HomeMy WebLinkAboutG-14-1009 I MASSACNUSI TTS UNIFOKM Al'e LIUA iiU rt rt-ncArLtctvut IL,
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=� CITY: L.Z • NA DATE
JOESITE ADDRESS: y9' C '1, t'. LoFri Z OWNERS NAME pakev it y
G OWNER ADDRESS: \k- rIE4� ' • [1 ...t. A
PRTYPEIvT OCCUPANCY TYPE COMMERCIAL❑ E UCAT IONAL ❑ ' P1SID N I IAL
CLEARLY NEM ❑ RENOVATION:❑ REPLACEMENT:❑ MAY 29 2014 I ' S SUBMITTED: YES❑ NO❑
I APPLIANCES-1 FLOOR Bsnr, 1 I 2 3 I 4 5 t].iIoDl JG7==I-H 8 rriTESr II 10 111 12 13 14
I BOILER I I --1----1- -- _1 I
BOOSTER I I I I
CONVERSION BURNER I I
III
COOK
STOVE
TOVE
I I II I IIII
I
I III I iI I ,III
I _I
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
i
LABORATORY COCK I
MAKEUP AR UNIT 4�OVEN
POOL HEATER I
ROOM/SPACE HEATER 'ROTOP UNIT \\tic;akiti
TEST
•
UNIT HEATER
UN'VE TED ROOM HEATER
WATER HEATER
& 5 !niFI / I I I1 I
II
-
_
I I
• I l I 1 1 I I I 1 1 1
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL Ch.142 YES arICIO 0
If you have checked YES please Indicate the type of coverage checking the appropriate box below.
LIABILITY INSURANCE POLICY OTHERTYPE INDEMNITY 0 BOND 0
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 0 AGENT 0
SIGNATURE OF OWNER OR AGENT /
hereby certify that all of the details and information I have submitted(or entered)regarding this application are true:Fd accurate to tie bEl.f f my
Knowledge and that all plumbing work and installations performed under the perm&issued for this application wil •- comphanc7- ,/r/erhnent
provision of the Massachusetts State Plumbing Code aid Chapter 142 of the General Laws. / //// ,
PLUMBERIGASFIi I ER NAME: S& t O Li1DRSS:LICENSE#3q l / S1GRATUri11���...
COMPANY NAME kW �CE Ar_4 :A(C ( a I y 4NJ (wc
CITY: ?leyvviou'Ct STATE VFW_ ZIP:O Y466 • FAX:
TEL 66S ,215-17e-e-q/ f EMAIL:
MASTER 0 JOURNEYMAN LP INSTALLER 0 CORPO.RATION 0# PARTNERSHIP 0# LC 0 s
'=- I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
• ,- ..1-___ _.: am 2L�WLOtir+t t I 1 �//MAA.. DATE:.4 L � ^�PERMIT4 714—m9
+ JOSSrrE ADDRESS- £11 C.4-(27: W C- +-r Q` OWNER'S
.N.AME:` Paevb-xty
GOWNER ADDRESS* ITE ( �Ya! i
.� a
PPR.TEivT OCCUPANCY TYPE COIJMERCLAL❑ EC UC TIONAL 0---
REBID I lail
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 1y�Mg 9�J2014 P S SUBIv11TTED: YES 0 NO❑
APPLIANCES? FLOOR-+ Bsmt I 1 I 2 3 I 4 E Ur !iv G7JE1'?8rr ear 10 11 112 13 I 14
i -- — 4
BOILER I I I i r--�---___=-.�I I I
BOOSTER I I I I ,I I
I CONVERSION BURNER I I I I
I COOK STOVE I I i I •
I
I DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
alnillIMMIIMMINI
FURNACE I / I I I I I
GENERATOR V
GRILLE I I I I I
INFRARED HEATER I I I L I
LABORATORY COCK f
MAKEUP AIR UNIT I I I I
OVEN
POOL HEATER I I
ROOM/SPACE HEATER I I I I
I ROOFTOPUNIT I L I I
I TEST I I I I
UNIT HEATER I I_
UNVEN T ED ROOM HEATER I I I
I WATER HEA I titI I I '
I I
I - I I I I
I I I l I I I I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.'142 YES len 0
If you have checked YES,please indicate the type of coverage checking the appropriate box below.
LIABILI YINSURANCEPOLICY OTHER TYPE INDEMNITY 0 BOND 0
OWNER'S INSURANCE WAVER 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 appUcadon waives this requirement
CHECK ONE ONLY: OWNER 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted(or entered)regarding this application are true Id accurate to the b-4 my
Knowledge and that a6 plumbing work and ins Illations performed underlie permft issued for this application wil •• complmncp lth ertinent
provision of the Massachusetts Stale Plumbing Code and Chapter 142 the General Laws.
22qq / --
PLUMBERIGASFIi itit NAME: S� f" Ot?r1y LICENSE#__L_ I SIGNATUr
COMPANY NAME fr)J4ML-QCT /114:74FA/C WC_,ADDREss: 2 F�(3Yr4r�l (��
CITY:/I ( y ix/burg STATE /4_ 7JP:0 0(46 d • FAX
TEL: S� 215-if?,,gap . L: EMIL
MASTER 0 JOURNEYMAN If/ LP INSTALLER 0 CORPORATION 0 a PARTNERSHIP❑4 LL-Co 4
LA i'
SI G p . PUS PACS FUItdNSI']5C1'OIlUS17ONLY )�INALI.NSI'ECI'IONNOTIs8
OUGIC Yos No •
• TIIIS APPLICATION SERVES ASTIIE PERMIT 0 ❑
FEE: E PERMIT —
)',LAN IiEYIL1Y NQ'I'ES