HomeMy WebLinkAboutG-14-925 ' r___ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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tH CITY s,y9-a/I.Qi/T}} 1 MA DATE ZJ/ji Il'f I PERMIT# 4941.-4941.— G— /926—
JOBSITE ADDRESS 347 i Q(JIric / :` . OWNER'S NAME / , 5 ex
GOWNER ADDRESS _ ti19rrya--_ - JTE1 -4611--T7-1FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL'
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: " PLANS SUBMITTED: YES NO❑
APPLIANCES 2 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1
BOOSTER --1I—I--1'
CONVERSION BURNER I1 II —11-11 1'_J_�I`� I,
COOK STOVE _— 1. _ _ 1 �- nL 1 { i U—_i—) {
DIRECT VENT HEATERI � —I, —1
DRYER 11_�_ _ i-� 1 1-—
_A! 1-1,__�
FRYOLATOR _
FIREPLACE -I { t 1 I 1
GENERATOR y —Ij —1 ,
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FURNACE �� , ----1i-1
GRILLE —v '_ { } II —1
INFRARED HEATER _ _ I _{I HP-Min
LABORATORY COCKS 1
MAKEUP AIR UNIT 'OM-1IISIMIML[ISI®1a.
OVEN --P I 1`, —
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POOL HEATER I I
ROOM I SPACE HEATER '—II —11 )MI—II I I }I }I {i }'
ROOF TOP UNIT —II I---I i I— �,._ —Ij—{i—{—I
TEST —�-- _ j
UNIT HEATER i= —1 I 1 1 1 —}—{ }
UNVENTED ROOM HEATER _1-71-4----1 I II _
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Isla- io- 1 i r - T i— �_APS 83 zo>> J. 1
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BUILDINGS fnENr INSURANCE COVERAGE
I I-pv a current li surance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY ❑ BOND ❑
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 ❑ AGENT 0
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to th: .:- of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pe ' : pro '-ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /
PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE# 13417 I SAO URE
MP Q MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIPD# V LLC at
COMPANY NAME: Checkoway Enterprises ADDRESS 11 Scar90 Hill Road
CITY Dennis STATE MA ZIP 02638 TEL 508-385-1911
FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net