Loading...
HomeMy WebLinkAboutBLDG-15-002418 4 l4 n7/4P:' PA,2ctcL : • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1= CRY r � In I MA DATE I OJ�j'/f y I PERMIT# II'Jb ir-Cayh{' • JOBSITE ADDRESS Erro. in , " ... ..d . ri OWNER'S NAME Wa../i . .:.li.II I. I OWNER ADDRESS Maillainimmins Ta • FAX TYPE T •OCCUPANCY TYPE COMMERCIAL D • •EDUCATIONAL 0= j t t RES Epl�nmAL K Cr2ABLY NEW:D . RENOVATION:EI REPLACEMENT:(J�L,�/' .j nor �� ',nit.PLANS UBMITTED: YES 0 NOD APPLIANCES 7 FLOORS-. BSM 1 2 3 I 4 I 5 6 ( 7 8 8 10 11 12 13 14 BOILER I_ r. , 1 :r�.., I �_ S— i ' .ia; 1_1 . 'l 1 BOOSTER . • �� L� _ I . _._ JII .- CONVERSION BURNER _ilei _r — =I COOK STOVE _11, _ ECT VENTHEATER E:tT IL FIREPLA E --IL I�r--7 IL __ FIREPLACE • � � i _„ � !L„� , II....m.e1�m._.,. I FURNACE _ m _ ,L__--II ... I L---i II _ .,� I ..m.l ! GENERATOR • ._miI .....- IAL L a �L_.- GRML INFRARED HEATER �L� MP -- .1 _ illi L- LABORATORY COCKS �J r r 7"7- MAKEUP AIR UNIT __ - I� J OVEN i POOL'HEATER JSI _ _ _I _ i ROOM ISPACE HEATER 1� __ F . 'H r ROOF TOP UNIT L _ _ L_„_ 'iM l _J I �I IL_- ILS TEST - ... i {T I ._ L f L _ UNIT HEATER � s— .. Th —UNVENTED � �� UNVENTED ROOM HEATER �ltIANJI [���iF , . WATER -EATER .1 7 MaiL . y- OTHER i_ IMITIESST MC . _ r-1LlgNEJIMissa _ate_ �I 41LII�l1� �a �I _ _ -moms II Costa iagsrl igrato INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142YES NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY_ OTHER TYPE INDEMNITY 0 BOND 0 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: OWN • t •GENT 0 • - SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding tills application are hue and a— }�f - .- of my knowledge work that all plumbing woand Installations performed under the perk Issued for this application will be in compliance ' -I I '•- p vision of the • Massachusetts State Plumbing Coda and Chapter 14422,of the General Laws. PLUMBER-GASFITTER NAME fQ(C K )rRG9 {LICENSE# 15(‘,/ SIGNATURE MP1MGF0 JP 0 JGF0 LPGI© CORPORATION# i&(a ,IPARTNERSHIP 0#I ILLC 0# • COMPANY NAME: B Eggq (' Iro f• f/v C ,ADDRESS I t O 6 t-P e d 's Ili /f (6.) 45 1 MY 1474 vt r l I STATEMilP suanim. -7 ]y- - WS( FAX I CELL EMAIL - • Email: • �? ft