HomeMy WebLinkAboutBLDG-15-003575 / -`_T I IVWJAAl:r7UJ t I is U NI rurJYI Hr rLIi.Atw,� rvnr.. u....0 .., . •�... -.-.. _ ._ . .. .---_ .-_.__
1 G1: Yitoo'1o,/-�lM MA. DATE 127311/`( P�.M1TF biterr35'7
JOESITE ADDRESS. ?7 (fPrnIAI Pk 11-14- X.9 OWNERS NAME an"luG TXRDy
I G OMER ADDRESS: l •,,A 3C0?- 72'9tiFA;-
TYPEOR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL 27 .
PRDTT
CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0
APPLIANCES? FLOOR Smt 11 12 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 11 12 1 13 1 14
1 BOILER 1 I I 1 I 1
BOOSTER I I I I I I I I
1 CONVERSION BURNER I I I I I I
COOK STOVE I I I I I
DIRECTVENT HEATER I I I I I l
DRYER I I I I l
FIREPLACE I I I I I I
FRYOLATOR 1 I I I I I
FURNACE I I I . I '
GENERATOR 1 I I I I I
1 GRILLE I I I I _1 .
INFRARED HEATER I I I I I I
1 LABORATORY COCK I . I I ' I I I
I MAKEUP AIR UNC T I I I 1 I I
l CNBI PoHEATER y1scnNNEc I I I I I I_
POOL
1 I r 1._L--1
.
ROOM/SPACE H TEP, I I I I I 1 '
I ROOF TOP uNIT I I I I I I I
TEST
U rN - .- r .. C 14 L I_
I u Z l za RoOliEATER I I I I I I I
N*TER HEATERJt4 -7/) I I I I I I .I
_ DEC 31284. i 1 11
__ r I I I 1 I I l I
13UILUu ,�r.I -
INSURANCE COVERAGE
1 hair- .1 1 - pokey or its svbstriftal equiv-tientwhich mzathe requiresnetts of MGL Ch.142 YESNO ❑
If you have checked YES,please indicatethe type of coverage Kiting the approptiaa box below.
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑
OWNER'S INSURANCEWANIRIamaware twat the licenseedoes not have the insurance covazgerequiredbyChapter142ofthe
Massachusetts General Laws,and that my signature on this permit appflcon waives this requirement
CHECK ONE ONLY: OWNER 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
hereby catty that all of tie details and miormauon I have subrriMed(or entered)regarding this application are true and accurate to the best of my 1
KnowIedge and that all plumbing work and insallafions performed under tie perms(issued h this application will be in compliance wdh all Parket
proton of The Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBERIGASI-IIIt1-WAMED977/9/i/V !7. £ ),NG LICENSE# 1528/ SIGNATURE
COMPANYNAME:6GFMP2/C /jvanl&t/.0177/UC- ADDRESS: PO. ,Box G
CITY: c cY+G4/1o, STATE (HA ZIP: 02510 FAX
508)317.9 8° Cal: 47'?)737- C°'-717AARI.
MASTER LTJ JOURNEYMAN 0 LP INSTALLER 0 CORPORATION Eli 4,,72_ ?AR NE SHIP❑4 at 0 g .
TlOS 1'AOr, 0I1INSLEICI'0RWig ONLY FIPIAL 1tY5I'LrCA70N N011sS
01_1G1 r S Rt I'LC'- 11! 1111 r, Yes No
TIIIS APPLICATION SERVES AS TIIE PERMIT ❑
FEE; $ PERMIT 0 _
KLAN IUKYILWY NO'I'Is8
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