HomeMy WebLinkAboutBLDG-16-002122 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
?- L=. ' crrY ' :� A. MA DATE /a ( PERMIT#/ ✓l6/G-oC�gal.
' G JOBSITE ADDRESS �2� e- 124 . -I OWNER'S NAME: A1I lid 5u/Yiv-n zit f
• OWNERADDRFSS';&n,1/40 • f TEL -147--'1FAXI I.
TYPE OR OCCUPANCY TYPE COMMEFtCIALL1 EDUCATIONAL 7:1 RESIDENTIAL
PRINT .
CLEARLY NEW:,.-J RENOVATTON:74 REPLACEMENT:_J PLANSSUBMITIED: YES Q NO"C:1
APPLIANCES 7 FLOORS-. BSL 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1- I—F,!�t—CJ`-3_J'� —1' I ..
CONVERSION BURNER • _j- 1__I JJ Jam.I€_11_L J J 1_J-!-}`__ J/_J-j
COOK STOVE - —J • I_ f_ 1JJLill IJ __-J=I-1 _..-.t1U1�. H
DIRECT VENT HEATER J J.J__(—J_J--1-J�__J!_1_�:-1.JI
DRYER• ,� .. 1- .. - ..
FIREPLACE Gni_1_Li]_.:11 _�J J.I.1_.1_1_1
_i•_. .. - ,_ • I
• _ _ .
` FRYOLATOR - 1 J.-1�J .-r ;-,.%)-11
1 .. .Jj_ ._. . .. ;
40 FURNACE J-J.�—1 J-•I —1___i—J'—I—I,J. (_1
GENERATOR _1_ J—I—E—I_I_1 A-1 i —�—J Jam'
lF.
r GRILLE -J,_,___I• 221:1 I_I—J:_JF— ,-1_J_J U J1-
JI
INFRARED HEATER . _I • _J 1._...1 " 1'—•J:__1_= •�'_,_1'_J -ii
LABORATORY TER J_l-]T-i JI J�J�I I _ . .1,. J• ,i _Li-J_J
r. MAKEUP AIR UNIT • --tt_ILLI'-J JI_1 -Li-�ij-_J I J • I_J
OVEN _1_J—Li L.11:111 1_1 JI.JI ... I�J--1 LLD _l .
1� POOL HEATER ..,;:.4.-.;,:_f___Lf-...1 J,1.JJ_____'..__.J:—f—J_(TI .L. 11_J1
ROOM/SPACE HEATER `_l_J_j_I.T1_,_l'�.,I-_1_1=_•_iJJ,_I. I " 1
ROOF TOP UNIT —__J_1I-J_I'_ ! IiIJyJ_ _I_j J - t
TEST -1=1--I / 1:_J JCr....)-J_4 1__I•_____I.___I L__J—(
UNIT HEATER -_--,i.I__I_I T1 _,,,LI_J J I�J_,1,-JI L___1
UNVENTED ROOM HEATER • I___LI _.-1__J—!_1�J�J_.I�___1____11___1._____J.. __J
WATERHEe1 _____----- _J 1 Imo.=_I L t-- I_j
_
OTHER t ( 1' 1•__.:i'_J o. I.= I .. 1 II._—i LL-1—.1,-.LE._:-1. _I r
' ,, ._.._._ .._w. I-1-=-1 I�I .-_1TI' 1—I_1J—('_JL_J__ I
IL IJ-J_..I-.__I - . .. .
... J --1_J'JIJ_1 L1_:_1 .-_`IJ hK
t INSURANCE COVERAGE -
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES u NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COTVERAG CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY �l . . 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 ONLY: OWNER J AGENT
SIGNATURE OF OWNER OR AGENT
h I hereby certify that as of the details and Information I have submitted or entered regarding this application am true and axurate to the best of my bmowledge
and that all plumbing work and Installations pertained under the permit Issued for this application veil be In prancet• a8 Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws (/ . _
PLUMBER-GASFITTER NAME i Gr -cZ7 ••-f LICENSE# Ort} SIGNATURE
MP✓J MGF , JR J JOE LPG(CI ;.CORPORATION C.„1# /c 1 PARTNERSHIP Me.-- LLC att '•__-11
COMPANY NAME (1 r`44,E f9A./r_ j ADDRESS 7 �i-7 l rl. gig
CITY ? .....Q-/�tf['u.7l. I STATE- APP--43� T� , f rELZ f f�tf'T 7,
FAX•— '1 1 C Z.f rl -� MNL 3'h r8! /CQ O `-4E!' - "td4 4(lc./. [aah/?.-- -----
_- ..---- 1
El -- IA
_50/70/ ,o (W19 -Ind