HomeMy WebLinkAboutG-14-709 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
+':j l CITY 61A-ie 1 MA DATE i/tI N (PERMIT#n c
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G JOBSITE ADDRESS a . i 4... . ,,,, .WNER'S NAME (1�/.[2_ /444cy 1
OWNER ADDRESS 120.(ll,ikt-te imay y/4'i404/ L Say--3 fl-G&MI4FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL
PRINT ❑ ❑ RESIDENTIALO/
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO t❑'
APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER MI ain IIIII.NENMI OMS .555
BOOSTER . 1l ;tel, illia',nI "iaMai
CONVERSION BURNER m_'_5;;aall alalas�1,5—aSim
COOK STOVE MU Mt S NM S SS 11111•011111 allir Mt Sit allaillif
DIRECT VENT HEATER ni'_ s s__SI_Sl la l`M*
DRYER 111. II Ial.10 •MI11.1',
FIREPLACE MIMI - 5555lS5NSSM_
FURNACE .1'M � I�� oi S
GRILLE 5 . i� 1� - 5 aiaiS ''
SN�■itlrr1��l�l��'�>��r;�ter»
GRNLEATOR silk __ , a
Milt,as sac millus
INFRARED HEATER 55MIL i MINIf 5 nell_ —a s
LABORATORY COCKS MI OS Mal N alla allaalla alla MEI 011011111MS MI a la
MAKEUP AIR UNIT lairallellosinfainalajaris,srl r 5 5
OVEN 1111.I 1, 1111I111111001�,a;1111111111111111r1 1111.rll.l1__r'11.11
POOLISPACEHEATER 555 ■Ilin5 ���a
a
ROOFTOPUNIT rli �1S�55�i1 5 MMAIt,�;�'
POOL HEATER' ln
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TEST 555—as a--a
UNIT HEATER 5asSa151 11111011111ei5,5'55
UNVENTED ROOM HEATER 11.111.101.0jg]all1101-01,011111T011110111111iOn —W1i
WATER H •TER MS;11.05;5_�",55555555 S
OTHER si�ss i.alsorI'rs a irate 1L ts5
linifMilimral o■�TMiiiss�I■ satiul sow l�tl pmmo r
ant raSaia��■rlr��r rsvr Maililt NOP NM
sints.am inn ma lioni•caltrouni as t•-•-a-armit
INSURANCE COVERAGE
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of 3L.Ch.142 YES ONO
CUILC SDE.-r
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BE ___0157./Ag Z
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ❑ BOND ❑ /4-0,...cO
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 pegnit application waives this requirement
CHECK ONE ONLY: OWNER ❑ AGENT ❑
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 the best of my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / ��
PLUMBER-GASFITTER NAME Kevin J.Sullivan I LICENSE#5-3-0-41-1 SI NG ATURE
MP 0 MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION[3# 2433 PARTNERSHIP❑# LLC❑#
COMPANY NAME: Ready Rooter,Inc. I ADDRESS P.O.Box 371 I
CITY Sandwich I STATE MA ZIP 02563 TEL 508-888-6055
FAX 1508-888-0242 (CELL IEMAIL kjs@readyrooter.com I
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