HomeMy WebLinkAboutG-14-1025 • MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK
re GTY: YP v✓' Ucd1-1 MA DATE l0 — 5-19
I PERMIT# 431:445-1
JOSSrrE ADDRESS: H L1 LL h 2 3 run e /Rj e+rOWNER'S NAME s i iOvT a l-14 v4 h 0
GOWNER ADDRESS: 6161 /1 4 14-0 ✓1'r'`?-e ' `cI TEL' FAX •
TYPE O
OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES 0 NO❑
APPLIANCES1 FLOOR I Ssmt 1 1 1 2 3 1 4 1 5 5 7 1 8 1 9 1 10 1 11 1 12 13 1 14
BOILER I I
dtBOOSTE3.. I
CONVERSION BURNER I I I I I I I I
111 COOK STOVE
DIRECTVENT HEATER
DRY
FIREPLACE!
FRYOLATOR
Cis FURNACE i1 I I I I i
LL. % GENERATORce, I I
L_._ GRILLES 1 I
INFRARED HEATER
I I I
LABORATORY COCK I I I I I
MAKEUP AIR UNIT I I
OVEN I I 1
POOL HEATER I I • I
ROOM/SPACE HEATER I I
ROOF TOP UNIT I I
TEST I I I I
UNIT HEATER I I
UNVENTED ROOM HEATER I I I I I
WATER HEA ittt I I I I
- I -
INSURANCE OVERAGE
I have a current liability insurance policy or its substantial actin/alech meets the requirements of MGL Ch.142 YES NO ❑
If you have checked YES,please indicate the type of covers y checking the appropriate box below.
LIABILITY INSURANCE POUCY OTHER TYPE INDEMNITY ❑ 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: OWNER 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of I
Knowledge and tat all plumbing work and intonations performed under the permit issued for this application y t be' m all P.
'
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER/GASFI I I tit NAME: 1 t Y J 4& (J h OU NSE#go4r"ft., G TURF
COMPANY NAME: Cy,17.P W r J19 7i 13 f-e 7Xe s DRESS l5 .3 c
144 tt �G
fc
CITY: M�J Fp
figte STATE ZIP: a)C Y 9 • FAX
TEL: iY�lb) i7) GELL: IIJPIL
MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 0 a PARTNERS:IiP 0 4' LC 21
Nuva C'P • TILLS MGR FOR INSPECTOR USE ONLY }SINAL INSPECTION NOTES
rnicrlPION NOTES
Vas No
THIS APPLICATION SERVES AS TIIE PERMIT 0 ❑
FEE: $ PERMIT P _
)'LAN REVIEW NOTES