HomeMy WebLinkAboutG-14-747 IfallwAV1 I VVL 11 V VI\II VI VTI AI I I.IVAI IVIS • -•"I•'• —•....• .� . —.— —..... . .. ..�..••
CITY: S, .(4 r Y7 h MA DATE //dy/ tel`/ //�� PERMIT# k/ya-72/7
JOBSrrE ADDRESS: 3l- o .Ti�ta A Aua NSG OWNER'S NAME: Deli el 1-5 /4r/caja
GOWNER ADDRESS: TEL' FA:
P)PPEI T OCCUPANCY-PIPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL Ly'/
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBhifl i ED: YES 0 NO 0
APPLIANCESI FLOOR Bsmt 1 1 2 3 1 4 1 5 1 6 7 1 8 9 10 11 12 13 1 14
BOILER I 1 I I I
BOOSTER 1 I
1 CONVERSION BURNER I I I
COOK STOVE t I I I
DIRECT VENT HEATER
DRYER I
FIREPLACE I I I
FRYOLATOR I I I
FURNACE I ' I I
GENERATOR 1 I
GRILLE I
INFRARED HEATER I I I
LABORATORY COCK
MAKEUP AIR UNIT I I I I
OVEN I .
POOL HEATER •
_
ROOM/SPACE HEATER I I I I .
I ROOF TEST TOP UNIT I II I I I
R is .r ;.1.,.'• TER
., .i=ca;I ua;,• . I I I I I
, sgLt?'s1�.T;S2A I I I I II
rtwaRTMCNT I I I i L I I I
gUt' Dpi//''�F INSURANCE COVERAGE ,L,"_J/
By _"..... .. -•r msurance policy oris substantial equivalent which meets the requirements of MGL Ch.142 YES NO 0 1
If you have checked YE5 please indicate the type of coverag y checking the appropriate box below.
LIABILITY INSURANCE POLICY OTHERTYPE INDEMNITY 0 BOND 0
OWNER'S INSURANC I e I i r• .m aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massa fag- - s,and the ' signature on this permit application waives this requirement ��
741a." CHECK ONE ONLY: OWNER L2f AGENT 0
SIGT" '•h' ' I •GENT
hereby certify that all of the details and mformauon I have submPded(or entered)regarding this apptcauon are true and accurate to the best of my
Knowledge and that all plumbing work and insallations performed under the per ml issued for this application will be in compliance whir all Pertinent
provision of the Massachusetts State Plumbing Coe and Chapter 142 of the General Laws. atetisaM
Pl
PLUMBERJGASFI i i tit NAME: r-"I Wi/Se/t LICENSE# 01-v13 k SIGNATURE
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COMPANY NAME: frn c� S Qr-n.Urnl T/ ea7AJ ADDRESS: 5-6 /4/re RP
CITY. wl Yrrna,n.& STATE elA ZIP: 0873 • FAX:
TEL: Gale' 77Y 35-3 €y7/ EMAIL
MASTER 0 JOURNEYMAN 0 LP INSTALLER 0 CORPORATION❑a :E 1, LC❑
1 n14
L JAN 29 �
D a/DE PAi -r
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