HomeMy WebLinkAboutBLDG-15-001551 "` CHUSETTS UNIFORM AF'VLIUA I!UN 1-1-ittA rCruvu I .vrcnr..,..., .a...� . .. 4...... .....,.
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cc CITY: \'0.f NJOU MP. DATE 1 a.1/l tI PERMIT; nedrage7
JOBSI T E ADDRESS: U 2• 9‘V • OWNER'S NAME {-4 AyPJ
GOWNER ADDRESS- TEL: FAX,
TYPE OR OCCUPANCY TYPE COMMERCW.❑ EDUCATIONAL 0 RESIDB1 IAIS
' PRTT
CL 4RLY IEW .ENOVAI ION:0 REPLACalENT:0 PLANS SUM I thLt YES 0 Non
1 APPL1ANCES7 FLOOR I B t 1 1 2 1 3 1 4 5 5 7 1 8 1 9 1 10 1 11 12 13 1 14
1 BOILER I I I I I I I I I
BOOs1di 1 I I I I I I I
1 CONVERSION BURNER I I I I • 1 I I I
COOK STOVE I I I I I I I
I DRECT Vag HEATER I 1 I JJ I I I I
DRYER I I I I I I
FIREPLACE I I I I I I
FRYOLATOR I I I I I
FURNACE I '
I GENERATOR I I I I I I
I GRILLE I I I I
1 INFRARED HEATER I I 1 I I I I
1 LABORATORY COCK I I I I I I I
MAKEUP AIR UNIT I I I I I I
OVEN
I I I I I
I POOL HEATER I I • I I I I
ROOM/SPACE HEATER I j I I I I •
I ROOF TOP UNIT I I I I I I
TEST I I I I I I
_ , I I I I I 1_ I
I �3 " I I I ' I
I AUG 20111 I I i i i I I
I 1 I I I 1 I I I I
BUILDINGAliMi r INSURANCECOVERAGE
----"--'1. :,. I t=ace poky or its subs l equi�ralentwhim'meets the requirements of NGL Ch.142 YES. NO ❑
If you have checked YES,please Idlcatethe type of coverage by checking the approprial box below.
LIABILITY INSURANCE POIJCI OTHER T YPE INDEMNITY' 0 BOND 0
OWNER'S INSURANCE WAIVER:Iamaware thatthe H``censseedoes not have the insurancecoverage required byChap r14_2ofthe .
Massachusetts General Ins,and that my signature on this permit appfcardonwaives this requirement
CHECK ONE ONLY: OWNER 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information l have subrrdLted(or entered)regarding this application are true and accurate tote best of my l
Knowbdge and that all plumbing work and insaliatons performed under ffie Parma issued for this application will be in co fiance Nal a6 Peerfinent
provision of he Massachusetts Sime Plumbing Code a Chapter 142 of the General laws. _
PLUMBERIGASHI ItKNAME: lc-etc N ok 0,muiis4AV 11 UCENSE# !call AA SIGNATURE
COMPANY NAME. (2)0t1 Si a e C" 1 V,v.,L t Rus &{{ec AD RESS: PM O % (so/ a-S g
CITY: Oct QA-A, S STATE it int— 72:0a-6 J . FAX:
TEL: 77 '1-2/6 litric u: EMAIL:
MASTIT OURNEYMAN 0 LP INSTAI I FR 0 CORPORATION 0: PARfles11!P 0 4 us g _
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