HomeMy WebLinkAboutG-14-826 `CA,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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'�-:.4(�E� CITY (- o, J MA DATE ��IPERMIT# 641-FR 6
JOBSITEADDRESS it-fslfl{ IOWNER'S NAME : �fcu S -k/' . _ ,
OWNER ADDRESS ',...5R ILI 4_- �_•„�� ___ i TEINSIg��i3�9�",O4qI9, ]FAXi •.
TYPE
1RINTR OCCUPANCY TYPE COMMERCIAL:3 EDUCATIONAL:0 RESIDENTIAL2Y
CLEARLY NEW:0 RENOVATION:El REPLACEMENT:rvJ PLANS SUBMITTED: YES 9 NOD
APPLIANCES 2 FLOORS-. 1SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER F-1-____Ci.____ •_I�i_.__t I i '.iIi
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BOOSTER ���_..___.-1' �i � . ...—I ._ J E=1 _Li
CONVERSION BURNER (— _.._' J(i.._f 1..__J .:__I --
II�.:J .._1:=:.I_�Lni----.
COOK STOVE T.-- _--,: J . I -•_•:____, ___-__
I I____I._..__- __ J_ _I____I. 4
_
DIRECT VENT HEATER --�_ � ,.—,-
__ I 1,.........1 I J_____L____ „-„�i , . 1._,_.1: , l._.,,.i
DRYER __,J:._..J .__ _!_._.J.___.I____.J_.__...I,...,._,J ,-.,. J-----1,_.-1. ..,i
FIREPLACE __, I.__„ I, . .,�- ._i'._ 1 .__I __._._ - J_. ,
FRYOLATOR f:1• _..�f J T_.__.J - ' l ' _I__ i _ ___
FURNACE 'r__—_. _ I, _J ,,,J'.. -_Ii _ r : ._ __._:__J ...e _.�.
GENERATOR -_,moi i__I___ ! —
GRILLE tin`s Lin _J ___,_i ,.._._.�. _J__•_______I_--,_ ____ ___
INFRARED HEATER . J-_ _.. ._ _ '
LABORATORY COCKS • 1 ;,____I
MAKEUP AIR UNIT
OVEN —._ ,,._.,_ I'.. I ...._.J ._.•' ._..._.I _: ': --J �•� `--- _J
POOL HEATER r:`..I .. i .. .I. .. .. " _ _ ..
ROOM ISPACE HEATER i..� iL.JJ ._._I -i; - .
__ I I . . ..
TEST 1 1_3—; «i ._ . 1 i _ _ . I -i _ii I
UNIT HEATER i _i ____:'_J __J' ._._.J __.____'____I � I
UNVENTED ROOM HEATER i'i.3 . r___ I __.._J _ • I_i,_-__.._1 _ ___, . J
.!'TtIER" li I I V . I I 1 I I f f I
tarry: ,, ir`_a,.. r.....1 ,.J _I __J .,...._I _____I _J —' _ I
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( � .t./IE INSURANCE COVERAGE _
I alt§gi¢liftittl.r. ce p�licy or its substantial equivalent which meets the requirements of MGL Ch.142 YES [J NO J
I I• 6UtRECRED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 'a OTHER TYPE INDEMNITY ,•_J BOND U
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 ON • OWNER AGENT C
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and Information I have submitted or entered regarding this application are tru accurate to the ,est of my kno -.z a
and that ell plumbing work and installations performed under the permit Issued for this application will ie In compliance rtln: t provision of .
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME STEPHEN A.WINSLOW ILICENSE#'12298 SIGNATURE
MPI.,.:fiJ MGF0 JP n JGF jJ LPGIED CORPORATION 0#'3281C __JPARTNERSHIP D#___,„}LLC .3#' I
COMPANY NAME E.F.Winslow Plumb(ng&Heabn�Co.,Inc. (ADDRESS:8 REARDON CIRCLE i
CITY ,SOUTH YARMOUTH I STATE: MA jZIP.02664 ;TEL,508-394.7778
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FAXI508-394.8256 j CELLI N/A [EMAIL' accounts.a able.refwinslow.com
PI LI - 101 LP II-
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY
(tt 605 d FINAL INSPECTION NOTES
' Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE $ PERMIT#
PLAN REVIEW NOTES
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