Loading...
HomeMy WebLinkAboutBLDG-15-000608 . ... 11�Ll ' c L " • q, k CITY: Bell H.w naa DA E At�(1/ 19 a}a/ / PEtJJriz�ltC�/sCdt� .... , JOESrTE ADDRESS: Il C/14/0 i n, p41 : OWNER'S NAME II n MadaLS •IG I OWNER ADDRESS: Se'WNi TEL FAX TYPE OR OCCUPANCY TYPE COMIJE.CLAL❑ EDUCATIONAL 0 RESIDENTIAL INT PRSIs'I' r CLEARLY IEW:'.i RENOVATION:a REPLACEMENT:0 PLANS SUBMI I I LO: YES 0 NO❑ bG APPLIANCES? FLOOR X Bait 1 2 3 I 4 5 6 8 1 9 10 11 12 I 13 14 b BOIL BOOSTER I I CONVERSION BURNER I I I COOK STOVE I I L___-1 I I DIRECT VENT HEATER I I DRYER / I FIREPLACE ` FRYOLATOR • I I FURNACE I . I I GENERATOR I I I GRILLE I I I INFRARED LABORATORYCK I I I MAKEUP AIR UNIT I I OVEN POOL HEATER I 'I I I I ROOM/SPACE HEATER I I I I nS ROOF TOP UNIT I I I I wwire UNIT HEATER I I �����i A�Lna UNVENTED ROOM HEATER I I 1111111r1M11- WATE3R HENT I I I I . �U I I I I I l: D1ilY,�1'=__ NNW BUIL IING •EPAR M N I INSURANCE COVERAGE `r. -- ='�='y • 3 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES R NO ❑oe' I If you have checked YES,please indicate the type of coverage by checking the appropriate box below. • LIABILITY INSURANCE PDUCY OTHERIWPE 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 MassachuseUs General Ins,and that my signature on this permit appllcadon waives this requirement CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT l hereby carnry that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and instillations performed under the permit issued for this applicafon will be in compliance all P�l +rfipent provision of the Massachusatrs State Plumbing Code and Chapter'1422 ooff the General Laws. %J%�// PLUMBER/GASH i I tKNAME 4 7 c f 11JS$?(ICf LICENSE# J/?SSS' ' II NATURE/� COMPANY NAME: p$/'b AC cl�OL- C, ADDRF�S:3nt7 4,1,, 4/ .0`' CITY: frudsivi STATE h_ Z1P: 0261/ .AJC Ta: 508 a37 9617 CELL: EMaJL: 'S MASTER$] JOURNEYMAN 0 LP INSTALLER 0 CORPORATION I I a X3175 PARTNasHip 0= LW 0 g MICR CA5 SYliC'1IOIY N9�Z�g a T1118 AGLFOR 1 5."ECI'OIIUSL ONLY }+INAL 1NSPECI'1ON NOTi 8 iN Yes No THIS APPLICATION SERVES AS TIIE PERMIT ❑ El p ©k--- 11 0 / FEE: $ PERMIT 0 FLAN IiEVIL V NOTES . }s