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TO 4 P OP FO T► P �CTOR TISP O Y
)1OUGTT PLUMBING INSPECTION NOTES Yes No
•
• A ops i 29,03 _ -I„ 0 0
FEE: $ rERMITfI�
T AUT) y,I�
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— . I IYIMJJM1..nuOL I IJ ururVNYa rr r LlL.n.w.• . v.�r�. r.u. ._.. _. .. . __
I CITY: War MRe(Uril• MA DATE I OW c/PERMIT r /94043-1,4,6740
JOBSrrE ADDRESS- 37 //N co /n/ stO • OWNER'S NAMEP/Ma W raf a< •
" - C OWNER ADDRESS: TEL 'r
POOR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL
CLii4RLY NEW:❑ RENOVATION:0 REPLACEMENT:L7 PLANS SUBKII i I EU: YES 0 NO 0
APPLIANCESI FLOOR-+ Bsnt 1 2 1 3 1 4 5 6 7 1 8 1 9 10 11 12 13 14
BOILER I I I
BOOSTER I I I
CONVERSION BURNER I I I
COOK STOVE I I I I
IDVENT HEATER i I
RYER
FIREPLACE I I
FRYOLATOR I
FURNACE • I I I�
GENERATOR I I I
I GRILLE I I I -
INFRARED HEATER I I I I I
I LABORATORY COCK I I I I I I
I MPJcEUPAIR UNIT
OVEN I I I
POOL HEATER •
I ROOM/SPACE HEATER I I I I I
I ROOF TOP UNIT I I I 1 I
TFgT I I I I I I
R1-141tHP V DI I I I
TER I I I I I II
I WATER h'EA ',0 /6 1 ' I I I I 1 I
AUG 18 2111 I I I I I I
` ) I I I I I I I
sui . . • •• • MilMlinlin
By: ///% INSURANCE COVERAGE
I hay- a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Cb.142 YES ErNO 0
If you have checked YES,please indicate the type of covera by checking the appropriate box below.
LIABILITY INSURANCE POLICY OTHER TYPEINDEMMTY 0 BOND 0
OWNER'S INSURANCE WAVER: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 appEcadon waives this requirement
CHECK ONE ONLY: OWNER 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT l
hereby carmy that all of the details and iniormalion I have submied(or entered)regarding this application-r i i -1 • - ••to the best of my
Knowledge and that all plumbing work and'negations performed under the pemul issued for this appli.I.n willin coI'1.rr. ce kr-al ent
provision of The Massachusetts Stale Plumbing e/and Chapter 142 of the General Laws. f , / •
PLUMBERIGAS I I r tkNAME NV/ '"0 TS LICENSE# 'L SIGNATUREAT
COMPANY NAME Zit'
/ i—ti ADDRESS: 36 wsW /"06fd Al /av V.
CffY: V"CJT ,//�H�/✓T STATE;Ai"' ZIP: 0Z473 • FAX:
TEL: Cl'- 77r-v1r/ GaL: sew -X67 -Wz y E i n: PIA/tc t ALS,It•ofi1a40/74*
MASTER B JOURNEYMAN D IP INSTALLER 0 CORPORATION 0- I PARTNERSHIP 0 4 U-C 2' ___
ti ,
OUGI GaSINSI' " • k '11[91'AQEIto1111L91'ECl'OIIUSI ONLY FINAL INS l'ECl'IONNOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT P
MAN REVIEW NOTES
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