II FRYOLATOR ' FURNACE N V 2 201 GENERATOR GRILLE -"Luny neer I LABORATORY COCKS 44- OMAKEUP NRUNIT Cie- / ' POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER • I have a curter*Habit,insurance INSURANCE COVERAGE policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YESZ] NO 0 N you have checked gs,please Indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY p OTHER TYPE INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the0 Massachusetts General Laws,and that my signature on this permit application required by Chapter 142 or the SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT hereby certify that at ci the debts and Information I have submitted(or entered)regarding this application are true and :.. torho best of my Knowledge and that all plumbing work and Inatatatbru performed under the pent Issued for this apptaaton will be In co . • ce with at Pertinent provision of the Massathisetb State Plumbing Code and Chapter 142 of the General Laws. PLUMBERlGASFITTERNAME I/>-r,4r.-y1.2 /2-42COCKIIICENSEI s SI ,imrase COMPANY NAME I ,...4.7.-024202-5 /n24/^ /✓4 I ADDRESS: CITY: I r�/t ISTATE 0211 ZIP. I n740/ I FAX: I TEL. I° cg< 9 cy I CELLI I EMAIL: L e " ,rt, MASTER 0 JOURNEYMAf,tLP INSTALLER 0 CORPORATION 010 (PARTNERSHIP 0 I U.0 0 tQ , BELOW FOR OFFICE USE ONLY FINAL INSPE�ETES nnrw roc 1NSPECIION NOTES Yes No Z-1 0 I. -If _. l'' -- H ' • 0 0 u _Ir, IA. FEE: $ PEW1R l___-- --r or ♦N aEYIEW NOTES_ - - ' ------------------- ------------- t