HomeMy WebLinkAboutBLDG-15-000380 — I IYL otM•nuOC Ito UPd1 rL' \YI raid r ••-•i% 6/n • • -- _•-- _- . . ..-
�; .._ tie CITY: 14/4-11444.4.1e4.47,—,
Ma DATE: A tij Lb /Y PERMIT r/34 !fetelej
JOESITEADDRESS: /O PA1Zt S+ OWNER'S NAME 3cAvw Lk)kg. 4at0
G OWNER ADDRESS: In PAR- (L 59- TEL' FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL -
PRNT
CLEARLY NEW:0 RENOVATION:❑ REPLACr7JEMS1-. PLANS SUBIv1 If i ED: YES 0 NO 0
APPLIANCES1 FLOOR-. Bund 1 2 1 3 1 4 5 6 1 7 1 8 9 10 11 12 13 14
1 BOILER I I
BOOSTER I I I
I CONVERSION BURNER I I I
COOK STOVE ! I I I I I
1 DIRECT VENT HEATER I I
DRYER I I
FIREPLACE I I I
FRYOLATOR I I I
FURNACE
GENERATOR
I GRILLE
INFRARED HEATER I I I I
LABORATORY COCK I I I I I I
MAKEUP AIR UNITI oval
I POOL HEATER I I • I I I I
ROOM/SPACE HEATER, I I I I I I
I ROOF TOP UNiT I I I I I I
I TEST
UNIT HEATER I I I I 1
1 UM n cn
- - I I I H Ali(;1 (14 71714 I I 1 I I 1 I
INSURANCE COVERAGE
u i a ' . rance policy or its substantial equnralentwhich meets the requirements of MGL Ch.142 YES&NO ❑
ecked YES,please indicate the type of coverage by checking the appropriat box below.
LIABILITY INSURANCE POLICY. OTHER TYPEINDEMNfIY 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 application waives this requirement
CHECK ONE ONLY: OWNER❑ AGENT 0
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information 1 have submtded(or entered)regarding this application are true and a- i•1-to the best of my
Knowledge and that all plumbing work and ins'allations performed under the permit issued for this applica5on ba' .a5ner�
provision of The Massachusetts State Plumbing Code and Char 142 of the General Laws
PLUMBERIGASLtKNAME: YnukG2 ln.r.pQCYV LICENSE# 17Gn07 SIGNATURE
COMPANY We vnkks weak- 8 S -t- ` ADDRESS: 9 ( 070t_ 9
CITY: kuo-f Gat . STATE /► - ZIP: D2.62 FAX:
TEL S72 77G /S t0 Gal: EMAIL:
MASTER 0 6i4SURNEYMAtet LP INSTALLER 0 CORPORATION 0-4 PAZTNERSH!P 0 4 LC 0 s
MICE GA I PL ". ll ► .Tr '
J'11151'AGUFOR INS17.C1'U11U51 ONLY -
yINALI.NSMal ONNOTits •
Yes No
TIIIS APPLICATION SERVES ASTIIE PERMIT 0 0 `,
+ FEE: $ PERMIT 0 _ •
J'EANItTYILIYNV'I'13S
Y
i
c